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Neonates Flashcards

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1
Q

Define term? Preterm? Neonate?

A

T- birth at 37-42 weeks gestation
P- birth before 37 weeks
Neonatal period - first month of life

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2
Q

Diabetes mellitus effect on fetus?

A

Congenital malformations - 3x more esp cardiac

Macrosomia- fetal insulin response to hyperglycaemia promotes excessive growth

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3
Q

Maternal Diabetes mellitus effect on neonate

A

Hypoglycaemia - transient due to increased insulin (avoid with early feeding)
Respiratory distress syndrome
Polycythaemia (haematocrit >0.65)

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4
Q

Which antiepileptic have effect on fetus? What is the effect ?

A

carbamazepine, valproate, phenytoin.

Mid facial hypoplasia; CNS, limb & cardiac malformations

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5
Q

Which drug used in blood has an effect on fetus and what does it do?

A

Warfarin

Interferes with cartilage formation; cerebral haemorrhages & microcephaly

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6
Q

What are the effects of amiodarone on the fetus

A

Hypothyroidism

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7
Q

Use of iodines/ propylthiouracil in pregnancy on fetus?

A

Goitre / hypothyroidism

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8
Q

Effect of lithium in pregnancy

A

Congenital heart disease

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9
Q

Use of tetracyclines in pregnancy

A

Enamel hypoplasia of the teeth

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10
Q

ACEi in pregnancy

A

Host of things including renal agenesis, CHD…..

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11
Q

Effect of alcohol on fetus

A

Growth restriction, characteristic face, cardiac defects, developmental delay

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12
Q

What are the characteristic facial features of fetal alcohol syndrome

A

Low nasal bridge, epicanthal folds, short palperbral fissure, flat mid face, short nose, indistinct philtrum, micrognathia

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13
Q

Smoking risks to fetus

A

Miscarriage & stillbirth, low birth weight, IUGR

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14
Q

Opiates effect on fetus

A

Prematurity, neonatal withdrawal, IUGR

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15
Q

Cocaine effect on fetus

A

Small placenta, prematurity, cerebral infarction, spontaneous abortion

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16
Q

Egs of congential infections causing issues

A

Rubella, cytomegalovirus, toxoplasmosis, varicella zoster, HIV

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17
Q

Effects of maternal rubella infection at different stages of pregancy

A

Before 8/40 - deafness, cardiac malformations, cataracts
13-16/40 - hearing impairment
>18/40 - minimal

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18
Q

Usual effect of CMV in pregancy

A

90% born normal

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19
Q

What are the clinical features if baby is affected by maternal CMV infection during pregnancy

A

Hepatosplenomegaly & petichae at birth

Neurodevelopmental problems - sensorineural deafness, CP, epilepsy, cognitive impairment

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20
Q

What type of organism causes toxoplasmosis? What are the effects on fetus ? Where is it found?

A

Protozoan (toxoplasma gandis)
Hydrocephalus; intracranial calcification; clorioretinitis; neurological damage.
Raw/undercooked meat, infected cat feaces

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21
Q

Usual effect on fetus with varicella zoster?

A

Unaffected

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22
Q

What can happen to fetus with maternal varicella zoster infection? What is the treatment ?

A

Congenital varicella syndrome - skin lesions, malformed digits, cataracts, CNS damage, chlorioretinitis

Varicella zoster immune globulin (VZIG) in susceptible women

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23
Q

What is the risk of transmission of HIV from mother to fetus? How is this minimised ?

A

1%

Zidovudine to mother in pregancy & labour & neonate for first 6/52 of life

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24
Q

Egs of drugs and fluids used in labour and effects on fetus

A

IV fluids - hyponatraemia in neonate
Analgesia (opioids) - respiratory suppression at birth
Sedatives (eg diazepam) - sedation, hypothermia, hypotension

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25
What is the scoring system used at birth to make sure fetus is ok? What are the parts?
Apgar score Heart rate, respiratory effort, muscle tone, reflex response to stimulation (crying), colour (blue/just- extremities, pink) All score 0,1 or 2 (2 is best )
26
What do you do if baby is not breathing / there is a poor respiratory effort? What if there is no improvement?
Stimulate, open and clear airway - bag and mask No improvement + HR
27
Egs of benign lesions in newborn
Neonatal urticaria (erytherma toxicum) Miliaria Mangolian blue spots Positional talipes
28
What is neonatal urticaria
Common rash at 2-3/7 *white, pin point papules at centre of erythermatous base* (Fluid contains eosinophils; lesions concentrated on trunk but can come and go all over)
29
What are miliaria
White pimples on the nose and cheeks from retention of keratin and sebaceous material
30
What are Mongolian blue spots ? Who are they found in usually?
Blue / black macular discolouration at lower spine / buttocks Asian / Afro Caribbean
31
What are positional talipes
Unlike true talipes equinovarus, the foot can be fully dorsiflexed to touch shin (just due to positioning in womb)
32
What are the two categories (and egs) for causes of IUGR
Intrinsic fetal problem - *chromosomal disorders, congenital infections, small normal fetus* Placental insufficiency (asymmetrical small growth - *brain sparring effect*) - pre eclampsia, multiple pregancy, sickle cell disease
33
Where can a fetus bleed / Bruise due to birth injuries ? What are they called ? How to differentiate ?
Look at image for help / card 136 Caput succadaneum - brusing/ odema over presenting part (Extends OVER skull margins) Cephal haematoma - subperiosteal haematoma (Doenst cross skull margins) Subaponeurotic haemorrhage - diffuse swelling of scalp with ++ blood loss (rare)
34
Egs of nerve palsy coming from brachial plexus ? What causes these palsys
Erb's, Klumpke's Damage due to traction of nerve roots from breech presentation / shoulder dystocia
35
Which nerve roots affected in Erb's palsy? Features?
Upper never roots *C5/6* | Straight arm with hand pronated and fingers flexed (*"waiters tip"*)
36
Which nerve roots are affected in Klumpke's palsy ? Features?
Lower nerve root damage *c8/t1* | Supinated forearm with wrists and fingers flexed "claw hand"
37
What causes facial nerve palsy? What are the features
Foceps or pressing against ischial spine of mother | Unilateral facial weakness
38
Prognosis of nerve palsys
90% resolve in 2 years
39
Causes of respiratory distress syndrome
SURFACTANT DEFICIENCY, hyaline membrane disease
40
What does surfactant do
Lowers alveolar surface tension & prevents collapse on expiration
41
Who commonly gets RDS
Infants born before 28 weeks
42
Features of RDS
Tachypnea (
43
What investigation can be done in RDS? What does it shoe?
Chest X-ray - defuse granular "*ground glass*" appearance
44
Management of lack of surfactant -> RDS
Before birth - glucocorticoids -> stimulate surfactant production After birth - surfactant therapy, oxygen (+/- CPAP intubation)
45
What does CPAP intubation stand for
Continuous positive airway pressure
46
Complications of intubation for RDS
Pneumothorax - increased WOB, decreased breath sounds & movement on affected side, transilluminates
47
Treatment of pneumothorax
Chest drain and try to avoid by ventilating with lowest pressures possible
48
Who commonly gets apnoea attacks ? How long do they last? What is the cause ? Predisposing factors?
Very low birthweight (
49
Treatment for apnea attacks ? If they are frequent?
Breathing usually restarts with *physical stimulation * | Freq with no underlying cause - *oral caffine* (+CPAP if severe)
50
How does caffeine work ?
Phosphodiesterase inhibitor
51
Who commonly gets PDA? Features? Treatment?
Preterm esp. With RDS Bounding pulse, hyper dynamic precordium + systolic murmur Usually closes spontaneously but prostaglandin inhibitors (eg ibuprofen ) if it doesn't
52
What is necrotising enterocolitis (NEC) ? Risk factors?
Necrosis of bowel secondary to infection & ischemia. | Rapid oral feeding with cows milk formula; prematurity; asphyxia; PDA
53
What are the features of NEC
Distended abdomen, vomiting (can be bilious), bloody stools
54
What's seen on abdo X-ray of NEC ?
Distended loops of bowel with mural thickening and intramural gas
55
Initial Treatment for NEC ? What can be done for necrosed segment?
Stop oral feeds, gastric aspiration & parenteral nutrition (TPN) Broad spectrum Abx - *penicillin, gentamicin & metronidazole* Ventilation & circulatory support often required Surgical resection
56
When does the suck reflex develop?
32-34/40
57
Where does intracranial haemorrhage usually occur ? What is the effect?
Germinal matrix / ventricles Small - no sequale Large - risk of cerebral palsy
58
What can happen with a large ventricular haemorrhage
Decrease CSF absorption -> hydrocephalus
59
What are the causes of periventricular white matter injury ? How can it be seen?
Follow ischemia / inflammation (with/out haemorrhage) | Appear as 'flare' of echo density in brain parenchyma on cranial USS
60
What is it called if there is multiple bilateral cysts on the periventricular white matter? What is this a risk for?
*periventricular leukomalacia* | 80% risk of spastic diplegia
61
Risk factors for intracranial haemorrhage / periventricular White matter injury? What is important here?
Pneumothorax, asphyxia, hypotension, hypoxia They are all complications of RDS
62
What is retinopathy of prematurity also called? What is it? What can it lead to? What are the risk factors?
Retrolentral fibroplasia - disease of blood vessels at junction of vascular & non-vascular retina -> vascular proliferation -> retinal detachment, fibrosis & blindness. *hyperoxia (PaO2 > 12kPa)*; ver low birth weight;
63
What is chronic lung disease of prematurity also called? What is it?
Bronchiopulmonary dysplasia - *oxygen requirement beyond 36/40* (or 28 days old if that occurs first)
64
What causes BPD
Pressure and volume trauma from *artificial ventilation, oxygen toxicity & infection*
65
Treatment of BPD ? Risk of with this?
Continued respiratory support + corticosteroids (dexamethasone) to try and wean off Neurodevelopmental problems
66
What's seen on chest X-ray of BPD
Widespread opaque often with cystic changes
67
What concentration of serum bilirubin to appear jaundiced ?
Over 80-120umol/L
68
If there is jaundice in first 24 hours of life what type of bilirubin is it? Due to? Egs?
Always pathological - unconjugated usually due to *haemolysis* 1 - haemolytic disease of the newborn - Rh / ABO incompatibility 2- intrinsic RBC defects: sphereocytosis, G6PD deficiency
69
When do you get Rh incompatibility
Rh -ve mother with Rh +ve baby
70
When do you get ABO incompatibility with baby? What does this cause ?
Group O mother with group A (sometimes B) baby | Competitively weak anti-A (or B) haemolysins -> mild anaemia, no organomegally, weakly +ve Coombs test
71
Jaundice at 2days - 3 weeks causes? Type of bilirubin ?
Infection (esp UTI) 'Breast milk' jaundice Physiological - diagnosis of exclusion Unconjugated
72
When does the term 'persistent neonatal jaundice' get used? What is the usual type of bilirubin?
Over 3 weeks Unconjugated Can tell conjugated as *dark urine & pale stools*, hepatomegally & poor weight gain may be present
73
Causes of conjugated bilirubaemia at over 3 weeks ?
Neonatal hepatitis syndrome | *biliary atresia*
74
Which bilirubin can cross the brain and cause kernicterus ?
Unconjugated
75
Management of neonatal jaundice ? Indications for more aggressive option?
Phototherapy - light in blue/green band breaks down unconjugated bilirubin Exchange transfusion - indicated if bilirubin +++, associated anaemia or if serum albumin is low
76
What wavelength of blue/green light
450nm
77
What are the long term risk of neonatal jaundice
*dyskinetic CP, sensorineural deafness, learning difficulties*
78
Egs of respiratory distress / causes in term infants
Transient tachypnea of newborn Meconium aspiration Diaphragmatic hernia Persistent pulmonary hypertension of the newborn
79
What causes transient tachypnea of the newborn? What's seen on chest X-ray? Treatment and prognosis?
Delay in reabsorbtion of the fetal lung fluid (more common in c-section) Prominent pulmonary vasculature with fluid in horizontal fissure Additional oxygen if required - can take several days to resolve
80
When do you get meconium aspiration ? What happens ?
Fetal distress -> meconium being passed into amniotic fluid and inhaled by infant. Lungs are overinflated with patches of collapse and consolidation
81
What happens in a diaphragmatic hernia? When is it usually diagnosed? What's seen on X-ray ? Treatment?
Abdo contents enter through hole in diaphragm (usually on left side) Antenatal USS Mediastinum shifted to right Surgery
82
What is persistent pulmonary hypertension of newborn? What is it also called?
Persistent fetal circulation | Failure of fetal circulation to switch to normal (less to lungs)
83
What often occurs with persistent fetal circulation?
Birth asphyxia, RDS, meconium aspiration, septicaemia
84
What happens in persistent fetal circulation
Increased pulmonary vascular resistance leads to R->L shunting and sever cyanosis
85
What's seen on chest X-ray of persistency fetal circulation ?
Heart normal size, pulmonary oligaemia (decreased blood flow)
86
Why is an echo done in persistent fetal circulation
To exclude CHD
87
Treatment of persistent fetal circulation
Assisted ventilation Inhaled nitric oxide (vasodilation) Sidenafil (viagra)
88
2 craniofacial abnormalities needing surgery?
Cleft lip/palate | Pierre-robin sequence
89
What happens in Pierre robin sequence?
Micrognathia (small jaw); posterior displacement of tongue; midline cleft/soft palate
90
What often occurs with oesophageal atresia ? What are the features if not diagnosed at birth
TOF & polyhydroaminos | Persistent salivation & drooling with coughing / choking & cyanotic episodes (esp after feeding)
91
What's common with oesophageal atresia ?
50% have other malformations *VACTERL association* | Vertebral, Anorectal, Cardiac, TracheoEsophageal, Renal & Limb
92
What is exomphalos
Abdo contents protude through umbilicus covered in transparent sac formed by amniotic membrane and peritoneum
93
What is gastroschisis
Bowel protrudes through anterior abdo wall adjacent to umbilicus with no covering sac
94
Treatment for exomphalos / gastroschisis?
Wrap in cling film to decrease fluid and head loss | Supportive therapy and surgery may be needed

Peadiatrics (14 decks)

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