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paeds > neonatal medicine > Flashcards

neonatal medicine Flashcards

1
Q

Cause of HIE

A 
Caused by reduced cardiac output essentially
Failure of gas exchange across placenta:
rupture, abruption, prolonged contractions
interuption of umbilical blood flow:
cord compression, shoulder dystocia
compromised foetus:
anaemia, IUGR
failure of cardio-resp adaptation:
don't start breathing
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2
Q

What are three clinical grades of HIE

A

mild:
irritable and excessive response to stimuli
increased reflexes
may be staring

Moderate:
slight abnormalities of tone and posture
increased reflexes
NOT FEEDING
may have seizures

severe:
no reflexes, unresponsive to pain
no tone or movement

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3
Q

Mx of HIE

A 
mild:
resuscitate (ABC)
therapeutic hypothermia
ventilate 
cardiovascular support (consider inotropes)
fluids 
moderate:
same as above
tx seizures
normoglycaemia
GIVE VIT K 
monitor liver
withhold feeding for 48 hours (at increased risk of NEC)H

severe:
as above +
cranial US to exclude other causes of haemorrhage
MRI brain

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4
Q

What are some injuries during birth

A

extracranial haemorrhage
caput succadeneum - bruising + oedema of presenting part BEYOND margins of skull bones
cephalhaematoma - haematoma below periosteum (confined to sutures)
Nerve palsies from breech birth
humerus+ clavicle fractures from breech birth

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5
Q

Signs of RDS

A 
see at birth or within 4 hours
Tachypnoea (>60)
subcostal recession w/ nasal flaring
grunting
cyanosis if severe
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6
Q

Mx RDS

A

ABC resus
resp support:
headbox/nasal cannulae
OR nasal continuous positive airway pressure OR positive pressure ventilation if baby doesn’t meet any of those criteria

Fluids
IV Abx (BSA)
URGENT CXR

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7
Q

How does pneumothorax happen

A

in ventilated RDS babies air leaks into pleural cavity

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8
Q

Mx pneumothorax

A

Small - observation + 100% o2
needle drainaige if urgent
chest drain - for all tension pneumothorax

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9
Q

what are causes of pneumothorax in term babies

A

Secondary to:
meconium aspiration
RDS
ventilation

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10
Q

Why are neonates prone to hypothermia

A

Thin skin
high SA:vol
no subcutaneous fat
often naked

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11
Q

What are the signs of PDA

A

it causes apnoea, bradycardia, increaed o2 requirements

can see bounding pulse, precordial impulse, systolic murmur

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12
Q

mx of PDA

A 
Close duct using IV indomethacin
or surgery (ligation or percutaneous catheter closure)
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13
Q

When can infants feed (suck and swallow)

A

35-36 weeks - before then NG

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14
Q

What are common causes of preterm brain injury

A

perinatal asphyxia and RDS

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15
Q

What is most severe kind of preterm brain injury

A

unilateral haemorrhagic infarction involving parenchyma - leaves you hemiplegic

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16
Q

What are other complications of preterm brain injury

A

intraventricular haemorrhage can lead to hydrocephalus

Ventricular involvement = 50% chance of neurodevelopmental problems

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17
Q

What is perventricular leukomalacia

A

multiple bilateral cysts on US (these cysts develop 2-4 weeks after injury)
high risk of spastic diplegia (stiff CP)

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18
Q

what is NEC

A

bacterial infection of ischaemic bowel wall

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19
Q

signs of NEC

A

infant can’t feed
distended abdo
bile stained vomiting
may get rectal bleeding

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20
Q

X-ray signs of NEC

A

distended bowel

thickened bowel wall cause of intramural gas (pneumatosis intestinalis)

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21
Q

Mx of NEC

A

stop feed (need TPN if stop for >24 hours, if confirmed NEC stop for 7 days)
BSA
NG tube and check aspirates
fluids
ventilation
Surgery if: perforation or child doesn’t respond to medicine

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22
Q

What causes retinopathy of prematurity

A

high o2 conc on NNU

can lead to retinal detachment

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23
Q

What is bronchopulmonary dysplasia

A

Damage to newborn’s lungs (often happen as a reuslt of ventilation or trauma)
CXR can show opacification
if they get RSV or pertussis they can go into resp failure

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24
Q

What are benign causes of neonatal jaundice

A

Too many RBC when born so they break down
RBC lifespan is shorter (70 days)
hepatic metabolism is slow

25
Q

Signs of kernicterus

A

acute- lethargy and poor feeding
severe - irritability
increased tone and arched back (opisthotonos)
seizures

26
Q

Causes of acute neonatal jaundice <24 hours

A 
Haemolytic:
Rhesus haemolytic disease
ABO incompatibility (less severe than Rhd)
G6PD
spherocytosis

Congenital infection

27
Q

Causes of neonatal jaundice 2 days - 2 weeks

A 
physiological
Breast milk jaundice 
dehydration
infection 
polycythaemia
28
Q

Causes of neonatal jaundice >2 weeks

A 
unconjugated:
infection
breast milk jaundice 
hypothyroidism
physiological

conjugated:
biliary atresia
neonatal hepatitis

29
Q

Which drugs can cause jaundice

A

Diazepam and sulfonamides displace bili from albumin so avoid in babies

30
Q

assessment of neonatal jaundice

A

measure bili:
if jaundice developed in less than 24 hours or baby is less than 35 weeks do serum bili
if not do transcutaenously

assess risk of kernicterus:
serum bili >340 in >37 weeks
bili rising >8.5 per hour
clinical signs

Ix for underlying cause:
haematocrit
blood group
DAT test
consider G6PD
31
Q

Tx of neonatal jaundice

A

Physiological: reassure
use threshold table to see what tx they need

Pathological unconj:
acute bili encephalopathy-
1 exchange transfusion
2 phototherapy
3 hydrate
4 IVIg

bili .>95th centile for photo
1 photo
2 hydrate

bili >95th centile for exchange
1 exchange
2 photo
3hydration
4 IVIg

Breast milk jaundie:
temporary cessation of BF
photo+hydration
exchange transfusion

32
Q

What happens if baby is on borderline for jaundice treatment

A

If >38 weeks and > 24 hours and within 50micromol of phototherapy threshold repeat bili measurements (within 18 hours if RF present, 24 if not present)

33
Q

What causes transient tachypnoea of newborn

A

caused by delay in reabsorption of fluid, most common cause of RDS

34
Q

mx for transient tachypnoea of newborn

A

supportive therapy

if tachypnoea goes on for more than 4-6 hours begin Abx

35
Q

What are the consequences of meconium aspiration

A

Infection
at increased risk of pneumothorax
increased risk of persistent pulmonary HTN

36
Q

Mx of meconium aspiration

A

if meconium staining but no Hx of GBS observe

if infection give Abx (IV ampicillin and gentamicin) and O2

37
Q

What is persistent pulmonary HTN associated with

A

RDS
Asphyxia
meconium aspiration
septicaemia

38
Q

mx of persistent pulmonary HTN

A 
urgent echo to check for congenital defects
oxygen 
ventilate
surfactant
suction secretions
fluids and inotropes
inhaled NO
ECMO
39
Q

How does diaphragmatic hernia presetn

A

generally L sided herniation so:

absent breath sounds on L and apex beat shifted R

40
Q

mx of diaphragmatic hernia

A

intubate
positive pressure ventilation
large NG tube + suction to prevent distension of intrathoracic bowel

Then go for surgical repair

41
Q

Consequence of diaphragmatic hernia

A

pulmonary hypoplasia due to compression from bowel loops

42
Q

What are early onset infections (<48 hours)

A

GBS
listeria
e.coli

43
Q

Late onset infections (>48 hours) causative organisms

A

coagulase negative staph (staph epidermidis)
staoh a
klebsiella
pseudomonas

44
Q

GBS mx

A

Intrapartum abx (IM benzylpenicillin) if:
previous baby w/ GBS
asymptomatic bacteriuria
infection during current pregnancy

give penicillin and gentamicin to babies

if it’s inc CSF change to benzylpenicillin and gentamicin

45
Q

Signs of listeria infection

A

these babies are often preterm

neonatal signs:
meconium staining (rare in preterm)
widespread rash
pneumonia etc.

46
Q

mx of neonatal listeria

A

amoxicillin and gentamicin

47
Q

Causes of conjunctivitis

A

Bacterial - staph and strep present w/ discharge and redness, gonococcal is purulent + swelling
viral is more relaxed

48
Q

RF for neonatal hypogylceamia

A 
IUGR
Preterm 
maternal DM
Polycythaemia
large
49
Q

Mx of neonatal hypoglycaemia

A

Prevention - feed baby within 30 mins of birth
aim for glucose >2.6

if BM <1.5 admit and give IV glucose
if BM 1.5-2.5 feed and then reassess in 30 mins

if it’s due to hyperinsulinism give glucagon infusion

50
Q

features of neonatal seizures

A

repetitive movements that continue when restrained

accompanied by eye movements and respiration changes

51
Q

Causes of neonatal seizures

A

neuro causes (HIE etc.)
metabolic (hypoglycaemia)
kernicterus
withdrawal (maternal opiates)

52
Q

Mx of cleft lip/palate

A

feeding assessment
refere to MDT
surgery
at risk of pierre robin sequence

53
Q

definition of failure to thrive

A

weight falls below 5th percentile multiple times or crosses 2 percentile lines

54
Q

Features of oesophageal atresia

A

Get transoesophageal fistula
associated with polyhydramnios
persent with salivation

55
Q

Causes of small bowel obstruction

A 
atresia/ stenosis of duodenum (down's)
atresia/stenosis of jejunum or ileum
volvulus
malrotation
meconium ileus/plug
56
Q

Causes of large bowel obstruction

A

Hirschprung

Rectal atresia

57
Q

mx chronic lung disease of prematurity

A

prophylaxis: steroids if established preterm labour <34 weeks
resp support : high flow o2, CPAP, invasive ventilation
medication: dexamethasone if > 8 days, give NO only if pulmonary hypoplasia or pulmonary HTN

58
Q

Group b strep mx

A

prevention:
itrapartum benzylpenicillin if: previous you’ve had previous invasive group B strep, group b strep colonisation, bacteriuria or infection in current pregnancy

59
Q

haemolytic disease of newborn mx

A

maternal:
anti-D Ig - give at 28 and 34 wks and at birth

baby:
Resusc (A+E)
exchange transfusion if (bili rising >8 per hour despite phototherapy, severe hyperbilirubinaemia unresponsive to phototherapy, significant anaemia <100)

phototherapy

IVIg - only for immune haemolysis

paeds (19 decks)

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