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MBChB IV Paediatrics > Problems in term neonate > Flashcards

Problems in term neonate Flashcards

1
Q

Upper airway disorders present with?

A

Stridor

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2
Q

Upper airway disorders

A

Cleft lip/palate
Pierre Robin Sequence
Choanal atresia

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3
Q

Cleft lip/palate

A 
1/1000 live births
Common craniofacial anomaly
Palate in isolation w/wo lip
Polygenic inheritance but family hx NB
Severity varies
MDT
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4
Q

Cleft lip/palate embryology

A

Fuses anterior to posterior (soft palate to hard palate)
8th week
Failure of fusion of medial + lateral nasal processes
Failure of fusion of palate and maxillary processes

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5
Q

Cleft lip management

A

3 month surgery or at birth

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6
Q

Cleft palate management

A

6 - 12 months surgery

Further surgery when older

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7
Q

Cleft lip/palate short term complications

A

Feeding difficulties

  • special nipples
  • dental plate
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8
Q

Cleft lip/palate long term complications

A

Recurrent OM with effusion - hearing impairment
Speech difficulties
Abnormal facial growth
Orthodontic problems

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9
Q

Pierre Robin Sequence

Inheritance

A

AR but some X linked with club foot and cardiac malformations reported

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10
Q

Pierre Robin Sequence

Embryology

A

7th and 11th week mandibular hypoplasia - micrognathia
Retroglossoptosis
Posterior palatal defect

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11
Q

Pierre Robin Sequence complications

A

Respiratory obstruction (hypoxia and cor pulmonale)

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12
Q

Pierre Robin Sequence management

A

Avoid tongue obstruction (nursing prone, CPAP via NPT)
NGT for feeding
Micrognathia improves over 1st 2 years
Surgery of posterior palate at 1 year

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13
Q

Choanal atresia

A

Bony/membranous obstruction between nasal cavity and nasopharynx

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14
Q

Newborn infants are ______ breathers

A

obligatory nose breathers

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15
Q

Choanal atresia

Clinical presentation

A

Respiratory distress + cyanosis

Obstruction relieved on crying or opening mouth

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16
Q

Choanal atresia management

A

Immediate: oral airway/tracheal tube via mouth
Definitive: surgical correction by ENT asap

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17
Q

Respiratory disorders

A 
TTN
Meconium aspiration
Congenital diaohragmatic hernia
Pneumonia
Pneumothorax
RDS
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18
Q

Transient tachypnoea of newborn

A

Most common RDS cause in term infants
More common post C/S
Delay in lung liquid absorption
Birth stress hormone response -> fluid moves from alveolar to interstitial space
Lower circulating [catecholamine]
Alveolar fluid reabsorption via Na channels in lung epithelium
Settles within 1/2 days of life but low O2 requirement and tachypnea for several days

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19
Q

Transient tachypnoea of newborn management

A

Oxygen
NG feeding
CPAP

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20
Q

Meconium

A

1st intestinal discharge from newborn (viscous, dark-green, intestinal epithelial cells, lanugo, mucus, intestinal secretions)

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21
Q

Meconium is sterile

T/F

A

True

Does not contain bacteria

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22
Q

Meconium finding in amniotic fluid

A

Infants born at term/post-term

Rare prior to 34-36 weeks gestation

23
Q

Meconium aspiration

Influencing factors

A 
Placental insuffiency
Hypoxia
Maternal HT
Preeclampsia
Oligohydramnios
Maternal drug abuse
24
Q

Meconium aspiration

Complications

A 
Airway obstruction
Surfactant dysfunction
Chemical pneumonitis
Pneumothorax
PPHN
25
Q

Meconium aspiration

Management

A 
NO CPAP
Prevent
Mechanical ventilation
Inotropes (systemic vasoconstrictors)
Sildenafil
Nitric oxide
Poor cry - ABC
No cry - suction then ABC
26
Q

Congenital pneumonia

Risk factors

A 
PROM
Maternal fever/tachycardia
Chorioamnionitis
Maternal UTI/vaginitis hx
Spontaneous preterm labour
27
Q

Infants with RSD

A 
Start on broad spectrum antibiotics until results known
Blood culture
CRP
CBC
LP
28
Q

Congenital pneumonia

Most common pathogen

A

GBS

Tx penicillin, ventilation (if respiratory failure signs)

29
Q

Congenital diaphragmatic hernia

A

Diaphragm defect - bowel herniates into thorax

Reduced foetal lung development -> pulmonary hypoplasia + PPHN

30
Q

Congenital diaphragmatic hernia

Types

A

Bochdalek (left sided through posterolateral foramen)

Morgagni (central anterior)

31
Q

Congenital diaphragmatic hernia

How to diagnose

A

Prenatal
CXY imaging
Clinically during resus

32
Q

Congenital diaphragmatic hernia

Clinical signs

A 
RDS
Chest asymmetry
Reduced air entry effected side
Displaced apex beat
Scaphoid abdomen
33
Q

Congenital diaphragmatic hernia management

A 
NO CPAP
Intubate and ventilate from birth
Maintain pH but allow permissive hypercapnia
Avoid bag mask ventilation
NG tube + apply suction
Stabilise and support circulation
Early PEN
NO for PPHN/consider sildenafil
Repair surgically once stable and PPHN resolving
34
Q

Pneumothorax development

A 
Spontaneous
Secondary (CPAP, mechanical ventilation)
35
Q

Pneumothorax clinical diagnosis

A

Unilateral decreased breath sounds
Unilateral decreased chest movements
Transillumination of the chest
Confirmed by CXR

36
Q

Pneumothorax management

A

ICD insertion

37
Q

Persistent pulmonary hypertension of newborn

A

PH leads to R-L shunting across patent formane ovale and patent DA, intrapulmonary

38
Q

Persistent pulmonary hypertension of newborn

Clinical presentation

A

Cyanosis (low O2)

Reduction between pre and post ductal saturations

39
Q

Persistent pulmonary hypertension of newborn

Causes

A 
Birth asphyxia
MAS
Sepsis
Diaphragmatic hernia
Occasionally primary disorder
40
Q

Persistent pulmonary hypertension of newborn

Investigations

A

CXR
- underlying cause/normal
- pulmonary oligaemia
ECG to exclude CHD

41
Q

Persistent pulmonary hypertension of newborn

Management

A

Oxygen
Optimize mechanical ventilation
Circulatory support as required
Consider surfactant therapy
Pulmonary vasodilator –inhaled nitric oxide (NO)
Oral/IV sildenafil may be considered
Consider high‐frequency oscillatory ventilation (HFOV)
Extracorporeal membrane oxygenation (ECMO) as rescue therapy for severe respiratory failure

42
Q

Congenital cardiac lesions

A

Most common group of structural malformations in newborns

43
Q

Congenital cardiac lesions presentation

A

Antenatal detection on ultrasound screening
Detection of a heart murmur on newborn examination
Heart failure – respiratory distress or shock
Cyanosis
Postnatal detection with oxygen saturation screening

44
Q

Congenital cardiac lesions risk factors

A 
Chromosomal disorders ( Down syndrome)
Maternal diseases (DM, drugs, SLE)
Congenital infections (Rubella)
Multiple pregnancy
Syndromes ( VACTERAL, TAR, CHARGE)
45
Q

Acyanotic congenital cardiac disorders

Most common?

46
Q

Acyanotic congenital cardiac disorders

Present w?

A

Shock OR heart failure and breathlessness

47
Q

Acyanotic congenital cardiac disorders

Left-to-right shunting

A

VSD, ASD, AVSD, PDA

Heart Failure:
Several weeks after birth
Breathlessness
Difficulty feeding
Sweating on the forehead during feeds
Tachypnoeaand tachycardia
Hepatomegaly
FTT
Recurrent chest infections
Gallop rhythm +/-murmur\
Cardiomegaly
48
Q

Acyanotic congenital cardiac disorders

Obstructive (duct dependent lesion)

A

Aortic coarctation, pulmonary stenosis, hypoplastic left heart

Shock:
Cold peripheries
Weak or absent pulses
Collapse
Low cardiac output
Hypotension
49
Q

Cyanotic congenital cardiac lesions

A

Central vs peripheral
<5g/dL hemoglobin
look at tongue + mucous membranes

50
Q

No respiratory cause of cyanosis

A

Cyanotic congenital heart defect

51
Q

Cyanotic congenital cardiac lesions

Diagnosis

A 
Hyperoxia test
PaO2<110mmHg likely to be cyanotic heart disease
CXR
ECG w/wo doppler
Cardiac catheterization
52
Q

Enlarged heart border may be due to normal ___

53
Q

Boot heart shape

A

Tetralogy of Fallot

54
Q

Cyanotic congenital cardiac lesions management

A

Maintain ABC
Provide ventilation if necessary
Correct metabolic acidosis, hypoglycaemia, hypocalcemia

If duct‐dependent defect suspected or confirmed:
Give prostaglandin intravenously to keep the ductusarteriosus
Patent (expect apnea after high‐dose prostaglandin)
Do not give additional oxygen unless SaO2 falls below 75%
(oxygen will make the duct more likely to close

If in heart failure:
high‐output failure (after first week of life) –fluid restriction
(acute only), diuretics, ACE inhibitors, e.g. captopril
low‐output failure/shock –inotropes, volume support; arrhythmias
require specific treatment.

Refer to pediatric cardiac center for expert advice, diagnostic imaging and management.

MBChB IV Paediatrics (81 decks)

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