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Paediatrics > neonates > Flashcards

neonates Flashcards

1
Q

when does the cardiovascular system begin to develop

A

end of the 3rd week

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2
Q

what is the critical period of heart development from fertilisation

A

day 20-50

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3
Q

how does the foetus receive oxygenated blood

A

umbilical vein to ductus venous to IVC

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4
Q

where is foramen ovale

A

between right and left atrium

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5
Q

what is the purpose of formate ovale

A

shunt blood form RA to LA

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6
Q

where does ductus arteriosus run

A

pulmonary artery form RV to aorta

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7
Q

what are the functions of the ductus arteriosus

A

¥ Protects lungs against circulatory overload
¥ Allows the right ventricle to strengthen
¥ Carries low oxygen saturated blood

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8
Q

what are the functions of the ductus venous

A

¥ Foetal blood vessel connecting the umbilical vein to the IVC
¥ Blood flow regulated via sphincter
¥ Carries mostly oxygenated blood

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9
Q

when does the pulmonary artery open properly

A

after 1st breath

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10
Q

when does formate ovale usually close

A

9 months - 1 year

5% doesn’t close

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11
Q

what is the blood pressure of a new born baby

A

70/44

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12
Q

what is defined as tachycardia and bradycardia in neonates

A

tachycardia - >160 b/min

bradycardia - <100 b/ min

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13
Q

what is the respiratory rate of a newborn baby

A

30-60/ min

Periodical breathing – not a fixed breathing rate (count breaths over 1 min

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14
Q

what are some non invasive ways of assessing a neonates breathing

A

Blood gas determination
Normal values - PaCO2 5-6 kPa, PaO2 8-12 kPa
Trans-cutaneous pCO2/O2 measurement

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15
Q

what are some invasive ways of assessing a neonates breathing

A

Capnography
Tidal volume 4-6 ml/kg
Flow-volume loop.

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16
Q

what innervates brown fat

A

sympathetic neurones

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17
Q

what does cold stress lead to

A

lipolysis
heat production
lack of surfactant

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18
Q

what are the 4 ways heat can be lost

A

radiation
convection
evaporation
conduction

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19
Q

do newborn babies have the shivering thermogenesis

A

no

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20
Q

when does physiological jaundice usually appear and disappear

A

day 2/3 - day 7/10

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21
Q

how long ma physiological jaundice last in preterm infants

A

21 days

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22
Q

when does breast fed jaundice usually appear

A

day 30

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23
Q

why can bilirubin cause kernicterus

A

lipid soluble so can cross blood brain barrier

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24
Q

what is the treatment for jaundice in babies

A

phototherapy - blue light converts bilirubin to water soluble form so can be excreted by kidneys

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25
Q

is it normal not to pass urine in the first 24 hours of life

A

yes

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26
Q

what makes fluid balance in premature babies harder

A

less fat in body composition
loss through kidney - slow GFR, reduced Na, decreased ability to dilute urine
increased insensible water loss - immature skin/ breathing

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27
Q

what is the normal physiological IWL and what may it be in a very premature baby

A

normal 20-40 ml/ kg. day

up to 80-100 ml/ kg/ day

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28
Q

why does anaemia of prematurity occur

A

Reduced erythropoesis.
Infection
Blood letting – most important cause

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29
Q

what is classed as small for gestation

A

<2.5kg, <10th centil

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30
Q

what is the obstetric diagnosis of small for gestation

A

IUGR - intrauterine growth restriction

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31
Q

what is the difference between symmetrical and asymmetrical hypotrophy in small for gestation babies

A

symmetrical- matching small weight length and head

asymmetrical - flattening weight gain, then head growth, then length (something happened)

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32
Q

what is defined as severe IUGR

A

<0.4th centile

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33
Q

what are some maternal causes of small for gestation

A

smoking, drinking

pre-eclampsia - bad perfusion

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34
Q

what are some foetal causes of small for gestation

A

chromosomal

infection - ToRCH

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35
Q

what are some placental causes of small for gestation

A

abruption, haemorrhage, praevia

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36
Q

why does the receiver baby in twin to twin perfusion do worse

A

hypoxic as lungs begin to resist the overflow

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37
Q

what are some features of Edwards syndrome (trisomy 18)

A

CV complications, wide eyes, upturned noses, small chin, low ears, overlapping toes, clenched fist

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38
Q

why is hypoglycaemia a common neonatal problem

A

not got enough glycogen stores to increase sugar

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39
Q

why is hypothermia a common neonatal problem

A

not got brown fat

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40
Q

why is metabolic acidosis a common neonatal problem

A

reduced krebbs cycle so anaerobic respitration– lactic acidosis

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41
Q

what long term health complications are neonates more susceptible to

A
  • Hypertension
  • Reduced growth
  • Obesity
  • Ischemic heart disease
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42
Q 
what are the definitions of;
RDS
NEC
PDA
IVH
BPD
PHH 
NAS
A 
respiratory distress syndrome
necrotising entero-colitis
patent ductus arteriosus 
intra-ventricular haemorrhage
broncho-pulmonary dysplasia
post-hemorrhagic hydrocephalus 
neonatal abstinence syndrome
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43
Q

why does post-hemorrhagic hydrocephalus sometimes occur in babies

A

IVH blocks the brain drainage of CSF, dilation of ventricles pushes brain tissue and it begins to expand

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44
Q

what is the most common neonatal problem

A

respiratory distress syndrome

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45
Q

what is classed as pre term and extremely preterm

A

< 37 weeks

<28 weeks

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46
Q

what is classed as low birth weight, very low birth weight and extremely low birth weight

A

<2500g
<15000g
<1000g

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47
Q

what is classed as low birth weight, very low birth weight and extremely low birth weight

A

<2500g
<15000g
<1000g

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48
Q

how is respiratory distress syndrome prevented

A

Antenatal steroids – 2 doses 12 hours apart – stress lungs to produce surfactant (usually produced by 32 weeks), without it the alveoli will collapse

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49
Q

how is respiratory distress syndrome managed

A

N-CPAP

minimal ventilation

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50
Q

what can be given to babies with apnoea/ irregular breathing

A

caffeine

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51
Q

what things may cause broncho-pulmonary dysplasia

A 
Overstretch by volu-baro-trauma		
Atelectasis (collapse of lung)
O2 toxicity – free radicals burning tissue	
Infection via ETT	
Inflammatory changes			
Tissue repair – scarring tissue
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52
Q

how is broncho-pulmonary dysplasia treated

A

Patience with Oxygen
nutrition & growth
steroids to get off ventilator

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53
Q

what causes IVH in neonates

A

Babies have poor blood pressure regulation in brain so a drop is compensated by high perfusion which leads to a bleed and infarction

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54
Q

how does a PDA lead to systemic ischaemia

A

LR shunt - additional blood to pulmonary circulation > over-perfusion of lugs > lung oedema + steal from systemic circulation > systemic ischemia

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55
Q

what are conseqeunces of PDA

A

Worsening of respiratory symptoms
Retention of fluids- low renal perfusion
Gastrointestinal problems (GE ischaemia)

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56
Q

what is NEC

A

Ischemic and inflammatory changes lead to necrosis of bowel

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57
Q

what are some visual/ hearing problems of premature babies

A

Eyes myopic, short sighted, hearing problems

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58
Q

what is the rule of thirds in neonate outcome

A

1/3 die,
1/3 have normal life or mild disability
1/3 have moderate or severe disability for lifetime

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59
Q

what are symptoms of sepsis in neonates

A
  • asymptomatic
  • Baby pyrexia or hypothermia – not good at controlling temperature
  • Poor feeding
  • Lethargy
  • Early jaundice
  • Hypoglycaemia/ Hyperglycemia
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60
Q

what are his factors for sepsis in neonates

A
  • PROM – prolonged rupture of membranes – should be <24 hours – beyond is a sign of infection or causes infection as bacteria rides up tract
  • Maternal pyrexia
  • Maternal Group B strep carriage
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61
Q

what is the management of neonatal sepsis

A
  • Admit NNU
  • Partial septic screen (FBC, CRP, blood cultures) and blood gas
  • Consider CXR, LP (full screen)
  • IV benzyl penicillin and gentamicin 1st line
  • 2nd line iv vancomycin and gentamicin
  • Add metronidazole if surgical/abdominal concerns
  • Fluid management and treat acidosis (look for on blood gas)
  • Monitor vital signs and support respiratory and cardiovascular systems as required
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62
Q

what are the commonest cases of sepsis in neonates

A

Group B strep
E.coli
listeria
coagn- negative staphylococci, haemophilia influenza

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63
Q

what is early and late onset on strep B neonatal sepsis

A

early - birth to 1 week

late - up to 3 months

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64
Q

what is the mortality of group b strep neonatal sepsis

A

4-30%

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65
Q

what are complications of group B strep neonatal sepsis

A

Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock

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66
Q

what are the Torch congenital infection

A

toxiplasmosis
rubella
cmv
herpes

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67
Q

give reasons for common term admissions into NNU

A 
sepsis
congenintal infection
respiratory distress
cardiac murmurs
cyanosis 
hypoglycaemia
hypothermia
jaundice 
birth asphyxia
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68
Q

what are complications of congenital infections in neonates

A

IUGR, brain calcifications, neurodevelopmental delay, visual impairment, recurrent infections

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69
Q

what is the characteristic finding of congenital syphillsis

A

raw rash on soles of feet/ hands

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70
Q

why does elective caesarean cause a lot of admissions into the neonatal ward

A

no hormone release from labour so babies lungs are not prepared
no squeeze through vaginal tract which helps to remove fluid

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71
Q

what are the main causes of respiratory distress in neonates

A

sepsis
TTN - transient tachypnoea of the newborn
meconium aspiration

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72
Q

when does TTN usually present

A

first fe hours of life

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73
Q

what are clinical signs of TTN

A

Grunting, tachypnoea, oxygen requirement, normal gases

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74
Q

what is the cause of TTN

A

delay in clearance of foetal lung fluids

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75
Q

what is the management of TTN

A

Supportive, antibiotics, fluids, O2, airway support (pressure/ flow)

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76
Q

what are risk factors for meconium aspiration

A

post dates (aged placenta), maternal diabetes, maternal hypertension, difficult labour

77
Q

what are symptoms of meconium aspiration

A

cyanosis, increased work of breathing, grunting, apnoea, floppiness

78
Q

why do babies with meconium aspiration struggle to maintain oxygenation

A

V/Q mismatch as meconium occupies lung.

79
Q

how would you investigate for meconium aspiration

A

blood gas, septic screen, CXR

80
Q

what is the treatment of meconium aspiration

A

¥ Suction below cords
¥ Airway support – intubation and ventilation
¥ Fluids and antibiotics iv
¥ Surfactant – meconium deactivates normal surfactant present
¥ NO – vasodilator increases perfusion of lungs
¥ ECMO- extra corporeal membrane oxygenation – cardiopulomonary bypass

81
Q

what is a complication of meconium aspiration

A

PPH - persistant pulmonary hypertension

82
Q

what is ECMO (extra corporeal membrane oxygenation) effectively

A

cardiopulmonary bypass

83
Q

at what level of deoxyhaemoglobin does cyanosis occur

A

5g/dl

84
Q

how would you investigate cyanosis in a neonate

A
  • Examination and history
  • Sepsis screen – always in differential
  • Blood gas and blood glucose
  • CXR
  • Pulse oximetry
  • ECG/ Echo
  • hyperoxia test – give 100% oxygen – if there is a problem then the arterial and venous bloods are mixed and the baby will not reach 100% sats
85
Q

what is the differential diagnosis of cyanosis in a neonate

A 
¥	TGA – aorta and pulmonary artery switched 
¥	Tetralogy of Fallots
¥	TAPVD
¥	Hypoplastic left heart syndrome
¥	Tricuspid atresia
¥	Truncus arteriosus
¥	Pulmonary atresia
86
Q

what is the treatment of cyanosis is a newborn baby

A
  • ABC
  • Inotropes as required
  • Fluid resuscitation
  • Respiratory support – care with O2
  • Prostin – prostaglandin E2
  • Nitric oxide
  • Cardiology referral
87
Q

where can simple jaundice be treated

A

post natal ward with mother

88
Q

what are causes for neonatal failure to pass stool

A 
Constipation			
Large bowel atresia
Imperforate anus +/- fistula	
Hirschsprungs disease
Meconium ileus  - think cystic fibrosis
89
Q

what are most cases of exomphalos associated with

A

congenital anomalies (atresias, trisomies, Beckwith Wiedemann)

90
Q

why does a diaphragmatic hernia cause pulmonary hyperplasia

A

undeveloped lung from presence of intestine

91
Q

what are some causes of hypoglycaemia in infants

A

mother with DM

IUGR

92
Q

how does a diabetic mother lead to a hypoglycaemic baby

A

high glucose in maternal blood causes the foetus B cells of the pancreas to produce more insulin - baby born hyperinsuli

93
Q

what is the management of hypoglycaemia in infants

A
  • Monitor blood glucose
  • Start iv 10% glucose
  • Increase fluids
  • Increase glucose concentration (central iv access) – lines into umbilicus
  • Give Glucagon
  • If still resistant - Steroids - Hydrocortisone
94
Q

what is birth asphyxia

A

lack of oxygen at or around birth

95
Q

what are some causes pf birth asphyxia

A 
Placental problem
Long, difficult delivery – get stuck in birth canal 
Umbilical cord prolapse
Infection
Neonatal airway problem – obstructed 
Neonatal anaemia
96
Q

what is the main complication of birth asphyxia

A

Hypoxic ischemic encephalopathy

97
Q

what are the 1st and 2nd stage of birth asphyxia

A

1st - within minutes without O2, cell damage occurs with lack of blood flow and O2
2nd - Reperfusion injury, can last days or weeks, toxins are released from damaged cells

98
Q

what is the management of birth asphyxia

A

Therapeutic hypothermia (cooling)
- Fluid restriction – avoid cerebral oedema
- Treat seizures
Cardiac/ respiratory support, monitor for renal/ liver failure (monitor urine)

99
Q

how should you follow up a baby born with birth asphyxia

A

MRI at 7-10 days

100
Q

describe the postnatal energy triangle

A
  • PINK – hypoxia
  • WARM – hypothermia
  • SWEET – hypoglycaemic
101
Q

what colours may the skin be when a baby is born and what are their causes

A 
pink - normal
yellow - jaundice
white - pallor
red - plethora
blue - cyanosis
102
Q

what may cause a baby to be born red

A

polycythaemia – increased red blood cells and viscosity leads to cardiac failure as heart struggles to circulate blood. May see cardiomegaly on xray

103
Q

what is erythema toxicum

A

maculo-papular rash – red pimples with white centre all over body
30 – 70% of normal term neonates.

104
Q

how is erythema toxicum treated

A

not - facies in 1 week

105
Q

what are mongolian blue sports

A

areas of blue- grey pigmentation often on the lower back/ buttocks

106
Q

what causes mongolian blue spots

A

accumulation of melanocytes

107
Q

why is it important to document noticed mongolian but spots

A

so they are not later mistaken for bruises.

108
Q

where are capillary navei usually located

A

forehead, eyelids, occiput, neck or midline of the back.

109
Q

when do capillary nave tend to fade

A

facial - 2 years

occipital tend not to

110
Q

when would you consider treating a capillary haemangioma

A

impinging of structure eg eye

111
Q

what does a capillary nave look like

A

flat/ pink lesion

112
Q

what are milia , their cause and when do the dissapear

A

White papules on the tip of the nose - hyperplastic sebaceous glands
Caused by the effect of the transplacental hormones
disappear with desquamation.

113
Q

what are milaria

A

immature sweat gland obstruction on face, scalp trunk

114
Q

what is the difference between millaria crystallina and miliaria rubra

A 
Miliaria crystallina – superficial vesicles, . Skin not inflamed.
Miliaria rubra ("prickly heat") papules and pustules from obstruction in the mid-epidermis
115
Q

what happens to sebaceous lesions during puberty

A

Sensitive to androgens -become larger and more wart-like

116
Q

what is a risk with sebaceous naevi

A

basal cell carcinoma

117
Q

what is a capillary hemangioma

A

A cluster of dilated capillaries appears within 1st month.
Raised + bright red, discrete edges
Usually regresses after 1yr of age.

118
Q

what causes port wine stains (naves flaemmeus)

A

dilated, mature capillaries in the superficial dermis

119
Q

what is the cause of cafe au lait sports

A

increased melanin in melanocytes

120
Q

what disease should you think about if a baby is born with >6 cafe au lait spots

A

neurofibromatosis

121
Q

what 2 things lead to the unconjugated hyperbilirubinaemia that is seen in physiological jaundice in neonates

A

increased red cell breakdown and immaturity of the hepatic enzymes

122
Q

is onset of jaundice in the first 24 hours normal

A

no

123
Q

why is recognition and treatment of severe neonatal unconjugated hyperbilirubinaemia so important

A

avoid bilirubin encephalopathy or kernicterus (brain damage due to deposition of bilirubin in the basal ganglia).

124
Q

what are some causes of unconjugated jaundice in the first 24 hours

A

Haemolytic - G6PD , Rhesus incompatibility, ABO incompatibilty, hereditary anaemia
TORCH (congenital infection

125
Q

what are some causes of unconjugated jaundice from the 2nd day - 3rd weeks

A 
¥	Physiological ( gone after 1st wk )
¥	Breast milk
¥	Sepsis
¥	Polycythaemia
¥	Cephalhaematoma – big lump on head 
¥	Crigler-Najjar Syndrome
Haemolytic disorders
126
Q

what are some causes of unconjugated jaundice after the 3rd week

A

¥ Hypothyroidism
¥ Pyloric stenosis
¥ Cholestasis

127
Q

when is surgery for biliary atresia most successful

A

< 6 weeks

128
Q

how would you investigate jaundice in a neonate

A
  • Bilirubinometer
  • Split Bilirubin (+ conjugated fraction)
  • FBC/ Blood film – coomb’s test
129
Q

how would you treat jaundice in a neonate

A
  • Treat underlying cause
  • Hydrate
  • Phototherapy – NICE guideline charts
  • Exchange transfusion (remove bilirubin)
    Immunoglobulin
130
Q

what is the first phase of bilirubin encephalopathy

A

first few days of life, decreased alertness, hypotonia, decreased feeding

131
Q

what is the 2nd phase of bilirubin encephalopathy

A

variable onset and duration, hypertonia of extensor muscles, retrocolis, opisthotonus

132
Q

what is the 3rd phase of bilirubin encephalopathy

A

infants > 1 week of age, hypotonia

133
Q

what babies are at risk of hypoglycaemia and why

A

Limited glucose supply - Premature babies, Perinatal stress
Hyperinsulinism - diabetic mothers
Increased glucose utilisation- Small and large for gestational age, Hypothermia, Sepsis

134
Q

what are symptoms of hypoglycaemia in neonates (unspecific)

A 
Jitteriness				Hypothermia
 Temperature instability			Lethargy
 Hypotonia – floppy 			Apnoea, irregular respirations
Poor suck / feeding			Vomiting
High pitched or weak cry			Seizures
Asymptomatic
135
Q

what is hypoglycaemia in a neonate defined as

A

blood sugar <2.6mmol/l

136
Q

when can bedside blood sugar measurement be inaccurate

A

At low or high levels
When there is poor perfusion – cold limbs when born
When there is polycythaemia

137
Q

what babies are most vulnerable to hypothermia

A

low birth weight

babies requiring prolonged resuscitation

138
Q

how is heat lost by conduction

A

from the body surface to cooler surface in direct contact e.g. cold towels, mattress

139
Q

how is heat lost by convection

A

from body surface to cooler air e.g. draughts through open windows, fans

140
Q

how is heat lost by evaporation

A

when liquid is converted to vapour e.g. wet skin, wet nappy

141
Q

how is heat lost by radiation

A

cooler solid surface that is not in direct contact put in close proximity to the body e.g. cot sides

142
Q

how is hypothermia in a neonate managed

A
  • Dry quickly
  • Remove wet linens
  • Use warm towels/blankets
  • Provide radiant warmer heat
  • Use heated/humidified oxygen
    Move away from drafts
143
Q

what is a tongue tie

A

short/ thick frenulum attached anteriorly to the base of the tongue

144
Q

what is the management if a tongue tie is affecting feeding

A

frenotomy

145
Q

how would judge that a baby is using increased effort to breath

A

grunting noises
retractions
nasal flaring

146
Q

what are retractions when breathing

A

region around the chest where the skin indraws

substernal/ subcostal/ intercosta/ suprasternal

147
Q

what would you evaluate about a baby with respiratory distress

A

respiratory rate
signs of increased effort
colour of baby
oxygen saturations

148
Q

what are some biological causes of airway obstruction in neonates

A

laryngomalacia - floppy larynx
tracheomalacia - floppy tracheal
bronchomalacia - weak bronchial cartilage

149
Q

how would you investigate a baby with a murmur

A

Check Colour, perfusion, respiratory status
Murmur location, type, radiation
Investigate - Oxygen saturation, 4 limb BP, CXR, Echo

150
Q

what 4 investigations are done to investigate a murmur in neonates

A

oxygen sats
4 limb BP
CXR
echo

151
Q

what is canal atresia

A

nasal obstruction
Baby is cyanotic at rest, “pinks up” with crying
If bilateral may need oral airway or endotracheal intubation

152
Q

what is pierre robin sequences

A

Very small jaw with tongue obstruction and possible cleft palate
Place prone to move the tongue forward

153
Q

what should you always check in an ophthalmology screening

A

red reflexes

154
Q

what causes a cleft palate

A

2 plates of the skull forming the hard palate (Maxillary and medial nasal) processes fail to merge by 9 weeks gestation, can occur after lip closure.

155
Q

what is the difference between a complete and incomplete cleft palate

A

incomplete - small gap in lip

complete - continue into nose

156
Q

how does retinoblastoma present clinically

A

leukocoria (white pupillary reflex), strabismus, red eye and reduced vision.

157
Q

what percentage of retinoblastoma are bilateral

A

30%

present earlier than unilateral (8 vs 28 months)

158
Q

what genetic mutation is associated with retinoblastoma

A

deletions on chromosome 13q14

159
Q

what are some dysmorphsim features of trisomy 21

A

Low set ears, downward slanting palpebral fissures, flat facial profile, epicanthic folds, single palmar creases, wide sandal gap

160
Q

what are the main features of trisomy 21

A 
dysmorphic features
hypotonia 
cardiac defects
learning difficulties
thyroid problems
161
Q

what is talipes

A

Medial (varus) or lateral (valgus) deviation of the foot

162
Q

what is the treatment for most talipes

A

physiotherapy – muscle strengthening re-alligns feet.

163
Q

what is the treatment of fixed talipes

A

vigorous manipulation, strapping, casting or possibly surgery

164
Q

what are risk factors for DDH

A 
Breech > 36 weeks		First degree relative with DDH 
Multiple birth		
Female
1st child		
 Large birth weight
165
Q

how would you examine a baby for DDG

A 
Leg length
General movement of the legs 
Groin creases – inguinal skin folds 
Ortolani test/ Barlow test
Ultrasound
166
Q

what is the management of DDH

A

Relocate head of femur to acetabulum so hip develops normally
Pavlik harmess – enhance relocation
Surgical reduction

167
Q

what is given when renal pelvis dilation is found antenatally

A

prophylactic antibiotics

prevent renal damage form vesicle-ureteric reflux

168
Q

what is a mucosa skin tag

A

A fold or continuation of the mucosa from the vaginal wall is often seen in newborn girls.It shrinks and disappears in the first week

169
Q

why is it normal to have vaginal bleeding in the 1st week

A

pseudomenstruation - withdrawal of maternal hormones

170
Q

what is classed as a microphonic

A

<2.5cm

171
Q

what is hypospadias

A

proximally displaced urethral meatus
a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum

172
Q

what is the difference between the different degrees of hypospadias

A

1st degree - the urethral meatus opens on the underside of the glans penis in about 50–75% of cases
2nd.degree – the urethra opens on the shaft in 20% of cases
3rd degree - the urethra opens on the perineum occur in 30% of cases

173
Q

what is chordee

A

ventral curvature of the penis

174
Q

how long must testicular torsion be treated in

A

6 hours

175
Q

can hydroceles or inguinal hernias be reduced?

A

inguinal hernias

hydrocoeles cannot be reduced as the fluid is in an enclosed space

176
Q

what would assist you in making the diagnosis of a hydrocele

A

transillumination

177
Q

what signs would point you to a male sex if you weren’t sure

A

bilateral non-palpable testes in full term newborn
Separation of the scrotal sacs with hypospadius.
hypospadius concomitant with undescended testicle

178
Q

what signs would point you to a female sex if you weren’t sure

A

clitoral hypertrophy
foreshortened vulva with a single opening
inguinal hernia containing a solid mass ( likely to be a gonad)

179
Q

how would you investigate the sex of a baby with ambitious genitalia

A

o Serum electrolytes and glucose (may need to repeat daily)
o Chromosome analysis - phenotype more important than genotype
o Pelvic/abdominal ultrasound scan to determine pelvic structures and the presence or absence of gonads.
o 17-hydroxyprogesterone
Serum for Testosterone

180
Q

what spinal dimples would you investigate with US and MRI

A

If the dimple is large, red, swollen, off midline ,higher than sacral area, pigmented, tender or accompanied by fluid

181
Q

what is a cephalohaematoma

A

Localised swelling over one or both sides of the head becomes maximal in size by the 3rd to 4th day of life
Soft, non translucent swelling

182
Q

what cranial bone is commonly affected by cephalohaematomas

A

parietal

183
Q

are cephalohaematomsas dangerous

A

no normally fade in 3- 4 weeks

184
Q

what is caput succedaneum and what causes it

A

scalp swelling over midline - serosanguinous, subcutaneous fluid collection with poorly defined margins
caused by the pressure of the presenting part of the scalp against the dilating cervix during delivery – vaginal opening too narrow, sutures overlap to decrease in size
resolves

185
Q

what is the most common neonatal peripheral nerve injury

A

unilateral facial nerve palsy - from direct trauma from forceps or from compression of the nerve against the sacral promontory while the head is in the birth canal

186
Q

what are signs of a birth peripheral nerve injury

A

decreased facial movement and forehead wrinkling on the side of the palsy, eyelid elevation, and flattening of the nasolabial folds and corner of the mouth
crying accentuates the findings

187
Q

how would you differentiate a facial palsy form an asymmetric crying facies

A

the eye and forehead muscles are unaffected

188
Q

what causes an asymmetric crying facies

A

congenital deficiency or absence of the depressor anguli oris muscle which controls the downward motion of the lip

189
Q

what side of the mouth is most commonly affected in asymmetric crying facies

A

left

Paediatrics (3 decks)

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