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Neonates Flashcards

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1
Q

What are causes of jaundice in the 1st 24hrs?

A

Haemolytic

TORCH - congenital infection

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2
Q

What are causes of jaundice from the 2nd day-3rd wk?

A 
Physiological (gone after 1st wk)
Breast milk
Sepsis
Polycythemia
Cephalhaematoma
Crigler-Najjar syndrome
Haemolytic disorders
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3
Q

What are causes of jaundice after the 3rd wk?

A

Breast milk
Hypothyroidism
Pyloric stenosis
Cholestasis

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4
Q

What is the treatment for jaundice?

A 
Treat underlying cause
Hydrate
Phototherapy
Exchange transfusion
Immunoglobin
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5
Q

What % of normal term neonates get erythema toxicum?

A

30-70%

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6
Q

What is erythema toxicum is?

A

Maculo-papular rash

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7
Q

What happens usually to erythema toxicum?

A

Fade by end 1st wk

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8
Q

What are Mongolian blue spots?

A

Blue-grey pigmentations

Accumulation of melanocytes

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9
Q

When do Mongolian blue spots usually present?

A

Lower back and buttocks

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10
Q

What happens to Mongolian blue spots?

A

Normally disappears three to five years after birth

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11
Q

What are stork marks?

A

Naevus simplex

Light colour capillary dilatation

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12
Q

Where are stork marks normally found?

A

Back of neck

Midline of face

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13
Q

What happens to stork marks?

A

Disappear within 1st 2yrs

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14
Q

What are examples of capillary vascular malformations?

A

Stork marks

Port wine stain

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15
Q

What is port wine stain?

A

Naevus flammeus
Present at birth, flat or slightly raised
Caused by dilated, mature capillaries in the superficial dermis

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16
Q

Do port wine stains go away?

A

Do not regress

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17
Q

What is an example of a capillary haemangioma?

A

Strawberry naevus

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18
Q

What is strawberry naevus?

A

Cluster of dilated capillaries which appears within first month after birth
Raised and bright red, with discrete edges, any part of body

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19
Q

What happens to strawberry naevus?

A

Usually regresss after one yr

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20
Q

What babies are at risk of limited glucose supply?

A

Premature babies

Perinatal stress

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21
Q

What babies are at risk of hyperinsulinism?

A

Infants of diabetic mothers

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22
Q

What babies are at risk of increased glucose use?

A

Hypothermia

Sepsis

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23
Q

What is the definition of hypoglycaemia in babies?

A

<2.0mmol/l blood sugar

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24
Q

When can bedside testing for hypoglycaemia be inaccurate?

A

At low/high levels
When poor perfusion
When polycythaemia

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25
What are symptoms of hypoglycaemia in babies?
``` Jitteriness Temperature instability Lethargy Hypotonia Apnoea, irregular respirations Poor suck/feeding Vomiting High pitched or weak cry Seizures Asymptomatic ```
26
What ways can babies become hypothermic?
Evaporation (wet skin) Conduction (cold towels) Convection (open windows) Radiation (cold objects nearby)
27
What is the management of babies with hypothermia?
``` Dry quickly Remove wet linens Use warm blankets Provide radiant warmer heat Use heated/humidified oxygen ```
28
What is tongue ties?
Short +/- thickened frenulum | Attached anteriorly -> base of tongue
29
When should you do a frenotomy for tongue tied ness?
Restriction of tongue protrusion beyond alveolar margins AND feeding affected
30
What types of GI problems can babies have?
``` Vomiting Posseting Mucous vomits Gastro-oesphageal reflux Cows milk protein intolerance Bilious vomiting Failure to pass meconium Bloody stools Bloody vomit ```
31
How can you assess respiratory function in babies?
RR Increased effort: grunting, retractions, nasal flaring Colour O2 sats
32
What areas should you assess for retractions?
Substernal Subcostal Intercostal Suprasternal
33
What % of cleft lip also have cleft palate?
70%
34
What are the types of cleft lip?
Complete - small gap in lip | Incomplete - continue into nose
35
Why does cleft lip occur embryonically?
Maxillary and medial nasal processes fail to merge | Usually 5wks gestation
36
What can cleft lip/palate issues be?
Feedings issues Airway problems Associated anomalies: hearing/heart/trisomies
37
What ophthalmological defects should you check for in babies?
Red reflexes Cataracts Retinoblastoma
38
What can spinal dimples suggest?
Spina bifida +/- tethered cord
39
What is a cephalohaematoma?
Localised swelling over one or both sides of head, becomes maximal in size by 3rd/4th day of life Soft, non translucent swelling
40
What is the treatment for cephalohaematomas?
No treatment required, usually resolution in 3-4wks
41
What happens if cephalohaematoma very large?
Increased haemolysis can occur = increased/prolonged neonatal jaundice
42
What are talipes?
Medial (varus) or lateral (valgus) deviation of foot
43
What is the treatment for Medial (varus) or lateral (valgus) deviation of foot?
Often positional, so just physio
44
What is the treatment for fixed talipes?
Strapping, casting or possibly surgery
45
What is a complication of talipes?
Developmental dysplasia of the hips
46
What are the tests for developmental dysplasia of the hip (DDH)?
Barlow test | Ortolani test
47
What are the treatment options for DDH?
Pavlik harness | Surgical reduction
48
What are the features of trisomy 21/DS?
``` Dysmorphism - low set ears, downward slanting palpebral tissues, epicanthic folds, single palmar creases, wide sandal gap Hypotonia Cardiac defects Learning problems Haematological problems Thyroid problems ```
49
What are the symptoms of sepsis in neonates?
``` Baby pyrexia/hypothermia Poor feeding Lethargy or irritable Early jaundice Tachypnoea Hypo or hyperglycaemia Floppy ```
50
What are risk factors for sepsis in neonates?
PROM (premature rupture of membranes) Maternal pyrexia Maternal Group B Strep carriage
51
What is the management of presumed sepsis in neonates?
``` Admit NNU Partial septic screen Consider CXR, LP IV penicillin and gentamicin - 1st line IV vancomycin and gentamicin - 2nd line Add metronidazole if surgical concerns Fluid management Treat acidosis Monitor vital signs Support resp/CVS systems ```
52
What are the commonest causes of neonatal sepsis?
``` Group B strep E.coli Listeria Coag-neg staph Haemophilus influenzae ```
53
What are the complications of GBS sepsis?
``` Meningitis DIC Pneumonia Resp collapse Hypotension and shock ```
54
What are the TORCH infections in neonates?
Toxoplasmosis Rubella CMV Herpes
55
What are causes of respiratory distress in neonates?
Sepsis TTN - transient tachypnoea of the newborn Meconium aspiration
56
What are the symptoms of TTN (transient tachypnoea of the newborn)?
Grunting, tachypnoea, O2 requirement, normal gases
57
What causes TTN (transient tachypnoea of the newborn)?
Delay in clearance of foetal lung fluids
58
When does TTN present?
First few hours of life
59
What are the risk factors for meconium aspiration?
Post dates Maternal diabetes Hypertension Difficult labour
60
What are the symptoms of meconium aspiration?
``` Cyanosis Increased work of breathing Grunting Apnoea Floppiness ```
61
What investigations should be done for meconium aspiration?
Blood gas Septic screen CXR
62
What is the treatment for meconium aspiration?
``` Suction below cords Airway support Fluids Antibiotics IV Surfactant NO or ECMO ```
63
What are investigations for a 'blue baby'?
``` Exam and history Sepsis screen Blood gas and glucose CXR Pulse oximetry ECG ECHO Hyperoxia test ```
64
What are differentials a 'blue baby'?
``` TGA ToF TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia ```
65
What is the treatment for hypoglycaemia?
``` Monitor blood glucose IV 10% glucose Increase fluids Increase glucose conc Glucagon Hydrocortisone ```
66
What is birth asphyxia?
Lack of O2 at or around birth leading to multi organ dysfunction
67
What are causes of birth asphyxia?
``` Placental problems Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia ```
68
What are the 2 stages of birth asphyxia?
1. Within minutes without O2, cell damage occurs with lack of blood flow and O2 2. Reperfusion injury, can last days/wks, toxins released from damaged cells
69
What are causes of failure to pass stool?
``` Constipation Large bowel atresia Imperforate anus +/- fistula Hirshsprungs disease Meconium ileum (think CF) ```
70
What are abdominal wall defects?
Diaphragmatic hernia
71
Which side does a diaphragmatic hernia usually affect?
Left

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