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CH > Term Babies > Flashcards

Term Babies Flashcards

1
Q

What is a common cause of respiratory distress in term babies?

A

Transient tachypnoea of the newborn

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2
Q

What are some of the less common causes of respiratory distress in term babies?

A
  • MAS
  • RDS
  • Pneumonia
  • Pneumothorax
  • Milk aspiration
  • PPHN
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3
Q

What are some of the non-pulmonary causes of respiratory distress in term babies?

A
  • Congenital heart disease
  • HIE
  • Severe anaemia
  • Metabolic acidosis
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4
Q

How does Transient tachypnoea of the newborn arise?

A

Occurs due to a delay in the reabsorption of lung liquid, more common after birth by CS

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5
Q

What are the investigations and tx of Transient tachypnoea of the newborn?

A
  • CXR show fluid in the horizontal fissure “wet lungs”
  • Usually settles within first few days of life but can take 1-2wks
  • Diagnosis of exclusion
  • Supplementary O2 may be required to maintain O2 sats
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6
Q

Who does MAS present in?

A

Increasing incidence with increasing gestation

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7
Q

What are some of the complications of MAS?

A
  • Lungs are over-inflated, accompanied by collage and consolidation.
  • High incidence of air leakage leading to pneumothorax and pneumomediastinum.
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8
Q

What is the tx of MAS?

A
  • Oxygen therapy (mild: nasal cannula; mod: CPAP; severe: mechanical).
  • Abx and supportive care
  • Vasopressor (dopamine)
  • Surfactant in severe MAS
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9
Q

What is a complication of MAS?

A

Many develop persistent pulmonary hypertension of the newborn

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10
Q

What are some of the risk factors for MAS?

A
  • Maternal hypertension
  • Pre-eclampsia
  • Chorioamnionitis
  • Smoking
  • Substance abuse
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11
Q

What are the classifications of congenital pneumonia?

A

True congenital
Intra-partum
Post-natal

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12
Q

What are the predisposing factors for congenital pneumonia?

A
  • PROM
  • Chorioamnionitis
  • Low birth weight
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13
Q

How does congenital pneumonia present, what are the investigations and tx?

A
  • Presents with respiratory distress
  • CXR
  • Broad spectrum Abx
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14
Q

How does PPHN arise?

A
  • There is a limit in blood flow to brain and lungs as blood vessels do not open up
  • Blood flows via DA and FO from R–>L due to high pulmonary vascular pressure
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15
Q

What are some of the symptoms of PPHN?

A
  • Breathing problems: rapid or slow breathing, grunting, retracting
  • Blue colour to skin
  • Cold hands and feet
  • Low BP
  • Low O2 sats
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16
Q

What are the investigations and tx of PPHN?

A

CXR: cardiomegaly and pulmonary oedema

Tx: mechanical ventilation and circulatory support
Inhaled nitric oxide

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17
Q

How does a pneumothorax in the newborn arise?

A
  • Spontaneous in up to 2% deliveries
  • Can occur secondary to MAS, RDS, iatrogenic due to CPAP
  • Usually asymptomatic but can cause respiratory distress
18
Q

What are the investigations and tx of pneumothorax?

A

CXR: hyperlucency with absent lung markings.

Tx: resolves if small, chest drain if large

19
Q

When do diaphragmatic hernias typically present in newborns?

A

As a failure to respond to resuscitation or respiratory distress

20
Q

What is the most common type of congenital diaphragmatic hernia?

A

Left-sided posterolateral Bochdalch hernia

21
Q

What is the outcome for babies with congenital diaphragmatic hernia?

A
  • Only 50% will survive

- Vigorous resuscitation may cause a pneumothorax, aggravating situation

22
Q

What will be seen o/e of a baby with congenital diaphragmatic hernia?

A

Apex beat and HS will be displaced to the R side of the chest, with poor air entry in left chest.

23
Q

What is the diagnosis and tx of a congenital diaphragmatic hernia?

A

CXR: bowel loops seen in the chest (left sided) mediastinal shift.

Tx: once diagnosis suspected, large NG tube inserted and suction applied to prevent distension of intrathoracic bowel.
-After stabilisation, the diaphragmatic hernia is surgically repaired.

24
Q

What is a key complication in congenital diaphragmatic hernia?

A

Pulmonary hypoplasia

Due to compression of herniated viscera throughout pregnancy has prevented lung development. High mortality.

25
Q

What is oesophageal atresia?

A

The oesophagus ends in a blind-ended pouch rather than connecting to the stomach

26
Q

What is oesophageal atresia associated with?

A
  • Usually associated with a tracheo-oesophageal fistula.

- Associated with polyhydramnios during pregnancy.

27
Q

What is the tx if oesophageal atresia is suspected?

A

A wide calibre feeding tube is passed and checked by CXR to confirm in stomach.

28
Q

What is the clinical presentation of oesophageal atresia at birth and beyond ?

A

After birth: Persistent salivation and drooling from the mouth.

Later on: the baby will cough and choke when fed and have cyanotic episodes.
-There may be aspiration into the lungs

29
Q

Almost half of babies with oesophageal atresia may have other congenital malformation, called…

A

VACTERL

V ertebral
A norectal 
C ardiac
T rache-
O esophageal
R enal and radial 
L imb
30
Q

What is the investigation and tx of oesophageal atresia?

A

CXR: NGT is curled up in oesophagus, unable to pass into stomach.

Tx:

  • Continuous suction into tube to decrease aspiration
  • Surgical repair.
31
Q

What is the presentation of small bowel obstruction?

A
  • Persistent, bile stained vomiting
  • Meconium may be initially passed then delayed or absent.
  • High lesions presenting soon after birth, low lesions presenting later.
32
Q

What are some of the causes of small bowel obstruction in the newborn?

A
  • Atresia or stenosis of duodenum
  • Atresia or stenosis of jejunum
  • Malrotation with volvulus
  • Meconium ileus
33
Q

How is the diagnosis of small bowel obstruction made?

A

Clinical + AXR

34
Q

What are the main causes of large bowel obstruction?

A

Hirschsprung’s disease or Renal Atresia

35
Q

How does Hirschsprung’s disease arise?

A

Absence of ganglion cells from myenteric and submucosal plexus

36
Q

What is the clinical presentation, diagnosis and tx of Hirschsprung’s disease?

A

-Delayed passage of meconium and abdominal distension
(>48hrs)
-Full thickness rectal biopsy for diagnosis
-Tx: rectal washouts initially then an anorectal pull procedure.

37
Q

What should bile-stained vomit be considered to be until proven otherwise?

A

Intestinal obstruction

38
Q

What is Gastroschisis?

A
  • Congenital herniation of abdominal contents
  • Often diagnosed antenatally.
  • Either: Exomphalos or Gastroschisis
39
Q

What is Exomphalos?

A
  • Herniation through umbilicus
  • Bowel and viscera covered with membranous sac
  • Associated with other congenital abnormalities
40
Q

Description of Gastroschisis?

A
  • Herniation through abdominal wall defected right to the umbilicus
  • Bowel NOT covered with membrane
41
Q

What is the tx of Gastroschisis?

A
  1. Cover abdomen with cling-film as high risk of heat and fluid loss.
  2. NG tube
  3. IV fluid replacement

Small defect: primary closure of abdomen.

Large defect: intestines closed in a sac, sutured to the edges of abdominal wall and contents gradually returned to peritoneal cavity.

CH (7 decks)

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