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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What is cleft lip/palate the result of?

A

failure of fusion of maxillary and premaxillary processes

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2
Q

What are the causes of cleft lip/palate?

A

genetics
benzodiazepines
anti epileptics
rubella

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3
Q

What genetic disorders is cleft lip/palate found in ?

A 
trisomy 18 (Edwards)
trisomy 13 (Patau)
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4
Q

How can cleft lip/palate be prevented?

A

no smoking during pregnancy
folic acid 5mg/day
avoid AEDs

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5
Q

how is cleft palate managed before surgical repair?

A

special teats and feeding devices

dental prosthesis

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6
Q

When is cleft lip usually repaired?

A

1st week of life (cosmetic reasons)

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7
Q

When is cleft palate usually repaired?

A

several months of age

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8
Q

What are the complications of cleft lip/palate? what rx for this should be avoided and why

A

secretory otitis media

adenoidectomy as gap between normal palate and nasopharynx will exacerbate feeding problems and speech

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9
Q

What is meconium

A

faecal material that accumulates in the faetal colon

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10
Q

What is meconium aspiration syndrome?

A

resp distress in the newborn due to the presence of meconium in the trachea

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11
Q

What increases the risk of meconium aspiration syndrome?

A 
post-term delivery (42w)
Hx of maternal HTN
Pre-eclampsia
chorioamnionitis
smoking 
substance abuse
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12
Q

what does meconium in the lung result in

A

mechanical obstruction
chemical pneumonitis
predisposition to infection

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13
Q

What are the complications of meconium aspiration syndrome?

A

may develop persistent pulmonary HTN of the newborn making it difficult to achieve adequate oxygenation despite high pressure ventilation

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14
Q

what is the rx of meconium aspiration?

A

artificial ventilation

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15
Q

what babies are more prone to getting necrotising enterocolitis and when?

A

preterm infants in the first few weeks of life

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16
Q

what is necrotising entercolitis?

A

inflammatory bowel necrosis

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17
Q

What are the features of necrotising enterocolitis?

A

→ Infant stops tolerating feeds
→ Milk is aspirated from the stomach
→ May be bile stained vomiting
→ Abdomen becomes distended and the stool sometimes contains fresh blood

18
Q

What is a serious complication of necrotising enterocolitis?how is this detected?

A

perforation

detected on XR or transillumination of the bowel

19
Q

What are ix for necrotising enterocolitis? what do they show?

A

XR:
distended loops of bowel
thickening of bowel wall
intramural gas (pneumatosis intestinalis)

20
Q

What is rx for necrotising enterocolitis

A
  1. stop oral feeding (except probiotics)
  2. abs e.g. cefotaxime + vancomycin
  3. surgery for bowel perforation
21
Q

When is jaundice normal in the neonate?

A

after 24hr to 14 days in term babies and 21 in poems (after this it becomes prolonged jaundice)

22
Q

When is jaundice pathological in the neonate?

A

in 1st 24hrs of birth

23
Q

What are the causes of jaundice in the first 24hrs of life

A

rhesus -ve disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

24
Q

What are the causes of physiological neonatal jaundice?

A
  1. raised bilirubin due to short rbc lifespan
  2. reduced bilirubin conjugation due to hepatic immaturity
  3. absence of gut flora impeding elimination of bile pigment
  4. exclusive breastfeeding
25
Q

What are the causes or prolonged jaundicE?

A 
breastfeeding 
sepsis (UTI, TORCH)
hypothyroidism
CF
biliary atresia (conjugated bilirubin, bile stools)
26
Q

what is clinical jaundice classed as?

A

> 80µmol/L plasma bilirubin

27
Q

What is a serious complication of neonatal jaundice?

A

KERNICTERUS as unconjugated bilirubin can be deposited in the brain (particularly basal ganglia) and cause it

28
Q

How is the potentially serious complication of neonatal jaundice prevented?

A

measuring transcutaneous bilirubin levels in babies discharged early

29
Q

What is kernicterus? what are the features?

A 
acute bilirubin encephalopathy 
lethargy 
poor feeding
hypertonicity
opisthotonus (form of spasm in which head, neck and spine are arched backwards)
shrill cry
30
Q

What increases the risk of developing kernicterus?

A

bilirubin levels >360µmol/L

31
Q

What are the long term consequences of kernicterus?

A

athetoid movements (slow, twisting, writhing movements)
deafness
reduced IQ

32
Q

How is kernicterus prevented?

A

phototherapy

exchange transfusion

33
Q

What are the investigations for jaundice presenting in the first 24 hrs of life?

A

FBC
blood film
blood groups (rare group incompatibility)
Coombs test

34
Q

What is the direct Coombs test used for? What does a positive result mean/

A

confirming haemolytic anaemia
detects abs against rbc’s
positive means that there are abs detected that attack the persons rbcs

35
Q

What is the indirect Coombs test used for? What does a positive result mean?

A 
Used in prenatal testing or prior to blood transfusion 
means either:
baby has haemolytic disease 
or donors blood isn't compatible 
it detects abs against foreign rbcs
36
Q

what are the investigations for prolonged jaundice?

A 
conjugated and unconjugated bilirubin
DAT coombs
TFTs
FBC and blood film
urine for MC&S and reducing sugars (microbial culture and sensitivity)
U&Es and LFTs
37
Q

When should babies be admitted to hospital w jaundice?

A 
features of bilirubin encephalopathy 
jaundice appearing <24hrs of age or >7days
unwell 
gestation <35w
prolonged jaundice
poor feeding 
pale stools and dark urine
38
Q

When is no treatment required for neonatal jaundice?

A

well neonates
physiological jaundice
breastmilk jaundice
bilirubin below rx threshold

39
Q

How does phototherapy work?

A

uses light energy to convert bilirubin to soluble products that can be excreted w/o conjugation

40
Q

What are the SE of phototherapy?

A 
reduced temp
eye damage - cover them
diarrhoea
separation from mother
fluid loss

Paediatrics (56 decks)

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