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Flashcards in Neonatal Deck (22):
1

What are the causes of hypoxic-ischaemic encephalopathy?

Failure of gas exchange across placenta (prolonged uterine contractions, placental abruption, ruptured uterus)

Interruption of umbilical blood flow (cord compression due to shoulder dystocia or cord prolapse)

Inadequate maternal perfusion (hypotension / hypertension)

Compromised foetus (IUGR, anaemia)

Failure of cardiorespiratory adaptation at birth (failure to breath)

2

What are the features of hypoxic-ischaemia encephalopathy?

Irritable child, abnormal response to stimulation, abnormal neurological signs, impaired feeding, seizures, multi-organ failure.

3

What are the causes of Erb's palsy?

Shoulder dystocia or breech delivery.

4

What is the prognosis for birth nerve palsies?

Most are transientt. Refer to orthopaedics / plastics if not resolved by 2-3 months.

5

What fractures are common in delivery?

Clavicle (shoulder dystocia)
Humerus (shoulder dystocia)
Femur (breech)

6

What is respiratory distress syndrome (RDS)?

Deficiency in surfactant leading to alveolar collapse and inadequate gas exchange.

7

How is RDS prevented?

Administration of steroids to mother antenatally if preterm delivery is anticipated.

8

What are the features of RDS?

Within 4 hours of delivery: tachypnoea (>60), laboured breathing, grunting, cyanosis.

9

What is the management of RDS?

Instillation of surfactant, titrated O2 (aim sats 91-95%), CPAP, intubation and ventilation.

10

How are apnoeas and bradycardias managed?

Caffeine until 32 weeks. May require CPAP or intubation and ventilation.

11

How is a PDA closed in preterm neonates?

Indomethacin / ibuprofen. If this fails, surgical ligation.

12

How are preterm neonates fed?

Before 35-36 weeks, neonates lack suckle reflex. Therefore will need breast milk fed through NG/OG line. Breast milk is preferable to formula, which carries increased risk of NEC.

13

What is definition of bronchopulmonary dysplasia?

Oxygen requirement post-36 weeks corrected age. This gives increased risk of going on to develop bronchiolitis and other LRTIs.

14

What is the risk of neonatal jaundice?

Development of kernicterus (encephalopathy due to deposition of unconjugated bilirubin in the basal ganglai). This is characterised by poor feeding, lethargy, irritability and increased muscle tone.

15

What is the likely cause of jaundice within 24 hours of birth?

Haemolysis (Rhesus, ABO, G6PD, spherocytosis)

Congenital infection

16

What is the likely cause of jaundice from 2 days to 2 weeks?

Physiological jaundice
Breast milk jaundice
Infection
Haemolytic

17

What is the likely cause of jaundice >2 weeks?

Unconjugated: physiological / breat milk, infection, hypothyroid, haemolytic.

Conjugated: bile duct obstruction, neonatal hepatitis

18

What is the management of jaundice in the neonate?

Phototherapy (converts unconjugated bilirubin into harmless water-soluble pigment to be excreted in urine)

Immunoglobulin: for Rhesus and ABO incompatability.

Exchange transfusion: replacement of neonate's blood with donor blood for intractable cases.

19

What are the components of the Guthrie test?

CF (immunoreactive trypsinogen)
Congenital hypothyroidism
Sickle cell
Metabolic disorders (MCADD, MSUD, PKU, IVA, GA1, HCU)

20

When is the Guthrie test performed?

Days 5-8.

21

What makes TORCH syndrome?

Toxoplasmosis
Other agents (syphillis, parvovirus, VZV, zika)
Rubella
CMV
HSV

22

What are the consequences of congenital infection?

Toxoplasmosis: 10% develop retinopathy, cerebral calification, hydrocephalus

Rubella: congenital heart disease, cataracts, impaired hearing

CMV: 5% hepatosplenomegaly and petechiae, neurodevelopmental disorders, hearing loss from birth. 5% develop later

HZV: scarring of skin, ocular and neurological damage. Mortality up to 30%. Most important if infection around delivery +/- 5 days.

Other: rashes, pneumonitis, bone abnormalities, anaemia, neutropenia