Sick term infant

Question 1

Where can infection source from in the newborn?

Answer 1

¥ Blood stream - bacteraemia/septicaemia
¥ CNS - meningitis
¥ Respiratory - pneumonia
¥ GU – UTI

Others:
Ð Skin
Ð Bone
Ð GI - necrotising enterocolitis

Question 2

What bacterial infection is seen in the newborn? 5

Answer 2

¥ Group B Streptococcus – this is most common and comes from mother birth canal
¥ E. coli – most common gram –ve infection
¥ Listeria myogenes – rarely seen
¥ Staphylococcus aureus – staphylococcus esp. if have co-morbidities and later on
¥ Staph epidermidis – as above

Question 3

What viral infections are seen in the newborn?

Answer 3

¥ Cytomegalovirus
¥ Parvovirus
¥ Herpes viruses
¥ Enteroviruses

Others
¥ Toxoplasma gondii
¥ HIV
¥ Syphilis - Treponema pallidum

Question 4

what is hypoxic ischaemic encephalopathy?

Answer 4

¥ Multi organ damage due to tissue hypoxia

¥ Lack of oxygen leading up to or during delivery

Question 5

What is the presentation of hypoxic ischaemic encephalopathy?

Answer 5

¥ Poor Apgar scores – active resuscitation required
¥ Commonly baby is born in a collapsed state, doesn’t start breathing properly
¥ Small no. of babies will have v. significant lack of neurodevelopment
¥ Neurodevelopmental sequeli - variable prognosis

Question 6

What is transient tachypneoa of the newborn?

• In what clinical picture is this commonly seen
• what is the treatment?

Answer 6

• Excess fluid in lungs directly related to birth
• Diagnosis of exclusion
• Most often seen in 35+ week gestation babies who are delivered by caesarian section without labor.
• Usually, this condition resolves over 24–48 hours.
• Treatment is supportive and may include supplemental oxygen and antibiotics.

Question 7

Why would a newborn have a pneumothorax?

Answer 7

• Spontaneous or secondary to active resuscitation

o Active resuscitation can be due to meconium aspiration

Question 8

What is hydrops foetalis? what can this present as?

Answer 8

Tachypnoea
-¥ Commonest cause of hydrops foetalis is rhesus disease
¥ Mum is +ve and baby is -ve
Chromosomal

Question 9

What is persistent pulmonary hypertension of the newborn (PPHN)

Answer 9

In-utero lung resistance is very high and baby is oxygenated via placenta, when baby is born this resistance falls and blood is oxygenated via lungs – however sometimes the lung pressure stays high = PPHN (giving oxygen is no use

Question 10

What congenital cardiac disease exists?

Answer 10

¥	Tetralogy of Fallot
¥	Transposition of great arteries
¥	Coarctation of the aorta (radio-femoral delay)
¥	TAPVD
¥	Hypoplastic heart – usually left side

Question 11

What 2 congenital respiratory diseases can occur?

Answer 11

Tracheo-oesophageal fistula
o Persistent vomiting
o Insert nasogastric tube – it won’t reach stomach

Diaphragmatic hernia
o Commonly LHS
o Allows variable amount of abdo. Contents into chest (liver/kidney/spleen)
o Can cause complication of lung hypoplasia as that lung is constrained and can’t grow

Question 12

What surgical complications of the newborn exist?

Answer 12

meconium ileus
malrotation
duodenal atresia
pyloric stenosis
eosophageal atresia

Question 13

Meconium ileus:

• what is this
• clinical features

Answer 13

Small bowel obstructed by meconium

• bilus vomit
• not passed meconium
• abdo. distension/mass

Question 14

Malrotation

• what does this predispose to?
• clinical features

Answer 14

Predisposes to midgut volvulus

• sudden bilous vomiting is malrotation until proven otherwise
• haematemesis
• abdo distension and tenderness

Question 15

Duodenal atresia:

• what is this
• clinical features

Answer 15

congenital absence or complete closure of a portion of the lumen of the duodenum.

• polyhydramnios
• distended fluid filled stomach
• vomiting +/- bile
• distension
• feed intolerant

Question 16

Pyloric stenosis:

• what is this
• clinical features

Answer 16

• projectile vomiting
• visible peristalsis
• olive-like mass palpable in right upper abdo. during feeds

Question 17

Eosophageal atresia

• what is this
• clinical features

Answer 17

• frothy saliva +/- choking
• polyhydramnios
• unable to pass wide bore orogastric tube
• air in stomach = fistula

Question 18

What is a wilms tumour?

-when does it present?

Answer 18

Wilms’ nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old.

Question 19

What are the features of a wilms tumour?

Answer 19

abdominal mass (most common presenting feature)
painless haematuria
flank pain
other features: anorexia, fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)

Question 20

What are the associations of a wilms tumour?

Answer 20

abdominal mass (most common presenting feature)
painless haematuria
flank pain
other features: anorexia, fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)

Question 21

what is the management of a wilms tumour?

Answer 21

nephrectomy
chemotherapy
radiotherapy if advanced disease
prognosis: good, 80% cure rate

Question 22

What are the features of an atypical UTI in children?

Answer 22

Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.

Question 23

What is kawasaki disease?

Answer 23

Kawasaki disease is a type of vasculitis which is predominately seen in children. Whilst Kawasaki disease is uncommon it is important to recognise as it may cause potentially serious complications, including coronary artery aneurysms

Question 24

What are the features of kawasaki disease?

Answer 24

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

Question 25

What is the management of kawasaki disease?

Answer 25

high-dose aspirin*
intravenous immunoglobulin
echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms