Neonatalogy Flashcards
1
Q
What are three severeties of HIE? What characterises them?
A
Mild - irritable neonate, increased response to stimulation. Staring. Impaired feeding. Most recover.
Moderate - abnormal tone/movement. Reduced feeding. Seizures
Severe - no normal spontaneous movements to pain. Hypo/hypertonia. Seizures prolonged and refractory to treatment. Multi-organ failure
2
Q
What is the mortality rate in severe HIE?
A
30-40%
3
Q
Management for HIE
A
Hypothermic cooking shown to reduce brain damage
4
Q
What is the prognosis of HIE features persisting beyond 2 weeks
A
Poor prognosis
5
Q
What may bilateral abnormalities in the basal ganglia/thalamus suggest in suspected HIE?
A
HIGH risk of later cerebral palsy
6
Q
Causes of HIE
A
Uterine rupture Plaental abruption IUGR Failure to breathe Cord compression Cord prolapse
7
Q
Jaundice <24 hours causes
A
SEPSIS until proven otherwise
Haemolysis (ABO incompatibility, Rhesus disease, G6PD deficiency)
Physiological
8
Q
Jaundice 24h-2 weeks causes
A
Physiological (breakdown product of excess Hct)
Breastfeeding
Haemolysis (ABO incompatibility, Rhesus disease, G6PD deficiency)
Polycythaemia
Infection
9
Q
Jaundice >2 weeks high unconjugated causes
A
Haemolysis
GI obstruction
Hypothyroid
10
Q
Jaundice >2 weeks high conjugated causes
A
Obstructive picture
- Biliary atresia
- Choledochal cyst
Hepatitis
- Infection
- a1 antitrypsin
11
Q
What is the commonest indication for a paediatric liver transplant?
A
Biliary atresia
12
Q
What is biliary atresia?
A
Destruction/absence of extrahepatic biliary tree and intrahepatic ducts
13
Q
Clinical features of biliary atresia
A
Normal birth weight but FTT
Pale stools, dark urine
Jaundice
Hepatomegaly (then splenomegaly)
14
Q
Ix for biliary atresia
A
USS abdomen TIBIDA scan (good uptake but no excretion into bowel) Liver biopsy
15
Q
Management of biliary atresia
A
Surgical bypass hepatoportoenterostomy (Kasai)
Ursodeoxycholic acid (bile movement)
Nutritional supplementation incl vitamins ADEK
Prophylactic abx to reduce risk of cholangitis
16
Q
Signs of resp distress in a neonate
A
Tachypnoea Increased WOB Grunting Recessions Cyanosis
17
Q
What is the primary cause of transient tachypnoea of the newborn?
A
Delay in lung liquid reabsorption
18
Q
In which type of birth is TTotN more common?
A
CS
19
Q
CXR TTotN
A
Fluid line in horizontal fissure
20
Q
What percentage of babies pass meconium before birth?
A
8-20%
21
Q
Three severities of meconium aspiration
A
Mild
Moderate
Severe
22
Q
What other resp disorder are babies who aspirate meconium more likely to suffer from?
A
Pneumothorax
23
Q
CXR features of meconium aspiration
A
Features of sepsis - unstable temperatures, resp distress, jaundice, slow CRT, apnoea
Overinflated lungs
Collapse
Consolidation
24
Q
Treatment of meconium aspiration
A
IF RFFS:
- IV ampicillin and gentamicin
25
Risk factors for sepsis
```
Chorioamnionitis
PROM
PPROM
Maternal fever during labour
FHR abnormalities
Oligohydramnios
```
26
What are the risk factors for pHTN?
RDS
Pneumothorax
Meconium aspiration
L to R shunt
27
Ix for pHTN
Urgent ECHO (congenital lesions)
28
Mx of pHTN
Mechanical ventilation and circulatory support
Inhaled nitric oxide and sildenafil (viagra) - both vasodilators
To consider ECMO
29
Complications of pHTN (with patent duct)
Eisenmenger's syndrome - L to R shunt becomes R to L shunt
30
What is a diaphragmatic hernia?
L sided herniation of abdo contents through posterolateral foramen of diaphragm
31
Disaphragmatic hernia signs
Apex beat and HS displaced to R -- pulmonary hypoplasia
32
Ix for suspected diaphragmatic hernia
CXR/AXR
33
Mx diaphragmatic hernia
Large NGT w/ suction applied (to prevent dilatation)
| Surgical repair once normal pulmonary pressures are maintained
34
Management of infant born to HbsAg positive mother
Vaccinaton shortly after birth
| AND HepB Ig if at risk
35
Management of infant with active HepB
Supportive therapy
| Immune active phase - treat with interferon/tenofovir disoproxil
36
Management of pregnant mother HbsAg positive
Antiviral monotherapy (tenofovir disoproxil) if viral load >200,000
37
Treatment/advice for rubella
Rest, fluids, paracetamol
AVOID other pregnant women for 6 days after rash onset
IM immunoglobulin
38
When is the highest risk of rubella transmission?
EARLY pregnancy (<20 weeks) - 8-10 weeks worst
39
Symptoms of rubella (in mother)
Rash (starting on face, spreading to body)
| Post-auricular lymphadenopathy
40
Three primary features congenital rubella syndrome
Deafness
Cataracts
Cardiac problems - PDA common
41
Which cardiac issue is common in congenital rubella syndrome?
PDA
42
Which neonates are at highest risk of hypoglycaemia?
IUGR
GDM
Prem
Hypothermic
43
Features hypoglycaemia neonate
Jittery, irritable, apnoea, lethargy, drowsy, seizures
44
What blood glucose is desirable for neonates to ensure normal neurodevelopmental outcome
>2.6
45
What is a complication of prolonged and symptomatic hypoglycaemia in the neonate?
Neurodisability
46
How is neonatal hypoglycaemia managed?
Glucose IV infusion (until BM >2.6)
Early/more frequent feeding
Glucagon/steroids if necessary
47
What blood glucose is desirable for neonates to ensure normal neurodevelopmental outcome
>2.0 pre feed
48
What is early onset sepsis?
Within 48 hours of birth
49
How is neonatal hypoglycaemia managed?
Glucose IV infusion (until BM >2.0)
Early/more frequent feeding
Glucagon/steroids if necessary
50
What is late onset sepsis?
After 48 hours of birth
51
Primary causes late onset sepsis
Nosocomial - lines, catheters, ventilation
52
Commonest early onset sepsis causative organisms
GBS
Listeria
E.coli
53
Commonest late onset sepsis causative organisms
Coagulase negative staph.
| E.g. staph epidermis
54
Abx for early onset sepsis organisms (+ve and -ve)
+ve benpen, amoxicillin
| -ve gentamicin
55
Abx for late onset sepsis organisms (+ve and -ve)
vanc/gent/fluclox
56
% of pregnant women with GBS (vaginal/faecal)
30%
57
When are abx appropriate (for mum and baby) in GBS positive mothers?
IF:
- Suspected sepsis in mother (intrapartum abx once labour starts)
- Previous baby with GBS (intrapartum abx)
For baby if increased risk and/or abx not started within 4 hours before birth
58
Treatment for listeria
Amoxicillin/cotrimoxazole
59
Features of listeria infection
Mec in a preterm baby (unusual).
Rash
Septicaemia
60
Conjunctivitis in newborn
Troublesome discharge,
Red
Itchy eyes
61
Commonest causative agent in conjunctivitis <48hr after birth
Gonococcal
62
Conjunctivitis causative agent
Chlamydia trachomatic
63
Ix/Mx for conjunctivitis
Swab
| Abx - erythromycin
64
Treatment of omphalitis
Aim to prevent involution by granuloma
| AgNo3
65
Highest risk for transmitting HSV
Mother with primary genital herpes infection within 6 weeks of birth
66
What is the risk of a mother with primary genital herpes infection transmitting to infant in vaginal delivery?
40%
67
Management of mother with primary genital herpes infection within 6 weeks of delivery
ELCS
IV aciclovir for mother
IV aciclovir for baby on delivery
68
Treatment for congenital CMV
Ganciclovir
69
When does necrotising enterocolitis present?
First few weeks of life
70
What is necrotising enterocolitis?
Bacterial invasion of ischaemic bowel wall
71
Which group of neonates are more likely to develop necrotising enterocolitis?
Those drinking cow's mil formula
72
Clinical features of necrotising enterocolitis
```
Reduced feeding
Milk aspiration
Bile stained vomit
Abdominal distension (tense, shiny skin)
PR bleed
BOWEL PERFORATION - SHOCK
```
73
AXR features of necrotising enterocolitis
Distended bowel loops, thickened bowel wall, intramural gas
74
Mx necrotising enterocolitis
STOP oral feed
Broad spec abx - vanc/cefotaxime
TPN
Surgery
75
Commonest cardia lesion in preterm babies
PDA
76
Management of PDA
Medical
- Prostacyclin synthetase inhibitor
- IV indomethacin
- Ibuprofen
Surgery - balloon
77
How much should a preterm baby be feeding?
60-90ml/kg/day
78
How much should a term baby be feeding?
90-120ml/kg/day
79
Baby with poor feeding maintenance fluids
2/3
80
Why is haemorrhage common (25%) in vLBW naeonates?
Fragile blood vessels around the germinal matrix above the caudate nucleus
81
Name one (resp) risk factor for neonatal naemorrhage?
Pneumothorax
82
Three types of brain injury in preterms
- Haemorrhage
- Ventricular dilatation (blockage of CSF drainage) --> hydrocephaly
- Periventricular leukomalacia
83
What clinical features does periventricular leukomalacia later present with?
Spastic diplegia
84
What % of vLBW babies have retinopathy of prematurity
35%
85
What is the pathophysiology of retinopathy of prematurity?
Vacular proliferation = detachment, fibrosis and blindness
86
Mx of ventricular dilation
Ventriculo-peritoneal shunt
87
Mx of retinopathy of prematurity
R/f to ophthalmology
| Laser therapy
88
Pathophysiology of respiratory distress syndrome
Reduced lung surfactant (type II pneumocytes) = reduced surface tension = alveolar collapse = impaired gas exchange
89
Is RDS more severe in male or female preterms?
Male
90
How can RDS be prevented?
Antenatal steroids (within 7 days of delivery)
91
Features of RDS
All within 4 hours of birth:
- Tachypnoea
- Cyanosis
- Increased WOB
- Expiratory grunt
92
CXR features of RDS
Granular/ground glass appearance
| Air bronchograms
93
Management of RDS
O2 ventilation (CPAP)
Exogenous surfactant via an ET tube
Supportive preterm therapy
94
Pathophysiology of pneumothorax in preterm
Air from overdistended alveoli tracks into interstitium
95
Risk factors for pneumothorax
Ventilation
RDS
Infection (mec aspiration)
96
Ix for pneumothorax
Transillumination
| CXR
97
Mx of pneumothorax in preterm
O2
Decompression
Chest drain
98
How can pneumothoraces be prevented in preterm babies?
Ventilate at lowest possible pressure
99
What is apnoea in the neonate?
Cessation of breathing for >20 seconds
100
What is the commonest cause of apnoea/bradycardia in preterm baby?
Immaturity of respiratory control
101
How is apnoea/bradycardia in preterm baby managed?
Physical stimulation
Caffeine
CPAP
102
What is bronchopulmonary dysplasia?
Chronic lung disease - continued O2 requirement beyond 36/40
103
CXR features of bronchopulmonary dysplasia
Widespread opacification
104
Management of bronchopulmonary dysplasia
Weaning from ventilation --> CPAP --> ambient O2
| Management of GORD - common comorbidity
105
What are infants with bronchopulmonary dysplasia more likely to suffer from?
GORD
Increased risk pertussis/RSV infection
106
Management of bronchopulmonary dysplasia
Weaning from ventilation --> CPAP --> ambient O2
- Steroids after 7/7 if still on ventilator
- Diuretics if on ventilator
- Caffeine
- Nitric oxide
(Management of GORD - common comorbidity)
107
Cause of cleft lip
Failure of fusion of frontonasal and maxillary processes in embryogenesis
108
Cause of cleft palate
Failure of fusion of the palatine processes and the nasal septum
109
What are cleft lip/palate associated with?
Maternal anti-convulsants
| Chromosomal abnormalities
110
Management of cleft lip/palate
Specialised feeding advice
Observe for airway problems (Pierre Robin sequence)
SLT/orthodontists
Surgery = definitive
111
Clinical features of Pierre-Robin sequence
Micrognathia, posterior displacement of the tongue and midline cleft of the soft palate
112
Presentation of Pierre-Robin sequence
```
Feeding difficulty --> FTT
Airway difficulty (cyanotic episodes)
```
-- as tongue falls back
113
Mx of Pierre-Robin sequence
Nasopharyngeal airway
| Maintaining prone position
114
Abx for GBS
Benpen and gent
115
Mx haemolytic disease of the newborn
Anti D Ig at 28 weeks and birth
- Exchange transfusion if severe
- Phototherapy
- IVIG
116
Mx toxoplasmosis in newborn
Pyrimethamine, sufadiazine, calcium folinate
+ prednisolone
117
RFs for RDS
Prematurity, male, CS, GDM, multiple pregnancy
118
Complications of mec aspiration
Infection (sepsis)
| Persistent pHTN of newborn
119
Most common cardiac defect in T21?
AVSD
120
When is benpen and gent coverage for suspected sepsis switched over to cefotaxime?
Once they have been out of the hospital and been exposed to a broader range of pathogens
121
Why do neonates have cefotaxime rather than ceftriaxone? When?
Ceftriaxone can cause biliary sludging
| After 1 month
122
Why do you need an anaesthetist if giving prostin (prostaglandin) for a duct-dependent circulatory problem?
Respiratory depression (apnoea)
123
Investigations for suspected metabolic problems
Gas - LDH (mitochondrial)
| Ammonia (urea cycle)
124
What might a raised ammonia indicate?
Urea cycle disorder
