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Paediatrics > Prematurity/Neonate > Flashcards

Prematurity/Neonate Flashcards

1
Q

When is baby prem?

A

Born before 37weeks gestation

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2
Q

Definition of chronic lung disease of prematurity

A

Need oxygen at 36weeks gestation.
Persistent hypoxia.
Also known as bronchopulmonary dysplasia.

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3
Q

Apnoea of prematurity

A

Unmyelinated brainstem before 34weeks gestations.
Often bradycardic too.
Rx = caffeine, NCPAP
Prevent with maternal antenatal corticosteroids.

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4
Q

APGAR score

A

Assessed at 1, 5 and 10mins of age.

Looks at baby heart rate, resp rate, muscle tone, colour, irritability reflex (cry).

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5
Q

Intraventricular haemorrhage

A

Preterms have unsupported blood vessels in subependymal germinal matrix = instability when blood pressure changes.
S+S = seizure, bulging fontanelle.
Can lead to cerebral palsy.

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6
Q

Retinopathy of prematurity

A

Retinal detachment and vision loss due to hyperoxia.
Abnormal fibrovascular and vascular proliferation.
Higher risk if supplement O2 causing fluctuating SpO2.
Screening!!
Rx = diode laser therapy.

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7
Q

Management of neonate sepsis

A

More common in preterms as less IgG transfer from placenta.
ABCDE
Blood culture
CXR
LP
Broad spec ABx e.g. Benzylpenicillin + gentamicin.

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8
Q

X-ray for NEC

A

Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis
Riger sign = air inside and outwide bowel wall.
Air outlining falciform ligament (football)
portal venous gas
Pneumoperitonemum from perforation

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9
Q

Diseases associated with oesophageal atresia

A

Congenital malformations in VACTREL = Verebral, anorectal, cardiac, tracheo-oesophageal, renal and radial Limb.

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10
Q

Micronathia, displacement of tongue (posteriorly) and midline cleft in soft palate

A

Pierre Robin Sequence.

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11
Q

Hypoxic-ischaemic encephalopathy

A
  • Brain injury secondary to low cerebral oxygen.
  • Encephalopathy develops within 24hrs of birth.
  • Causes can be antenatal intrapartum or postpartum (placenta abruption, cord prolapse, IUGR).
  • Rx = resus due to resp distress, prevent Hyperthermia, treat seizures.
  • Prognosis = if severe can have cerebral palsy, death, if mild complete recovery.
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12
Q

Clinical features of a septic preterm neonate

A 
Labile temperature
Poor feeding
Respiratory distress
Seizures
Lethargy/drowsy
Vomiting
Abdo distension
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13
Q

Common organisms for neonate sepsis

A

GBS, Listeria, E.coli. if late consider S.aureus.

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14
Q

Hydrops fetalis

A

Can occur n rhesus haemolytic disease
Fluid collection in numerous compartments of fetus.
Perinatal HF

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15
Q

Causes of respiratory distress syndrome in preterms

A

Deficiency of surfactant

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16
Q

Clinical features of preterm resp distress syndrome

A

Tachypnoea over 60breaths/min
Increased work of breathing - chest wall recessions, nasal flaring.
Grunting
Cyanosis

17
Q

CXR of preterm resp distress syndrome

A

Diffuse granulomar pattern (ground glass) +/- air bronchogram

18
Q

Management of preterm resp distress syndrome

A 
Oxygen
May need to intubate
Consider surfactant therapy
Keep warm
Fluids
19
Q

Non-worrying low O2 sats

A

In first 5-10mins of life can have 85% O2 if active baby

20
Q

What to check if continuing deterioration of preterm resp

A 
DOPE
Displaced ET tube
Obstruction to airflow
Pneumothorax
Equipment failure
21
Q

Periventricular leukomalacia pathophys

A

Injury to white matter surrounding ventricles leading to softening, necrosis and scarring.
Mostly due to intraventricular haemorrhage.
Can lead to cerebral palsy, learning difficulties, seizures.

22
Q

Clinical features of a baby with rhesus haemolytic disease

A 
Jaundice
CCF = oedema
Hypoalbuminaemia
Anaemia
Bleeding
Yellow vernix
Hepatospenomegaly
Hydrops fetalis = sever oedema!
23
Q

Maternal physiology in rhesus disease

A

Mother is RhD-ve. Maternal production of anti-D IgG antibodies on exposure to RhD +ve cross placenta(previous preg, miscarriage, amniocentesis).

24
Q

Jaundice, yellow urine, pale stools. hepatosplenomegaly.

A

Biliary tree occlusion e.g biliary atresia.

25
Q

Why are babies more susceptible to jaundice

A

RBC life span is short (70days) so more breakdown products.
High Hb at birth leads to physiological release of haemoglobin
Inefficient hepatic bilirubin conjugation in first few days of life.

26
Q

Causes of jaundice if <24hrs old

A

ALWAYS ABNORMAL!!!!
Haemolytic disease (RhD, G6PD deficiency)
Congenital infection

27
Q

Causes of jaundice if 24hrs-2weeks of age

A

Mostly normal = Breast milk jaundice
Infection (UTI)
Bruising (NAI)
Haemolysis (causes as for <24hrs)

28
Q

Causes of jaundice if over 2 weeks of age

A 
UNCONJUGATION = 
Hypothyroid
Pyloric stenosis (GI obstruction)
Haemolytic anaemia
CONJUGATED =
Bile duct obstruction
NEC
Hepatitis
if over 3 weeks INVESTIGATE!
29
Q

Rx for unconjugated

A

Phototherapy, exchange transfusion

30
Q

Which is more worrying high conjugated or unconjugated

A

Unconjugated as can lead to kernicterus

31
Q

Kernicterus

A 
Acute bilirubin encephalopathy
Lethargy 
Poor feeding
Hypertonia
Shrill cry
Arch back = opisthotonus
Seizures
Yellow bilirubin staining in brain
32
Q

Differentials for seriously unwell neonate

A 
THE MISFITS
T = Trauma/NAI (image brain)
H = Heart disease
E = Endocrine (CAH) 
M = Metabolic (DM, NA)
I = Inborn error of metabolism
S = Sepsis (GBS benpen + gentamicin)
F = Formula mishaps
I = Intestinal (NEC, malrotation)
T = Toxin
S  = Seizure/CNS
33
Q

Testing for autoimmune haemolytic diseases e.g. RhD

A

Direct Coombs test - look at RBC

34
Q

Prenatal testing for risk fo RhD

A

Indirect Coombs test - IgG antibodies in plasma

35
Q

Biliary atresia

A

Inflammation of biliary tree.
Hepatomegaly, pale stools, prolonged jaundice
High conjugated bilirubin
Surgical Rx

36
Q

Reasons for biliary obstruction causing pale stools and jaundice

A

Conjugated bilirubin is soluble = travels out in urine making it dark but can’t be excreted in faeces making that pale.

37
Q

General pathway of bilirubin metabolism

A

Haem form RBC haemoglobin forms unconjugated bilirubin in blood.
UCBili heads to liver with carrier protein where it is conjugated to make it water soluble.
Excretion via urine as urobilinogen or stools as stercobilinogen.

Paediatrics (16 decks)

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