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PAEDIATRICS > 2. Neonatal Unit > Flashcards

2. Neonatal Unit Flashcards

1
Q

State 5 objectives of examination of a newborn

A

To initiate health promotion
Detect congenital problems
Detect non acute neonatal problems
To ensure appropriate plan for outpatient monitoring
To check for problems arising from maternal disease, family disorders and problems during pregnancy

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2
Q

State 5 Down syndrome features

A

Pronounced sandal gap
Bilateral single palmar creases
Flat occiput and nasal bridge
Low set ears
Hypotonia

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3
Q

State 8 neonatal benign self limiting skin lesions

A

Ranula
Epulis
Milia
Epstein pearls
Mangolian sots
Vermix caseosa
Neonatal urtricaria
Neonatal pustular melanosis

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4
Q

State 5 Ts of cyanotic heart disease

A

Tetralogy of fallot
Transposition of great vessels
Tricuspid valve anomalies
Total anomalous pulmonary venous return
Persistent Truncus arteriosus

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5
Q

Define tetralogy of fallot

A

Simultaneous occurrence of 4 of the following
Right ventricular outflow tract obstruction (RVOTO) due to pulmonary infundibular stenosis
Right ventricular hypertrophy (RVH)
Ventricular septal defect (VSD)
Overriding aorta (the aorta is displaced above the VSD)

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6
Q

Define neonatal jaundice concentration

A

Serum bilirubin concentration >5mg/dL OR >85.5 micromol/L

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7
Q

Describe the pathophysiology of breastfeeding jaundice

A

Decreased feeing > reduced bowel movements > decreased bilirubin excretion > enterohepatic circulation > increased reabsorption > unconjugated hyperbilirubinemia

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8
Q

State 2 causes of physiologic jaundice

A

Increased fetal hemolysis due to short lifespan of fetal erythrocytes
Insufficient hepatic metabolism of bilirubin

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9
Q

State 4 causes of pathologic jaundice

A

Increased production of bilirubin eg conditions with increased hemolysis
Decreased hepatic uptake due to liver immaturity
Decreased conjugation- crigler najjer syndrome
Increased enterohepatic circulation

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10
Q

Define asphyxia and what causes it

A

Failure to initiate and maintain spontaneous and adequate breathing within 60 seconds of birth
Caused by a decrease of oxygen in the blood and an excess of carbon dioxide resulting in acidosis

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11
Q

State 4 clinical features of birth asphyxia

A

Bradycardia <100 beats per minute
Failure to breathe at 1 minute after birth
Floppy baby or poor muscle tone
Central cyanosis

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12
Q

State 5 predisposing maternal factors of asphyxia

A

Pre-eclampsia or eclampsia
Previous neonatal deaths
Prolonged rupture of membranes
Placenta Insufficiency
Placenta abruption
Placenta previa- placenta covers the cervix

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13
Q

State 5 labour and delivery predisposing factors of asphyxia

A

Operative vaginal delivery
Prolonged labour
Caesarean section
Breech or abnormal presentation
Prolapsed umbilical cord or cord compression

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14
Q

State 5 fetal predisposing factors of asphyxia

A

Prematurity
Postmaturity
Fetal distress
Intra uterine growth restriction
Meconium aspiration
Cerebral damage

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15
Q

Describe 4systems affected by birth asphyxia

A

Neuro- hypoxic ischemic encephalopathy > seizures abnormal tone and posture
GIT- necrosis > abdominal distension, bloody stools and food intolerance
Cardiac- arrhythmias and cardiac arrest
Kidney- acute tubular necrosis with hematuria, anuria, oliguria

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16
Q

Describe 4systems affected by birth asphyxia

A

Neuro- hypoxic ischemic encephalopathy > seizures abnormal tone and posture
GIT- necrosis > abdominal distension, bloody stools and food intolerance
Cardiac- arrhythmias and cardiac arrest
Kidney- acute tubular necrosis with hematuria, anuria, oliguria

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17
Q

Define hypoxic ischemic encephalopathy HIE

A

A condition when a neonate has experienced acute brain injury as expressed by encephalopathy (altered mental state) as a consequence of hypoxia (reduced oxygen supply)

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18
Q

Diagnostic criteria for HIE x4

A

Metabolic acidosis and pH <7
APGAR score of 5 at 10 minutes with continued need for resuscitation
Clinical evidence of encephalopathy - hypotonia
Presence of multiple organ system failures

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19
Q

State 2 maternal predisposing factors for early bacterial sepsis

A

Foul smelling amniotic fluid
Intrapartum maternal fever during birth

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20
Q

3 labour and delivery predisposing factors for early bacterial sepsis

A

Prolonged rupture of membranes
Spontaneous prematurity
Born before arrival to labour room

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21
Q

State 3 common bacterial infections in neonates

A

E.coli
Staphylcoccus
Streptococcus pneumonia Group B

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22
Q

Define cephalohematoma, its cause and characteristics x2

A

An unusual bulging that occurs under the scalp of an infant which gets harder over times
It is caused by rupture of the diploic or emissary veins
Limited by suture lines hence usually unilateral

23
Q

Define caput succedaneum

A

It is diffuse edematous swelling of the scalp caused by prolonged or abnormal vaginal delivery

24
Q

State 4 risk factors of prematurity

A

Multiple pregnancy
Cervical insufficiency
Previous preterm birth
Short cervical length

25
Q

Define bronchopulmonary dysplasia and it’s requirement

A

When the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli)
The need for at least 28 days of oxygen therapy for infants born at < 32 weeks gestational age

26
Q

Define periventricular leukomalacia

A

It is the symmetrical periventricular injury of cerebral white matter by necrosis and cystic formation caused by ischemia and infections

27
Q

State 3 sequelae for periventricular leukomalacia

A

Spastic cerebral palsy
Visual disturbances
Intellectual impairment

28
Q

State 4 indications for cerclage in cervical insufficiency

A

History indicated
Physical exam indicated
Ultra sound indicated
Unsuccessful cerclage

29
Q

Define bronze baby syndrome

A

A complication of phototherapy for neonatal jaundice occurring due to modified liver function. Common in direct hyperbilirubinemia

30
Q

State 5+ complications of prematurity

A
  1. Neonatal RDS and apneic attacks
  2. Jaundice, anemia, infections, retinopathy
  3. Necrotizing enterocolitis and food intolerance
  4. Cerebral and intraventricular hemorrhage
  5. Periventricular Leukomalacia
  6. Bronchopulmonary dysplasia
31
Q

Maternal predisposing factors of prematurity x5

A

Teenage pregnancy
Infection
Anemia
Poor nutrition
Hard labour

32
Q

Categories of birth weight x5

A

<750g
Extremely LBW <1000g
Very LBW <1500
LBW <2500
Macrosomia >4000

33
Q

State 4 nutrients that may cause prematurity if low in quantity

A

Selenium iron zinc folate

34
Q

State 3 signs of food intolerance

A

Vomiting of feeds tinged with bile
Abdominal distension
Bloody stools

35
Q

Define prolonged pathological jaundice, clinical presentation (2) and causes (3)

A

Jaundice lasting for more than 2 weeks in full term and 3 weeks in premature babies
Clay colored stool and dark yellow urine
Biliary atresia, hypothyroidism, neonatal hepatitis

36
Q

When to administer antibiotics on preterms x3

A

Spontaneous birth
Foul smelling amniotic fluid
PROM

37
Q

Define prematurity

A

A baby born between the gestational age of 28< 37weeks

37
Q

Describe management for a preterm baby x4

A

Tetracycline eye ointments
Chlorhexidine for cord care
Warmth + skin to skin contact
Vitamin K administration to prevent hemorrhagic disease

38
Q

State the family of complications x4

A

Neonatal sepsis> hypoglycemia and hypothermia> jaundice

39
Q

Benefits of Kangaroo mother care x5

A

Promotes psychosocial benefits
Decrease neonatal mortality
Decreases risk of infections
Improves brain development
Improves cardiopulmonary circulation

40
Q

Causes of convulsions x4

A

HIE
Hypoglycemia
Hypocalcemia
CNS infection

41
Q

Management of convulsions, in hypoglycemia and hypocalcemia

A

15ml/kg phenobarbital
If hypoglycemic- 2ml/kg of 10% glucose iv or ng
If Hypocalcemic- 2ml/kg of 10% calcium gluconate

42
Q

State 3 important growth monitoring parameters

A

Weight
Height or length
Head circumference

43
Q

State non nutritional factors affecting linear growth x6

A

Endocrine - growth hormone, thyroid hormone, steroids
Non endocrine - genetic disorders, chronic illness, undernutrition

44
Q

State 4 causes of microcephaly

A

Familial
Autosomal recessive condition with dvt delay
Congenital infection ie CMV
Acquired- hypoglycemia, perinatal hypoxia

45
Q

Causes of macrocephaly x5

A

Hydrocephalus
Cerebral tumor
Cerebral gigantism
Familial macrocephaly
Raised intracranial pressure

46
Q

Define growth spurt, catch up and catch down

A

Growth spurt is increase in growth velocity
Catch up - increase in growth rate to return to normal size
Catch down - weight falls down lower a genetically determined growth centile

47
Q

Causes of failure to thrive x5

A

Inadequate food
Vomiting
Malabsorption
Renal - UTI
Congenial heart disease

48
Q

Define short stature and differentials

A

Height < 2-2.5 standard deviations below the mean for age
Ddx:
Normal ie familial
Medical problems ie chronic illness, psychosocial dwarfism, LBW, small for gestational age

49
Q

State 4 constitutional causes of failure to thrive

A

Perinatal infections
Congenital syndromes
Chromosomal disorders
Inborn errors of metabolism

50
Q

Investigations for short stature x4

A

CBC, ESR
Bone age radiography
Insulin like growth factor
Free T4 and TSH levels

51
Q

Investigations for Screening for neonatal sepsis x4

A

Lumbar puncture
Blood culture
Urine culture
FBC- WBC

52
Q

4 signs of neurological problems in neonates

A

Rapid change in head size
Changes in muscle tone
Changes in body temperature
Feeding difficulties

PAEDIATRICS (20 decks)

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