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Neonatal Flashcards

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1
Q

What are some causes of Hypoxic-ischaemic encephalopathy?

A

excessive/prolonged uterine contractions

placental abruption

cord compression (shoulder dystocia, cord prolapse)

maternal hypotension or hypertension

IUGR

failure to breath

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2
Q

How does mild hypoxic-ischaemic encephalopathy present?

A

irritable, response, hyperventilation, impaired feeding

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3
Q

How does moderate hypoxic-ischaemic encephalopathy present?

A

marked abnormalities of tone and movement, can’t feed and may have seizures

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4
Q

How does severe hypoxic-ischaemic encephalopathy present?

A

no normal spont movements or response to pain

tone in the limbs may flunctuate between hypo and hypertonia

seizures prolonged

multi-organ failure

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5
Q

How would you manage an infant with hypoxic-ischaemic encephalopathy?

A

respiratory support

EEG

anticonvulsants

fluid restriction

treat hypotension

treat hypoglycaemia and hypocalcaemia

*mild hypothermia (wrapping infant in cooling blanket) can reduce brain damage if started with 6 hrs of brth

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6
Q

What are examples of some soft tissue injuries?

A

Caput Succedeneum

Cephalhaematoma

Chignon

Subaponeurotic haemorrhage - severe blood loss, hypovolaemic shock and coagulopathy

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7
Q

How does Erb palsy present? What nerve is damaged?

A

arm lies straight and limp

hands pronated

fingers flexed

Brachial nerve

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8
Q

How would a facial nerve palsy present?

A

unilateral, facial weakness on crying but eye remains open

may need methylcellulose drops

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9
Q

What causes respiratory distress syndrome?

A

deficiency of surfactant leading to widespread alveolar collapse and inadequate gas exchange

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10
Q

What are risk factors for respiratory distress syndrome?

A

male sex
diabetic mothers
Caesarean section
second born of premature twins

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11
Q

Clinical features of respiratory distress syndrome?

A

tachypnoea

laboured breathing with recession

nasal flaring

expiratory grunting

cyanosis

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12
Q

How would you manage respiratory distress syndrome?

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation

oxygen

assisted ventilation

exogenous surfactant given via endotracheal tube

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13
Q

What are some common conditions seen in preterm infants?

A

Pneumothorax

Patent ductus arteriosus

Haemorrhage

Necrotising Enterocolitis

Retinopathy of prematurity

Cerebral Palsy

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14
Q

Where is a common sign that brain haemorrhages occur in pre term infants?

A

germinal matrix above the caudate nucleus

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15
Q

What puts infants at higher risk of necrotising enterocolitis?

A

Drinking cow’s milk formula rather than only breast milk

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16
Q

How does necrotising enterocolitis present?

A

intolerant to feeds

milk aspirated - vomiting which may be bile-stained

abdomen becomes distended

stool sometimes has fresh blood

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17
Q

What investigation would you carry out in suspected necrotising enterocolitis? What would you see?

A

X-ray

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)

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18
Q

What is treatment for necrotising enterocolitis?

A

stop oral feeding

broad-spec abx

parenteral nutrition needed

surgery for perforation

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19
Q

How do you define bronchopulmonary dysplasia? What causes it?

A

infants who require oxygen post-gestational age of 36 weeks

pressure and volume trauma from artificial ventilation, oxygen toxicity and infection

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20
Q

What would you see on x-ray of someone with bronchopulmonary dysplasia?

A

widespread areas of opacification

fibrosis

lung collapse

cystic changes

overdistension of lungs

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21
Q

How do you treat bronchopulmonary dysplasia?

A

prolonged artificial ventilation

CPAP

short course corticosteroid

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22
Q

What should given when discharging a premature baby?

A

iron as supplementation or in preterm formula for 6 months

multivitamins

prophylaxis against RSV if bronchopulm dysplasia (pavlizumab)

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23
Q

What problems do prem infants tend to develop later in life?

A

cerebral palsy

trouble with fine motor skills

concentration

behaviour problems

abstract reasoning

multi-tasking

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24
Q

What is a common non-pathological cause of neonatal jaundice?

A

marked physiological release of haemoglobin from the breakdown of RBC because of high Hb conc. at birth

RBC life span of newborn infants are shorter than adults

hepatic bilirubin metabolism is less efficient in the first few days of life

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25
What are some pathological causes/consequences of neonatal jaundice?
haemolytic anaemia infection metabolic disease liver disease kernicterus
26
What is kernicterus?
encephalopathy resulting from the deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei *bilirubin is fat-soluble and can therefore cross BBB
27
How does kernicterus present?
lethargy poor feeding irritability increased muscle tone (lie with arched back, opisthotonos) seizures coma
28
Long-term complications of kernicterus?
choreoathetoid cerebral palsy learning difficulties sensorineural deafness
29
What are causes of jaundice <24 hrs?
rhesus haemolytic disease ABO haemolytic disease hereditary spherocytosis glucose-6-phosphodehydrogenase
30
What causes jaundice 2-14 days
physiological usually breastfed babies dehydration infection
31
What are causes of prolonged jaundice?
biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice congenital infections e.g. CMV, toxoplasmosis
32
What should investigations should be done if there is jaundice beyond 14 days?
PROLONGED JAUNDICE SCREEN conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention direct antiglobulin test (Coombs' test) TFTs FBC and blood film urine for MC&S and reducing sugars U&Es and LFTs
33
What should be done if jaundice is suspected?
In first 72 hrs all babies should be checked for jaundice clinically and if clinically jaundiced, a transcutaneous measurement made
34
How would you manage jaundice?
phototherapy exchange transfusion
35
What are some causes of respiratory distress in term infants?
transient tacypnoea of the newborn meconium aspiration pneumonia pneumothorax milk aspiration persisten pulmonary hypertension of the newborn diaphragmatic hernia
36
What causes transient tachypnoea of the newborn? What would you see on an X-ray?
delay in resorption of lung liquid, common after C-section fluid in horizontal fissure
37
What are the effects of meconium aspiration on the fetus?
mechanical obst of lungs pneumonitis pre-disposing to infection lungs over-inflated pneumothorax persistent pulmonary hypertension of the newborn
38
What are risk factors for pneumonia?
prolonged rupture of membranes chorioamnionitis low birthweight
39
What is associated with persistent pulmonary hypertension of the newborn?
birth asphyxia meconium aspiration septicaemia respiratory distress syndrome
40
How does PPHN present?
cyanosis pulm oligaemia
41
How would you manage PPHN?
mechanical ventilation and circulatory support inhaled NO sildenafil
42
How does diaphragmatic hernia present?
resp distress failure to respond to resus apex beat and heart sounds displaced to right side
43
What is biggest complication assoc. with diaphragmatic hernia?
pulmonary hypoplasia
44
What are the differences between early infection and late infection?
early - <48 hrs after birth, bacteria that have infected birth canal late - >48 hrs, source of infection is the victims environment
45
Antibiotics are given to cover which organisms in an early infection?
group B strep listeria gram positive (amox or benzylpenicillin) gram negative (gentamicin)
46
Antibiotics are given to cover which organisms in an late infection?
flucloxacillin and gentamicin if doesn't work > vancomycin
47
What can be used to monitor responsiveness to treatment in infection?
blood cultures CRP
48
Risk factors for group b strep infection?
preterm prolonged rupture of membranes maternal fever during labour mater chorioamnionitis previously infected infant
49
What organisms can cause conjunctivitis in neonate? What are the specific treatments?
Staph/Strep - neomycin Gonococcal (gram stain discharge immediately - can lead to blindness ) - cephalosporin Chlamydia trachomatis -erythromycin
50
How would a herpes simplex virus infection present in a neonate?
anytime up to 4 weeks of age localised herpetic lesions on the skin or eye encephalitis disseminated disease
51
Hypoglycaemia usually seen in what groups of neonates?
IUGR preterm diabetes mums large-for-dates hypothermic polycythaemic
52
How would hypoglycaemia present in a neonate?
jitteriness irritability apnoea lethargy drowsiness seizures
53
How would you manage a hypoglycaemic infant?
prevented by early and frequent milk feeding IV glucose glucagon hydrocortisone
54
If a neonate is having a seizure, what should be ruled out first?
hypoglycaemia meningitis
55
Causes of seizures in neonates?
HIE Cerebral infarction septicaemia/meningitis metabolic (glucose, sodium, calcium, magnesium) intracranial haemorrhage drug withdrawal infection kernicterus
56
What is cleft lip and palate associated with?
maternal anticonvulsant use
57
Who should be involved in the care for a baby with cleft lip and palate?
Plastics ENT Paediatrician Orthodontist audiologist speech therapist
58
How does oesophageal atresia present?
persistent salivation drooling cough and choking during feeding yanotic episodes
59
What are causes of small bowel obstruction in neonates?
atresia or stenosis of duodenum atresia or stenosis of jejunum malrotation with volvulus meconium ileus meconium plug
60
What are causes of large bowel obstruction in neonates?
hirschprung rectal atresia
61
What are the steps to neonatal resuscitation?
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
62
What are prenatal. perinatal and postnatal causes of cerebral palsy?
Prenatal - cerebral malformation, TORCH infection, metabolic Perinatal - hypoxia, intrapartum trauma, prematurity complications Postnatal - head trauma, stroke, meningitis
63
How does cerebral palsy present?
spasticity = UMN signs, rigidity, hyperreflexia/tonia, delayed milestones, poor co-ordination, persistent primitive reflexes epilepsy audiovisual development resp problems poor growth
64
APGAR
``` Score Pulse Respiratory effort Colour Muscle tone Reflex irritability 2 > 100 Strong, crying Pink Active movement Cries on stimulation/sneezes, coughs 1 < 100 Weak, irregular Body pink, extremities blue Limb flexion Grimace 0 Absent Nil Blue all over Flaccid Nil ``` 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

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