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Paediatrics > Neonatal + newborn > Flashcards

Neonatal + newborn Flashcards

1
Q

Causes (up to 2 weeks) of neonatal jaundice

A

<24 hrs after birth = sepsis (most common - TORCH infections or maternal vaginal tract organisms), ABO incompatibility + Rhesus disease (more likely if difficult birth due to blood mixing) 24 hrs - 2 weeks = physiological, breastmilk, dehydration, infection, haemolysis

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2
Q

Causes of prolonged jaundice

A

Unconjugated = physiological/ breastmilk, infection, hypothyroidism, haemolytic anaemia, high GI obstruction, G6PD Conjugated = bile duct obstruction, hepatitis Biliary atresia = surgery needed in 6 weeks >14 days in term, >21 days in pre-term infants

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3
Q

Complications of jaundice

A

Kernicterus = due to deposits of bilirubin in basal ganglia + brainstem S+S = lethargy, poor feeding, seizures, opisthotonus (hypertonia) RF: preterm, hypoxia, acidosis

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4
Q

What is physiological jaundice?

A

Bilirubin rises as infant is adapting, infant is slow to conjugate and excrete it Rise in unconjugated Not apparent for 24 hours. Fades by 14 days Common in preterms 2/3 normal babies get it Associated with difficulty establishing feeds - particularly new mums + breastfeeding

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5
Q

S+S jaundice

A

Starts at head/face and spreads Yellow discolouration of skin + sclera Dark urine + pale stools (if conjugated)

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6
Q

Investigations + management of jaundice + SE

A

<24hrs: FBC, blood group, DCT (Direct Coombs test), U+E, sepsis screen, bilirubin (conjugated/ unconjugated/ total) Over 24hrs: just bilirubin Phototherapy with light at wavelength 450 (from blue-green band). Check bilirubin every 6-8 hrs if severe, every 10hrs otherwise. Take off phototherapy when 50 below treatment line. Check bilirubin again after treatment, then discharge SE = temp instability, macular rash, bronze skin discolouration Exchange transfusion if severe

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7
Q

Causes of birth asphyxia

A

Failure of gas exchange across placenta due to: prolonged uterine contractions, placental abruption, ruptured uterus Interruption of blood flow due to cord compression, shoulder dystocia, cord prolapse Inadequate maternal placental perfusion due to IUGR, HTN

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8
Q

Hypoxic ischaemic encephalopathy

A

If evidence of severe hypoxia, resuscitation needed, evidence of hypoxic damage

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9
Q

S+S of birth asphyxia (mild, moderate, severe)

A

Mild = irritable, responds excessively to stimulation, hyperventilation Moderate = abnormalities of tone + movement, seizures, can’t feed Severe = no movements, hypo/hypertonia, prolonged seizures

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10
Q

Management of asphyxia

A

Respiratory support Fluid restriction Mild hypothermia

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11
Q

Types of pigmented birthmarks

A

Moles Cafe au lait spots Mongolian blue spots

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12
Q

Types of vascular birthmarks

A

Macular stains (salmon patches) Haemangiomas Port wine stains

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13
Q

CNS conditions causing skin lesions

A

Neurofibromatosis = cafe au lait spots Tuberous sclerosis = seizures, developmental delay, ash leaf-shaped macules on trunk, angiofibroma (papules over the nose), periventricular tubers (white spots at edge of ventricles on CT) Sturge Weber syndrome = unilateral port wine stains, intracranial haemangioma, presents with hemiplegia seizures, learning problems, glaucoma

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14
Q

Stork marks

A

Flat, pinkish capillary haemangiomas on forehead + eyelids. Fade over 2 years

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15
Q

Port wine stain

A

Capillary haemangioma (naevus flammeus) Starts pale then darkens

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16
Q

Strawberry mark

A

Soft, bright red capillary haemangioma Appears in days after birth, enlarges in first 6 months White areas develop Disappear before school age

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17
Q

Albinism in black vs white people

A

White = autosomal recessive Black = autosomal dominant

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18
Q

Mongolian blue spots

A

Large blue-grey patches, commonly over lumbosacral area + buttocks Common in asian + blacks Gradually fade

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19
Q

Cephalhaematoma causes

A

Bleeding below periosteum, confined within margins of skull sutures - doesn’t cross suture lines Common during assisted delivery

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20
Q

Subglial/ suba[pneurotic lesion S+S

A

Above periosteum Crosses suture line Life-threatening

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21
Q

Haemolytic disease cause

A

Increased red cell destruction Due to mother being negative for the antigen (anti-D, A, B or anti-Kell) Baby is positive Mother creates antibodies which cross placenta causing haemolytic anaemia (IgG crosses placenta)

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22
Q

Haemolytic disease in neonate S+S

A

Increased reticulocyte count Increased unconjugated bilirubin Jaundice Anaemia Hypoproteinaemia

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23
Q

Diagnosis of haemolytic disease

A

Positive direct anti-globulin test (Coomb’s)

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24
Q

Management of haemolytic disease

A

Transfusion + phototherapy

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25
Q

Complications of prematurity

A

Respiratory distress syndrome Hypoglycaemia/ calcaemia Jaundice Retinopathy Anaemia Necrotising enterocolitis Inguinal hernias Patent ductus arteriosus

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26
Q

Pathology of respiratory distress syndrome

A

Deficiency of surfactant Alveoli collapse = atelectasis Inadequate gas exchange Proteinaceous exudate seen on histology

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27
Q

S+S respiratory distress syndrome

A

CO2 retention = resp failure >60 breaths a min Chest wall recession Nasal flaring Expiratory grunting Cyanosis

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28
Q

X ray findings with RDS

A

Hazy, ground glass appearance

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29
Q

Management of RDS

A

Glucocorticoids given antenatally Surfactant therapy CPAP/ high flow

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30
Q

CPAP vs highflow

A

Continuous positive airway pressure Highflow = humidified air

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31
Q

IUGR causes (symmetrical vs asymmetrical)

A

Symmetrical = head circ equally reduced, due to prolonged IUGR, usually due to chromosomal abnormalities, congenital infection, maternal drug/ alcohol, chronic medical condition Asymmetrical = abdo circ is less than hea Usually due to placental dysfunction (pre-eclampsia, multiple pregnancy, maternal smoking)

32
Q

Risks to fetus for IUGR

A

Intrauterine hypoxia Asphyxia during labour Hypothermia, hypoglycaemia, hypocalcaemia Polycythaemia

33
Q

Talipes equinovarus - what is it, what causes it

A

Club foot Postural = caused by intrauterine compression Secondary to oligohydraminos, malformation or neuromuscular disorder Associated with DDH

34
Q

S+S talipes equinovarus

A

Entire foot inverted + supinated Forefoot adducted Heel rotated inwards + in plantar flexion Affected foot is shorter Calf muscles thinner

35
Q

Management of club foot

A

Plaster casting + bracing (Ponsetti method)

36
Q

What is a neonate?

A

Term - up to 28 days Pre-term - up to 44 weeks gestation

37
Q

Causes of conjugated jaundice?

A

Bile duct obstruction, hepatitis Biliary atresia = surgery needed in 6 weeks

38
Q

What is the NICE treatment threshold graph for?

A

Jaundice Uses total bilirubin + age (in days) to show whether it needs treating with phototherapy or exchange transfusion Slope at beginning = lower threshold in first few days of life to stop acceleration

39
Q

Conjugated jaundice - treatment + complications

A

Doesn’t cause kernicterus due to not crossing blood brain barrier Therefore doesn’t need to be treated with phototherapy Treat underlying cause

40
Q

When will reflux resolve?

A

Usually by 10-18 months

41
Q

Difference between reflux + GORD

A

GORD - negative symptoms

42
Q

What are the types of spina bifida?

A

Myelomeningocele - most severe, spinal cord protruding with no skin covering Meningocele - meninges protrude out (spinal cord still covered) Occulta - vertebrae don’t form properly, causing small gap in spine.

43
Q

What is possetting?

A

Blowing bubbles after feeding Feeds well + gains weight - no problem

44
Q

What are the TORCH infections?

A

Toxoplasmosis Other (syphilis, VZV, parvovirus B19) Rubella Cytomegalovirus Herpes

45
Q

What is parvovirus B19 + effects on neonate?

A

Also called slapped cheek or Fifth disease Can cause anaemia in fetus + miscarriage High risk from 4-20 weeks gestation Immunoglobulins are checked - if negative, risk of getting virus. Checked after 1 month for signs of virus. If infected, referred to specialist clinic Check for growth + anaemia Can treat with intrauterine blood transfusion if baby is anaemic

46
Q

Describe toxoplasmosis in pregnancy + how it affects neonate, + treatment

A

Parasite found in meat, cat faeces + unpasteurised goat milk Symptoms like flu - blood test for ab to infection if worried Causes congenital toxoplasmosis - can cause miscarriage/ stillbirth Causes hydrocephalus, calcifications of brain or retinochoroiditis Most dangerous in 1st + 2nd trimester Abx - spiramycin - reduces risk of transmission

47
Q

What are the effects of syphilis in pregnancy?

A

Can cause miscarriage, stillbirth, IUGR, fetal hydrops or congenital syphilis, Hutchinson teeth

Screening offered to all women Treat with penicillin during pregnancy

48
Q

What is the Jarich-Herxheimer reaction?

A

Complex allergic response to antigens from dead organisms, causing fetal distress + uterine contractions Occurs in syphilis

49
Q

Herpes in pregnancy

A

Can cause neonatal herpes, affecting skin/ eyes/ mouth, CNS or disseminated infection Risk greatest if new infection acquired within 6 weeks of delivery Treat with acyclovir for 5 days + daily suppressive aciclovir until delivery (if in 3rd trimester) CS if 1st episode herpes in 3rd trimester

50
Q

VZV infection in pregnancy + effect on neonate

A

If uncertain of immunity, check immunoglobulins If not immune + had significant exposure, give VZIG (effective up to 10 days after contact) Complications: pneumonia, hepatitis, encephalitis FVS in fetus: skin scarring, eye defects, hypoplasia of limbs, neuro abnormalities - due to reactivation of herpes in utero Complicates from 3 weeks to 28 weeks gestation

51
Q

Rubella in pregnancy

A

Notifiable disease Investigate If rubella confirmed + <20wks, risk of congenital rubella syndrome Human normal immunoglobulin given if termination unacceptable

52
Q

Congenital rubella syndrome S+S

A

Deafness Eyes - retinopathy, cataracts, glaucoma Congenital heart disease

53
Q

Cytomegalovirus in pregnancy

A

Most common cause of viral congenital infection Causes hearing loss + neurological disability Causes flu like symptoms in mum No treatment during pregnancy - antivirals given to neonates after birth

54
Q

CMV at birth - S+S

A

Jaundice Petechial rash Hepatosplenomegaly Microcephaly SGA Majority asymptomatic - will go on to have hearing loss

55
Q

Pathology of G6PD deficiency

A

G6PD = enzyme used in to keep NADPH levels accurate See Heinz bodies on blood film X linked Most people asymptomatic

56
Q

Drugs that precipitate haemolytic crisis in G6PD pts

A

Nitrofurantoin + quinolones Sulfonamides Dapsone Aspirin Vit K Sulfonylureas

57
Q

What is favism?

A

Acute haemolytic crisis due to broad beans eaten in G6PD

58
Q

G6PD consequences for neonates

A

Neonatal jaundice + haemolysis risk (early jaundice) No treatment

59
Q

What is exomphalos?

A

Failure of gut to return to abdo cavity

Causes defect in abdo wall, with peritoneal sac protruding

Associated with trisomy 18 (15%)

Also called omphalocele

60
Q

What is gastroschisis?

A

Intestines protrude through abdo wall

61
Q

What is caffeine used for in neonates?

A

To wean off ventilation

62
Q

What are the RF for tetralogy of fallot?

A

Rubella or alcoholism during pregnancy, poor nutrition or mother >40 y/o

63
Q

What are the classical signs + symptoms of NEC?

A

Non specific signs, bloody stools, abdo distension, bilious vomiting, apnoea

Erythema

Bradycardic, shock, resp distress

64
Q

What do you see on AXR in NEC?

A

double line due to intramural + intraluminal gas

65
Q

What is the management of NEC?

A

NBM (gut rest for 2 weeks), NGT + IVI (drainage), IV abx, TPN, O2, surgical review (most recover by conservative medical management)

66
Q

RF for NEC

A

Prematurity + low birth weight

67
Q

What is a protective factor for NEC?

A

Breast milk

68
Q

What are the complications of NEC?

A

perforation, strictures, short bowel syndrome, fistulae, abscesses, recurrence

69
Q

What does a football sign mean on AXR?

A

black around umbilicus = free air (perforation) – because x ray is taken lying flat so air floats to top

70
Q

If a neonate is unwell, what initial investigations would you do?

A

Blood gas

Bloods - sepsis screen

CXR + AXR

71
Q

When do you get the sucking reflex?

A

35 weeks

72
Q

What are signs of a stress response?

A

High glucose + high platelets

73
Q

What investigations would you run for ?pyloric stenosis?

A

Blood gas - metabolic alkalosis - low potassium + chloride

USS - long, narrow pyloric canal

74
Q

RF for pyloric stenosis

A

Male first born

6-8 weeks old

75
Q

Management of pyloric stenosis

A

NBM + fluids to correct acid base balance (takes around 24hrs to correct)

Pyloromyotomy - open = Ramstedt’s procedure or laparoscopic

Paediatrics (19 decks)

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