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3a Child Health > Neonatology > Flashcards

Neonatology Flashcards

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1
Q

What does extended hypoxia lead to?

A

hypoxic-ischaemic encephalopathy(HIE)

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2
Q

What is the APGAR score?

A

Scores heart rate, resp effort, muscle tone, response to stimulation and skin colour in a newborn

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3
Q

What can you do if there is still significant volume of blood in the placenta?

A

Delayed umbilical cord clamping to give more time for Hb, iron stores and blood pressure to increase

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4
Q

What is respiratory distress syndrome?

A

Inadequate surfactant commonly in babies under 32 weeks leads to lung collapse and inadequate gas exchange

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5
Q

What is the presentation of RDS?

A

Cyanosis, tachypnoea, chest in drawing, grunting

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6
Q

What is the main investigation for RDS?

A

CXR - bilateral, diffuse ground glass lungs

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7
Q

What is the management of RDS?

A

Antenatal dexamethasone to mothers of suspected preterm labour to increase surfactant
Intubation and ventilation
Endotracheal surfactant

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8
Q

What is bronchopulmonary dysplasia?

A

Impaired alveolar development in pre-term infants and require mechanical ventilation damaging their fragile lungs

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9
Q

What are the symptoms of bronchopulmonary dysplasia?

A

Breathing quickly
Nostril flaring
Grunting
Pulling at the chest

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10
Q

What is the treatment for bronchopulmonary dysplasia?

A

None specifically
Oxygen
Diuretics
Corticosteroids

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11
Q

What is meconium aspiration?

A

Meconium enters the respiratory tract and can cause mechanical obstruction and chemical pneumonitis

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12
Q

What is meconium composed of?

A

Skin, intestinal cells, hair, vernix and amniotic fluid

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13
Q

What are the features of meconium aspiration?

A

Respiratory distress, pneumonitis, pneumothorax, bacterial pneumonia

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14
Q

What are the investigations for meconium aspiration?

A

Pre and post ductal saturations to assess respiratory involvement and detect congenital cardiac lesions
Capillary gas
FBC
CRP
CXR

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15
Q

What is the management of meconium aspiration?

A

Endotracheal suction for prevention
Oxygen therapy
Antibiotics
Surfactant

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16
Q

What is HIE?

A

Hypoxia during birth

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17
Q

What can HIE lead to?

A

Permanent brain damage causing cerebral palsy

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18
Q

What are some causes of HIE?

A

Maternal shock
Asphyxia
Intrapartum haemorrhage
Prolapse cord
Nuchal cord

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19
Q

What is the staging for HIE?

A

Sarnat Staging (mild, moderate and severe)

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20
Q

What is the management of HIE?

A

Neonatal resuscitation
Circulatory support
Nutrition
Acid base balance treatment
Therapeutic hypothermia

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21
Q

What does TORCH stand for?

A

Toxoplasmosis
Rubella
CMV
HSV
HIV
Zika

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22
Q

What are TORCH infections?

A

An infection of the developing foetus or newborn that can occur in utero, delivery or after birth

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23
Q

How are TORCH infections transmitted?

A

Placenta, passing through the birth canal or through breastmilk

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24
Q

What are some shared symptoms of TORCH infections?

A

Fever, lethargy, cataracts, jaundice, hepatosplenomegaly, low birth weight, hearing loss

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25
What rash is often seen in TORCH infections?
Blueberry muffin rash
26
What is toxoplasmosis?
Protozoan parasite transmitted via undercooked meats and cat faeces
27
How do you treat toxoplasmosis?
Pyrimethamine and sulfadiazine
28
What can Zika cause in pregnancy?
Microcephaly Foetal growth restriction Cerebellar atrophy
29
What are some investigations for TORCH infections?
Prenatal USS PCR Viral culture CT scans
30
What are some causes of increased bilirubin production?
Haemorrhage ABO incompatibility Haemolytic disease of the newborn Polycythaemia Sepsis and DIC
31
What are some causes of decreased bilirubin clearance?
Prematurity - immature liver Breast milk jaundice Neonatal cholestasis Gilbert syndrome
32
What are some investigations for neonatal jaundice?
FBC and blood film Conjugated bilirubin Blood type testing Thyroid function
33
What is a treatment for neonatal jaundice?
Phototherapy - blue light breaks down bilirubin Exchange transfusions
34
What is kernicterus?
Bilirubin crossing the blood-brain barrier causing CNS damage
35
What is necrotising entercolitis?
Part of the bowel becomes necrotic and can lead to perforation, peritonitis and shock
36
What are some risk factors for necrotising enterocolitis?
Very low birth weight or premature Formula feeds Respiratory distress Assisted ventilation Sepsis PDA
37
What is the presentation of necrotising entercolitis?
Intolerance to feeds Vomiting - green bile Generally unwell Distended tender abdomen Absent bowel sounds Blood in stools
38
What are some investigations for necrotising entercolitis and what is the gold standard?
Gold - X-ray showing dilated loops of bowel CRP DBC U&E
39
What is the management of necrotising entercolitis?
NBM with IV fluids NG tube to drain fluid and gas Surgical emergency - remove dead bowel tissue
40
What is gastroschisis?
Foetal abdominal organs protrude outside the abdomen with no protective membrane coating
41
What are some risk factors for gastroschisis?
Maternal smoking Maternal age under 20 Environmental exposures Aspirin and ibuprofen
42
What is the presentation of gastroschisis?
Visible at birth or on USS at 20 weeks Omphalocele
43
What is the management of gastroschisis?
Sterile clear covering over the herniated contents such as cling film Surgery to reduce organs and close abdominal wall defect NG tube to decompress bowel
44
What is oesophageal atresia?
Congenital birth defect with incomplete formation of the oesophagus Upper and lower oesophagus and stomach do not connect
45
What does oesophageal atresia cause?
A pouch so food doesn't reach the stomach
46
What does oesophageal atresia occur alongside?
Tracheo-oesophageal fistula - connection between lower oesophagus and trachea
47
What are the causes of oesophageal atresia?
Polyhydraminos VACTERL conditions
48
What are the symptoms of oesophageal atresia?
Aspiration pneumonia at any feeding attempt Excessive secretions Coughing Cyanosis Failure to thrive White frothy bubbles in the mouth
49
What are the investigations for oesophageal atresia?
USS Feeding tube to see if it reaches the stomach X-ray
50
What is the treatment for oesophageal atresia?
Surgical repair IV nutrition and suction tube Antibiotics
51
When are most cases of gestational diabetes diagnosed?
Routine testing at 24-28 weeks
52
What are some complications of gestational diabetes?
Marcosomia (large baby) Increased risk of shoulder dystocia Neonatal hypoglycaemia Hyperbilirubininaemia
53
What is shoulder dystocia?
Shoulder stuck at pubic bone during delivery
54
What are some risk factors for gestational diabetes?
Previous GDM Over 35 years Obesity PCOS Smoking Family history of T2DM
55
What are the investigations for gestational diabetes?
Oral glucose tolerance test at 24-28 weeks HbA1c Foetal USS every 4 weeks from 36-38 weeks
56
What is the management of gestational diabetes?
Glucose monitoring Diet Exercise Metformin and insulin if exercise and diet cannot control
57
What is hypoglycaemia?
A blood glucose of less than 2.6 mmol/L
58
What are the risk factors for hypoglycaemia?
Gestation/ prematurity under 37 weeks Maternal beta blocker use Infant of a diabetic mother Hypothermia Cord pH of less than 7.1 Inborn errors of metabolism
59
What is the presentation of hypoglycaemia?
Hypotonia Lethargy Poor feeding Hypothermia Apnoea Irritability Pallor
60
What is the treatment for hypoglycaemia?
IV dextrose infusion as a bolus then continuous infusion IM glucagon Keep them 'warm, pink, sweet and calm'
61
What is group B strep?
Lives in rectum or vagina and normally harmless but it can cause meningitis and sepsis
62
What are some risk factors for group B strep infection?
Premature baby, previous GBS infection, fever during labour, waters broken more than 24 hours before birth
63
What is cleft lip/ palate?
Congenital condition with split or open section of the upper lip Palate - defect in the hard or soft palate at the roof of the mouth
64
What are some complications of cleft lip/ palate?
Feeding, swallowing and speech problems Psycho-social implications Hearing problems Ear infections Glue ear
65
What is the management of cleft lip and palate?
plastic, maxillofacial and ENT surgeons Dentists SLT Surgery - lip at 3 months and palate at 6-12 months
66
When are the effects of alcohol in pregnancy the greatest?
First 3 months - can lead to miscarriage, small for dates and premature delivery
67
What are some features of foetal alcohol syndrome?
Microcephaly Thin upper lib Small flat philtrum Short palpebral fissure Learning disability Cerebral palsy
68
What is pathognomic of NEC?
Pneumatosis intestinalis/ gas in the gut wall

3a Child Health (14 decks)

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