neonates Flashcards
(88 cards)
1
Q
describe vitellointestinal duct remnant
A
two loops of bowel can intertusscept at the duct to cause ‘rams horn’ appearance
2
Q
presentation of choanal atresia
A
cyanotic when feeding - improve when crying
unable to pass NG tube
part of CHARGE syndrome
3
Q
embryological cause of CDH
A
failure of pleuroperitoneal canals to close
4
Q
newborn problems born to gestational diabetic mums
A
- hypoglycaemia
- resp distress syndrome - delayed maturation, due to IGF-1
- hypertrophic cardiomyopathy
- polycythaemia
- macrosomia
5
Q
how to manage hypo in newborns
A
- bolus 2.5mls/kg 10% dextrose
- fluid maintenance 60mls/kg 10% dex
6
Q
features of maternal use of phenytoin in baby
A
flat nasal bridge
strabismus
ptosis
neck webbing
VSD + ASD
7
Q
features of maternal warfarin use in pregnancy
A
short limbs
microcephaly
cerebral haemorrhages
nasal hypoplasia
8
Q
features of ACE- I use in pregnancy
A
renal tubular agenesis
oligohydramnios
neonatal anuria
IUGR
9
Q
causes of polyhydramnios
A
- idiopathic
- duodenal atresia, oesophageal atresia, CDH
- myotonic dystrophy, SMA
- Barters syndrome
5, maternal diabetes - trisomy
10
Q
features of rubella infection in pregnancy
A
- cardiac - pulmonary stensosis, PDA, cardiomegaly
- ocular - cataracts, retinitis
- hearing defects - deafness
11
Q
features of cytomegalovirus infection in pregnancy
A
- intraventricular calcifications
- sensorineural hearing loss
- IUGR
- microcephaly
5.cataracts - purpuric rash
12
Q
test for CMV in prgenancy
A
CMV PCR
AVOID TODDLER URINE
13
Q
Features of toxoplasmosis in pregnancy
A
- hydrocephalus - macrocephaly
- cerebral calcifications
- acute fundal chorioretinitis - hyperpigmented lesions around macula, leukocoria
14
Q
features of varicella zoster infection in pregnancy
A
severe scarring of the skin
cataracts / corneal clouding
limb/ digital dysplasia/ hypoplasia
vesicular rash
high rate of mortality
15
Q
features of syphilis infection in pregnancy
A
rash/ peeling hands and feet
jaundice
sepsis
IUGR
16
Q
guthrie heelprick test for which conditions
A
- PKU
- hypothyroidism - most common
- maple syrup urine
- galactossaemia
- MCADD - high false +ve
- cystic fibrosis
- isovaleric acidaemia
- glutaric aciduria type 1
- homocystinuria
repeat test on day 28 if born < 32/40
17
Q
how is maple syrup urine disease tested
A
high leucine levels
18
Q
how is MCADD tested in heel prick test
A
high otctanolycarnitine
19
Q
signs of vit K deficiency
A
bruising
malaena
prolonged bleeding
intracranial haemorrhage
present 1-8 weeks of life (usually day 3-7)
20
Q
drugs that impair vit K
A
rifampicin
anti epileptics
warfarin
21
Q
management if bleeding and no vit K at birth
A
- IV vit K
- fresh frozen plasma
22
Q
test results for vit K deficiency
A
- prolonged PT
- prolonged APTT
- fibrinogen and thrombin time normal
23
Q
what is erythema toxicum
A
white pin point palpules with red base in first 2-3 days of life
fluid contains EOSINOPHILS
24
Q
newborn hearing test
A
otoacoustic emission testing
if fails, auditory brainstem response
25
what does breast milk contain
1. 90% water
2. carbohydrate - lactose *
3. lipid - cholesterol, omega 3, long chain, 50% total energy for grey matter development and myelination
4. protein - 0.9g/dl, whey protein *, lactoferrin
5. igA
6. vit A rich
26
what is colostrum
thick sticky fluid 3-4 days after delivery
increase gut motility and reduced neonatal jaundice
1st immunisation
27
disadvantages of BF
low in vit D
cannot breast feed if HIV +ve
complications - mastitis, engorgement, sore
contraindicated in PKU and galactosaemia
28
advantages of BF
immunity and protection
36% reduction in SIDS
protects against severe eczema
+ve effect of intelligence
reduces obesity
protects against T2DM
reduced prevalence of NEC
29
antibodies to rhesus antigens
IgG
30
antibodies to AB blood groups
IgM
31
diagnosis of polycythaemia
venous blood haematocrit > 65%
32
management of polycythaemia
if neonate symtpomatic or haematocrit >70% : partial exchange transfusion (remove blood and replace with 0.9% saline and aim haematocrit 50%)
33
common causes of early onset neonatal sepsis
1. group B strep !!
2. E.coli - common in preterm, low BW
3. listeria - granulomatous rash (pale nodules), mec liquor
4. h.influenza
5. herpes
6. enterovirus
34
common causes of late onset neonatal sepsis (>72 hours - 90 days of life)
1. coag neg staph -(staph epidermidis) common cause of line infections
2. e.coli
3. klebsiella
35
red flags for neonatal sepsis
1. suspected or confirmed infection in another baby
2. apnoea
3. seizures
4. need for CPR
5. need for mechanical ventilation
6. signs of shock
36
risk factors for neonatal sepsis
1. PROM >18 HOURS in pre term or >24 hours in term
2. preterm < 37 weeks
3. GBS in previous or current pregnancy
4. chorioamnionitis
5. altered behaviour/ floppy
6. intrapartum fever
7. feeding difficulties
8. signs of resp distress
9. jaundice within 24 hours
10. temp abnormality
11. metabolic acidosis
12. altered glucose regulation
37
management of early onset neonatal sepsis
benzylpenicillin + gentamicin
+ CRP, lumbar puncture and blood cultures
38
presentation of meckels diverticulum
lower GI bleeding
intussusception
small bowel volvulus
39
test for meckels diverticulum
technetium 99m scan
40
cause of duodenal atresia
failure of vacuolation and recanalisation of duodenum at 7 weeks
41
risk factors for duodenal atresia
trisomy 21
CF
prader willi
congenital heart disease
diaphragmatic hernia
oesophageal fistula
42
duodenal atresia signs antenatal
polyhydramnios
double bubble sign
43
presentation of duodenal atresia
1. bilious vomiting in 1st few dayd of life (20% non bilious if before ampulla of vater)
2. abdo distension
44
management of duodenal atresia
1. XR - double bubble
2. NG tube to decompress stomach
3. open laparotomy surgery
45
risk factors for NEC
1. preterm
2. low birth weight
3. smoking
4. formula feeding / enteral feeds
5. placental insufficiency/ abruption
6. hypoxia, shock
7. anaemia
46
presentation of NEC
1. shocked baby
2. blood in stool
3. abdo distension
4. bilious vomiting and diarrhoea
47
x ray findings in NEC
pneumoperitoneum * - perforation
bowel wall oedema
intramural gas
portal venous gas
48
management of NEC
1. bloods (metabolic acidosis, high lactate), cultures, prolonged PT/APTT
2. NG tube and NBM
3. IV fluids
4. antibiotics for 14 days
5. surgery if perforate or medical treatment not working
49
describe hirschsprungs disease
failure of neural crest cells from neuroectoderm to migrate and populate distal colon causign absence of ganglion cells.
50
presentation of hirschsprungs disease
1. failure to pass meconium in first 48 hours
2. abdo distension
3. vomiting
4. poor geeding
51
management of hirschsprungs disease
1. abdo x ray - contrast enema shows transition zone
2. rectal suction biopsy
52
presentation of HIE
1. MILD - irritable, hyperventilation, hypertonia, impaired feeding
2. MODERATE - hypotonic, difficulty feeding, seizures
3. SEVERE - hypotonoa, prolonged seizures
53
coolin criteria for hIE
SECTION A
APGARS <5 at 10 mins
resus >10 mins
acidosis < 7 within 60mins
BE >1 WITHIN 60 mins
SECTION B
hypotonia
altered state of consciousness
abnormal primitive reflexes
54
presentation of tracheo-oesophageal fistula
resp distress
abdo distension
unable to pass NG tube
excessive salivation
vomiting and choking on feeds
55
antenatal signs of tracheo-oesophageal fistula
polyhydramnios
absence of fetal bubble
'large for dates'
56
causes of neonatal seizures
1. HIE (40%)
2. intracranial haemorrhage - usually 1st 24 hours of life
3. hydrocephalus
4. biochemical - hypoglycaemia, hypocalcaemia, hyponatraemia
5. inborn errors of metabolism
6. drug withdrawal
57
1st line management for neonatal seizures
phenobarbital - activates GABA-A receptor (side effect = apnoea)
58
cause of spinal muscular dystrophy
autosomal recessive
deletion/ mutation of SMN1 gene on chromosome 5
degeneration of alpha motor neurones in anterior horn of spinal cord
59
presentation. of type 1 spinal muscular dystrophy (werdnig hoffman disease)
die before < 2 y/o
profound hypotonia and muscle weakness
symmetrical flaccid paralysis
resp distress
poor feeding
60
presentation of type 3 and 4 spinal muscular dystrophy
>18 months old
proximal muscle weakness
absent tendon reflexes
61
describe the common problems of brain injury in preterms
1. haemorrhage (20%) - due to incompletely developed cerebral blood vessels and rupture of germinal matrix. occurs within 72 hours of life
2. periventricular leukomalacia (3%) - ischaemic white matter injury, high risk of cerebral palsy
3. ventricular dilatation
62
classification of preterm
late preterm: 34- 36+6
moderately preterm: 32 - 33+6
very preterm: 28+0 - 31+6
extremely preterm: < 28 weeks
63
when does retinal blood flow develop
retinal blood growth from 28 weeks until 2-4 weeks after birth
64
risk factors for retinopathy of prematurity
1. oxygen therapy
2. < 31/40 gestation
3. birth weight < 1.5kg
65
describe retinopathy of prematurity
vascular proliferation of retina causing retinal detachment, fibrosis and blindness
66
screening for ROP
4-5 weeks post natal age + then every 2 weeks
67
management of ROP
laser therapy + intravitreal anti VEGF
68
cause of resp distress syndrome (hyaline membrane disease)
insufficient type 2 alveolar cells to produce adequate surfactant (lipoprotein)
69
when is surfactant produced
from 24 weeks gestation
maintains alveolar pressure by reducing surface tension and increases functional residual capacity
epithelium - stored in lamellar bodies in type 2 pneumocytes
70
components of surfactant
largest component = phosphatidylcholine
SP-B and SP-C
71
x ray of RDS
ground glass appearance
72
management of RDS
1. resp support - CPAP maintains end expiratory pressure
2. surfactant < 1 hour of birth - give < 34 weeks gestation via endotracheal tube
3. caffeine - increase resp drive
73
resp problems in preterm babies
1. RDS
2. pneumothorax
3. apnoea of prematurity
3. bronchopulmonary dysplasia / chronic lung disease - oxygen requirement > 37 weeks gestation/ 28 days old
4. pulmonary haemorrhage
74
RF for chronic lung disease
prolonged ventilation
high ventilation pressures
75
factors keeping PDA open
hypoxia
high blood flow
prostaglandin E2
76
management of closing PDA
1st line= ibuprofen (less side effects than indomethacin)
77
when is epidermal maturation complete by
34 weeks gestation
78
risk factors for prematurity
1. maternal age < 17 and >35 y/o
2. lower socio economic class
3. poor nutritional status, low BMI
4. substance abuse e.g. smoking, cocaine
5. previous preterm delivery
6. infections
7. chromosomal anomalies
79
when are antenatal steroids given
if impending delivery < 35 weeks gestation
betamethasone 12mg x 2 doses 24 hours apart or dexamethasone 6mg X4 12 hours apart
80
calculate minute ventilation
tidal volume x rate
determines PCO2
81
types of congenital diaphragmatic hernia
1. bochdalek hernia -> left sided
2. morgani hernia -> right sided
3. hiatus hernia
82
cause of CDH
maldevelopment of pleuroperitoneal canal
causes pulmonary hypoplasia
83
presentation of CDH
severe resp distress
displacement of heart sound / reduced breath sounds
scaphoid anterior abdomen
84
management fo CDH
1. intubate and ventilate (avoid CPAP and face mask Oxygen)
2. NG tube
3. iVF
4. surgery !!!
85
side effect of IV chloramphenicol in babies
'grey baby syndrome' - cV shcok and collapse due to reduced hepatic glutathione metabolism
86
congenital herpes simplex virus
hepatosplenomegaly
cranial USS - oedema
petechial rash and vesicular lesions
87
oxygen requirement for preterm babies
Boost II study shows sats 91-95% best for preterm babies
88
muscles of soft palate
tensor veli palatini - innervated by medial pterygoid nerve
other 4 muscles innervated by vagus nerve
