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Paediatrics > Neonatal medicine > Flashcards

Neonatal medicine Flashcards

1
Q

what is hypoxic - ischaemic encephalopathy?

A

neonatal brain injury secondary to prenatal, perinatal or postnatal asphyxia

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2
Q

aetiology of hypoxic ischaemic encephalopathy

A

abnormal CTG,
poor Apgar scores
metabolic acidosis

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3
Q

what does Apgar stand for?

A 
appearance
pulse rate
grimace 
activity
respiration
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4
Q

mild Signs and symptoms of hypoxic ischaemic encephalopathy

A

mild: irritable
increased one and reflexes
staring eyes
poor feeding

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5
Q

moderate Signs and symptoms of hypoxic ischaemic encephalopathy

A

lethargy
reduced tone and reflexes
seizures

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6
Q

severe Signs and symptoms of hypoxic ischaemic encephalopathy

A

coma, reduced tone , absent reflexes, prolonged seizures, multi organ failure

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7
Q

Ix for hypoxic ischaemic encephalopathy

A

cerebra function monitor (CFM), electroencephalogram (EEG) , MRI brain

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8
Q

Rx hypoxic ischaemic encephalopathy

A

respiratory and circulatory support
anticonvulsants
cooling

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9
Q

Cx of hypoxic ischaemic encephalopathy

A

cerebral palsy
learning difficulties
epilepsy
hearing and visual impairment

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10
Q

Aetiology of Respiratory distress in infants

A 
meconium aspiration syndrome
comgenital pneumonia
persistant pulmonary hypertension the newborn (PPHN)
heart failure
pneumothorax
diaphragmatic hernia
transient tachypnoea of newborn
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11
Q

what is meconium aspiration syndrome?

A

aspiration of meconium during delivery causing pneumonitis

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12
Q

CXR findings in meconium aspiration syndrome

A

patchy infiltrates

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13
Q

specific treatment for meconium aspiration syndrome

A

surfactant

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14
Q

what is congenital pneumonia

A

congenital infection of lungs

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15
Q

CXR findings in congenital pneumonia

A

focal consolidation

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16
Q

specific treatment for congenital pneumonia

A

antibiotics

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17
Q

pathology of pneumothorax

A

may be spontaneous
often iatrogenic
- high pressure ventilation / continuous positive airway pressure (CPAP)

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18
Q

Rx of pneumothorax

A

often resolved small

chest drain if large / symptomatic

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19
Q

what is a diaphragmatic hernia

A

herniation abdominal contents into chest cavity through diaphragm leading to pulmonary hypoplasia

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20
Q

specific treatment of diaphragmatic hernia

A

surgical repair

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21
Q

what is transient tachypnoea

A

delay in resorption of lung fluid, associated with Caesarean section,resolves spontaneously

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22
Q

Signs and symptoms of respiratory distress in term infants

A 
tachypnoea
grunting 
intercostal/ subcostal recession
tracheal tug
nasal flare
cyanosis
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23
Q

Ix of resp distress syndrome in term infants

A

CXR

Echo if cardio cause

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24
Q

Rx of resp distress in term infants

A

resp support: O2, continours positive ariway pressure (CPAP) invasive ventilation

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25
Q

Cx of resp distress in term infants

A

chronic lung disease

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26
Q

what is prematurity

A

28-36 weeks

27
Q

what is extreme prematurity

A

23-27 weeks

28
Q

Cx of prematurity

what are they susceptible to?

A 
respiratory distress syndrome (RDS)
persistent ductus arteriosus (PDA)
retinopathy of prematurity (ROP)
intraventricular haemorrhage (IVH(
hypoglycaemia 
hypothermia 
sepsis
29
Q

management of the pre term infant

A

require feeding support with high energy nasogastric/ orogastirc tube (NGT/OGT) feeds ± total parenteral nutrition (TPN)
nursing in warm humid incubator, cot warmer,

30
Q

Cx prematurity
what is respiratory distress syndrome
(hyaline membrane disease)

A

lack of surfactant secreted by type 2 pneumocytes

31
Q

Cx prematurity
what is respiratory distress syndrome
(hyaline membrane disease)
Symptoms and signs

A

resp distress
tachycardia
hypoxia
CXR

32
Q

Cx prematurity
Tx respiratory distress syndrome
(hyaline membrane disease)

A

antenatal steroids
exogenous surfactant
resp support as for resp distress syndrome

33
Q

Cx prematurity

patent ductus arteriosus what is it?

A

failure of ductus arteries to close leading to left right shunting, fluid overload and heart failure

34
Q

Cx prematurity
patent ductus arteriosus
Tx

A

fluid restriction
ibuprofen
surgical : ligation of duct

35
Q

Cx prematurity

necrotising enterocolitis what is it?

A 
ischaemia of gut wall and secondary infection of bowel
risk factors:
prematurity
milk feeding (higher risk with formula)
sepsis 
ibuprofen
36
Q

Cx prematurity
necrotising enterocolitis
Signs and symptoms

A

intolerance of feeds
distended abdo
vomiting
per rectum bleeding

37
Q

Cx prematurity
necrotising enterocolitis
Tx

A

nil by mouth
TPN
antiB
surgery if severe

38
Q

Cx prematurity

retinopathy of prematurity what is it?

A

proliferation of blood vessels at junction of non-vascularised and vascularised retina
risk factors:
extreme prematuri
excessive O2 therapy

all at risk infants require ophthalmology screening

39
Q

Cx prematurity
retinopathy of prematurity
Tx

A

laser therapy for sever disease

40
Q

Cx prematurity

intraventricular haemorrhage what is it?

A

haemorrhage of blood vessels in germinal matrix secondary to hypoxia/ resp distress syndrome RDS

41
Q

Cx prematurity
intraventricular haemorrhage
Tx

A

treatment of ventricular dilatation (CSF taps, shunt insertion)

42
Q

A of neonatal sepsis

A 
prolonged rupture of membranes 
chorioamnionitis 
materna pyrexia/ sepsis 
maternal carriage of GPS 
prematurity 
indwelling central lines 
poor hand hygiene
43
Q

pathogens causing neonatal sepsis

A

GBS

E. coli

44
Q

S of Neonatal sepsis

A 
resp distress 
apnoea 
temperature instability 
poor feeding 
often non specific
45
Q

Ix Neonatal sepsis

A 
inflammatory markers - CRP WBC
blood culture
lumbar puncture
urine microscopy, culture and sensitive MC+S
CXR
46
Q

Rx neonatal sepsis

A

maternal antiB when risk factors for sepsis present
broad spectrum antiBs (to cover GBS ad gram negatives), strict hand washing and infection control measures on neonatal unit

47
Q

What is classed as hypoglycaemia in neonates?

A

glucose level below 2.5 mmol/L

48
Q

Aetiology for hypoglycaemia

A 
prematurity 
small for gestational age (SGA), 
macrosomina, 
infants of diabetic mothers, 
sepsis, 
polcythaemia, 
metabolic
49
Q

S of hypoglycaemia in neonates

A 
jitteriness 
poor feeding 
irritability 
drwosiness 
apnoea
seizures
50
Q

Ix hypoglycaemia neonates

A

blood glucose level, metabolic screen of persistent of sever hypoglycaemia

51
Q

Rx hypoglycaemia neonates

A

early and frequency milk feeds, iv 10 per cent dextrose

52
Q

Cx hypoglycaemia neonates

A

seizures

neurological impairment

53
Q

what is oesophageal atresia?

A

oesophagus ends in blind ended pouch rather than connecting normally to stomach
often associated with trachea-oesophageal fistula

54
Q

S of oesophageal atresia

A

polyhydramnios (fetes unable to swallow amniotic fluid), excess oral secretions, aspirations and regurgitation when fed

55
Q

Ix oesophageal atresia

A

CXR

56
Q

Rx oesophageal atresia

A

surgical repair

57
Q

aetiology of birth injuries

A

large babies, instrumental/difficult delivery

58
Q

what is Erb’s palsy ?

A

C5 / C6 brachial plexus injury

59
Q

Sings of Erb’s palsy

A

asymmetrical Moro reflex (limp arm, waiters tip position)

60
Q

treatment of era’s palsy

A

physio

61
Q

what is Klumkes palsy?

A

C8/T1 brachial plexus injury

62
Q

Signs of Klumpke’s Palsy

A

wrist / hand muscle weakness

63
Q

Tx for Kulmpke’s palsy

A

Phyiso

Paediatrics (15 decks)

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