Problems in term neonate Flashcards

Question

Meconium aspiration | Management

Answer 1

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

Answer 2

``` PROM Maternal fever/tachycardia Chorioamnionitis Maternal UTI/vaginitis hx Spontaneous preterm labour ```

Answer 3

``` Start on broad spectrum antibiotics until results known Blood culture CRP CBC LP ```

Answer 4

GBS | Tx penicillin, ventilation (if respiratory failure signs)

Answer 5

Diaphragm defect - bowel herniates into thorax | Reduced foetal lung development -> pulmonary hypoplasia + PPHN

Answer 6

Bochdalek (left sided through posterolateral foramen) | Morgagni (central anterior)

Answer 7

Prenatal CXY imaging Clinically during resus

Answer 8

``` RDS Chest asymmetry Reduced air entry effected side Displaced apex beat Scaphoid abdomen ```

Answer 9

``` 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 ```

Answer 10

``` Spontaneous Secondary (CPAP, mechanical ventilation) ```

Answer 11

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

Answer 12

ICD insertion

Answer 13

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

Answer 14

Cyanosis (low O2) | Reduction between pre and post ductal saturations

Answer 15

``` Birth asphyxia MAS Sepsis Diaphragmatic hernia Occasionally primary disorder ```

Answer 16

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

Answer 17

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

Answer 18

Most common group of structural malformations in newborns

Answer 19

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

Answer 20

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

Answer 21

Shock OR heart failure and breathlessness

Answer 22

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 ```

Answer 23

Aortic coarctation, pulmonary stenosis, hypoplastic left heart ``` Shock: Cold peripheries Weak or absent pulses Collapse Low cardiac output Hypotension ```

Answer 24

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

Answer 25

Cyanotic congenital heart defect

Answer 26

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

Answer 27

Tetralogy of Fallot

Answer 28

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.