Neonatology Flashcards
(165 cards)
1
Q
Define ‘Pre-term’
A
Delivery before 37 weeks completed gestation
Extreme - before 28 weeks, Very Preterm - 28 to 32 weeks, Moderate - 32 to 37 weeks
2
Q
Describe the aetiologies of Preterm Infants
A
25% planned (life threatening pre-eclampsia etc)
30% are due to PPROM
25% are due to emergency (severe infection, placental abruption)
3
Q
State Naegele’s rule of EDD
A
LMP + 7d -3m +1y
4
Q
If an EDD wasn’t noted, the age of the baby can be estimated using Dubowitz Scoring. What is it?
A
Used following birth of baby
Uses external physical and neurological features to give a score which then gives a two week window of estimation
Neuromuscular - posture, popliteal angle, heel to ear
Physical - skin, lanugo hair, genitals, eye/ear
5
Q
After birth the preterm will have a full range of bloods. Describe three other investigations required.
A
CXR (likely to require intubation so looks for any abnormalities which may complicate endotracheal tube)
AXR (check that central line via umbilical artery is in correct place, looks for NE)
Cranial USS (assess for intraventricular haemorrhage or white matter damage)
6
Q
If a preterm birth is inevitable, what can be done antenatally?
A
Arrange delivery in tertiary centre delivery suite Antenatal steroids Magnesium Sulphate (neuroprotective)
7
Q
At what age are preterm babies rescucitated?
A
<23 weeks ~ not performed
23-23+6 weeks ~ may be a decision not to
24-24+6 weeks ~ commenced unless severely compromised
> 25 weeks ~rescucitation and NICU
8
Q
Name three things that can aid a newborns thermal regulation after delivery
A
Plastic Wrap
Heated Mattress
Overhead Lamp
9
Q
What is the long term respiratory management considerations in preterm infants?
A
Surfactant Administration
Intubation and Oxygenation
Caffeine
10
Q
What is the long term Cardiovascular management considerations in preterm infants?
A
Inotropes
Fluids
Ibuprofen/Indomethacin
11
Q
What is the long term GI management considerations in preterm infants?
A
TPN
NG
Abx
12
Q
Survival of preterm babies is rare before 23 weeks. Name four later complications in childhood of prematurity
A
Gross Motor Delay
Fine Motor Impairment
Behavioural Abnormalities
Speech and Language Abnormalities
13
Q
Name a family support group for premature infants
A
Bliss
14
Q
What are the five categories of withdrawing Paediatric care?
A
- The Brain Dead Child
- The Permanent Vegetative State
- No Chance (treatment delays death but doesn’t improve life quality or potential, not in best interest of patient)
- No Purpose (may be able to survive with treatment but it would not be in patients best interest , may leave them in a worse condition)
- Unbearable Situation (When child or family feel that more treatment is too much to handle)
15
Q
Jaundice occurs in 60% of term infants and 80% preterm. What is the relevance of conjugation?
A
Unconjugated can be physiological or pathological
Conjugated is always pathological
16
Q
Physiological jaundice starts at day 2-3 and is resolved by day 10. Give two causes.
A
Increased RBC break down (high concentration required in utero that is no longer needed)
Immature liver (lags behind and unable to conjugate at these high concentrations)
17
Q
When can Physiological Jaundice become Pathological?
A
If baby is premature
If further extensive breakdown (eg from bruising)
18
Q
Define Pathological Jaundice
A
A jaundice which requires treatment or further investigation
19
Q
Give three risk factors for pathological jaundice
A
Prematurity
Low Birth Weight
Diabetic Mother
20
Q
Describe the non physiological jaundice in terms of onset time frame - less than 24 hours
A
Haemolytic Disorders (Rhesus, ABO incompatibility, G6PD, Spherocytosis)
Congenital Infection
21
Q
Describe the non physiological jaundice in terms of onset time frame - 24 hours to 2 weeks
A
Breast Milk Jaundice Dehydration Infection (UTI) Haemolytic Bruising Crigler Najjar Syndrome
22
Q
Describe the non physiological jaundice in terms of onset time frame - more than 2 weeks
A
Unconjugated: Infection, Hypothyroidism, Haemolytic Anaemia, High GI Obstruction
Conjugated: Bile Duct Obstruction, Neonatal Hepatitis
23
Q
Describe four possible clinical features of Neonatal Jaundice
A
- Discolouration (examine sclera, gums, skin blanche)
- Drowsy (difficult to rouse, short feeds)
- Altered Muscle Tone
- Seizures
24
Q
Bilirubin needs to be measured if the Jaundice is not visible to the naked eye. Describe the two methods.
A
Transcutaneous Bilirubinometer (if >35 weeks gestation and >24 hours old, can be used for repeats as long as level is under 250 and no treatment required)
Serum Bilirubin if <35 weeks, <24 hours old or previous level >250
Want to know total and conjugated/unconjugated
25
Name five further investigations for Neonatal Jaundice
```
Blood Group
Direct Coombs
FBC (haemoglobin and haematocrit)
Infection Screen
LFTs
```
26
Phototherapy is a management option for Neonatal Jaundice, how is this decided?
Treatment threshold graphs that are gestation specific
If above line - phototherapy initiated and bilirubin monitored
If below line by more that 50, and clinically well don’t repeat
If below line by less than 50 and well, repeat in 18-24 hours
27
How does Phototherapy work for jaundice?
Via Photo- Oxidation
Adds oxygen to bilirubin so it dissolves more easily
28
When should phototherapy be stopped?
6-12 hourly repeats once stable
Stop once more than 50 below threshold
Check for rebound 12-18 hours after stopping
29
Another option for Jaundice management is Exchange Transfusion. When is this used?
If Acute encephalopathy or levels more than 8.5 micromol/l
30
What can you give as an adjunct to pathological jaundice due to ABO/Rhesus incompatibility?
IVIG
31
Kernicterus is the main complication of Neonatal Jaundice, what is it?
Bilirubin induced brain dysfunction
| Accumulates in CNS grey matter causing irreversible damage
32
Define Early Onset Neonatal Sepsis
Sepsis within the first 48 - 72 hours of life, most commonly due to GBS
33
State three methods of spread causing Neonatal Sepsis
Chorioamnionitis
Birth Canal
Haematogenous
34
Give two early and two late manifestations of neonatal GBS
Early - RDS, Pneumonia
| Late - Sepsis, Meningitis
35
State five red flags of Neonatal Sepsis
- RDS starting more than 4hrs after birth
- Seizures
- Signs of Shock
- Abx given to mother around birth
- Suspected in another baby if multiple pregnancy
36
Give three differentials for Neonatal Sepsis
TTN
RDS
Meconium Aspiration
37
Describe the management of Neonatal Sepsis
Initial empirical IV Benzylpenicillin and Gentamicin
If meningitis suspected - Amoxicillin and Cefotaxime
Known GBS - Benzylpenicillin
Continued for 7-10d if positive blood culture, or 14 days if CSF culture positive
38
How would you manage raised CRP in first 24 hours of life but negative cultures?
5 days IV Antibiotics
39
Define Sudden Infant Death Syndrome
Sudden and unexplained death of a child under one (remaining unexplained even after post mortem and history review)
40
Describe the 1994 triple risk model of SIDS
```
Underlying vulnerability (eg premature)
Critical Development (1-3 months)
Exogenous Stressor (Sleeping Prone)
```
41
Give four risk factors for SIDS
- Smoking (maternal in pregnancy and passive)
- Alcohol and Substance Abuse
- Preterm Birth (often placed prone to improve resp function so should get used to sleeping on back pre discharge)
- Bed Sharing
42
Give three protective factors for SIDS
Breast Feeding
Dummies
Room Sharing
43
What is a Life Threatening Event Syndrome?
Combination of apnoea/change in colour/change in muscle tone/coughing/gagging
50% underlying condition 50% unknown
44
Describe a social benefit, and retraction to breast feeding
Benefit : It’s free
| Detractions: Public Taboo
45
Give two medical benefits of breast feeding for the mother and the child
Child : Increased Immunity, Decreased SIDS risk
| Mother: Decreased Breast Cancer, Decreased Ovarian Cancer
46
Why are feeding difficulties more common in preterm babies?
Coordination between suckling/swallowing and breathing is normally developed between 34-36 weeks
47
Give three broad causes for difficulty feeding in term babies
Anatomical Malformations (Cleft Palate, Tongue Tie)
Sleepiness (Hyperbilirubinaemia, Hypoglycaemia, Hypothyroidism)
Neurological (Strokes, Seizures, SAH)
48
Give four causes for feeding difficulties in infants
Cows Milk Protein Allergy
GORD
Colic
Lactose Intolerance
49
What is Colic?
Thought to be a combination of GORD, CMPA and Constipation
Crying more than three hours a day, more than three days a week for more than three weeks.
Drawing up knees and arching back
50
Give three points of the approach to a Dysmorphic Child
- Make an accurate diagnosis
- Recognise associated abnormalities and medical problems
- Optimise QoL
51
Describe the three types of dysmorphia in a child
Normal Spectrum of human variance (no medical significance)
Minor Anomaly (eg flat philtrum, bifid uvula)
Major Anomaly (has medical/surgical/cosmetic significance)
52
When should you suspect a genetic condition in a child?
```
Multiple minor anomalies (>3)
Or
More than one major anomaly
Or
One major and a few minor anomalies
```
53
Give an example of sex limited and sex influences expression
Limited - Hereditary Prostate Cancer
| Influenced - Hypospadias
54
Define Malformation
Defect of morphogenesis in organ or structure
Can be isolated or part of a chromosomal disorder
55
Define Deformation
Abnormal form/position caused by extrinsic disruptive forces on developing foetus
56
Define Disruption
Destructive breakdown or interference with a normally developing structure
57
Define Dysplasia
Error of morphogenesis due to abnormal cellular organisation in a specific tissue (eg Achondroplasia)
58
Define Downs Syndrome
Genetic disorder caused by Trisomy 21 (non disjunction in maternal oogenesis, or mosaic)
59
Give 6 features of Downs Syndrome
```
Generalised Hypotonia
Low Set Ears
Upslanting Eyes
Flat Occiput
Single Palmar Crease
Intellectual Impairment (IQ 26-70)
```
60
Give four other pathologies associated with Downs
Congenital Heart Defects
Deafness
Cataracts
Leukaemia
61
How is Downs Syndrome diagnosed prenatally?
PAPP-A
b - HCG
Nuchal Translucency
Maternal Age
62
How is Downs Syndrome diagnosed Post Natally?
Chromosome analysis via microarray showing Trisomy 21
63
Give four management points of Downs Syndrome
Specialist referrals (audiology, cardiology)
Genetic Counselling
Use of Downs Syndrome Association
Annual TFTs
64
What is the prognosis of Downs Syndrome?
Life expectancy well into adult life although most develop Alzheimer’s by 40 years old
Majority can live semi independent with supervision
65
What is Patau Syndrome?
Trisomy 13
Median survival of 8.5 days
66
Give 5 features of Patau Syndrome
```
SGA
Microcephaly
Cleft Lip
CHD
Polydactyly
```
67
What is Edwards Syndrome?
Trisomy 18
Median life expectancy is 74 days
68
Give 5 features of Edwards Syndrome
```
SGA
CHD (particularly VSD)
Short Sternum
Overriding fingers
Rocker Bottom Feet
```
69
What is Turners Syndrome?
Genetic disorder caused by non disjunction characterised by the karyotype 45,X
70
Give 5 features of Turners Syndrome
```
Short Stature
Neck webbing
Ptosis
Wide spread nipples
Puffy hands and feet
```
71
Give three associated anomalies of Turners Syndrome
CHD
Renal Abnormalities
Hypoplastic Ovaries
72
What is Digeorge Syndrome?
Genetic disorder caused by micro deletion on Chromosome 22
Characterised by ToF, Wide Nasal Bridge, Hypocalcaemia (Parathyroid Hypoplasia), T Cell Deficiency (Thymus Aplasia)
73
What is Marfans Syndrome?
Autosomal dominant mutation on fibrillin gene
Characterised by tall and slim, pectus malformation, scoliosis, high arched palate, lens dislocation and cardiac abnormalities
74
What is Noonan’s Syndrome?
Mutation on chromosome 12
Characterised by Pulmonary Stenosis, Short Stature, Broad Neck, Developmental delay
(‘Male Turners’)
75
What is Williams Syndrome?
Micro deletion on chromosome 7
Characterised by periorbital fullness, full cheeks, small spaced teeth, over friendliness
76
State four features of Angelman Syndrome?
Severe Developmental delay
Speech impairment
Ataxic Gait
Hand flapping
77
State the features of Fragile X Syndrome
Gaze Avoidance
Stereotyped Repetitive Behaviour
Resistance to change of routines
Commonest inherited cause of mental retardation
78
Describe four features of Prader Willi Syndrome
Floppy babies with feeding difficulties
Rapid Weight Gain between 1 and 6 years
Learning difficulties
Food foraging and behavioural problems
79
Define Hypoxic Ischaemic Encephalopathy
During perinatal asphyxia, gas exchange (placental or pulmonary) ceases resulting in cardio respiratory depression. Compromised cardiac output reduces cerebral perfusion.
80
Give 5 broad aetiologies of HIE
- Failure of gas exchange across placenta (placental Abruption)
- Interruption of Umbilical Blood Flow (cord compression)
- Inadequate maternal placental perfusion (hypotension)
- Compromised foetus (IUGR)
- Failure of Cardioresp abnormalities
81
How does HIE present?
Encephalopathy + Respiratory Failure + Myocardial Dysfunction + Metabolic Dysfunction + Other Organ Dysfunction
82
Describe mild HIE
Irritable, Staring eyes, Hyperventilation, Impaired Feeding
83
Describe moderate HIE
Marked abnormalities of tone and movement, cannot feed, may have seizures
84
Describe Severe HIE
No spontaneous movement, no response to pain, fluctuating tone, prolonged seizures
85
Describe some management considerations for HIE
- Respiratory support
- Treating clinical seizures with anticonvulsants
- Fluid restrict due to transient renal impairment?
86
What is the prognosis of HIE?
If mild then complete recovery
If moderate and appear neurologically normal at two weeks - good
If severe - over 80% have neurodevelopmental disability
87
What is Respiratory Distress Syndrome?
Deficiency of surfactant to lower surface tension leading to collapse of alveoli
Common in infants born prior to 28 weeks, or infants of diabetic mothers
88
Give four clinical features of RDS (at delivery or within four hours)
- Tachypnoea
- Laboured breathing with chest wall recession
- Expiratory grunting
- Cyanosis if severe
89
What would be seen on a CXR of RDS?
Bilateral and diffuse ground glass appearance (generalised atelectasis)
Air bronchograms
Reduced lung volume
90
The level of respiratory support to manage RDS depends on severity of disease. Describe the options.
Nasal CPAP/High Flow Oxygen
Endotracheal Intubation and Surfactant (eg Curosurf - first dose as bolus)
91
Other than ventilators support, what managements should be considered in RDS?
Antibiotics (Penicillin and Gentamicin until Congenital Pneumonia is ruled out)
IV fluids until baby is stable
Gastric feeds with minimal volume
If preterm delivery is inevitable - maternal corticosteroids
92
What is Necrotising Enterocolitis?
Life threatening inflammation of the bowel commonly affecting terminal ileum and proximal colon, 90% premature babies
93
The aetiology of Necrotising Enterocolitis is a multifactorial exaggerated immune response within immature bowel. Give four risk factors
Prematurity
Hypoxia
Polycythaemia
Hyperosmolar milk feeds
94
NEC normally presents in the second week after birth, give three early and three late features.
Early: Vomiting, Poor Feed Tolerance, Distension
Late: Abdominal Tenderness, Blood/Mucous in stool, Shock
95
As well as a full range of bloods, an AXR will be carried out for NEC. Give three features
Gas in the gut wall (Pneumatosis Intestinalis)
Intestinal Distension
Gas outlining falciform (football sign)
96
NEC is staged using examination and radiological features via Bell Staging. Outline stages I-III
I - Suspected NEC
II - Proven NEC
III - Advanced NEC
97
How should feeding be managed in NEC?
Stop milk feeds for 10-14 days and insert NG tube
| Start TPN
98
What is the definitive management of NEC?
Antibiotics for 10-14d (Benzylpenicillin, Gentamicin, Metronidazole)
Surgery if perforation/deterioration despite treatment/obstruction secondary to strictures
Surgical repair can be primary if localised disease, if extensive then resection and enterostomy followed by reanastamosis
99
Define Tracheoesophageal Fistula and state it’s associations
One or more fistulae communicating between normal trachea and oesophagus
Associated with VACTERL, CHARGE and trisomy 13/18/21
100
Define VACTERL Syndrome
```
Vertebral Defects
Anorectal Malformations
CVS Defects
TOF
Oesophageal Atresia with or without TOF
Renal Abnormalities
Limb Deformities
```
Defined when >3
101
What is CHARGE Syndrome?
```
Coloboma
Heart Defects
Atresia Chonae
Retarded Development
Genital Hypoplasia
Ear Abnormalities
```
102
How does TOF present Antenatally?
Polyhydramnios
Absent foetal stomach bubble
USS
103
How does TOF present post natally?
RDS
Choking
Frothing
Feeding difficulties
104
Name two investigations for TOF
AXR - curled NG tube, air in stomach
| Fluoroscopy (swallow contrast)
105
Describe the five types of TOF
A - Pure Oesophageal Atresia
B - Oesophageal Atresia with proximal TOF
C - Oesophageal Atresia with distal TOF
D - Oesophageal Atresia with proximal and Distal TOF
E - H type (no atresia)
106
How are the non E type TOF repaired?
Pre-op bronchoscope followed by open thoracotomy
Fistula ties off
Anastomoses of oesophagus created
107
How are the E type TOF (H) repaired?
Surgery formed via neck
| Risk of recurrent laryngeal nerve damage
108
Give four causes of Small Bowel Obstruction in Neonates
Atresia/Stenosis of Duodenum
Atresia/Stenosis of Jejunum/Ileum
Malrotation with Volvulus
Meconium Ileus
109
Give two causes of Large Bowel Obstruction in Neonates
Hirschsprung
| Rectal Atresia
110
Define Omphalocoele and its presentation
Abdominal contents protrude through umbilical ring covered with transparent sac, often associated with other congenital abnormalities
Presents as a raised maternal AFP and 4-12cm Abdo wall defect
111
What’s the management for Omphalocoele?
Replacement of sac into abdominal cavity followed by closure
If the sac ruptures it’s treated the same as Gastroschisis
112
What is Gastroschisis and how does it present?
Abdominal contents herniate into amniotic sac with NO peritoneal covering
Presents as an opening less than 5 cm to the right of the umbilical cord
113
How is Gastroschisis managed?
There is a great risk of dehydration and protein loss so abdomen should be wrapped in several layers of clingfilm
Most sorted with primary closure
If larger it is enclosed in silastic sac and contents are gradually returned
114
Define Meconium Aspiration Syndrome
Spectrum of disorders characterised by varying degrees of RD following aspiration (occurring either antenatally or during birth)
115
Describe the pathophysiology of MAS
Normally post term babies due to hypoxic stress leading to gasping
Results in obstruction (?Atelectasis), Hypoxia, Pulmonary Inflammation, Infection, Surfactant Inactivation, PPH
116
Give three risk factors for MAS
Gestational Age >42 weeks
Oligohydramnios
Thick Meconium
117
Describe 5 investigations for MAS
Chest a ray (patchy opacity, consolidation, increased lung volumes)
Infection Markers
ABG
Dual Pulse Oximetry (on RUL and LLL to determine shunts)
Cranial USS
118
Give three differentials for MAS
Transient Tachypnoea of the Newborn
Persistent Pulmonary Hypertension
Surfactant Deficiency
119
How is MAS is managed?
```
O2 therapy (extent depends on severity)
Antibiotics (stopped after 48 hours if culture is negative, eg ampicillin/gentamicin)
```
Potentially surfactant, or inhaled NO
120
Give three complications of MAS
Air leak (Meconium causes alveolar hyperdistension leading to pneumothorax)
Cerebral palsy
Persistent Pulmonary Hypertension
121
Define Transient Tachypnoea of the Newborn
Delayed clearance/absorption of lung fluid after birth, often after caesarean section.
Managed with oxygen and spontaneously resolves within 24 hours
122
Describe the CXR of TToN
Streaky perihilar changes
| Fluid in horizontal lung fissures
123
Define Bronchopulmonary Dysplasia
Form of chronic lung disease affecting infants born preterm with oxygen requirements at 36 weeks
Impaired alveolar development with mechanical/oxidative/inflammatory factors
124
Give three risk factors Bronchopulmonary Dysplasia
Gestational Immaturity
FH of Asthma
LBW
125
How does the CXR present for Bronchopulmonary Dysplasia?
Hyperextended chest with diffuse patchy collapse and fibrosis interspersed by radiolucent cystic areas
126
Give five managements for Bronchopulmonary Dysplasia
```
Caffeine Citrate for premature
Oxygen
Diuretics
Corticosteroids
Immunisation against RSV
```
127
Describe the pathophysiology of Persistent Pulmonary Hypertension of the Newborn
Failure of the normal circulatory transition occurring after birth, causing R-L shunting and severe hypoxia
Can be Idiopathic, due to Diaphragmatic Hernia, or constricted vasculature due to RDS/MAS
128
How is Persistent Pulmonary Hypertension of the Newborn managed?
Treat underlying cause
Oxygen
Dopamine
Inhaled Nitric Oxide
129
Retinopathy of Prematuriy is the leading cause of preventable blindness. Who is most at risk?
Infants born at <32 weeks or weighing <1500g
130
Describe the pathophysiology behind Retinopathy of Prematurity
In utero retinal development occurs in a relatively hypoxic environment
Incompletely developed if premature and the hyperoxic environment can cause vasoconstriction and retinal ischaemia
131
Retinopathy of Prematurity can be classed by Severity and Location. Describe the stages of Severity
```
1 - Demarcation line visible
2- Ridge evident
3 - Ridge with fibrovascular proliferation
4 - Subtotal retinal detachment
5 - Total Retinal Detachment
```
132
Retinopathy of Prematurity can be classed by Severity and Location. Describe the stages of Location
Zone 1 - 30 degree radius from optic disc
Zone 2 - Nasal Regina periphery in circle
Zone 3 - circumference includes temporal and nasal retina
133
What does ‘+’ disease mean in Retinopathy of Prematurity
Engorgement of Posterior Vessels
Iris Rigidity
Vitreous Haze
134
When are infants screened for Retinopathy of Prematurity?
<27 weeks - screen at 30 to 31 weeks
27-32 weeks - screened at day 28 to 35 of life
Screen fortnightly unless plus/stage three disease
135
How is Retinopathy of Prematurity managed?
Diode Laser Treatment within 72 hours alongside steroid eye drops
Can be retreated if no regression at 10-14d
136
Name three causes of Vitamin K Deficiency (and subsequent HDN)
Breast Milk
Maternal Anticonvulsants
Newborn liver disease
137
Describe the presentation of mild and severe HDN
Mild - Bruising, Haematemesis, Malaena
Severe - Intracranial Haemorrhage
138
How is HDN prevented?
IM Vitamin K immediately after birth
If mother is on anticonvulsants then they receive an extra dose at 36 weeks
139
Describe the pathophysiology behind Intraventricular Haemorrhage
Related to rapid alterations in blood flow (eg severe RDS, hypoxia)
Bleeding can dilate ventricles and cause periventricular infarction due to compression
140
How do Intraventricular Haemorrhages present?
Most occur within 72 hours and 50% are asymptomatic
Larger bleeds can present with bulging fontanelle, neuro dysfunction, jaundice
141
Intraventricular Haemorrhages are seen on Cranial USS. Who should be screened and when?
At risk or pre term infants
At one day, one week and one month
142
The management for Intraventricular Haemorrhage is supportive. How can it be prevented?
Antenatal steroids and Indomethacin
143
Give two complications of Intraventricular Haemorrhage
Periventricular infarction
Post haemorrhage ventricular dilation (leading to CSF accumulation and raised ICP)
144
Describe the difference between Subgaleal and Cephalohaematoma
Subgaleal - boggy swelling all over scalp
Cephalohaematoma - subperiosteal bleed limited by suture lines
145
What is Periventricular Leucomalacia?
Softening the white matter associated with extreme prematurity (poor perfusion)
Visible on USS as Periventricular echodensities
Increased risk of cerebral palsy
146
What is Cleft Lip?
Failure of fusion of frontonasal and maxillary processes (can be unilateral or bilateral)
147
What is Cleft Palate?
Failure of fusion of palatine processes and nasal septum
148
Give two environmental and one syndromic cause of Cleft Palate
Foetal Alcohol Syndrome, Folic Acid Deficiency
Pierre Robin Syndrome
149
Apart from an obvious deformity, how could Cleft Lip/Palate present?
Difficulty feeding
Upper airway obstruction
Frequent Otitis Media
150
Spina Bifida is failure of midline fusion of dorsal vertebral bodies. What are the three types?
Occulta - no herniation, overlying dimple of hair
Meningocoele - herniation of meninges and fluid with a skin covering
Myelomeningocoele - involvement of neural tissue causing paralysis, incontinence etc
151
Milia is an example of benign neonatal dermatology, what are they?
<2mm yellow/white spots
Normally on face
Secondary to blocked sweat glands
152
Erythema Toxicum is an example of benign neonatal dermatology, what is it?
Discrete erythematous maculopapular lesions often with a white centre
Mostly over knees/elbows/trunk/face
153
Harlequin Colour Change is an example of benign neonatal dermatology, what is it?
Marked erythema/pallor in different halves/quadrants due to vasomotor immaturity
154
Superficial Capillary Haemangioma is an example of benign neonatal dermatology, what is it?
Also known as Stork Mark
Erythematous Vascular marks on eyelids/face/scalp/nose
155
Mongolian Blue Spots is an example of benign neonatal dermatology, what are they?
Bluish black machines often in lumbosacral region
Mostly non Caucasian
156
What is Nappy Rash?
Usually contact dermatitis from ammonia in urine
157
How would you manage simple nappy rash
Frequent nappy changes
Barrier Cream (Zinc)
158
When would you suspect a secondary infection of nappy rash? How would you manage?
Flexural or Satellite lesions
Topical Nystatin
159
What is Infantile Seborrhoeic Eczema? How is it managed?
Commonly affecting face/neck/behind ears/scalp
Normally resolves in weeks
Avoid detergents and give mild emollient and steroid
160
State the five parameters of the APGAR score
```
Activity
Pulse
Grimace
Appearance
Respiratory
```
161
How is ‘Activity’ of APGAR scored?
0 - none
1- flexed limbs
2 - active
162
How is ‘Pulse’ of APGAR scored?
0 - no pulse
1 - <100
2 - >100
163
How is ‘Grimace’ of APGAR scored?
0 - floppy
1 - minimal response
2 - prompt response
164
How is ‘Appearance’ of APGAR scored?
0 - Blue
1 - Blue Extremities
2 - Pink
165
How is ‘Respiratory’ of APGAR scored?
0- none
1 - slow and irregular
2 - vigorous
