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Finals > Paeds: Neonatology > Flashcards

Paeds: Neonatology Flashcards

1
Q

Neonatal Jaundice

what is jaundice

A

the condition of abnormally high levels of bilirubin in the blood

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2
Q

Neonatal Jaundice

describe the excretion of biliruibin

A

broken down RBCs release unconjugated bilirubin into the blood

unconjugated bilirubin is conjugated in the liver

conjugated bilirubin is excreted in 2 ways: via the biliary system into the GI tract or via the urine

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3
Q

Neonatal Jaundice

why does physiological jaundice occur

A

fetal RBCs break down more rapidly, releasing lots of bilirubin which is usually excreted by the placenta

this leads to a normal rise in bilirubin after birth

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4
Q

Neonatal Jaundice

how long does physiological jaundice usually last

A

mild yellowing of skin + sclera from 2-7d of age

usually resolves completely by 10d

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5
Q

Neonatal Jaundice

how can the causes of neonatal jaundice be split into

A
  • increased production

- decreased clearance

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6
Q

Neonatal Jaundice

causes due to increased production of biliruibin

A
  • haemolytic disease of the newborn
  • ABO incompatibility
  • haemorrhage
  • intraventricular haemorrhage
  • cephalo-haematoma
  • polycythaemia
  • sepsis + DIC
  • G6PD deficiency
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7
Q

Neonatal Jaundice

causes due to decreased clearance of bilruibin

A
  • prematurity
  • breast milk jaundice
  • neonatal cholestasis
  • extrahepatic biliary atresia
  • endocrine disorders (hypothyroid + hypopituitary)
  • Gilbert syndrome
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8
Q

Neonatal Jaundice

what is a common cause of jaundice in the first 24h of life

A

neonatal sepsis

needs urgent inx and mnx

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9
Q

Neonatal Jaundice

why is physiological jaundice exaggerated in premature babies

A

due to the immature liver

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10
Q

Neonatal Jaundice

why are breastfed babies more likely to have neonatal jaundice

A
  1. components of breast milk inhibit the ability of the liver to process the bilirubin
  2. inadequate dehydrated breastfed babies: slow passage of stools, increasing absorption of bilirubin in the intestines
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11
Q

Neonatal Jaundice

what causes haemolytic disease of the newborn

A

incompatibility between the rhesus antigens on the surface of the RBCs of the mother and fetus

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12
Q

Neonatal Jaundice

pathophysiology of haemolytic disease of the newborn

A

pregnant rhesus D -ve woman and rhesus D +ve child

mother’s immune system recognises this rhesus D antigen as foreign and produce antibodies to the rhesus D antigen. Mother has become sensitised

subsequent pregnancy, the mother’s anti-D antibodies can cross the placenta and attach to RBCs of the rhesus D +ve fetus and cause the immune system of the fetus to attack their own RBCs

this leads to haemolysis, causing anaemia and high biliruibin levels –> haemolytic disease of the newborn

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13
Q

Neonatal Jaundice

what does rhesus D negative mean?

A

does not have the rhesus D antigen

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14
Q

Neonatal Jaundice

what does rhesus D positive mean

A

does have the rhesus D antigen

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15
Q

Neonatal Jaundice

what is prolonged jaundice

A

jaundice that lasts:
>14d in full term babies
>21d in premature babies

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16
Q

Neonatal Jaundice

inx

A
  • FBC + blood film: polycythaemia or anaemia
  • conjugated biliruibin
  • blood test typing for ABO or rhesus incompatibility
  • Direct Coombs Test
  • Thyroid function
  • Blood + urine cultures
  • G6PD levels
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17
Q

Neonatal Jaundice

what do elevated conjugated bilirubin levels indicate

A

a hepatobiliary cause

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18
Q

Neonatal Jaundice

what are treatment threshold charts

A

in jaundiced neonates, total bilirubin levels are monitored and plotted on it

if the total bilirubin reaches the threshold on the chart, they need to be commenced on trx

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19
Q

Neonatal Jaundice

treatment threshold chart: what is plotted on the x axis

A

age of baby

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20
Q

Neonatal Jaundice

treatment threshold chart: what is plotted on the y axis

A

total bilirubin level

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21
Q

Neonatal Jaundice

mnx

A

phototherapy

if extremely high: exchange transfusion

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22
Q

Neonatal Jaundice

what does phototherapy do?

A

converts unconjugated bilirubin into isomers

that can be excreted in the bile and urine without requiring conjugation in the liver

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23
Q

Neonatal Jaundice

what light in phototherapy is used

A

blue light is the best at breaking down biliruibin

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24
Q

Neonatal Jaundice

what is double phototherapy

A

2 light boxes shining blue light on the baby’s skin

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25
Q

Neonatal Jaundice

once phototherapy is complete, what should be measured

A

a rebound bilirubin 12-18h after stopping phototherapy

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26
Q

Neonatal Jaundice

why do we treat neonatal jaundice

A

to prevent kernicterus

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27
Q

Neonatal Jaundice

what is kernicterus

A

a type of brain damage caused by excessive bilirubin levels causing direct damage to the CNS

as bilirubin can cross the blood-brain barrier

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28
Q

Neonatal Jaundice

how does kernicterus present

A

a less responsive. flopping, drowsy baby with poor feeding

damage to the CNS is permanent: Cerebral palsy, learning disability + deafness

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29
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

meaning

A

hypoxia: lack of oxygen
ischaemia: restriction in blood flow to the brain
encephalopathy: malfunctioning of the brain

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30
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

what can prolonged or severe hypoxia lead to

A

permanent damage to the brain causing cerebral palsy

severe HIE can result in death

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31
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

when should you suspect HIE

A

when there are events that could lead to hypoxia during the perinatal or intrapartum period

acidosis (pH<7) on the umbilical artery blood gas

poor Apgar scores

features of HIE

evidence of multi organ failure

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32
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

causes

A

anything that leads to asphyxia (deprivation of O2) to the brain:

  • maternal shock
  • intrapartum haemorrhage
  • prolapsed cord: causing compression of the cord during birth
  • nuchal cord: wrapped around neck of baby
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33
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

grades (Sarnat Staging): Mild

A
  • poor feeding, generally irritability + hyper-alert
  • resolves within 24h
  • normal prognosis
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34
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

grades (Sarnat Staging): Moderate

A
  • poor feeding, lethargic, hypotonic + seizures
  • can take weeks to resolve
  • up to 40% develop cerebral palsy
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35
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

grades (Sarnat Staging): Severe

A
  • reduced consciousness, apnoeas, flaccid + reduced or absent reflexes
  • up to 50% mortality
  • up to 90% develop cerebral palsy
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36
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

mnx

A

neonatal specialist supportive care:
- neonatal resus + ongoing optimal ventilation

  • circulatory support
  • nutrition
  • acid base balance
  • trx of seizures
  • therapeutic hypothermia
  • follow up by MDT to assess development and support any lasting disability
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37
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

what is therapeutic hypothermia

A
  • actively cooling the core temp of the baby according to a strict protocol
  • transferred to neonatal ICU using cooling blankets + cooling hat
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38
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

therapeutic hypothermia: what is the target temp

A

33 and 34 degrees measured using a rectal probe

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39
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

therapeutic hypothermia: how long is the cooling done for

A

72h

then baby gradually warmed to a normal temp over 6h

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40
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

how does therapeutic hypothermia work

A

reduces inflammation and neurone loss after the acute hypoxic injury

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41
Q

Hypoxic-Ischaemic Encephalopathy (HIE)

what does therapeutic hypothermia reduce the risk of

A
  • cerebral palsy
  • development delay
  • learning disability
  • blindness
  • death
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42
Q

Prematurity

definition

A

birth before 37 weeks gestation

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43
Q

Prematurity

define extreme preterm

A

under 28w

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44
Q

Prematurity

define very preterm

A

28-32w

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45
Q

Prematurity

define moderate to late preterm

A

32-37w

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46
Q

Prematurity

when should you consider resuscitation

A

babies <500g or <24w gestation

as outcomes are likely to be very poor

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47
Q

Prematurity

associations

A
  • social deprivation
  • smoking
  • alcohol
  • drugs
  • overweight or underweight mothers
  • maternal co-morbidities
  • twins
  • personal or FH of prematurity
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48
Q

Prematurity

what are the 2 options of trying to delay birth in:

  • women with a hx of preterm birth
  • cervical length of ≤25mm before 24w
A
  • prophylactic vaginal progesterone

- prophylactic cervical cerclage

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49
Q

Prematurity

what is cervical cerclage

A

putting a suture in the cervix to hold it closed

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50
Q

Prematurity

what are the options to improve outcomes where preterm labour is suspected or confirmed

A
  • tocolysis with nifedipine
  • maternal corticosteroids
  • IV MgSO4
  • delayed cord clamping or cord milking
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51
Q

Prematurity

what is nifedipine

A

a CCB that supresses labour

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52
Q

Prematurity

what does IV MgSO4 do

A

offered before 24w gestation and helps protect the baby’s brain

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53
Q

Prematurity

how does delayed cord clamping or cord milking help

A

can increase the circulating blood volume and haemoglobin in the baby

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54
Q

Prematurity

issues in early life

A
  • resp distress syndrome
  • hypothermia
  • hypoglycaemia
  • poor feeding
  • apnoea + bradycardia
  • neonatal jaundice
  • intraventricular haemorrhage
  • retinopathy of prematurity
  • necrotising enterocolitis
  • immature immune system and infection
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55
Q

Prematurity

long term effects

A
  • chronic lung disease of prematurity
  • learning + behavioural difficulties
  • susceptibility to infections, esp resp
  • hearing + visual impairment
  • cerebral palsy
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56
Q

Apnoea of Prematurity

definition of apnoea

A

periods where breathing stops spontaneously for >20s

or shorter periods with O2 desaturation or bradycardia

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57
Q

Apnoea of Prematurity

apnoea is very common in ____

A

premature neonates

occur in almost all babies <28w

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58
Q

Apnoea of Prematurity

what does apnoea in term infant usually indicate

A

underlying pathology

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59
Q

Apnoea of Prematurity

cause

A

immaturity of the autonomic nervous system that controls respiration and heart rate

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60
Q

Apnoea of Prematurity

what developing illnesses is apnoea often a sign of?

A
  • infection
  • anaemia
  • airway obstruction (may be positional)
  • CNS pathology: seizures, haemorrhage
  • GOR
  • neonatal abstinence syndrome
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61
Q

Apnoea of Prematurity

mnx

A
  • attach apnoea monitors to premature babies: make a sound when apnoea is occurring
  • Tactile stimulation: prompts baby to restart breathing
  • IV caffeine: prevents apnoea + bradycardia in babies with recurrent episodes
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62
Q

Apnoea of Prematurity

prognosis

A

episodes will settle as the baby grows and develops

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63
Q

Retinopathy of Prematurity

what is it

A

abnormal development of the blood vessels in the retina can lead to scarring, retinal detachment and blindness

typically affects babies before 32w

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64
Q

Retinopathy of Prematurity

pathophysiology

A

retinal blood vessels develop at 16w and is complete by 37-40w

vessel formation is stimulated by hypoxia (which is normal)

when retina is exposed to higher O2 concs in a preterm (supplementary O2), the stimulant for normal blood vessel development is removed

when the hypoxic environment recurs, the retina responds by producing XS blood vessels (neovascularisation) + scar tissue

these abnormal blood vessels may regress and leave the retina without a blood supply

the scar tissue may cause retinal detachment

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65
Q

Retinopathy of Prematurity

what are the zones that the retina is divided into?

A

Zone 1, 2 and 3

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66
Q

Retinopathy of Prematurity

retina: what is included in zone 1

A

optic nerve and macula

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67
Q

Retinopathy of Prematurity

retina: where is zone 2

A

from the edge of zone 1 to the ora serrata, the pigmented border between the retina and ciliary body

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68
Q

Retinopathy of Prematurity

retina: where is zone 3

A

outside the ora serrata

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69
Q

Retinopathy of Prematurity

how are the retinal areas described as

A

a clock face e.g. there is disease from 3 to 5 o’clock

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70
Q

Retinopathy of Prematurity

how are the areas of disease described as

A

from stage 1 (slightly abnormal vessel growth)

to stage 5 (complete retinal detachment)

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71
Q

Retinopathy of Prematurity

what does ‘plus disease’ describe

A

additional findings such as tortuous vessels and hazy vitreous humour

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72
Q

Retinopathy of Prematurity

who should be screened for RoP

A

babies born before 32w or under 1.5kg by an ophthalmologist

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73
Q

Retinopathy of Prematurity

at what age should screening start?

A

30-31w gestational age in babies born before 27w

4-5w of age in babies born after 27w

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74
Q

Retinopathy of Prematurity

how often should screening happen and when to cease?

A

at least every 2w

cease once the retinal vessels enter zone 3, usually at around 26w gestation

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75
Q

Retinopathy of Prematurity

what is involved in screening

A

all retinal areas need to be visualised

screening involves monitoring the retinal vessels as they develop

and looking for plus disease

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76
Q

Retinopathy of Prematurity

what is the aim of trx

A

systemically targeting areas of the retina to stop new blood vessels developing

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77
Q

Retinopathy of Prematurity

1st line trx

A

transpupillary laser photocoagulation

to halt and reverse neovascularisation

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78
Q

Retinopathy of Prematurity

other trx options apart from transpupillary laser photocoagulation

A
  • cryotherapy
  • injections of intravitreal VEGF inhibitors
  • surgery if retinal detachment occurs
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79
Q

Respiratory Distress Syndrome

pathophysiology

A

affects premature neonates, born before the lungs start producing adequate surfactant

inadequate surfactant –> high surface tension within alveoli –>atelectasis –> inadequate gas exchange –> hypoxia, hypercapnia + resp distress

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80
Q

Respiratory Distress Syndrome

what is atelectasis

A

lung collapse

81
Q

Respiratory Distress Syndrome

why does atelectasis occur

A

high surface tension within alveoli make it more difficult for the alveoli and lungs to expand

82
Q

Respiratory Distress Syndrome

what does the CXR show

A

ground glass appearance

83
Q

Respiratory Distress Syndrome

mnx

A

antenatal steroids eg dexamethasone given to mothers with suspected or confirmed preterm labour

84
Q

Respiratory Distress Syndrome

what does antenatal steroids do

A

increase the production of surfactant and reduces the incidence and severity of resp distress syndrome

85
Q

Respiratory Distress Syndrome

what may premature neonates need and why

A
  • intubation + ventilation: to fully assist breathing
  • endotracheal surfactant: artificial surfactant delivered via endotracheal tube
  • CPAP: via nasal mask to help keep lungs inflated
  • supplementary O2: to maintain O2 sats between 91-95%
86
Q

Respiratory Distress Syndrome

short term complications (6)

A
  • pneumothorax
  • infection
  • apnoea
  • intraventricular haemorrhage
  • pulmonary haemorrhage
  • necrotising enterocolitis
87
Q

Respiratory Distress Syndrome

long term complications (3)

A
  • chronic lung disease of prematurity
  • retinopathy of prematurity
  • neuro, hearing and visual impairment
88
Q

Necrotising Enterocolitis

what is it

A

a disorder affecting premature neonates

where part of the bowel becomes necrotic

cause is unclear

life threatening emergency

89
Q

Necrotising Enterocolitis

what can a necrotic bowel lead to

A

bowel perforation –> peritonitis –> shock

90
Q

Necrotising Enterocolitis

RFs (5)

A
  • v low birth weight or v premature
  • formula feeds
  • resp distress + assisted ventilation
  • sepsis
  • patent ductus arteriosus + other congenital heart disease
91
Q

Necrotising Enterocolitis

presentation

A
  • intolerance to feeds
  • vomiting, esp with green bile
  • generally unwell
  • distended, tender abdomen
  • absent bowel sounds
  • blood in stools
  • perforation: peritonitis + shock, severely unwell
92
Q

Necrotising Enterocolitis

blood tests

A
  • FBC: thrombocytopenia, neutropenia
  • CRP: inflammation
  • Capillary blood gas: metabolic acidosis
  • Blood culture: sepsis
93
Q

Necrotising Enterocolitis

inx of choice of dx

A

abdo X-ray

supine position (lying face up)

lateral and lateral decubitus views may be helpful

94
Q

Necrotising Enterocolitis

what may x-ray show (5)

A
  • dilated loops of bowel
  • bowel wall oedema (thickened bowel walls)
  • Pneumatosis intestinalis
  • Pneumoperitoneum
  • gas in the portal veins
95
Q

Necrotising Enterocolitis

what is pneumatosis intestinalis

A

gas in the bowel wall - a sign of NEC

96
Q

Necrotising Enterocolitis

what is pneumoperitoneum

A

free gas in the peritoneal cavity and indicates perforation

97
Q

Necrotising Enterocolitis

mnx

A
  • nil by mouth, IV fluids, TPN, abx
  • nasogastric tube can be inserted to drain fluid + gas from the stomach + intestines
  • surgical emergency, immediate referral to neonatal surgical team
98
Q

Necrotising Enterocolitis

complications

A
  • perforation + peritonitis
  • sepsis
  • death
  • strictures
  • abscess formation
  • recurrence
  • long term stoma
  • short bowel syndrome after surgery
99
Q

Neonatal Abstinence Syndrome

what is it

A

refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy

100
Q

Neonatal Abstinence Syndrome

substances that cause it

A
  • opiates
  • methadone
  • benzos
  • cocaine
  • amphetamines
  • nicotine or cannabis
  • alcohol
  • SSRI antidepressants
101
Q

Neonatal Abstinence Syndrome

how long does it take after birth for withdrawal from most opiates, diazepam, SSRIs and alcohol to happen

A

between 3-72hrs

102
Q

Neonatal Abstinence Syndrome

how long does it take for withdrawal from methadone and other benzos to occur

A

between 24h - 21d

103
Q

Neonatal Abstinence Syndrome

CNS signs and symptoms (6)

A
  • irritability
  • increased tone
  • high pitched cry
  • not settling
  • tremors
  • seizures
104
Q

Neonatal Abstinence Syndrome

vasomotor and resp signs and symptoms

A
  • yawning
  • sweating
  • unstable temp + pyrexia
  • tachypnoea
105
Q

Neonatal Abstinence Syndrome

metabolic and GI signs and symptoms

A
  • poor feeding
  • regurg or vom
  • hypoglycaemia
  • loose stools with a sore nappy area
106
Q

Neonatal Abstinence Syndrome

mnx pre birth

A
  • mothers that are known to use substances have an alert on their notes so when they do give birth, the neonate can have extra monitoring and management
107
Q

Neonatal Abstinence Syndrome

mnx of babies

A
  • monitored on a NAS chart for at least 3d (48h for SSRIs)
  • urine sample from neonate to test for substances
  • quiet + dim environment w/ gentle handling + comforting
108
Q

Neonatal Abstinence Syndrome

medical trx options for moderate to severe sx

A

opiate withdrawal:
- PO morphine sulphate

non-opiate withdrawal:
- PO phenobarbitone

gradually weaned off

109
Q

Neonatal Abstinence Syndrome

does SSRI withdrawal typically require medical trx

A

no

110
Q

Neonatal Abstinence Syndrome

additional considerations (6)

A
  • test for hep B, C and HIV
  • safeguarding + socials services
  • safety net advice
  • follow up: paeds, social services health visitors, GP
  • support mother to stop using substances
  • check suitability for breastfeeding in mothers with substance use
111
Q

Neonatal Sepsis

common organisms

A

group B strep!

e-coli

112
Q

Neonatal Sepsis

RFs

A
  • vaginal GBS colonisation
  • GBS sepsis in a previous baby
  • Maternal sepsis, chorioamnionitis or fever > 38ºC
  • prem (<37w)
  • PRoM (prolonged)
  • early rupture of membrane
113
Q

Neonatal Sepsis

Clinical Features

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Resp distress or apnoea
  • Vomiting
  • Tachycardia or bradycardia
  • Hypoxia
  • Jaundice within 24 hours
  • Seizures
  • Hypoglycaemia
114
Q

Neonatal Sepsis

red flags

A
  • Confirmed or suspected sepsis in the mother
  • Signs of shock
  • Seizures
  • Term baby needing mechanical ventilation
  • Respiratory distress starting >4h after birth
  • Presumed sepsis in another baby in a multiple pregnancy
115
Q

Neonatal Sepsis

mnx if there is 1 RF or clinical feature

A

monitor the observations and clinical condition for at least 12 hours

116
Q

Neonatal Sepsis

mnx if there are ≥2 RFs or clinical features

A

start antibiotics

1st line: benzylpenicillin and gentamycin

117
Q

Neonatal Sepsis

mnx if there is a single red flag sign

A

start antibiotics

1st line: benzylpenicillin and gentamycin

118
Q

Neonatal Sepsis

what should be done alongside giving abx

A
  • blood cultures
  • check FBC + CRP
  • lumbar puncture if meningitis suspected
119
Q

Neonatal Sepsis

when to check CRP and blood cultures

A

Check the CRP again at 24 hours and 5d if still on trx and

blood culture results at 36 hours

120
Q

Neonatal Sepsis

when to consider stopping abx at 36h

A
  • if the baby is clinically well
  • blood cultures are negative 36 hours after taking them
  • both CRP results are <10
121
Q

Neonatal Sepsis

when to consider stopping abx at 5d

A
  • if the baby is clinically well
  • lumbar puncture and blood cultures are negative
  • CRP has returned to normal at 5 days.
122
Q

Neonatal Sepsis

if any of the CRP results are >10, what do you consider performing

A

lumbar puncture

123
Q

infant born >42w stuck during prolonged labour. at 18m. now has hypertonia and unable to walk. What is it

A
  • infant has hypoxic ischaemic encephalopathy

HIE is a common antenatal cause of cerebral palsy

124
Q

what is Transient tachypnoea of the newborn (TTN)

A

tachypnoea shortly after birth

caused by delayed resorption of fluid in the lungs and is strongly associated with caesarean section and prematurity

125
Q

x ray signs of Transient tachypnoea of the newborn (TTN)

A

hyperinflation, and fluid in the horizontal fissure

126
Q

mnx of Transient tachypnoea of the newborn (TTN)

A

oxygen. TTN should resolve in a couple of days with resorption of lung fluid.

127
Q

Birth Injuries

what is Caput Succedaneum

A

oedema collecting on the scalp, outside the periosteum

128
Q

Birth Injuries

what causes Caput Succedaneum

A

pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery.

129
Q

Birth Injuries

what is the periosteum

A

a layer of dense connective tissue that lines the outside of the skull and does not cross the sutures (the gaps in the baby’s skull).

130
Q

Birth Injuries

can Caput Succedaneum cross the suture lines

A

yes as the fluid is outside the periosteum

131
Q

Birth Injuries

is there any discolouration in Caput Succedaneum

A

no

132
Q

Birth Injuries

trx of Caput Succedaneum

A

will resolve within a few days.

133
Q

Birth Injuries

what is cephalohaematoma

A

a collection of blood between the skull and the periosteum

134
Q

Cephalohaematoma

cause

A

damage to blood vessels during a traumatic, prolonged or instrumental delivery.

aka traumatic subperiosteal haematoma.

135
Q

Cephalohaematoma

does the lump cross the suture line

A

no because the blood is below the periosteum

136
Q

difference between Cephalohaematoma and Caput Succedaneum

A

Cephalohaematomas do not cross the suture line and there may be discolouration of the skin

137
Q

Cephalohaematoma

why is there risk of anaemia and jaundice

A

blood collects in the haematoma and breaks down, releasing bilirubin

138
Q

Cephalohaematoma

mnx

A

monitored for anaemia, jaundice

resolves without treatment within a few months.

139
Q

Facial Paralysis

facial nerve injury is typically associated with what delivery

A

forceps delivery

140
Q

Facial Paralysis

mnx

A

Function normally returns spontaneously within a few months.

If function does not return they may required neurosurgical input.

141
Q

Erbs Palsy

what is it

A

injury to the C5/C6 nerves in the brachial plexus during birth

142
Q

Erbs Palsy

what is it associated with

A
  • shoulder dystocia
  • traumatic or instrumental delivery
  • large birth weight.
143
Q

Erbs Palsy

presentation

A

weakness of:

  • shoulder abduction + external rotation
  • arm flexion
  • finger extension

‘waiter’s tip’ arm

  • Internally rotated shoulder
  • Extended elbow
  • Flexed wrist facing backwards (pronated)
  • Lack of movement in the affected arm
144
Q

Erbs Palsy

mnx

A
  • Function normally returns spontaneously within a few months.
  • If not, then they may required neurosurgical input.
145
Q

Fractured Clavicle

associated with what

A

shoulder dystocia, traumatic or instrumental delivery and large birth weight.

146
Q

Fractured Clavicle

presentation

A
  • lack of movement or asymmetry in the affected arm
  • asymmetry of shoulders
  • pain + distress on movement of arm
147
Q

Fractured Clavicle

dx

A

US or Xray

148
Q

Fractured Clavicle

mnx

A

conservative, occasionally with immobilisation of the affected arm. It usually heals well

149
Q

Fractured Clavicle

complication

A

injury to the brachial plexus, with a subsequent nerve palsy.

150
Q

Neonatal Resuscitation

what are the Principles of Neonatal Resuscitation

A
  1. warm the baby
  2. calculate APGAR score
  3. stimulate breathing
  4. inflation breaths
  5. chest compressions
151
Q

Neonatal Resuscitation

when is the APGAR score calculated

A

done at 1, 5 and 10 minutes whilst resuscitation continues

152
Q

Neonatal Resuscitation

how to stimulate breathing

A
  • dry vigorously with towel
  • neutrally positioned head to keep airway open
  • gasping or unable to breath: check for airway obstruction (i.e. meconium) and consider aspiration
153
Q

Neonatal Resuscitation

when are inflation breaths given

A

when the neonate is gasping or not breathing despite adequate initial simulation.

154
Q

Neonatal Resuscitation

how many inflation breaths can be given

A

Two cycles of 5 inflation breaths (lasting 3 seconds each)

155
Q

Neonatal Resuscitation

if there is no response to 2 cycles of 5 inflation breaths, what next

A

30 seconds of ventilation breaths

156
Q

Neonatal Resuscitation

if there is no response to 30 seconds of ventilation breaths, what next

A

chest compressions

157
Q

Neonatal Resuscitation

when performing inflation breaths what should be used in term or near term babies

A

air

158
Q

Neonatal Resuscitation

when performing inflation breaths what should be used in pre-term babies

A

air and oxygen

159
Q

Neonatal Resuscitation

when should you perform chest compressions

A

HR <60bpm despite resus and inflation breaths

160
Q

Neonatal Resuscitation

what ration of chest compressions to ventilation breaths

A

3:1

161
Q

Neonatal Resuscitation

severe situational mnx (prolonged hypoxia–> HIE)

A

therapeutic hypothermia, IV drugs, intubation

162
Q

Neonatal Resuscitation

when should Neonates that require neonatal resuscitation have their umbilical cord clamped

A

sooner to prevent delayed in getting the baby to the resuscitation team

163
Q

Newborn Examination

when is it performed

A

within the first 72h after birth

repeated at 6-8w by GP

164
Q

Newborn Examination

before starting, what q’s should you ask parents

A
  • Has the baby passed meconium?
  • Is the baby feeding ok?
  • Is there a family history of congenital heart, eye or hips problems?
165
Q

Newborn Examination

before examination., what should be checked

A

pre-ductal and post-ductal oxygen saturations

ductus arteriosus

166
Q

Newborn Examination

how are pre-ductal sats measured and why

A

baby’s right hand

right hand received blood from R subclavian artery, a branch of the brachiocephalic artery. which branches from the aorta before the ductus arteriosus

167
Q

Newborn Examination

how are post-ductal sats measured and why

A

in either foot

foot receives blood from the descending aorta. which occurs after the ductus arteriosus

168
Q

Newborn Examination

structure of examination

A
  • general appearance
  • head
  • shoulders + arms
  • chest
  • abdomen
  • genitals
  • legs
  • back
  • reflexes
  • skin
169
Q

Newborn Examination

general appearance: what are you looking for

A
  • Colour (pink is good)
  • Tone
  • Cry
170
Q

Newborn Examination

head: what are you looking for

A
  • general appearance
  • circumference
  • anterior + posterior fontanelles
  • sutures
  • ears
  • eyes
  • red reflex
  • mouth
  • suckling reflex
171
Q

Newborn Examination

shoulders and arms: what are you looking for

A
  • shoulder symmetry
  • arm movements
  • brachial pulse
  • radial pulse
  • palmar creases
  • digits
  • pre ductal reading (right wrist)
172
Q

Newborn Examination

chest: what are you looking for

A
  • observe breathing
  • heart sounds
  • breath sounds
173
Q

Newborn Examination

abdomen: what are you looking for

A
  • observe the shape
  • umbilical stump
  • palpate
174
Q

Newborn Examination

genitals: what are you looking for

A
  • observe
  • palpate testes + scrotum
  • inspect penis
  • inspect anus
  • meconium?
175
Q

Newborn Examination

legs: what are you looking for

A
  • observe legs + hips
  • barlow + ortolani
  • count toes
176
Q

Newborn Examination

back: what are you looking for

A

Inspect and palpate the spine

177
Q

Newborn Examination

which reflexes to check

A
  • moro
  • suckling
  • rooting
  • grasp
  • stepping
178
Q

Conditions Arising in Pregnancy

what can alcohol in early pregnancy lead to

A
  • miscarriage
  • small for dates
  • preterm delivery
  • fetal alcohol syndrome
179
Q

Conditions Arising in Pregnancy

features of fetal alcohol syndrome

A
  • microcephaly
  • thin upper lip
  • smooth flat philtrum (the groove between the nose + upper lip)
  • short palpebral fissure (horizontal distance from one side of the eye and the other)
  • learning disability
  • behavioural difficulties
  • hearing + vision problems
  • cerebral palsy
180
Q

Conditions Arising in Pregnancy

to prevent rubella syndrome, what should women planning to become pregnant have

A

MMR vaccine

if in doubt they can be tested for rubella immunity

181
Q

Conditions Arising in Pregnancy

can pregnant women receive the MMR vaccine

A

no because it is a live vaccine

Non-immune women should be offered the vaccine after giving birth.

182
Q

Conditions Arising in Pregnancy

features of congenital rubella syndrome

A
  • congenital cataracts
  • PDA, pulmonary stenosis
  • learning disability
  • hearing loss
183
Q

Conditions Arising in Pregnancy

what can chickenpox in pregnancy lead to

A
  • mum: varicella pneumonitis, hepatitis or encephalitis

- neonate: fetal varicella syndrome, severe neonatal varicella infection

184
Q

Conditions Arising in Pregnancy

if in doubt if mother has had chickenpox?

A

IgG levels for VZV can be tested

+ve = immunity

185
Q

Conditions Arising in Pregnancy

if woman not immune to VZV, what can they be treated with if within 10d of exposure

A

IV varicella immunoglobulins

186
Q

Conditions Arising in Pregnancy

trx if chickenpox rash starts in pregnancy

A

PO aciclovir

if they present within 24h and >20w gestation

187
Q

Conditions Arising in Pregnancy

typical features of congenital varicella syndrome

A
  • FGR
  • microcephaly, hydrocephalus, learning disability
  • scars + significant skin changes following the dermatomes
  • limb hypoplasia (underdeveloped)
  • cataracts + inflammation in the eye (chorioretinitis)
188
Q

Conditions Arising in Pregnancy

features of congenital cytomegalovirus

A
  • FGR
  • microcephaly
  • hearing loss
  • vision loss
  • learning disability
  • seizures
189
Q

Conditions Arising in Pregnancy

how is toxoplasma gondii primary spread

A

contamination with faeces from a cat this a host of the parasite

190
Q

Conditions Arising in Pregnancy

what is the classic triad of features in congenital toxoplasmosis

A
  • intracranial calcification
  • hydrocephalus
  • chorioretinitis
191
Q

Conditions Arising in Pregnancy

how is zika virus spread

A
  • by host Aedes mosquitos

- by sex with someone infected with the virus

192
Q

Conditions Arising in Pregnancy

features of congenital Zika syndrome

A
  • microcephaly
  • FGR
  • intracranial abnormalities: ventriculomegaly + cerebellar atrophy
193
Q

Conditions Arising in Pregnancy

Pregnant women that may have contracted the Zika virus should be tested for
?

A

the viral PCR and antibodies to the Zika virus

194
Q

Conditions Arising in Pregnancy

trx for zika virus

A

none

195
Q

Sudden Infant Death Syndrome

what is it

A

a sudden unexplained death in an infant.

usually occurs within the first six months of life.

196
Q

Sudden Infant Death Syndrome

RFs(4)

A
  • prematurity
  • low birth weight
  • smoking during pregnancy
  • male baby
197
Q

Sudden Infant Death Syndrome

how to reduce the risk

A
  • put baby on back when not supervised
  • keep head uncovered
  • place their feet at foot of bed to prevent them sliding down + under blanket
  • keep cot cleat of toys + blankets
  • room temp of 16-20 degrees
  • avoid smoking
  • avoid co-sleeping
  • If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers
198
Q

Sudden Infant Death Syndrome

what support is available for parents

A
  • the lullaby trust

- Bereavement services and bereavement counselling

199
Q

Sudden Infant Death Syndrome

what is the CONI team

A

Care of Next Infant

  • supports parents with their next infant after a sudden infant death.
  • provides extra support, home visits, resuscitation training, movement monitors

Finals (47 decks)

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