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Child Health > Neonates > Flashcards

Neonates Flashcards

1
Q

When is the newborn baby check completed

A

Completed within the first 72 hours of life
Usually between 6-24 hours
Repeated by the GP at 6-8 weeks

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2
Q

What is the purpose of the newborn baby check

A

It is designed to recognise serious congenital abnormalities
Particularly developmental dysplasia of the hip, congenital heart disease, congenital cataracts and cryptorchidism.
Also alleviates parental concerns and promotes good health

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3
Q

What is considered a term baby

A

Term is anything between 37 and 42 week

Due date is 40 weeks

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4
Q

What is the earliest viabilty for a foetus

A

Around 23 weeks

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5
Q

What is the normal RR and breathing pattern for a neonate

A

RR 40-60

Periodic breathing, they breath fast and then slow

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6
Q

What is considered tachypnoea in a neonate

A

Breathing consistently over 60 bpm

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7
Q

How is CPAP used in neonates

A

CPAP keeps the lungs from collapsing

Baby still has to breath out against the pressure but this stops a complete alveolar collapse

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8
Q

Grunting in a neonate can be a sign of what

A

Respiratory distress
Hypoglycaemia
Sepsis
Cold

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9
Q

What is considered an apnoea in a neonate

A

Cessation of breathing for more than 20 seconds

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10
Q

Why should you avoid ventilating neonates

A

It can cause barotrauma to the lungs - leads to chest problems in later life
Can cause a pneumothorax

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11
Q

How does respiratory distress appear on a CXR

A

Lung fields are hazy - ground glass appearance

Due to collapsed alveoli - don’t have air in them so they appear white on CXR

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12
Q

How do you manage RDS

A

Anyone below 29 weeks is intubated and given prophylactic surfactant
The artificial surfactant comes from pigs lungs and is administered directly into the lungs via ET tube

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13
Q

How are chest drains inserted in babies

A

Put a needle into the cavity and then pass a wire into the space
The catheter can then be passed over the wire and the wire removed.

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14
Q

What is chronic lung disease/ bronchopulmonary dysplasia

A

A consequence of RDS

Diagnosed if the child requires O2 beyond 36 weeks corrected gestation and has CXR changes

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15
Q

How can you prevent bronchiolitis in vulnerable neonates

A

metapneumovirus on top of RSV
Give a monoclonal antibody (IgG) to RSV to children who are going home on oxygen due to CLD
Get monthly injections for first 2 years of life to vulnerable babies

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16
Q

Why are C-section babies more prone to transient tachypnoea of the newborn

A

Babies should reabsorb fluid through the stress of labour and then the first breath causes more absorption
C-section babies are more prone to TTN as they haven’t gone through labour

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17
Q

Neonates are obligate nasal breathers - true or false

A

True

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18
Q

When do babies develop the suck refelx

A

At 32 weeks

Therefore babies born before this will not be able to feed properly and require parenteral nutrition

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19
Q

How do you progress feeding in preterm babies

A

Babies born before 32 weeks will not have a developed suck reflex
The will need parenteral nutrition
Then progress to NG followed by oral feeds
Give them a dummy while NG feeding so they associate sucking with a feed

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20
Q

Why can you not give oral tetracycline to a neonate

A

Causes yellowing of the teeth in children

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21
Q

How do you manage neonatal acne

A

It should go away on its own

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22
Q

What causes neonatal acne

A

Caused by mum’s hormones

More common in boys

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23
Q

What causes physiological jaundice of the newborn

A

Caused by the breakdown of red blood cells
Baby’s have a high RBC count as they need to optimise O2 transport
Once born and breathing they don’t need as many so lots break down
Also need to switch to adult haemoglobin so cells with foetal type also need broken down

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24
Q

Jaundice within 24hrs is likely pathological - true or false

A

True

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25
Q

When does physiological jaundice of the newborn present

A

At least 24hrs after birth

Any earlier and it is pathological

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26
Q

At which point would you need to investigate ‘physiological jaundice’

A

If the baby is still jaundiced at 2 weeks old

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27
Q

List potential causes of pathological jaundice in a neonate

A

Could be cause by a haemolytic reaction - ABO or rhesus incompatibility

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28
Q

What is biliary atresia

A

A congenital abnormality where there is no link between liver and gut
It causes backflow of bile and liver damage
Causes conjugated jaundice

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29
Q

How do you manage biliary atresia

A

Requires an operation within 45-60 days to create a path for bile

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30
Q

What signs suggest conjugated jaundice

A

Pale stools and dark urine

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31
Q

How does phototherapy for neonatal jaundice work

A

It is just a specific wavelength of blue light, it is not UV
It causes photoisomerization - makes the bilirubin water soluble so that it can be excreted in the urine
Used for both pathological and physiological jaundice

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32
Q

Why must babies be under a heat shield whilst getting phototherapy

A

They have to be naked to absorb the light but it is important they stay warm too
Babies are bad at preserving body heat

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33
Q

How do you determine if neonatal jaundice needs treatment

A

There is a bili chart which determines if the SBR requires treatment
It is corrected for gestation

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34
Q

What is the risk of high bilirubin levels in babies

A

Risk of kernicterus
This is when unconjugated bilirubin crosses the BBB and deposits in the brain - can cause encephalopathy and a type of CP with movement disorder

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35
Q

What causes the waiter’s tip sign in babies

A

Called Erb’s palsy

Caused by brachial plexus injury (C5/6), often due to shoulder dystocia

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36
Q

How do you manage Erb’s palsy in children

A

Most get better often with physio

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37
Q

How do you treat necrotising enterocolitis

A

Stop feeding the baby and give triple antibiotic therapy

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38
Q

How does necrotising enterocolitis appear on AXR

A

Has a soap bubble appearance
Presents with free gas, gas in the bowel wall and dilated bowel loops
May lead to perforation

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39
Q

What causes necrotising enterocolitis

A

Ischemic bowel - leads to widespread necrosis in the small and large intestine
May be due to premature bowel, bacterial overgrowth and poor blood supply
It is a problem of prematurity

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40
Q

Babies temperature on admission is directly related to their mortality and morbidity - true or false

A

True

The colder they are on admission, the sicker they are

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41
Q

What is involved in the APGAR score

A

Activity, pulse, grimace, appearance, respiration
Scale is subjective
Max score of 10 (8 and above is good though)
Recorded at 1 min 5 min and 10 min

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42
Q

How do you prevent heat loss in premature babies

A

Prem babies are put in plastic bags to prevent heat loss by evaporation
It also protects their immature skin

Should also put a hat on them

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43
Q

GCS is not applicable in neonates - true or false

A

True
They cannot follow commands or
speak so the scores don’t apply
Tend to just use AVPU

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44
Q

What would you look for in the D and E sections of a ABCDE exam of a newborn

A

Pupil size, reactivity and fundi if possible
Posture (decorticate or decerebrate which indicate brain damage)
Neck stiffness
Fontanelles - bulging indicates raised ICP
Rashes - purpura, petechiae, bruising
Fever

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45
Q

List reversible causes of LOC in children

A

Hypoxia
Hypoglycaemia
Hypothermia
Hypotension/hypertension

Infection - meningitis/encephalitis 
Ingestion 
Trauma - time critical (TC)
Metabolic conditions - may get very sick with simple illnesses 
Raised ICP - TC 
Stroke - TC
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46
Q

What is the purpose of steroids given in premature births

A

Helps the lungs develop before baby is born - encourages surfactant production
2 doses are given to mum - last dose given at least 12 hours before birth

47
Q

What is the purpose of magnesium sulphate given in premature births

A

Reduces neurodevelopmental impairment (e.g. CP)
Given to mum within 24 hours of delivering the baby
Given as an 8 hour infusion

48
Q

When does surfactant start being produced

A

Around 24 weeks

However, even babies up to 34 weeks may be surfactant deficient - not enough produced

49
Q

Steroids will always prevent RDS in neonates - true or false

A

False
Steroids promote production but may not completely prevent RDS
Babies may still be surfactant deficient

50
Q

What is oscillation

A

One of the highest type of breathing support given to neonates - via ventilator
Causes rapid breaths that get CO2 out of lungs
Given to babies who are acidotic

51
Q

Why is vitamin K given to newborns

A

Helps with clotting and reduced haemorrhage risk

52
Q

Why is caffeine citrate given to neonates

A

To help with respiratory rate, prevents apnoeas and serve as neuroprotection

53
Q

What are the 1st line antibiotics for neonates

A

Benpen and gent

54
Q

Most premature babies are given prophylactic antibiotics - true or false

A

True

Prematurity is a risk factor for sepsis

55
Q

Premature babies are given multivitamins - true or false

A

True
Their vitamin stores are not yet built up
Only given once fully enterally fed
Children up to 5 should be given multivitamins - new Scottish guidelines

56
Q

Where can a neonate pick up a candida infection

A

Birth canal or breast

57
Q

What is transient neonatal pustular melanosis

A

A brown, scaly, hyperpigmented macular rash seen in newborns

58
Q

Most strawberry haemangiomas will go away on their own - true or false

A

True
Most go away in a few months
If extensive or causing facial distortion they can be removed

59
Q

Why is it important to document the presence of a mongolian blue spot on newborn exam

A

May be confused with NAI if missed on initial exam

Looks like a bruise

60
Q

What is a mongolian blue spot

A

A type of birth mark - blue in appearance

Most common in south American and south African children

61
Q

What is a stork bite

A

A reddish mark seen on the head of a newborn
Very common sign
Goes away in a couple of weeks

62
Q

When do the fontanelles usually close

A

Anterior font closed by 18 months

Posterior closes by 6 weeks

63
Q

What is cephalhaematoma

A

Bleeding under periosteum on the parietal bones - benign hemorrhage
Caused by minor birth trauma
Leads to a mishapen head in newborns - swells
Does not cross the midline

64
Q

What is cephalhaematoma

A

Bleeding under periosteum on the parietal bones - benign hemorrhage
Caused by minor birth trauma
Leads to a mishapen head in newborns - swells
Does not cross the midline

65
Q

What is caput succedaneum

A

Swelling in a newborns scalp -c an make head cone shaped
Caused by fluid collecting as the baby descends - more common in prolonged labors
Typically goes away in around 48 hours

66
Q

When might you see a conjunctival haemorrhage in a newborn

A

Haemorrhage often seen following difficult delivery – due to pressure
Will go away in a few day

67
Q

Why is it important to check for the red reflex in a newborn

A

Picks up congenital cataracts and retinoblastoma

If cataract not picked up in first 6 weeks they don’t form important neural connection which leads to blindness

68
Q

A family history of hearing loss increases a child’s risk of hearing issues - true or false

A

True

69
Q

What is choanal atresia

A

Congenital abnormality where the bony part of back of nose does not allow air exchange
Watch for colour change when mouth closes

70
Q

What ear features should you look for in the newborn exam

A 
Tags/pits
Position - e.g. low set 
Unusual shape
Papillomas
Hairy ear
71
Q

All babies should receive a hearing assessment before leaving hospital - true or false

A

True
Early identification of hearing loss has been demonstrated to prevent many adverse consequences and facilitate language acquisition

72
Q

Why might a newborn present with breast growth

A

The breast tissue can be abnomrally enlarged - 3-4cm due to affects of maternal oestrogens

73
Q

List signs of congestive heart failure in newborns

A

Heart gallop, tachycardia and abnormal pulses

Hepatomegaly

74
Q

List the 5 areas of the heart that should be listened to on newborn examination

A

The Apex …mitral area
Lower left sternal edge at 4th intercostal space - tricuspid area
Left of the sternum in the 2end intercostal space - pulmonary area
Right of the sternum in the 2end intercostal space - aortic area
Midscapular area , posteriorly - coarctation area

75
Q

Which pulses should be checked in newborns

A

Brachial, radial and femoral pulses

Should be checked for rate, rhythm and volume

76
Q

What abnormalities are seen in the tertralogy of fallot

A

Large ventricular sepal defect
An overriding aorta
Stenosis of pulmonary valve
Right ventricular hypertrophy

77
Q

It is uncommon to be able to feel the liver and/or spleen in healthy newborn - true or false

A

False

It is common

78
Q

How many blood vessels are found in the umbilicus

A

Should have 2 arteries 1 vein

79
Q

What should you look for in examination of the umbilicus

A

Inspect for discharge, redness or edema around base of the cord
Should be translucent. A greenish yellowish colour suggests meconium staining

80
Q

If a child has ambigious genitalia how do you assign a gender

A

You DONT

Any infant with ambigious genitalia should not undergo gender assignment until a formal endocrinology evaluation

81
Q

What is cryptotorchidism

A

When the testes (one or both) have not descended

82
Q

What is phimosis

A

When the foreskin cannot be retracted

83
Q

What is a vaginal tag

A

A small appendage or flap on the mucous membranes

It is a common neonatal variation that usually disappears in a few weeks

84
Q

How do you examine the male genitalia

A 
Determine site of meatus 
Palpate bilateral testicles
Examine for inguinal hernia
Look for hypospadias, epispadias, chordae.
Observe colour of scrotum
85
Q

How do you examine the female genitalia

A

Inspect for size and location of the labia, clitoris, meatus, and vaginal opening

86
Q

What does abnormal pigmentation/ hairy patches over the lower back suggest

A

Increases the suspicion that there is an underlying vetebral abnormality

87
Q

What is spina bifida

A

A defect in closure of the neural tube - incomplete development of the brain, spinal cord, and/or meninges
It is associated with malformations of the vertebrae & spinal cord

88
Q

A single palmar crease may be a sign of what

A

Down’s syndrome

89
Q

What are the main risk factors for hip dysplasia

A

Breech presentation
Female gender
Family history

90
Q

List signs of hip dysplasia which may be seen on newborn exam

A

Asymmetry of legs
Extension of one or both sides of groin folds or buttock creases
Range of abduction, may reveal subtle instability
Instability test Barlow and Ortalani tests

91
Q

Which reflexes should be present in newborns

A 
Rooting reflex
Glabellar reflex
Grasp reflex
Neck righting reflex 
Moro’s reflex
92
Q

What is considered low birth weight

A

Low Birth weight: birth weight less than 2500g
Very low birth weight (VLBW): birth weight less than 1500g
Extremely Low Birth weight (ELBW): birth weight less than 1000 g

93
Q

What is considered small for gestational age

A

<10th centile in weight expected for gestation

94
Q

What is considered large for gestational age

A

> 90th centile in weight expected for gestation

95
Q

List risk factors for preterm birth

A

Carrying more than one baby (twins, triplets, or more).
Problems with the uterus or cervix.
Chronic health problems in the mother, such as high blood pressure, diabetes, and clotting disorders.
Certain infections during pregnancy.
Cigarette smoking, alcohol use, or illicit drug use during pregnancy

96
Q

Should you cut the cord immediately after birth

A

If the baby is OK and can be kept warm then you should delay cord clamping for at least a minute to allow placental transfusion

97
Q

How should you position a newborns head to open their airways

A

Keep head in a neutral position = over extension will block airway due to different anatomy
Instead use a jaw thrust
Can use gentle suction - only if secretions evident

98
Q

Why are babies bad at regulating their temperatures

A

Low BMR
Minimal muscular activity
Subcutaneous fat insulation is negligible
High ratio of surface area to body mass

99
Q

Why are prem babies at increased risk of nutritional compromise

A

Limited nutrient reserves
Immature metabolic pathways
Increased nutrient demands - lots of associated medical/surgical conditions which increase demand or reduce delivery

100
Q

What is meant by early onset neonatal sepsis

A

Sepsis caused by bacteria that is acquired before or during delivery

101
Q

What is meant by late onset neonatal sepsis

A

Sepsis caused by an infection which is acquired after delivery - nosocomial or community sources

102
Q

List some common respiratory complications of prematurity

A

Respiratory distress syndrome (RDS)
Apnoea of prematurity
Bronchopulmonary dysplasia

103
Q

What is the primary pathology behind RDS

A

Surfactant deficiency and structural immaturity of the lungs

104
Q

What secondary pathological changes occur in RDS

A

Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair – fibrosis, altered structure

105
Q

List the clinical features of RDS

A

Respiratory distress - tachypnoea, grunting, intercostal recessions, nasal flaring, cyanosis
Worsens over minutes to hours
Gradually worsens at 2-4 days then a gradual improvement

106
Q

What is intraventricular haemorrhage

A

A type of intracranial haemorrhage that occurs in preterm infants
Begins with bleeding into the germinal matrix.

107
Q

What are the risk factors for intraventricular haemorrhage

A

Prematurity
Respiratory distress syndrome - hypoxia, acidosis and hypotension make it more likely to have an unstable cerebral circulation

108
Q

How does intraventricular haemorrhage present

A

25-50% are clinically silent
Intermittent deterioration - hypoxia, pallor, hypotension, tachycardia, irritability, apnoea
Some experience a catastrophic deterioration and cardiovascular collapse

109
Q

What is the most common neonatal surgical emergency

A

Necrotising enterocolitis

110
Q

How does necrotising enterocolitis present

A

Occurs usually after recovering from RDS
Early signs: lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia

111
Q

How does necrotising enterocolitis present

A

Occurs usually after recovering from RDS
Early signs: lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia

112
Q

When is the newborn screening test carried out

A

Ideally 5 days after birth
Babies up to their first birthday are eligible for the test, however the test for Cystic Fibrosis must
be done before 8 weeks of age

113
Q

What is screened for in the heel prick test

A 
Phenylketonuria
Cystic Fibrosis
Congenital Hypothyroidism
Medium-chain Acyl Co-A
Dehydrogenase Deficiency
(MCADD)
Sickle Cell Disorder 
Maple Syrup Urine Disease
(MSUD)
Isovaleric Acidaemia (IVA) 
Glutaric Aciduria Type 1
(GA1)
Homocystinuria (HCU)

Mostly enzyme deficiency

Child Health (14 decks)

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