Fetal Medicine Flashcards
(107 cards)
1
Q
Describe Apgar score parameters?
A
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
2
Q
Apgar score components include?
A
Pulse Respiratory effort Colour Muscle tone Reflex irritability
3
Q
A score of 0 in the agpar score parameters is?
A
Absent pulse No resp effort Blue all over Flaccid No reflex irritability
4
Q
A score of 1 in the agpar score parameters is?
A
< 100 pulse
Resp effort weak & irregular
Body pink, extremities blue
Limb flexion Grimace
5
Q
A score of 2 in the agpar score parameters is?
A
> 100 pulse resp effort Strong, crying Pink baby Muscle tone - Active movement Cries on stimulation/sneezes, coughs
6
Q
Normal term babies often have hypoglycaemia especially in the first 24 hrs of life
A
true
7
Q
Normal term babies often have hypoglycaemia without sequalae due to
A
they can utilise alternate fuels like ketones and lactate
8
Q
There is no agreed definition of neonatal hypoglycaemia but a figure of < 2.6 mmol/L is used in many guidelines.
A
true
9
Q
Transient hypoglycaemia in the first hours after birth is common.
A
true
10
Q
Persistent/severe hypoglycaemia may be caused by:
A
preterm birth (< 37 weeks) maternal diabetes mellitus IUGR hypothermia neonatal sepsis inborn errors of metabolism nesidioblastosis Beckwith-Wiedemann syndrome
11
Q
Neonatal hypoglycaemia leads to hypo/hyperthermia
A
hypothermia
12
Q
Neonatal hypoglycaemia symptoms - autonomic (hypoglycaemia → changes in neural sympathetic discharge)
A
‘jitteriness’
irritable
tachypnoea
pallor
13
Q
Neonatal hypoglycaemia symptoms - neuroglycopenic
A
poor feeding/sucking weak cry drowsy hypotonia seizures
14
Q
Management of neonatal hypoglycaemia depends on
A
severity of the hypoglycaemia and if the newborn is symptomatic
15
Q
Management of neonatal hypoglycaemia - asymptomatic
A
encourage normal feeding (breast or bottle)
monitor blood glucose
16
Q
Management of neonatal hypoglycaemia - symptomatic or very low blood glucose
A
admit to the neonatal unit
intravenous infusion of 10% dextrose
17
Q
Causes of neonatal hypotonia include:
A
neonatal sepsis
Werdnig-Hoffman disease (spinal muscular atrophy type 1)
hypothyroidism
Prader-Willi
18
Q
Causes of maternal hypotonia include:
A
maternal drugs e.g. benzodiazepines
maternal myasthenia gravis
19
Q
Neonatal sepsis occurs when a serious bacterial or viral infection in the blood affects babies within the first ? days of life.
A
28
20
Q
Neonatal sepsis is categorised into early-onset and late-onset
- define
A
(EOS, within 72 hours of birth)
LOS, between 7-28 days of life
21
Q
Neonatal sepsis account for 10% of all neonatal mortality
A
true
22
Q
Black race is an independent risk factor for group B streptococcus-related sepsis
A
true
23
Q
The overall most common causes of neonatal sepsis are ?, accounting for approximately two thirds of neonatal sepsis cases
A
The overall most common causes of neonatal sepsis are group B streptococcus (GBS) and Escherichia coli, accounting for approximately two thirds of neonatal sepsis cases
24
Q
Early-onset sepsis in the UK is primarily caused by
A
Early-onset sepsis in the UK is primarily caused by GBS infection (75%)
25
Late-onset sepsis usually occurs via the transmission of pathogens from the environment post-delivery, this is normally from contacts such as the parents or healthcare workers
Infective causes are more commonly
coagulase-negative staphylococcal species such as Staphylococcus epidermidis, Gram-negative bacteria such as Pseudomonas aeruginosa, Klebsiella and Enterobacter, and fungal species
26
Risk factors of neonatal sepsis
Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
premature
low birth weight
,aternal chorioamnionitis
27
Neonatal sepsis - Patients typically present with a subacute onset of what most commonly?
```
Respiratory distress (85%)
Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea
```
28
Temperature is not usually a reliable sign as the temperature can vary from being raised, lowered or normal for neontal sepsis
Term infants are more likely to be ?
Pre-term infants are more likely to be ?
Term infants are more likely to be febrile
| Pre-term infants are more likely to be hypothermic
29
Neonatal sepsis ix wht will usually establish the diagnosis
Blood culture
30
sepsis - in neonates, parameters on full blood examination are usually not always useful for diagnosis, rather may help to exclude healthy neonates
true
31
neonatal sepsis - what will sequential assessment will help to guide management and patient progress with treatment
crp
32
metabolic acidosis is particularly concerning for neonatal sepsis, particularly a base deficit of ≥10 mmol/L
true
33
first-line regimen for suspected or confirmed neonatal sepsis
intravenous benzylpenicillin with gentamicin
34
Neonatal Sepsis - Other important management factors to consider include
Maintaining adequate oxygenation status
Maintaining normal fluid and electrolyte status
Prevention and/or management of hypoglycaemia
Prevention and/or management of metabolic acidosis
35
Jaundice in the first 24 hrs is normal
false
| always pathological
36
Causes of jaundice in the first 24 hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
37
Jaundice in the neonate from the c. 2-14 days is common (up to 40%) and usually physiological.
true
38
Jaundice in the neonate from the c. 2-14 days is common (up to 40%) and usually physiological. is most commonly seen in which babies
breastfed
39
If there are still signs of jaundice after 14 days a prolonged jaundice screen is performed, including:
```
conjugated and unconjugated bilirubin
direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
```
40
Causes of prolonged jaundice
```
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis
```
41
Newborn resuscitation - first thing to do?
1. Dry baby and maintain temperature
2. Assess tone, respiratory rate, heart rate
3. If gasping or not breathing give 5 inflation breaths
4. Reassess (chest movements)
5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
42
Peripheral cyanosis, for example of the feet and hands, is very common in the first 24 hours of life and may occur when the child is crying or unwell from any cause
true
43
Central cyanosis can be recognised clinically when the concentration of reduced haemoglobin in the blood exceeds
5g/dl
44
the hyperoxia test / nitrogen washout test is used to
may be used to differentiate cardiac from non-cardiac causes
45
Describe The nitrogen washout test
The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
46
Causes of cyanotic congenital heart disease
tetralogy of Fallot (TOF)
transposition of the great arteries (TGA)
tricuspid atresia
47
Initial management of suspected cyanotic congenital heart disease
supportive care
prostaglandin E1
used to maintain a patent ductus arteriosus in ductal-dependent congenital heart defect
48
Acrocyanosis is
peripheral cyanosis around the mouth and the extremities
49
Acrocyanosis is always pathological
false
often seen in healthy newborns
It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition
it occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.
50
Moro reflex is
Head extension causes abduction followed by adduction of the arms
Present from birth to around 3-4 months of age
51
Grasp reflex is
Flexion of fingers when object placed in palm
| Present from birth to around 4-5 months of age
52
Rooting reflex is
Assists in breastfeeding
| Present from birth to around 4 months of age
53
Stepping reflex is
Also known as walking reflex
| Present from birth to around 2 months of age
54
Sudden infant death syndrome is the commonest cause of death in the first year of life. It is most common at
3 months of age.
55
Sudden infant death syndrome major risk factors
```
putting the baby to sleep prone
parental smoking
prematurity
bed sharing
hyperthermia/ head covering
```
56
Sudden infant death syndrome incidence increases in winter
true
57
Sudden infant death syndrome Protective factors
breastfeeding
room sharing (but not bed sharing, which is a significant risk factor)
the use of dummies (pacifiers)
58
Following a cot death siblings should be screened for
potential sepsis and inborn errors of metabolism.
59
The risk of SDLD decreases with gestation
true
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks
60
risk factors for SDLD include
male sex
diabetic mothers
Caesarean section
second born of premature twins
61
SDLD Chest x-ray characteristically shows
'ground-glass' appearance with an indistinct heart border
62
SDLD mx
prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube
63
Infantile colic describes a relatively common and benign set of symptoms seen in young infants. It typically occurs in infants aged?
less than 3 months old
64
Infantile colic sx
characterised by bouts of excessive crying and pulling-up of the legs, often worse in the evening.
65
Infantile colic occurs in up to 20% of infants. The cause of infantile colic is unknown.
true
66
Necrotising enterocolitis is one of the leading causes of death among premature infants.
true
67
Necrotising enterocolitis sx
feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.
68
Abdominal x-rays are useful when diagnosing necrotising enterocolitis, as they can show:
dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
portal venous gas
pneumoperitoneum resulting from perforation
air both inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)
69
Meconium aspiration syndrome refers to
respiratory distress in the newborn as a result of meconium in the trachea
70
Meconium aspiration syndrome occurs when?
in the immediate neonatal period
71
Meconium aspiration syndrome is more common in
post-term deliveries - babies born after 42 weeks
maternal hypertension, pre-eclampsia, chorioamnionitis, smoking or substance abuse.
72
commonest cause of respiratory distress in the newborn period.
Transient tachypnoea of the newborn
73
Transient tachypnoea of the newborn is caused by
delayed resorption of fluid in the lungs
74
Transient tachypnoea of the newborn is more common following?>
It is more common following Caesarean sections, possibly due to the lung fluid not being 'squeezed out' during the passage through the birth canal
75
Transient tachypnoea of the newborn CXR
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure
76
Transient tachypnoea of the newborn mx
Supplementary oxygen may be required to maintain oxygen saturations. Transient tachypnoea of the newborn usually settles within 1-2 days
77
Microcephaly may be defined as
occipital-frontal circumference < 2nd centile
78
Microcephaly causes
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
79
Cleft lip and palate commonest variants are:
isolated cleft lip (15%)
isolated cleft palate (40%)
combined cleft lip and palate (45%)
80
Cleft lip and palate pathophysiology?
polygenic inheritance
maternal antiepileptic use increases risk
cleft lip results from failure of the fronto-nasal and maxillary processes to fuse
cleft palate results from failure of the palatine processes and the nasal septum to fuse
81
Cleft lip and palate problems?
feeding: orthodontic devices may be helpful
speech: with speech therapy 75% of children develop normal speech
increased risk of otitis media for cleft palate babies
82
Cleft lip and palate mx
cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
cleft palates are typically repaired between 6-12 months of age
83
on the Y chromosome there is a sex-determining gene (SRY gene) which causes differentiation of the gonad into a testis
```
true
if absent (i.e. in a female) then the gonads differentiate to become ovaries
```
84
Ambiguous genitalia Most common cause in newborns is
congenital adrenal hyperplasia
85
Neonatal blood spot screening (previously called the Guthrie test or 'heel-prick test') is performed at?days of life
Neonatal blood spot screening (previously called the Guthrie test or 'heel-prick test') is performed at 5-9 days of life
86
Neonatal blood spot screening consists of?
```
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
```
87
most common congenital infection in the UK.
Cytomegalovirus
88
The major congenital infections encountered in examinations are
rubella, toxoplasmosis and cytomegalovirus
89
Features of Rubella infection?
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma
90
Features of Toxoplasmosis infection?
Cerebral calcification
Chorioretinitis
Hydrocephalus
91
Features of Cytomegalovirus infection?
Growth retardation
| Purpuric skin lesions
92
Fetal alcohol syndrome features
```
short palpebral fissure
thin vermillion border/hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
growth retardation
epicanthic folds
cardiac malformations
```
93
Newborn babies are relatively deficient in
vitamin K
94
Newborn babies are relatively deficient in vitamin K. This may result in
impaired production of clotting factors which in turn can lead to haemorrhagic disease of the newborn . Bleeding may range from minor brushing to intracranial haemorrhages
95
haemorrhagic disease of the newborn risk factors?
Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk
96
all newborns in the UK are offered vitamin K, either intramuscularly or orally
true
97
Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents when?
4 to 8 months of life
98
Infantile spasms features
characteristic 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap
99
Infantile spasms ix
the EEG shows hypsarrhythmia in two-thirds of infants
| CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
100
Infantile spasms mx
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used
101
Shaken baby syndrome
| This syndrome encompasses the triad of
retinal haemorrhages, subdural haematoma, and encephalopathy.
102
Caput succedaneum describes
oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery.
103
Caput succedaneum sx
soft, puffy swelling due to localised oedema
| crosses suture lines
104
Caput succedaneum mx
No treatment is needed.
105
A cephalohaematoma is seen as
a swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region
106
Cephalohaematoma Jaundice may develop as a complication.
true
107
A cephalohaematoma up to 3 months to resolve.
true
