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Med Finals - Paediatrics > Neonates > Flashcards

Neonates Flashcards

(59 cards)

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1
Q

Main principles of neonatal resuscitation

A

Warm the baby
Calculate APGAR scores
Stimulate breathing
Inflation breaths
Chest compression

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2
Q

What is assessed in APGAR score

A

Appearance
Pulse
Grimmace
Activity
Respiration

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3
Q

APGAR score A1

A

Appearance
0 - blue/pale centrally
1 - Blue extremities
2 - Pink

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4
Q

APGAR score P

A

Pulse
0 - Absent
1 - <100
2 - >100

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5
Q

APGAR score G

A

Grimmace
0 - No response
1 - Little response
2 - Good response

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6
Q

APGAR score A2

A

Activity
0 - Floppy
1 - Flexed arms and legs
2 - Active

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7
Q

APGAR score R

A

Respiration
0 - Absent
1 - slow irregular
2 - strong/crying

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8
Q

What is assessed in blood spot screening

A

9 congenital condition
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
MCADD
MSUD
IVA
GA1
Homcystin

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9
Q

Define port wine stain

A

Pink patches of skin often on the face caused by abnormalities of the capillaries - they dont fade and often turn a darker red or purple.
Rarely related to sturge-weber syndrome

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10
Q

Define caput succedaneum

A

Fluid collection on the scalp outside the periosteum - results from a traumatic, prolonged or instrumental delivery
Fluid is ably to cross the suture lines and theses are benign with no treatment required

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11
Q

Define cephalohaematoma

A

Collection of blood between the skull and periosteum - lump does not cross suture line
Slight risk of anaemia or jaundice but should resolve without intervention

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12
Q

Define Erbs palst

A

Results from injury to C5/C6 nerves during birth
Associated with shoulder dystocia, traumatic or instrumental delivery
Waiters tip appearance - internally reotated, extended elbow, flexed wrist facing backwards, lack of movement

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13
Q

Define neonal sepsis

A

Sepsis caused by an infection in the neonatal period

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14
Q

Common causative organisms in neonatal sepsis

A

Group B streptococcus!!!
E. coli
Listeria
Klebsiella
Staphylococcus aureus

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15
Q

Risk factors for neonatal sepsis

A

Vaginal GBS
GBS in previous baby
Maternal sepsis
Prematurity
Early rupture of membrane
Prolonged rupture of membrane

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16
Q

Presentation of sepsis

A

Fever
Reduce tone and activity
Poor feeding
Respiratory distress
Vomiting
Tachycardia or brady cardia
Hypoxia
Jaundice
Seizures
Hypoglycaemia

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17
Q

Red flags of sepsis

A

Confirmed or suspected sepsis in mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Respiratory distress starting more than 4 hours after birth
Presumed sepsis in another baby in multiple pregnancy

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18
Q

Management of sepsis

A

Antibiotics - benzylpenicillin
Blood cultures
FBC and CRP
Lumbar puncture

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19
Q

Define hypoxic ischaemic encephaopathy

A

Occurs in neonates as a result of hypoxia during birth - can lead to damage to the brain causing cerebral palsy

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20
Q

Causes of hypoxic ischaemic encephalopathy

A

Maternal shock
Intrapartum haemorrhage
Prolapsed cord
Nuchal cord - around neck

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21
Q

Management of hypoxic ischaemic encephalopathy

A

Supportive neonatal resuscitation
Therapeutic hypothermia
Lots of follow up!

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22
Q

Define physiological jaundice

A

Due to high levels of fetal haemoglobin there is high turnover of RBCs resulting in lots of bilirubin leading to mild yellowing of skin and sclera - presents at 2-7 days. Normally resolves within 10 days

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23
Q

When is jaundice pathological

A

When presenting within the first 24 hours of life

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24
Q

When does physiological jaundice present

Study These Flashcards
A

2-7 days of life

25
Causes of jaundice - increased bilirubin
Haemolytic disease of the newborn ABO incompatibility Haemorrhage Intraventricular haemorrhage Cephalo-haematoma Polycythaemia Sepsis and DIC G6PD deficiency
26
Causes of jaundice - decreased clearance
Prematurity Breast milk jaundice Neonatal cholestasis Extrahepatic biliary atresia Endocrine - hypothyroid, hypopituitary Gilbert syndrome
27
Define breast milk jaundice
Components of breast milk inhibit processing of bilirubin, more likely to become dehydrated by inadequate feeding, poor feeding leads to slow stools worsening excretion of bilirubin
28
Define haemolytic disease of the newbord
Caused by incompatibility between the rhesus antigens on the surface of the red blood cells of the mother and fetus.
29
Investigations in jaundice
FBC and film Bilirubin Blood typing Direct coombs test Thyroid function Blood and urine cultures G6PD deficiency
30
Management of jaundice
Treatment graphs Phototherapy Exchange transfudion
31
When should bilirubin be measured following phototherapy
12-18 hours after stopping
32
What is associated with preterm birth
Social deprivation Smoking Alcohol Drugs Over or under weight Maternal co-morbidities Twins Personal or FH
33
Short term complications of preterm delivery
Respiratory distress Hypothermia Hypoglycaemia Poor feeding Apnoea Bradycardia Neonatal jaundice Intraventricular haemorrhage Retinopathy or prematurity Necrotising enterocolitis Immature immune system and infection
34
Long term complications of premature delivery
Chronic lung disease of prematurity Learning and behavioural difficulties Susceptibility to infections - particularly resp Hearing and visual impairment Cerebral palsy
35
Define apnoea of prematurity
Define as period where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or bradycardia.
36
Causes of apnoea or prematurity
Immature autonomic nervous system Infection Anaemia Airway obstruction CNS pathology Gastro-oesophageal reflux Neonatal abstinence
37
Management of apnoea of prematurity
Monitoring Tactile stimulation Intravenous caffiene Settle as development happens
38
Define retinopathy of prematurity
Condition affecting preterm babies - abnormal development of blood vessels in the retina can lead to scarring, retinal detachment and blindness.
39
Management of retinopathy of prematurity
Systematically targeting areas of the retina to stop new blood vessels developing Transpupillary laser photocoagulation Cryotherapy Injections of VEGF inhibitors Surgery for complications
40
Define necrotising enterocolitis
NEC is a disorder affecting premature neonates, where part of the bowel becomes necrotic leading to perforation, peritonitis and shock.
41
Risk factors for NEC
Very low birth weight Very premature Formula feeds Respiratory distress Assisted ventilation Sepsis Patent ductus arteriosus
42
Presentation of NEC
Intolerance to feeds Vomiting - green bile Generally unwell Distended tender abdomen Absent bowel sounds Blood in stools Peritonitis and shock
43
Investigations in NEC
Bloods - FBC, CRP, gas, culture Abdo xray
44
What is seen on xray in NEC
Dilated loops of bowel Bowel wall oedema Pnumatosis intestinalis - gas in bowel wall Pneumoperitoneum - perforation Gas in portal veins
45
Management of NEC
Nil by mouth IV fluids TPN Antibiotics NG to remove gas Surgical emergency - removal of dead bowel
46
Complications of NEC
Perforation Peritonitis Sepsis Death Strictures Abscess formation Recurrence Long term stoma Short bowel syndrome
47
Define neonatal abstinence syndrome
Withdrawal symptoms that happen in neonates of mothers that used substances during pregnancy
48
Substances causing neonatal abstinence syndrome
Opiates Methadone Benzodiazepines Cocaine Amphetamines Nicotine or cannabis Alcohol SSRI
49
Clinical signs of abstinence syndrome
Irritability Icreased tone High pitched cry Not settling Tremors Seizures Yawning Sweating Unstable temp Tachypnoea Poor feeding Regurgitating Hypoglycaemia Loose stools Sore nappy area
50
Management of abstinence syndrome
Lots of monitoring replacement of substance - morphine
51
Define fetal alcohol syndrome
Certain effects and characteristics that are found in children of mothers that consumed significant amounts of alcohol during pregnancy
52
Features of fetal alcohol syndrome
Microcephaly Thin upper lip Smooth flat philtrum Short palpebral fissure Learning disability Behavioural difficulties Hearing and vision problems Cerebral palsy
53
Features of congenital rubella syndrome
Cataracts Congenital heart disease Learning disability Hearing loss
54
Features of congenital varicella syndrome
Severe - pneumonitis, hepatitis or encephalitis Fetal varicella syndrome Neonatal varicela Fetal growht restriction Microcephaly Hydrocephalus Learning dificulties Scars and skin changes - following dermatomes Limb hypoplasia Cataracts and inflammation in eye
55
Features of congenital cytomegalovirus
Fetal growth restriction Microcephaly Hearing loss Vision loss Learning disability Seizures
56
Clasic triad in congenital toxoplasmosis
Intracranial calcification Hydrocephalus Chorioetinitis
57
Define sudden infant death syndrome
A sudden unexplained death in an infant - cot death, uaually within the first six months
58
Risk factors for SIDS
Prematurity Low birth weight Smoking during pregnancy Male baby
59
How to minimise risk of SIDS
Put baby on back when not supervised Keep head uncovered Place feet at foot of bed to prevent sliding down under blanket Keep cot clear of toys and blankets Maintain comfortable room temperature - 16-20 Avoid smoking - dont handle after smoking Avoid sleeping in the same bed - especially if drinking alcohol, drugs smoking sleeping tablets or sleep disorders

Med Finals - Paediatrics (17 decks)

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