Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LR Child Health > The Sick Newborn > Flashcards

The Sick Newborn Flashcards

1
Q

What are the top 4 causes of death in neonates (first 28 days of an infants life)?

A

Prematurity (14%)
Birth asphyxia and birth trauma (10%)
Pneumonia (5%)
Sepsis (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which scoring system is carried out within minutes of birth to assess perinatal adaptation?

A

The Apgar Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 5 considerations in the Apgar score?

A 
Colour (Appearance)
Heart rate (Pulse)
Responsiveness (Grimace)
Tone (Activity)
Resp rate (Resp rate)

*spells out Apgar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe how the Apgar score is calculated

A
  • Each component (HR, RR, responsiveness, tone, colour) is given a score from 0-2
  • 0 = not present, 1 = abnormal, 2 = abnormal
  • Normal score is >=8 /10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
In the clinical assessment of a newborn, what is a normal...
- Colour
- Heart rate
- Temperature
- SaO2
- Central cap refill
?
A
  • Colour: pinkish (not blue or pale white)
  • Heart rate: 120 - 140 bpm
  • Temperature: 36.5 - 37.4 degrees Celsius
  • SaO2: >=95%
  • Central cap refill: 2 - 3 seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The initial management for an unwell adult is ABCDE. What is it for a newborn?

A

Temperature + ABCDE + antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is temperature management so important for newborns?

A

Hypothermia exacerbates all conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are sick newborns always started on antibiotics?

A

As sepsis is always a differential in the sick newborn

Stop antibiotics once infection is ruled out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does sepsis present?

A

Non-specific presentation:

  • Quiet baby
  • Poor feeding
  • Floppy (poor tone)
  • Tachypnoea or apnoea
  • Tachycardia or bradycardia
  • Temperature instability
  • Parents complaining of baby ‘not being themselves’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Suggest 3 ways in which a newborn can acquire an infection

A

Antenatally (e.g., mother is infected or membranes rupture)
Perinatally (e.g., from mother’s genitalia at delivery)
Postnatally (e.g., in intensive care environment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List 5 common sites of infection in the newborn

A
  • Bloodstream (bacteraemia/septicaemia)
  • CNS (meningitis/encephalitis)
  • Respiratory (pneumonia)
  • GU (UTI, usually later presentation)
  • GI (necrotising enterocolitis, more common in preterms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 most common bacterial causes of infection in the newborn?

A
  • Group B Strep (most common)
  • E. coli
  • Staph aureus
  • Staph epidermis (usually after a procedure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is Group B Strep most commonly acquired?

A

Mother is colonised with Group B Strep but does not know

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What 2 antibiotics are started empirically in the sick newborn and why these 2?

A

Benzylpenicillin and gentamicin

  • They have a synergistic effect for Group B Strep which is the most common cause of infection
  • They offer gram +ve and gram -ve cover
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fungal infections are uncommon in newborns. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which antibiotic for Group B Strep increases risk of fungal infection and why?

A

Cefotaxine

It offers wider cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List 6 viral infections which can affect newborns

A 
Cytomegalovirus
Parvovirus
Herpes virus
Enteroviruses
Syphilis
HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Syphilis in newborns is becoming less common. T/F

A

False

It is becoming more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is a baby at highest risk of acquiring syphilis?

A

If the mother has early stage syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most important factor for preventing transmission of syphilis to the baby?

A

Treatment 30 days prior to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is treatment of maternal syphilis so important? (2)

A
  • It readily crosses the placenta

- It has high foetal mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List 4 causes of respiratory distress

A

Transient tachypnoea of the newborn (TTN)
Pneumothorax
Meconium aspiration
Respiratory distress syndrome

23
Q

List 5 clinical signs of respiratory distress

A 
Tachypnoea (>60 breaths/min)
Inter- or subcostal recession
Grunting
Cyanosis
Low SaO2 (<95%)
24
Q

What is the most common cause of TTN? Why?

A

Caesarean section

Increased adrenaline production is not activated -> Na channels are not activated -> clearing of lung fluid into interstitium + lymphatic system is delayed

25
Q

What is the characteristic CXR finding in TTN?

A

Fluid in the horizontal fissure

26
Q

How is TTN managed?

A

It resolves over the first 24 hours of life but respiratory support may be required until then

27
Q

List 4 causes of pneumothorax in the newborn

A
  • Spontaneous during birth
  • Resuscitation (puts increased pressure on lungs)
  • Infection (makes the lungs stiffer)
  • Meconium aspiration (“”)
  • Surfactant deficiency (“”)
28
Q

How can transillumination be used to investigate a potential pneumothorax?

A

A light is shined on the baby’s chest

Less illumination is seen on the side of the pneumothorax

29
Q

How is a pneumothorax managed?

A

Ranges from conservative to chest drain insertion depending on severity

30
Q

Where is a chest tube inserted in a large pneumothorax?

A

4th or 5th intercostal space, midaxillary line

31
Q

Respiratory distress syndrome is caused by…

A

Surfactant deficiency

32
Q

List 8 risk factors for RDS

A 
Preterm birth
Intra-uterine growth restriction (IUGR)
Maternal diabetes
Infection
Birth asphyxia
Multiple birth
Prolonged rupture of membranes (PROM)
Meconium aspiration
33
Q

What is the CXR appearance of RDS?

A

Ground-glass appearance, air bronchograms

non-specific, looks similar to infection or TTN

34
Q

How is RDS treated?

A 
Respiratory support (CPAP to prevent alveolar collapse)
Surfactant replacement
35
Q

What is meconium aspiration syndrome and when is it most common?

A

When baby passes meconium in the uterus and inhales it

Most often a sign of foetal distress in post-term babies

36
Q

What are 3 complications of meconium aspiration syndrome?

A

Airway obstruction
Airway inflammation
Surfactant dysfunction

37
Q

What is the CXR appearance of meconium aspiration?

A

Patchy areas of opacification bilaterally

38
Q

What is the treatment for meconium aspiration syndrome?

A

Supportive:

  • Ventilation
  • Antibiotic cover
39
Q

What is hypoxic ischaemic encephalopathy (HIE)?

A

Interruption of O2 supply to the baby resulting in tissue hypoxia and multi-organ damage

40
Q

What are the signs of HIE?

A

Very sick baby -> poor Apgar score
Requires resuscitation
Acidosis

41
Q

What is the treatment of HIE?

A

Therapeutic hypothermia

42
Q

Why does is therapeutic hypothermia used to treat HIE?

A

It is neuroprotective so can prevent secondary damage to the baby’s brain

43
Q

Foetal heart failure is most commonly caused by…

A

Rhesus disease

44
Q

Persistent pulmonary hypertension of the newborn (PPHN) is treated with…

A

Nitric oxide to reduce pulmonary pressure

45
Q

List 5 congenital cardiac diseases

A 
Tetralogy of Fallot
Transposition of the great arteries
Coarctation of the aorta
Total anomalous pulmonary venous drainage (TAPVD)
Hypoplastic heart
46
Q

List 5 clinical signs of a congenital cardiac disease

A

Tachypnoea but little signs of respiratory distress
Cyanosis and low SaO2 which is unresponsive to O2
Heart murmur (but may just be PDA)
Absent femoral pulses (e.g., coarctation of the aorta)
Circulatory collapse

47
Q

List 2 congenital respiratory diseases

A

Tracheo-oesophageal fistula (most often a blind-ending oesophagus)

Diaphragmatic hernia (bowel loops may be seen in CXR)

48
Q

Green/bilious vomiting can be a sign of the life-threatening condition…

A

Malrotation + volvulus

49
Q

The most common newborn metabolic disorder is…

A

Hypoglycaemia

50
Q

List 4 causes of hypoglycaemia in the newborn

A
  • Reduced fat/sugar reserves if LBW or SGA
  • Maternal diabetes
  • Maternal medications e.g., beta blockers
  • A more complex metabolic disorder e.g., hyperinsulinaemia
51
Q

How is hypoglycaemia treated?

A

Oral dextrose gel or IV sugars

52
Q

Inborn errors of metabolism may present as… (3)

A
  • Acidosis
  • Hypoglycaemia
  • Jaundice
53
Q

Several inborn errors of metabolism are screened for in…

A

The newborn blood spot test ~ day 5

LR Child Health (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions