Neonates Flashcards
(158 cards)
1
Q
What problem can prems get with their eyes?
A
Retinopathy of prematurity
2
Q
what problem can prems get with their bones?
A
osteopenia of prematurity
3
Q
what problems can prems get with their lungs? (x3)
A
Respiratory Distress Syndrome
Pneumothorax
Bronchopulmonary Dysplasia
4
Q
what problem can prems get with their heart?
A
PDA = patent ductus arteriosis
5
Q
what problems can prems get with their metabolism?
A
hypocalcaemia and general electrolyte imbalance
6
Q
what problem can prems get with their liver
A
jaundice
7
Q
what problem can prems get with their blood?
A
anaemia of prematurity
8
Q
how much does a baby weight to class as ‘very low birth weight’ (VLBW)
A
<1500g
9
Q
what is a baby weighing under <1000g called
A
‘extremely low birth weight’
<750g = incredibly low birth weight
10
Q
what range do you aim to keep O2 sats within for prems? why?
A
91-95%
under 91% = risk of NEC
over 95% = risk of retinopathy
11
Q
give me two key reasons why prems have lung problems
A
- not enough alveoli yet
- not enough surfactant yet
(so atelectasis)
so decreased gas exchange
12
Q
what do you give to the mother to prevent resp distress syndrome in prems?
A
glucocorticoid
stims surfactant prod
13
Q
Resp Distress Syndrome causes tachypnoea >60, laboured breathing, recession, nasal flaring, and WHAT SOUND on expiration?
A
expiratory grunting
14
Q
What does CXR show in Resp Distress Syndrome?
A
ground glass
air bronchogram
15
Q
what is air bronchogram on a CXR and when do u see it?
A
pattern of air-filled bronchi on background of airless lung
Resp Distress Syndrome
16
Q
what is a sign that Resp Distress Syndrome has got really severe?
A
cyanosis
17
Q
what is the treatment for Resp Distress Syndrome in prematurity?
A
surfactant therapy
+/- CPAP/ high flow o2 / mech vent
18
Q
A chronic lung disease of prematurity. What’s it called?
A
Bronchopulmonary Dysplasia
19
Q
What is the main complication of Resp Distress Syndrome?
A
persistent pulmonary hypertension of newborn
20
Q
If a prem needs 02 at term (past 36wks), this is…
A
Bronchopulmonary Dysplasia
21
Q
What causes bronchopulmonary dysplasia in prems ?
A
failure of alveolarisation :(
barotrauma from mech vent
wean them onto CPAP/nasal o2. Go home on o2.
22
Q
In Resp Distress Syndrome, sometimes alveoli get overdistended, letting air into the pleural cavity. What’s this called?
A
Pneumothorax!
23
Q
How do you investigate suspected pneumothorax in a prem?
A
transillumination of chest wall with fibre optic light!
CXR
24
Q
Pneumothorax in prems can cause decreased breath sounds and decreased chest movements on affected side. What is the treatment of a tension pneumothorax?
A
chest drain
25
Why do apnoea and bradycardia occur in prems?
brainstem not fully myelinated
26
Sometimes prems stop breathing for 20-30 seconds. What's this called?
apnoea and bradycardia (brainstem problem)
27
What investigation for interventricular haemorrhage in prem?
cranial ultrasound
28
Interventricular haemorrhage in prem can lead to what two sever consequences?
1. hydrocephalus--> cerebral palsy
| 2. infarction --> hemiplegia
29
Periventricular leukomalacia = loss of white matter in prems. Cranial ultrasound show?
multiple bilateral cysts
can lead to spastic diplegia
30
Give me three reasons why prems are vulnerable to hypothermia
1. large surface area
2. thin skin
3. less subcutaneous fat
31
Which problem in premature neonates is caused by HYPEROXIC insult?
Retinopathy
| vascular proliferation --> fibrosis --> blindness in some cases
32
Retinopathy of prematurity leads to loss of which reflex?
red reflex
33
What is the treatment for retinopathy of prematurity
laser therapy
34
ischaemia and bacterial invasion of the bowel in prems. What's this?
necrotizing enterocolitis (NEC)
35
What are the three key symptoms of necrotizing enterocolitis?
1. Distended Abdo
2. Bilious Vomit
3. Feed Intolerance
36
Two bad consequences of necrotizing enterocolitis
shock
| perforation
37
What does AXR show in necrotizing enterocolitis?
intramural gas (distended abdo)
38
What is the treatment for necrotizing enterocolitis?
STOP ORAL FEEDING!
| total parenteral nutrition (TPN)
39
Why are prems at particular risk of infection and sepsis?
- IgG doesnt go across placenta until Last Trimester!
- Mum might have had premature labour due to infection
- Nosocomial from mech vent / cath!
40
Neonatal jaundice is very common. Even more so in prems. At what bilirubin level is neonatal jaundice clinically visible?
80 umol/L
41
Two causes of jaundice <24hrs of age
```
haemolytic disorders (e.g. rhesus disease)
congenital infections
```
42
Two causes of jaundice >24hrs-2wks of age
physiological jaundice of the newborn
| breastmilk jaundice
43
Why does physiological jaundice of the newborn happen? Three reasons, you can get em :)
1. high Hb conc at birth
2. newborn rbc 70 day lifespan (instead of 120)
3. bili metab less effective in first days
44
4 factors exacerbating jaundice between 24hrs-2wks...
infection
dehydration
bruising
polycythaemia
45
How to investigate jaundice of the newborn
transcutaneous bilirubin meter
serial serum bilirubins - plot on chart
split bili - to see if conjugated.
46
what is the usual treatment for neonatal jaundice?
correct dehydration, start Abx (sepsis risk)
if serial bilis meet threshold:
PHOTOTHERAPY
47
if serial bilirubins climbing dangerously high in neonatal jaundice, how do you treat?
EXCHANGE TRANSFUSION
48
in jaundice >2weeks of age, this may be because of conjugated or unconjugated bilirubin. Give me two causes of high unconjugated?
hypothyroidism
infection (esp UTI)
or just prolonged breastmilk / physiological >2wks
49
In jaundice >2wks of age, with high CONJUGATED bilirubin, what are the two key causes?
BILIARY ATRESIA
| NEONATAL HEPATITIS
50
4 week old baby with pale stools + dark urine, hepatomegaly and growth faltering. Conjugated bilirubin is high. What are the two likely diagnosis?
Biliary atresia
| Neonatal hepatitis
51
Bile ducts narrowed / blocked / absent. What's this?
biliary atresia
52
What is the treatment for neonatal biliary atresia?
Kasai hepatoporoenterostomy
53
What causes neonatal hepatitis, apart from congenital infection of hepatitis?
Inborn errors of metabolism
a-1 anti-trypsin deficiency
cystic fibrosis
54
Unconjugated bilirubin deposits in basal ganglia and brainstem nuclei.... causing encephalopathy. What's this?
Kernicterus.
55
Why is it UNconjugated bili deposits that cause kernicterus?
fat-sol -- cross blood brain barrier
56
Neonate with lethargy, and poor feeding goes on to have opisthotonos, seizures and coma. What comes to mind?
kernicterus
57
Try your best to give me three complications of kernicterus.
dyskinetic cerebral palsy
learning difficulties
sensorineural deafness
58
premature babies are usually fed with TPN. whats this
total parenteral nutrition
59
why do you not build up feeds too quickly in prems?
risk of NEC
60
What would you give for pulmonary hypertension in newborn?
sildenafil
61
Give me four complications of intubation of premature babies. (Acronym: DOPE)
Displaced tube
Obstructed tube
Pneumothorax
Equipment problem
62
What is often one of the first clinical signs of neonatal jaundice
YELLOW SCLERAE
63
If a newborn has jaundice with pale stools and dark urine, what should you be worried about?
Biliary atresia
64
What is biliary atresia
Bile ducts narrowed / blocked / absent.
65
How do you investigate biliary atresia?
radio-isotope scan, then liver biopsy
66
What kind of cerebral palsy can kernicterus result in?
dyskinetic cerebral palsy
67
Albert is a 10 day old neonate. He has just his heelprick bloodspot (biochemical screening). The lab phone up to say is TSH is very high. What's the problem?
high TSH = congenital hypothyroidism
| bc high TSH means not enough T4
68
What is the average birthweight ?
3.5kg (7.7 lbs)
69
What is the normal range for birth weight?
2.7 - 4.1kg
70
What counts as low birth weight?
<2.5kg
71
What counts as high birth weight?
>4kg
72
What is the commonest cause of congenital hypothyroidism WORLDWIDE?
iodine deficiency
73
What are the commonest causes of congenital hypothyroidism IN THE UK? (x2)
- maldescent of thyroid
| - athyrosis
74
What is maldescent of the thyroid? (cause of congenital hypothyroidism)
the thyroid stays sublingual - at the base of the tongue!
75
What is athyrosis? (cause of congenital hypothyroidism)
the thyroid fails to develop
76
What is the commonest cause of congenital hypothyroidism in CONSANGUINEOUS COUPLES?
dyshormonogenesis (error of T3/4 synthesis)
77
Congenital hypothyroidism is usually asymptomatic or picked up neonatal biochemical screening. If symptomatic, it can present with.... (x7) (in order from head to toe)
- delayed development
- growth problems
- coarse facies
- hoarse cry
- feeding problems
- constipation
- prolonged jaundice >2wks
78
What is treatment for congenital hypothyroidism?
oral thyroxine lifelong!!
79
Newborn screening consists of three main screens...
newborn BloodSpot
newborn hearing screening
6-8wk baby check
80
How many conditions screened for in newborn BloodSpot (Guthrie)?
9
81
What conditions are screened for in newborn BloodSpot?
sickle cell
CF
congenital hypothyroidism
6 x inherited metabolic disorders
82
Give 2 examples of the 6 inherited metabolic disorders screened for in newborn BloodSpot.
phenylketonuria
maple syrup disease
homocysteniuria
MCADD
83
For newborn BloodSpot, heel prick blood test is done at 5days old. If positive, what do you do?
repeat.
| refer to specialist.
84
You do baby check (NIPE) at ____ and then again at 6-8wks.
72hrs
85
What do you check in 6-8wk baby check?
eye
heart
hips
testes
86
6-8wk baby check: what do u check in eyes
cataracts
87
6-8wk baby check: what do u check in testes
undescended
88
When do u do newborn hearing screening?
before leave hosp
89
what's the special name for newborn hearing screening
automated otoautoacoustic emission
90
If newborn hearing screening positive, what next
refer for audiology assessment
91
How common is sickle cell?
1 in 2000
92
How common is CF?
1 in 2500
93
How common is congenital hyopthyroid?
1 in 3000
94
Normal physiology of thyroid hormones after birth?
not much thyroxine transferred from mum to foetus. foetus makes inactive T3
after birth, surge in TSH and T3/4, which normalises within a week
95
What counts as early onset neonatal sepsis?
<48hrs after birth
96
What counts as late onset neonatal sepsis?
>48hrs after birth
97
Give me a key cause of late onset neonatal sepsis.
staph epidermidis
| often from indwelling cath, parenteral nutrition
98
Give me some examples of when early onset neonatal sepsis is caused by bac ascending via birth canal, infecting foetus VIA AMNIOTIC FLUID.
prolonged ROM, chorioamnionitis
99
Give me some examples of when early onset neonatal sepsis is caused by infection VIA PLACENTA.
congenital viral or Listeria monocytogenes
100
Give four causes of early onset neonatal sepsis.
prolonged ROM, chorioamnionitis
| congenital viral or Listeria monocytogenes
101
What is treatment for early onset neonatal sepsis?
BenPen or gentamycin
102
What is treatment for late onset neonatal sepsis?
flucloxacillin or gentamycin
103
What antibiotic is good for staph epidermidis
vancomycin
104
Broad spec Abx for late onset neonatal sepsis if fluclox/gentamycin don't work?
meropenem
105
Why do you repeat CRPs in early onset neonatal sepsis?
takes 12-24hrs to rise - repeat CRP
106
What grams does gentamycin get?
gram negatives
107
Prolonged Abx for neonatal sepsis can cause....
candida
108
Give me some non-specific clinical features of neonatal sepsis...
```
temp instability (fever --- hypothermia)
resp distress
poor feeding
vomiting
irritability, lethargy
seizures
jaundice,
hyper/hypoglycaemia
```
109
Investigations for neonatal sepsis
FBC
CRP
cultures - if pos, LP
CXR
110
3 serious sequalae of neonatal meningitis.
cerebral abscess
hydrocephalus
hearing loss
111
2 signs of neonatal meningitis
bulging fontanelle
| opisthotonos
112
Treatment for neonatal meningitis?
IV cefotaxime
113
Does GBS cause early or late onset neonatal sepsis?
both!
114
What percent of women are carriers of GBS?
20%
115
<48hrs of birth, how does GBS present?
early - resp distress and pneumonia - sepsis
116
>48hrs of birth, how does GBS present?
late - meningitis!
| occasionally osteomyelitis / septic arthritis
117
Listeria monocytogenes can cause pneumonia and meningitis in neonates. True or false?
true
118
are sticky eyes common in neonates?
yes
119
Normal sticky eyes in neonate - how treat?
clean w saline
120
Staph/strep conjunctivitis - how to treat?
chloramphenicol
121
Gonorrhoea conjunctivitis - how to treat?
IV cefuroxime
122
Chlamydia conjunctivitis - how to treat?
oral erythromycin
123
Neonate with purulent discharge, conjunctiva injection, and eyelid swelling. Likely diagnosis?
gonorrhoea or chlamydia conjunctivitis
124
Mum test for Hep B?
HBsAg
(surface antigen e = more risky for chronic)
if pos - neonate should get vaccination
125
I want EIGHT causes of neonatal seizures.
Rule out meningitis and hypoglycaemia ASAP.
- HIE.
- meningitis
- hypoglycaemia
- hypoNa, Ca, Mg
- inborn errors of metabolism
- neonatal abstinence syndrome
- congenital infection
- kernicterus
126
hypo whats can cause neonatal seizures?
hypoglycaemia
| hypoNa, Ca, Mg
127
Investigations for neonatal seizures?
```
BM
bloods
cultures (if pos - LP)
cerebral US
aEEG
```
128
```
BM
bloods
cultures (if pos - LP)
cerebral US
aEEG
```
These are investigations for?
neonatal seizures
129
Basic treatment for neonatal seizures?
treat cause. anticonvulsants.
130
Neonatal hypoglycaemia = < ...?
<2.6
131
3 causes for neonatal hypoglycaemia
diabetic mum
preterm / IUGR
ill
132
What's the mechanism behind hypoglycaemia in neonates with diabetic mums?
high insulin levels
133
What's the mechanism behind hypoglycaemia in neonates who are preterm / IUGR?
poor glycogen stores
134
Give me some symptoms of neonatal hypoglycaemia.
drowsiness, irritability, seizures, sweating, pallor
135
Prolonged hypoglycaemia in neonate can cause permanent neurodisability. True or false?
true
136
Treatment for neonatal hypoglycaemia??
IV glucose via central venous cath
(10% bolus, 10% infusion)
don't respond / seizures? - IM glucagon
137
To treat neonatal hypoglycaemia you give IV glucose via central venous cath (10% bolus, 10% infusion). When would you give IM glucagon?
if having seizures / not responding
138
What blood glucose level would you aim for when treating neonatal hypoglycaemia?
>2.6
139
Investigations for neonatal hypoglycaemia?
confirm w lab blood glucose
serum insulin, GH, cortisol, C-peptide
urine: organic acids
140
When investigating neonatal hypoglycaemia, you want to confirm with lab the blood glucose. You want to check the urine for organic acids. You also want to check the serum for what FOUR things?
insulin
GH
cortisol
C-peptide
141
Failure of fusion of frontonasal and maxillary processes. What's this?
cleft lip
142
Failure of fusion of palatine processes and nasal septum. What's this?
cleft palate
143
When does cleft lip present?
3 months
144
When does cleft palate present?
6-12 months
145
3 symptoms of cleft palate?
feeding difficulties
cough/choking
secondary otitis media
146
Treatment for cleft lip / palate?
surgical repair
147
Micrognathia (small jaw) and cleft palate combo makes you think of
Pierre Robin sequence (airway obstruction)
148
This condition causes salivation, choking and aspiration. If chronic it can cause GORD and cough.
oesophageal atresia
149
Investigations and treatment for oesophageal atresia?
pass tube and x ray it
| surgery
150
Persistent green vomiting and delayed meconium can be signs of small bowel obstruction. Give me FOUR causes of this in neonates :)
duodenal atresia
malrotation /volvulus
CF - meconium ileus
meconium plug, passes spontaneously!
151
What condition is duodenal atresia common in ?
Down's
152
FOUR causes of LARGE bowel obstruction in neonates ? :)
Hirschsprung
rectal atresia
exomphalos
gastroschisis
153
Which sticky outy guts through umbilicus is covered with sac?
exomphalos
154
Treatment for exomphalos?
dry with heater and it closes up
155
Treatment for gastroschisis?
NG tube, fluids, wrap it in SILO silastic sack.
156
What condition is a SILO silastic sack for.
gastroschisis
157
What happens in exomphalos / gastroschisis?
abdo contents through umbilicus
158
Abdo contents through umbilicus. What's this?
exomphalos / gastroschisis
