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Neonatology Flashcards

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1
Q

What is a caput succedaneum?

A

oedema collecting on the scalp, outside the periosteum
caused by pressure to the scalp during a traumatic, prolonged or instrumental delivery
OUTSIDE the periosteum -> ABLE to cross suture lines
resolves within a few days

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2
Q

What is a cephalhematoma?

A

haematoma between the skull and the periosteum
aka traumatic subperiosteal haematoma
INSIDE the periosteum -> DOES NOT cross suture lines
resolves within a few months
can cause anaemia and jaundice depending on size

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3
Q

Caput succedaneum vs cephalhematoma?

A

Caput succedaneum can cross suture lines as it is outside the periosteum, successfully resolves within few days

cephalhematoma is below the periosteum and therefore does not cross suture lines, successfully resolves within few months
risk of anaemia and jaundice

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4
Q

What is Erb’s palsy?

A

‘waiters tip’ appearance
internally rotated shoulder
extended elbow
pronated flexed wrist
lack of movement in affected arm

C5/C6 nerve roots in the brachial plexus

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5
Q

Presentation of fractured clavicle?

A

lack of movement
asymmetry of movement
asymmetry of shoulders
pain and distress on movement of the arm

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6
Q

Fractured clavicle risk factors?

A

shoulder dystocia
traumatic or instrumental delivery
large birth weight

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7
Q

Common birth injuries?

A

caput succedaneum
cephalohematoma
subgaleal haemorrhage
Erb’s palsy
Klumpke’s palsy
clavicle #

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8
Q

Common organisms causing neonatal sepsis?

A

GBS
E coli
Listeria
Klebsiella
Staph aureus

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9
Q

RFs for neonatal sepsis?

A

GBS colonisation
GBS sepsis in prev baby
maternal sepsis
chorioamnionitis
maternal fever > 38
prematurity
PPROM
PROM

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10
Q

Presentation of neonatal sepsis?

A

fever
hypotonia
poor feeding
respiratory distress
apnoea
vomiting
tachycardia or bradycardia
hypoxia
jaundice in first 24hrs
seizures
hypoglycaemia

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11
Q

Red Flags for neonatal sepsis?

A

confirmed or suspected maternal sepsis
signs of shock
seizures
term baby needing mechanical ventilation
respiratory distress starting >4hrs after birth
sepsis in another baby in multiple pregnancy

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12
Q

Neonatal sepsis management?

A

Start Abx if two or more features/RFs or if one RED FLAG
Start Abx within 1hr of decision
Blood cultures before Abx
baseline FBC and CRP
LP

benzylpenicillin + gentamicin

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13
Q

When to stop Abx in neonatal sepsis?

A

baby is clinically well, blood cultures are negative for 36hrs after taking them and 2 CRPs are <10

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14
Q

Causes of hypoxic-ischaemic encephalopathy?

A

anything that leads to asphyxia

maternal shock
intrapartum haemorrhage
prolapsed cord
nuchal cord

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15
Q

Grading of HIE?

A

Sarnat Staging

Mild -> poor feeding, irritability, hyperalert
normal prognosis, resolves within 24hrs

Moderate -> poor feeding, hypotonic, lethargic, seizures
can take weeks to resolve, up to 40% develop CP

Severe -> red. consciousness, apnoeas, flaccid, reduced or absent reflexes
up to 50% mortality
up to 90% develop CP

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16
Q

Mx of HIE?

A

NICU
supportive care (resuscitation, ventilation, circulatory support, nutrition, acid-base balance, treatment of seizures)
therapeutic hypothermia

follow up with MDT for lasting brain damage

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17
Q

What is therapeutic hypothermia?

A

active cooling to 33-34 degrees for 72 hours using cooling blankets and a cooling hat
aim is to reduce inflammation and neurone loss after the acute hypoxic injury
reduces long-term risks of CP, developmental delay, learning disability, blindness and death

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18
Q

Causes of neonatal jaundice?

A

Incr. production:
haemolytic disease
ABO incompatibility
haemorrhage
IVH
cephalohematoma
polycythaemia
sepsis and DIC
G6PD deficiency

Red. excretion:
prematurity
breast milk jaundice
neonatal cholestasis
extrahepatic biliary atresia
endocrine disorders
Gilbert syndrome

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19
Q

What is prolonged jaundice?

A

more than 14 days in term babies
more than 21 days in prem babies

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20
Q

Causes of prolonged jaundice?

A

biliary atresia
hypothyroidism
G6PD deficiency

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21
Q

Investigations for neonatal jaundice?

A

FBC and blood film
bilirubin (conjugated and unconjugated)
blood type testing
Direct Coombs test
thyroid function
blood culture
G6PD levels

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22
Q

Mx of neonatal jaundice?

A

plot bilirubin levels on treatment threshold charts
phototherapy
IVIG in haemolysis
exchange transfusions v rare

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23
Q

What is kernicterus?

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A

complication of neonatal jaundice as unconjugated bilirubin can cross the BBB and cause brain damage

results in CP, learning disabilities and deafness

24
Q

Classifying prematurity?

Study These Flashcards
A

<28wks - extreme preterm
28-32wks - very preterm
32-37wks - moderate to late preterm

25
Associations with prematurity?
social deprivation smoking alcohol drugs over or underweight mother maternal co-morbidities multiple pregnancy FHx of prematurity
26
Mx of prematurity pre-birth?
tocolysis with nifedipine maternal corticosteroids IV magnesium sulphate delayed cord clamping or cord milking
27
Complications of prematurity?
early: respiratory distress syndrome hypothermia hypoglycaemia poor feeding apnoea or bradycardia neonatal jaundice IVH retinopathy of prematurity NEC immature immune system and infections late: CLDP learning disabilities behavioural issues susceptibility to infections, particularly resp hearing and visual impairment CP
28
Mx of apnoea of prematurity?
apnoea monitors tactile stimulation IV caffeine
29
What is retinopathy of prematurity?
retinopathy caused by abnormal development of blood vessels in the retina due to oxygen exposure too early results in scarring, retinal detachment and blindness
30
Screening for retinopathy of prematurity?
performed by an ophthalmologist 30-31wks gestational age for babies <27wks 4-5wks of age in babies >27wks screening every 2 weeks until retinal vessels enter zone 3
31
Tx of retinopathy?
transpupillary laser photocoagulation to halt and reverse neovascularisation cryotherapy intravitreal VEGF inhibitors Sx if retinal detachment occurs
32
RDS appearance on CXR?
'ground-glass' appearance
33
What causes respiratory distress syndrome?
lack of surfactant in the premature lungs leads to an increase in surface tension within the alveoli -> inadequate expansion of the lungs and inadequate gaseous exchange resulting in hypoxia, hypercapnia and respiratory distress
34
Mx of RDS?
antenatal maternal steroids intubation and ventilation supplementary O2 CPAP ET surfactant
35
Complications of RDS?
Early: pneumothorax infection apnoea IVH pulmonary haemorrhage NEC Late: CLDP retinopathy of prematurity neurological, hearing and visual impairment
36
What is necrotising enterocolitis?
NEC disorder affecting premature neonates where part of the bowel becomes necrotic life-threatening illness as can cause perforation, peritonitis and shock
37
RFs for NEC?
prematurity low birth weight formula feeding RDS and assisted ventilation sepsis PDA and other congenital heart disease
38
Presentation of NEC?
intolerance to feeds vomiting, green bile unwell distended, tender abdomen absent bowel sounds blood in stools features of peritonitis and shock
39
Investigations for NEC?
Bloods: FBC (neutropenia, thrombocytopenia) CRP blood gas (metabolic acidosis) blood culture PFA
40
Features of NEC on PFA?
dilated loops of bowel bowel wall oedema pneumatosis intestinalis (pathognomonic) pneumoperitoneum (perforation) gas in portal veins
41
Mx of NEC?
nil by mouth with IV fluids, TPN and antibiotics NG tube can be used to drain 'drip and suck' surgical emergency
42
Complications of NEC?
perforation peritonitis shock death sepsis strictures abscess formation recurrence long-term stoma short bowel syndrome
43
Substances which cause neonatal abstinence syndrome?
opiates methadone benzos cocaine amphetamines nicotine cannabis alcohol SSRIs
44
What is neonatal abstinence syndrome?
presence of withdrawal symptoms in a neonate following birth due to consumption of substances by the mother during the pregnancy
45
Signs and symptoms of neonatal abstinence syndrome?
CNS: irritability incr. tone high pitched cry not settling tremors seizures Resp: yawning sweating unstable temperature tachypnoea GI: poor feeding regurgitation or vomiting hypoglycaemia loose stools and sore nappy area
46
Mx of neonatal abstinence syndrome?
monitoring in neonates of mothers with known addictions quiet and dim environment with gentle handling medical mx if severe (morphine sulphate for opiates, phenobarbitone for non-opiates) support mother to stop consider social services check breastfeeding suitability
47
Foetal alcohol syndrome features?
microcephaly thin upper lip smooth philtrum short palpebral fissures learning disability behavioural difficulties hearing and vision CP
48
Congenital rubella syndrome features?
congenital cataracts congenital heart disease (PDA, pulmonary stenosis) learning disability hearing loss
49
Congenital varicella syndrome features?
fetal growth restriction microcephaly hydrocephalus learning disability limb hypoplasia scars and skin differences along dermatomes chorioretinitis
50
Congenital CMV features?
fetal growth restriction microcephaly hearing loss vision loss learning disability seizures
51
Congenital toxoplasmosis features?
intracranial calcification hydrocephalus chorioretinitis
52
Minimising the risk of SIDS?
baby on their back head uncovered feet at foot of bed keep cots clear of toys and blankets maintain room temp between 16 and 20 avoid smoking avoid co-sleeping if co-sleeping avoid alcohol, drugs, sleeping tablets or deep sleepers
53
Features of APGAR score?
Appearance (skin colour) Pulse Grimace Activity Respiration /10 - 2 for each assess at 1, 5 and 10 mins
54
Principles of neonatal resuscitation?
warm the baby calculate APGAR score stimulate breathing inflation breaths (2 cycles of 5 breaths) chest compressions avoid delayed cord clamping (resuscitation takes priority)
55
Immediate care after birth?
skin to skin clamp umbilical cord (wait 1 minute) dry the baby keep baby warm Vit K label measure weight and length
56
Heelprick test tests for?
9 congenital conditions, day 5 galactosaemia ADA severe combined immunodeficiency cystic fibrosis congenital hypothyroidism phenylketonuria maple syrup urine disease glutaric aciduria type 1 homocystinuria medium-chain acyl-COA dehydrogenase deficiency
57
Barlow and Ortolani tests?
Barlow - testing for dislocation: flex hip to 90 apply posterior force through femur and gently adduct thigh pressure onto the knee posteriorly positive if the hip dislocates Ortolani- testing for reduction of dislocated hip: flex hip to 90 gently abduct the hip and exert and upward force positive if clunk is heard as the hip relocates

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