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Flashcards in Neonatal Deck (40):
1

What is cleft lip/palate the result of?

failure of fusion of maxillary and premaxillary processes

2

What are the causes of cleft lip/palate?

genetics
benzodiazepines
anti epileptics
rubella

3

What genetic disorders is cleft lip/palate found in ?

trisomy 18 (Edwards)
trisomy 13 (Patau)

4

How can cleft lip/palate be prevented?

no smoking during pregnancy
folic acid 5mg/day
avoid AEDs

5

how is cleft palate managed before surgical repair?

special teats and feeding devices
dental prosthesis

6

When is cleft lip usually repaired?

1st week of life (cosmetic reasons)

7

When is cleft palate usually repaired?

several months of age

8

What are the complications of cleft lip/palate? what rx for this should be avoided and why

secretory otitis media
adenoidectomy as gap between normal palate and nasopharynx will exacerbate feeding problems and speech

9

What is meconium

faecal material that accumulates in the faetal colon

10

What is meconium aspiration syndrome?

resp distress in the newborn due to the presence of meconium in the trachea

11

What increases the risk of meconium aspiration syndrome?

post-term delivery (42w)
Hx of maternal HTN
Pre-eclampsia
chorioamnionitis
smoking
substance abuse

12

what does meconium in the lung result in

mechanical obstruction
chemical pneumonitis
predisposition to infection

13

What are the complications of meconium aspiration syndrome?

may develop persistent pulmonary HTN of the newborn making it difficult to achieve adequate oxygenation despite high pressure ventilation

14

what is the rx of meconium aspiration?

artificial ventilation

15

what babies are more prone to getting necrotising enterocolitis and when?

preterm infants in the first few weeks of life

16

what is necrotising entercolitis?

inflammatory bowel necrosis

17

What are the features of necrotising enterocolitis?

→ Infant stops tolerating feeds
→ Milk is aspirated from the stomach
→ May be bile stained vomiting
→ Abdomen becomes distended and the stool sometimes contains fresh blood

18

What is a serious complication of necrotising enterocolitis?how is this detected?

perforation
detected on XR or transillumination of the bowel

19

What are ix for necrotising enterocolitis? what do they show?

XR:
distended loops of bowel
thickening of bowel wall
intramural gas (pneumatosis intestinalis)

20

What is rx for necrotising enterocolitis

1. stop oral feeding (except probiotics)
2. abs e.g. cefotaxime + vancomycin
3. surgery for bowel perforation

21

When is jaundice normal in the neonate?

after 24hr to 14 days in term babies and 21 in poems (after this it becomes prolonged jaundice)

22

When is jaundice pathological in the neonate?

in 1st 24hrs of birth

23

What are the causes of jaundice in the first 24hrs of life

rhesus -ve disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

24

What are the causes of physiological neonatal jaundice?

1. raised bilirubin due to short rbc lifespan
2. reduced bilirubin conjugation due to hepatic immaturity
3. absence of gut flora impeding elimination of bile pigment
4. exclusive breastfeeding

25

What are the causes or prolonged jaundicE?

breastfeeding
sepsis (UTI, TORCH)
hypothyroidism
CF
biliary atresia (conjugated bilirubin, bile stools)

26

what is clinical jaundice classed as?

>80µmol/L plasma bilirubin

27

What is a serious complication of neonatal jaundice?

KERNICTERUS as unconjugated bilirubin can be deposited in the brain (particularly basal ganglia) and cause it

28

How is the potentially serious complication of neonatal jaundice prevented?

measuring transcutaneous bilirubin levels in babies discharged early

29

What is kernicterus? what are the features?

acute bilirubin encephalopathy
lethargy
poor feeding
hypertonicity
opisthotonus (form of spasm in which head, neck and spine are arched backwards)
shrill cry

30

What increases the risk of developing kernicterus?

bilirubin levels >360µmol/L

31

What are the long term consequences of kernicterus?

athetoid movements (slow, twisting, writhing movements)
deafness
reduced IQ

32

How is kernicterus prevented?

phototherapy
exchange transfusion

33

What are the investigations for jaundice presenting in the first 24 hrs of life?

FBC
blood film
blood groups (rare group incompatibility)
Coombs test

34

What is the direct Coombs test used for? What does a positive result mean/

confirming haemolytic anaemia
detects abs against rbc's
positive means that there are abs detected that attack the persons rbcs

35

What is the indirect Coombs test used for? What does a positive result mean?

Used in prenatal testing or prior to blood transfusion
means either:
baby has haemolytic disease
or donors blood isn't compatible
it detects abs against foreign rbcs

36

what are the investigations for prolonged jaundice?

conjugated and unconjugated bilirubin
DAT coombs
TFTs
FBC and blood film
urine for MC&S and reducing sugars (microbial culture and sensitivity)
U&Es and LFTs

37

When should babies be admitted to hospital w jaundice?

features of bilirubin encephalopathy
jaundice appearing <24hrs of age or >7days
unwell
gestation <35w
prolonged jaundice
poor feeding
pale stools and dark urine

38

When is no treatment required for neonatal jaundice?

well neonates
physiological jaundice
breastmilk jaundice
bilirubin below rx threshold

39

How does phototherapy work?

uses light energy to convert bilirubin to soluble products that can be excreted w/o conjugation

40

What are the SE of phototherapy?

reduced temp
eye damage - cover them
diarrhoea
separation from mother
fluid loss