What Is/Are..... Flashcards
Possible consequences of NEC
Strictures, with incr risk of obstruction
Malabsorption if substantial resection was required
TPN complications:
Thrombophlebitis, central line infection, hyperglycaemia, cirrhosis, metabolic imbalance, acidosis, osteopenia, cholestasis
Respiratory Distress Syndrome
RDS aka Hyaline Membrane Disease
Absence of surfactant in lungs at birth due to prematurity
Type 2 pneumocytes begin to produce surfactant at 22wks
Surfactant reduces surface tension in the alveoli preventing them from collapsing, it also enhances gas exchange
Complications of RDS
Pneumothorax: high pressure O -> alveoli-> interstitium
Lobar collapse
Chronic lung disease of prematurity: pressure and volume trauma caused by long term ventilation
Cor pulmonale: due to pulm htn
Intra ventricular haemorrhage: due to fluctuations in BP and pH
Diaphragmatic hernia
Abdominal contents herniate up into the thorax (L side)
Usually detected on antenatal USS
Mass effects during development -> pulmonary hypoplasia
Asymmetrical chest signs & CXR
NG tube -> stabilise -> surgical repair
Vigorous resus -> pneumothorax
Tracheo-oesophageal fistula
Failure of normal development
Abnormal connection between trachea and oesophagus
Frothing at mouth seen as infant unable to swallow saliva
May lead to aspiration pneumonia
Laryngomalacia
Congenital laryngeal stridor
Flaccid supraglottic structures
Presents later than RDS
Most severe in older babies
Nitrogen Washout Test
Differentiates betw resp and cardiac causes of cyanosis
10 mins 100% Oxygen = max saturation of pulm circulation
Cyanosis improves: resp cause
No improvement: R -> L shunt
VATER / VACTERL
Vertebral anomalies, Anal malformations, Tracheoesophogeal-oesophageal fistula, Radial and Renal abnormalities
+ Cardiac deformity
+ Limb deformity
Three or more req to apply the term
Total Parenteral Nutrition
Elemental feed delivered through a catheter into a central vein
When enteral feeding is inappropriate because:
gut needs to be rested
absorption is inadequate
following severe trauma/burns
Patent Ductus Arteriosus
Failure of ductus between aorta and pulmonary artery to close
Left to right shunt
Bounding pulse, systolic murmur
If more severe -> HF : desaturation and respiratory distress
If symptomatic -> indomethacin or surgical ligation
Tetralogy of Fallot
An overriding aorta
Right ventricular outflow tract obstruction
Ventricular septal defect
Right ventricular hypertrophy
Assoc with: Noonan’s, Down’s,
Congenital heart disease:
L -> R shunt
Breathless
Ventricular Septal Defect
Persistent Ductus Arteriosus
Atrial Septal Defect
Congenital heart disease:
R -> L shunt
Blue
Tetralogy of Fallot
Transposition of the Great Arteries
Congenital heart disease:
Mixed
Breathless and Blue
Atrioventricular septal defect
Congenital heart disease:
Outflow obstruction in well child
Asymptomatic with murmur
Pulmonary stenosis
Aortic stenosis
Congenital heart disease:
Outflow obstruction in sick neonate
Collapsed with shock
Coarctation of the aorta
Hypo plastic left heart syndrome
Innocent murmurs
aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge
No parasternal thrill
No radiation
Physiological jaundice
>50% term babies, >80% preterm babies Mild Day 2-3 until end of first week Inefficient bilirubin metabolism Immature hepatic function Frequent RBC breakdown due to short 70 day lifespan
Breast milk jaundice
Diagnosis of exclusion
Appears within first 2 weeks, may last weeks
Mild, self limiting
? Dehydration due to poor feeding technique
? Component of breast milk inhibiting bilirubin metabolism
Kernicterus
Too much unconjugated bilirubin
Fat solubility -> crosses blood brain barrier
Deposited in: basal ganglia and brain stem nuclei
Lethargy, poor feeding, irritability, incr tone, seizures, coma
Less common due to prevention of resus haemolytic disease w. anti-D
Jaundice
Rhesus haemolytic disease ABO incompatibility G6PD deficiency Spherocytosis Congenital infection
Jaundice at 2 days - 2 weeks
Physiological jaundice
Breast milk jaundice
Dehydration
Infection
Rhesus haemolytic disease
Usually identified antenatally Severe presentation: anaemia, hydrops, hepatosplenomegaly D Kell Duffy
ABO incompatibility
ABO antibodies = mostly IgM don’t cross placenta
Gp O women may have IgG anti A/B haemolysin
Peak jaundice at 12-72 hrs
Positive direct antibody (Coombs) test
G6PD deficiency
Mediterranean/Middle East/Far East/Afro-Caribbean descent X linked Haemolysis precipitated by: Infection Drugs: ? Favs beans
Phototherapy
450nm light (blue-green visible spectrum)
Photoisomerizes unconjugated BR -> water soluble
Excreted in urine
Cover eyes
Regular serum BR
Hypoxic-Ischaemic Encephalopathy
Perinatal hypoxia
Clinical manifestations can present up to 48hr post asphyxia
Neuronal damage: primary death, delayed reperfusion secondary death
Delay allows neuroprotection using hypothermia
Caput succedaneum
Bruising + oedema of presenting part
Extends beyond margins skull bones
Resolves in a few days
Cephalhaematoma
Bleeding below periosteum
Haematoma confined by skull suture margins, soft centre
Often involves parietal bone
Resolves over several weeks
Chignon
Oedema and bruising from Ventouse delivery
Subaponeurotic haemorrhage
Diffuse boggy swelling of scalp
V uncommon
–>severe blood loss, hypovolaemic shock and coagulopathy
Brachial nerve palsy
Traction to brachial plexus nerve roots
Breech delivery or shoulder dystocia
C5+6 = Erb’s palsy +/- phrenic nerve palsy (elevated diaphragm)
If not resolved by 2-3 months -> ortho/plastics
Intraventricular haemorrhage
In 25% V low birthweight infants Diagnosed on cranial ultrasound First 72 hrs Germinal matrix above caudate nucleus Assoc with perinatal asphyxia and RDS May impair CSF drainage -> vent dilatation -> hydrocephalus
Retinopathy of prematurity
Vascular proliferation at junction betw vasc + non vasc retina
–> retinal detachment –> fibrosis –> blindness
Oxygen therapy
35% V low birthweight infants
Screened weekly by opthalmology
Laser therapy reduces visual impairment
Bronchopulmonary Dysplasia
Oxygen requirement at 36 wks post-menstrual age
Due to pressure and volume trauma
From artificial ventilation, oxygen toxicity, infection
Transient tachypnoea of the newborn
Diagnosis of exclusion
Delay in resorption of lung liquid
Most common cause of resp distress, more post c-section
Additional ambient oxygen, may take a few days to resolve
CXR: fluid in horizontal fissure
Meconium aspiration
Increased with incr gestation
Lung irritant -> mech obstruction + chemical pneumonitis
Artificial ventilation
CXR: overinflation, patches of collapse + consolidation
Air leak –> pneumothorax/pneumomediastinum
Persistent pul htn -> inadequate oxygenation despite ventilation
Neonatal pneumonia
PROM
Chorioamnionitis
Low birthweight
Persistent pulmonary hypertension of the newborn
High pulm vasc resistance: R -> L shunt Cyanosis soon after birth Mech vent + circulatory support Inhaled NO beneficial CXR: normal heart size, pulm oligaemia Urgent echo to rule out congenital heart disease
Early onset sepsis
PROM, chorioamnionitis
Resp distress, apnoea, T instability
Broad spec IV abx:
Gp B strep, gram +ve, gram -ve: benzylpenicillin + gentamycin
Blood cultures: if -ve with no clinical signs stop abx after 48hrs
LP: if neuro signs/+ve blood cultures
Congenital Adrenal Hyperplasia
AR
absence 21 hydroxylase
Systemic Juvenile Idiopathic Arthritis - Still’s disease
High fever, nocturnal spikes Malaise + anorexia Salmon pink rash Anaemia Raised platelets + neutrophils Raise CRP
Kawasaki’s
Vasculitis
Bacterial toxin acts as super-antigen
6 months - 4 yrs
Prolonged fever, cervical lymphadenopathy, strawberry tongue, conjunctival infection, rash, arthralhia, finger tip desquamation
Coronary artery involvement -> aneurysm or thrombosis
Contraindications to LP
Resp compromise Cardiac compromise Raised ICP Coma/rapid decr in consciousness Focal neuro signs Coag disorder or thrombocytopenia Local infection at LP site
UTI: causative organisms
E.coli Proteus: common in boys Pseudomonas: with urinary tract abnormality Klebsiella Strep.faecalis
Vesicoureteric reflux
Ureters enter bladder at perpendicular angle
= shorter intramural course
-> reflux of urine on bladder contraction
Severe reflux: renal pelvis dilatation, calyces
Incomplete bladder emptying: predisposition to infection
Infection -> scarring, serious bilat scarring ->chronic renal failure
Pyloric stenosis
Projectile vomiting 4 - 8 wks M-4:F-1 1/500 males Incr risk with family history Rapid dehydration: untreated -> death
Gastro-oesophageal reflux
Severe vomiting
0 - 3 months
Full abdomen
Worsens over weeks
Posseting
Normal
Follows feeding
Non-forceful regurgitation of milk