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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

When does the cardiovascular system begin to develop?

A

End of the third week

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2
Q

When does the heart begin to beat?

A

Beginning of the fourth week

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3
Q

When is the critical period of heart development?

A

Day 20-50 after fetilisation

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4
Q

Where does oxygenated blood originate from in foetal circulation?

A

Umbilical vein

Passes through Ductus Venosus

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5
Q

What is ductus venosus?

A

Foetal blood vessel connecting umbilical vein to IVC

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6
Q

What type of blood is carried by ductus venosus

A

Mostly oxygenated

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7
Q

How does blood get to the foetal aorta from the right atrium?

A

Passes through foramen ovale (to LA->LV->Aorta)

Passes from Right Ventricle (to PA -> through Patent Ductus Arteriosus->Aorta)

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8
Q

What is the saturation of foetal blood?

A

60-70%

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9
Q

What is the function of ductus arteriosus?

A
  • Protect lungs against circulatory overload
  • Allows right ventricle to strengthen
  • Carries low oxygen saturated blood
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10
Q

What does the ductus arteriosus go on to become?

A

A ligament

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11
Q

What does the ductus venosus go on to become?

A

A ligament

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12
Q

What does the umbilical vein go on to become?

A

A ligament

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13
Q

What do the umbilical arteries go on to become?

A

Ligaments

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14
Q

What happens to foramen ovale after birth?

A

Closes and leaves depression

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15
Q

What is normal newborn respiratory rate?

A

30-60 breathes per minute

Periodical breathing

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16
Q

What is normal newborn heart rate?

A

120-160 b/min

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17
Q

What defines tachycardia in a newborn?

A

> 160 b/min

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18
Q

What defines bradycardia in a newborn?

A

<100 b/min

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19
Q

What factors help to regulate temperature in newborns?

A

Brown fat - lipolysis triggered by cold -> heat production

In utero - maternal thermoregulation

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20
Q

What are some non-invasive methods of measuring newborn respiratory function?

A
  • Blood gas determination

- Trans-cutaneous pCO2/O2 measurement

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21
Q

What are some invasive methods of measuring newborn respiratory function?

A
  • Capnography
  • (Tidal volume -> Minute ventilation)
  • Flow-volume loop
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22
Q

On what day does physiological jaundice present?

A

DOL 2-3

Disappears ~7-10 DOL in term, <21 in premature

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23
Q

What irreversible change in the brain can be caused by high levels of bilirubin?

A

Kernicterus

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24
Q

What treatments are available for newborn jaundice?

A

Exchange transfusion

Phototherapy

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25
Q

What are fluid losses caused by in newborns?

A
  • Shift of interstitial fluid

- Diuresis (But normal not to pass urine for first 24hrs)

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26
Q

What are fluid losses caused by in premature infants?

A
  • Increased loss through kidney (Slower GFR, Reduced Na reabsorption,
  • Increased Insensible Water Loss
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27
Q

What causes physiological anaemia of newborn?

A

Reduced RBC production compared to in uterus

Increase in EPO between wk 10-20

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28
Q

What causes anaemia of prematurity?

A
  • Reduced erythropoeises
  • Infection
  • Blood letting
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29
Q

What is classified as small for gestational age?

A

-Born under 10th weight centile

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30
Q

What is classified as severe small for gestational age?

A

-Born under 0.4th weight centile

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31
Q

What are some maternal causes for small for gestational age?

A
  • Maternal smoking

- Maternal Pre-Eclamptic Toxemia (PET)

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32
Q

What are some foetal causes for small for gestational age?

A
  • Choromosomal abnormalities (Trisomy 18)

- Foetal Infection (eg CMV)

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33
Q

What are some placental causes for small for gestational age?

A

-Placental abruption

34
Q

Why can twin pregnancies result in small for gestational age babies?

A

-Donated circulation from one baby to another

35
Q

What are some common problems associated with small for dates?

A
  • Perinatal Hypoxia
  • Hypoglycaemia
  • Hypothermia
  • Polycythaemia
  • Thrombocytopenia
  • Hypoglycaemia
  • GI problems
  • RDS, Infection
36
Q

What are some long term problems associated with small for dates?

A
  • Hypertension
  • Reduced growth
  • Obesity
  • Ischemic heart disease
37
Q

What is classifies as premature?

A

<37 weeks

38
Q

What is classified as extremely premature?

A

<28 weeks

39
Q

What is classified as low birth weight?

A

<2.5kg

Very low - <1.5, Extremely - <1

40
Q

What is used for prevention of respiratory distress syndrome (RDS)?

A

Antenatal steroids

41
Q

What can be used in treatment of broncho-pulmonary dysplasia (BPD/CLD)?

A
  • Patience
  • Nutrition and growth
  • Steroids (Dex)
42
Q

What can be used in treatment of broncho-pulmonary dysplasia?

A

Patience
Nutrition and growth
Steroids

43
Q

What treatment may be used for minor breathing problems (Apnoea, irregular breathing, desaturations)?

A
  • Caffeine

- NCPAP

44
Q

What treatment may be used for Intraventricular haemorrhage?

A

Prevention - AN steroids
Treatment - Sympthomatic
Drainage?

45
Q

What can be the result of patent ductus arteriosus (PDA)?

A
  • Worsening respiratory symptoms (Over-perfusion of lungs>Oedema)
  • Systemic ischaemia (eg GI ischaemia)
  • Retention of fluids
  • GI problems
46
Q

What treatments are available for Necrotising Entero-Colitis (NEC)?

A
  • Surgical intervention often needed

- Conservative management sometimes possible (Antibx + Parenteral nutrition)

47
Q

What are the outcomes of extreme prematurity?

A

1/3 dies
1/3 normal life/mild disability
1/3 moderate/severe disability

48
Q

What treatments are used in Post-Haemorrhagic Hydrocephalus?

A

Shunting (Peritoneal)

49
Q

Roughly under what birth weight would be considered small for gestational age at term?

A

2.5kg

50
Q

What is used in early treatment of respiratory distress syndrome?

A

Surfactant

Early extubation
Non-invasive support
Minimal ventilation

51
Q

What features may be seen in bronchopulmonary dysplasia (BPD/CLD)?

A
  • Overstretch by volu-baro-trauma
  • Atelectasis
  • Infection via ETT
  • O2 toxicity
  • Inflammatory changes
  • Tissue repair - scarring
52
Q

-What are the reasons that cause physiological jaundice in newborns?

A

-Increased red cell breakdown
Plus
-Immaturity of hepatic enzymes
-> Unconjugated hyperbilirubinaemia

53
Q

When should jaundice be considered always pathological?

A

If <24 hours

54
Q

What may plethora be potentially caused by?

A

Polycythaemia

55
Q

What is erythema toxicum?

A

A maculo-papular rash common in normal term neonates.

Fades by end of first week

56
Q

What are mongolian blue spots?

A

Blue-grey pigmentations on lower back + buttocks - caused by accumulation of melanocytes

57
Q

What is a naevus simplex?

A

Flat pink lesion caused by capillary dilatation. Commonly at forehead and back of neck - gradually fades

58
Q

What is a port wine stain (naevus flammeus)?

A

Flat/slightly raised wine-coloured lesion caused by mature dilated capillaries in superficial dermis. Do not regress.

(Associated with Sturge Weber + Klippel-Trenaunay)

59
Q

What is a strawberry naevus?

A

Raised and bright red lesion with discrete lesions - caused by a cluster of dilated capillaries.
Usually regresses after 1 yr.

60
Q

What are the three major considerations of the ‘energy traingle’?

A

Hypothermia
Hypoglycaemia
Hypoxia/anoxia

61
Q

What are some risk factors of hypoglycaemia in neonates?

A 
Limited glucose supply
-Premature babies
-Perinatal stress
Hyperinsulinism
-Infants of diabetic mothers
Increased glucose use
-Hypothermia
-Sepsis
62
Q

What is considered hypoglycaemia in neonates?

A

Blood sugar <2.0 mmol/l

63
Q

List some symptoms of hypoglycaemia in neonates?

A
  • Jitteriness
  • Temperature instability
  • Lethargy
  • Hypotonia
  • Apnoea, irregular respirations
  • Poor suck / feeding
  • Vomiting
  • High pitched or weak cry
  • Seizures
  • Asymptomatic
64
Q

How should cold stress be treated?

A
  • Dry quickly
  • Remove wet linens
  • Use warm towels/blankets
  • Provide radiant warmer heat
  • Use heated/humidified oxygen
65
Q

What areas of a baby can be used to assess for respiratory retractions?

A
  • Substernal
  • Subcostal
  • Intercostal
  • Suprasternal
66
Q

What issues may be caused by cleft lip/palate issues?

A

Feeding issues

  • Special bottles and teats
  • Can still attempt breast feeding

Airway problems

Associated anomalies

  • Need hearing screen
  • Need cardiac echo
  • Remember trisomies
67
Q

What is the treatment of cephalohaematoma?

A

No treatment requires - resolution in 3-4 wks

68
Q

List some signs of sepsis in neonates?

A
  • Baby pyrexia or hypothermia
  • Poor feeding
  • Lethargy or irritable
  • Early jaundice
  • Tachypnoea
  • Hypo or hyperglycaemia
  • Floppy
  • Asymptomatic
69
Q

What are some neonatal risk factors for sepsis?

A
  • PROM (Premature rupture of membranes)
  • Maternal pyrexia
  • Maternal GBS carriage
70
Q

What is the management of presumed sepsis in a neonate?

A

-Admit
-Partial septic screen (FBC, CRP, blood cultures) and blood gas
-Consider CXR, LP
-IV penicillin and gentamicin 1st line
2nd line - vanc + gent
Add metronidazole if surgical/abdo concerns
-Fluid management

71
Q

What are the commonest organisms that cause neonatal sepsis?

A
  • Group B strep
  • E.coli
  • Listeria
  • Coag-neg staphylococcii
  • Haem. influenzae
72
Q

What complications may arise from GBS sepsis?

A

-Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock

73
Q

List some common causes for neonatal respiratory distress?

A
  • Sepsis
  • TTN (Transient tachypnoea of newborn)
  • Meconium aspiration
74
Q

What investigations should be used for ‘the blue baby’?

A
  • Examination and history
  • Sepsis screen
  • Blood gas and blood glucose
  • CXR
  • Pulse oximetry
  • ECG
  • Echo
75
Q

List some differential cardiac diagnoses for ‘the blue baby’?

A
  • TGA
  • Tetralogy of Fallots
  • TAPVD
  • Hypoplastic left heart syndrome
  • Tricuspid atresia
  • Truncus arteriosus
  • Pulmonary atresia
76
Q

What treatment should be used for hypoglycaemia in neonates in NNU?

A
  • May manage with enteral feeds
  • Monitor blood glucose
  • Start IV 10% Glucose
  • Increase fluids
  • Increase glucose concentration
  • Glucagon
  • Hydrocortisone
77
Q

What are some causes of birth asphyxia?

A
  • Placental problem
  • Long, difficult delivery
  • Umbilical cord prolapse
  • Infection
  • Neonatal airway problem
  • Neonatal anaemia
78
Q

What are some causes of failure to pass stool in neonates?

A
  • Constipation
  • Large bowel atresia
  • Imperforate anus +/- fistula
  • Hirshsprung’s disease
  • Meconium ileus (Think CF)
79
Q

What treatments may be used for diaphragmatic hernia?

A
  • Intubation at birth
  • Respiratory support
  • Surgery
  • ECMO
80
Q

What treatments may be used for Neonatal Abstinence Syndrome?

A

Monitoring - Finnegan Scoring
-Urine toxicology

Treatment

  • Comfort
  • Morphine
  • Phenobarbitone

Paediatrics (18 decks)

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