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paeds > neonates > Flashcards

neonates Flashcards

1
Q

what does an apgar score predict?

A

how much medical attention a baby is going to need

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2
Q

why do babys not usually score 10

A

their hands and feet are pale, but will pinked up as circulation established

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3
Q

a score of what is normal?

A

7

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4
Q

what does APGAR stand for

A 
appearance 
pulse 
grimace 
activity 
respiratory effort
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5
Q

in a child less than 1, what should blood pressure, RR, and heart rate be?

A

HR 110-160
RR 30-40
blood pressure 70-90 (systolic)

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6
Q

what test is taken from the heel at day 5 to check for things like CF?

A

guthrie skin prick

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7
Q

what else does the guthrie skin test check for

A 
♣	PKU  phenylketonuria. 
♣	IVA  isovaleric acidaemia. 
♣	HCU   homocysteinuria. 
♣	MSUD  Maple syrup urine disease. 
MCADD  medium chain acyl-CoA dehydrogenase deficiency
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8
Q

who does hearing checks in hospital ? in community >

A

in hospital before discharge by midwife

in community within 4 weeks by health visitor

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9
Q

when are the post natal baby checks carried out

A

6-8 weeks by the GP

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10
Q

when are pre terms examined ?

A

6 weeks after expected date of delivery and not at six weeks gestation, at this point they should be at same developmental level

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11
Q

who needs to be at the delivery of a pre term?

A

neonatologist

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12
Q

why is cord cutting delayed in pre term?

A

can be delayed for up to 3 minutes to encourage maternal metal transfusion

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13
Q

what does delayed cord cutting reduce the risk of?

A

need for transfusion and reduce risk of RDS, hypoxia and associated complications

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14
Q

hypothermia management: deliver baby in a room of what temperature?

A

26 degrees

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15
Q

what do you wrap baby in ?

A

plastic bag or towel

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16
Q

you would place hypothermic baby in incubator. an incubator is an independent risk of?

A

infection

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17
Q

what do you give to mothers before delivery to prevent RSD?

A

steroids (x2 doses, 12 hours apart)

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18
Q

presentation of RDS?

A

tachypnoea
increased work of breathing
onset of symptoms from minutes - hours after birth
symptoms do not resolve after 24 hours like TTN

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19
Q

investigations for RDS?

A

02 is low

x ray shows ground glass appearance

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20
Q

management of RDS

A

surfactant and ventilation

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21
Q

how can you ventilate in RDS?

A

intubate

CPAP

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22
Q

broncho pulmonary dyplasia - what is it?

A

long term comp associated with ventilation of babies largely in the context of RDS due to a combination of barotrauma and oxygen toxicity

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23
Q

how would bronchopulmonary dysplasia present?

A

hypoxia and difficulty weaning off ventilator

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24
Q

is the damage that accord from BPD reversible?

A

no

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25
Q

what is apnoea of pre maturity?

A

gaps between breaths of over 20 seconds

may require ventilation due to risk of hypoxia

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26
Q

pathophysiology of apnea of pre maturity?

A

breathing centres in brain not fully developed , baby “forgets” to breath

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27
Q

inflammatory necrosis of the intestine thought to be associated with gut immaturity.

A

necrotizing enterocolitis

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28
Q

how would necrotising enterocolitis present?

A

poor feeding
mucous and blood stained diarrhoea
abdominal distension and tenderness

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29
Q

what do you see in the bowel wall?

A

pneumostasis intestinalis (air cysts(

30
Q

management of NE?

A

stop feeding, supportive care and abx

or surgical removal of part of the bowel

31
Q

in peri ventricular haemorrhage, where does intra cranial haemorrhage start ?

A

germinal matrix

32
Q

when does per ventricular haemorrhage usually startt?

A

usually within first day of life

33
Q

outcome of peri ventricular haemorrhage?

A

variable mortality but most associated with long term neurological problems

34
Q

what causes birth asphyxia?

A

reduction of oxygen supply and accumulation of co2 due to cessation of blood supply to the foetus at time of delivery

35
Q

how does asphyxia present ?

A

bradycardia and low apgar score

36
Q

management of asphyxia?

A

recitation with oxygen

37
Q

what is CNS complication of birth asphyxia?

A

hypoxic ischaemic encephalopathy

38
Q

early and late sepsis defined as?

A 
early = within 48 hours 
late = after 48 hours
39
Q

causitive organisms of early and late sepsis?

A

early is coli and group B strep

late is listeria and staph

40
Q

management of sepsis in a a newborn?

A

benxylpenicillin and gentamycin

41
Q

treatment of pneumonia in newborn?

A

amoxicillin

42
Q

what is Opthalmia neonatorum caused by?

A

passage of chlamydia from mother to baby

43
Q

what STI do symptoms develop more quickly in? gonorrhoea or chlamydia?

A

gonorrhoea (gone up tubes faster)

44
Q

whats the main risk factor for developing TTN?

A

c section (don’t get the squeeze of vaginal delivery to get rid of fluid in the lungs)

45
Q

how does TTN present?

A

a rr of over 60

46
Q

most cases of TTN resolve within?

A

24 hours

47
Q

meconium stained amniotic fluid then respiratory distress following delivery

A

meconium aspiration syndrome

48
Q

when does baby usually pass meconium

A

within 24 hours

49
Q

management of MAS?

A

suctioning and supportive care

50
Q

o yanosis, respiratory distress pulmonary odemea.
o Oedema: sacral, ankle, peri orbital.
o Hepatosplenomegaly.
in newborn?

A

heart failure

51
Q

persistent pulmoary hypertension caused by?

A

a failure of fetal circulation. get right to left shunting of blood and get cyanosis and loud S2

52
Q

care for pulmonary hypertension ?

A

inotropes to increase systemic pressure while fetal circulation naturally adapts

53
Q

when are inborn errors of metabolism screened for?

A

day 5

54
Q

what is haemorrhagic disease of the newborn caused by?

A

vitamin K deficiency

55
Q

prevention of haemorrhagic disease of the newborn/

A

vitamin K injection at birth (given by midwife)

56
Q

what is kernicterus ?

A

rare type of brain damage that occurs with jaundice

57
Q

most common cause of seizures in newborn?

A

hypoxic ischaemic encephalopathy

58
Q

management of seizures in neonates?

A

phenobarbitol and phenytoin

59
Q

pshysiological jaundice occurs after?

A

24 hours

60
Q

bilirubin level in physiological jaundice?

A

under 200

61
Q

why do you get accumulation of bilirubin in the blood?

A

RBC have a shorter lifespan

reduced ability of the liver to conjugate bile and for gut to eliminate it

62
Q

what is pathological jaundice defined as?

A

jaundice that occurs within 24 hours

63
Q

causes of pathological jaundice?

A

sepsis
haemorrhagic disease of the newborn
red cell incompatibility
inherited (G6PD, spherocytosis)

64
Q

what is prolonged jaundice defined as?

A

jaundice that lasts more than 14 days

65
Q

what is plotted to help choose between two potential management options?

A

babies age and bilirubin levels

66
Q

what are the two management options?

A

phototherapy and exchange transfusion

67
Q

how does phototherapy work?

A

baby placed in incubator with UV light source

this helps to break down to products that don’t require conjugation for release

68
Q

what does exchange transfusion involve

A

removing blood with high bilirubin levels and replacing it with normal blood

69
Q

in prolonged jaundice, need to investigate for inherited conditions such as?

A

G6PD
galactoseamia
hypothyroidism

70
Q

what is kernicterus

A

bilirubin iduced encephalopthy

71
Q

management of kernicterus

A

exchange transfusion and phototherapy

72
Q

long term outcomes ?

A

deafness and reduced IQ

paeds (23 decks)

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