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Neonatology Flashcards

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1
Q

Gestational Age

A

Time from start of last period

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2
Q

Embryonic Age (Foetal Age)

A

Time from fertilisation (formation of zygote)
Estimated using ultrasound
- 1st trimester: crown rump length
- 2nd/3rd trimester: head circumference and femur length

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3
Q

Gestational Age (2)

A

Embryonic Age + 14 days

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4
Q

Which is more commonly use in clinical practice: Gestational Age or Embryonic Age?

A

Gestational Age

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5
Q

Stages of Ovulation (According to CM) (6)

A
  1. Follicular phase
  2. Dominant follicle development
  3. Lutenizing hormone surge
  4. Ovulation
  5. Corpus luteum formation
  6. Luteal phase
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6
Q

3 Stages of Gestation

A

Germinal stage
Embryonic stage
Foetal stage

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7
Q

Stages of Gestation - Germinal Stage

A

conception to implantation

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8
Q

Stages of Gestation - Embryonic Stage

A

To Approx. Week 9

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9
Q

Stages of Gestation - Foetal stage

A

Approx. Week 9 to Birth

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10
Q

Human Chorionic Gonadotropin (hCG)

A
  • hormone detected on pregnancy tests
  • syncytiotrophoblast releases the hormone hCG which enters the mother’s blood stream
  • stimulates the corpus luteum of the ovary to produce progesterone to maintain the pregnancy
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11
Q

Ectoderm fait (external)

A

Cells derived from the ectoderm ultimately give rise to the:
- Epidermis
- Central nervous system
- Peripheral nervous system
- Eyes
- Internal ears
- Many connective tissues of the head

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12
Q

Mesoderm fait (middle)

A

Cells derived from the mesoderm ultimately give rise to:
- Skeletal muscles
- Blood cells and blood vessel linings
- Cardiovascular system
- Excretory systems incl kidneys
- Reproductive organs
- Visceral smooth muscular coats
- Serosal linings of all body cavities, ducts and internal organs
( Excluding in the head and limbs, they are the source of connective tissues, cartilage, bones, tendons, ligaments and dermis )

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13
Q

Endoderm fait (internal)

A

Cells derived from the endoderm ultimately give rise to epithelial linings. This includes linings of:
- Full alimentary tract (GI tract)
- Respiratory system
- Glands opening onto the GI tract and glandular cells of associated organs such as the liver and pancreas

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14
Q

Clinical indications for Neonatal EEG (3)

A
  • Assess the severity of brain dysfunction and determine prognosis
  • Detect seizures and assess response to treatment
  • Assess cerebral maturation
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15
Q

Considerations for neonatal EEG (4)

A
  • Size and vulnerability
  • Myelination and sulcation
  • Skull thickness
  • State of baby (medication/sedation)
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16
Q

Recommended electrodes for neonatal (2)

A
  • self-adhesive wet gel with snap lead wire
  • self-adhesive wet gel with pre-attached lead wire
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17
Q

Disadvantage of cup/disc electrodes

A

impedance gel risks skin damage, pressure injury

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18
Q

Electrodes used in practice for clinical neonatal EEG

A

Disposable hydrogel electrodes

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19
Q

Extra-cerebral electrodes in neonatal EEG montage (7) + state what is key

A

Key: ECG & respiratory
Other: Left & right EOG, Left & Right EMG, Sp02

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20
Q

What area of the scalp is mainly missing electrodes in the limited montage and why?

A

Frontal lobe
- poorly developed
- lots of artefact

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21
Q

What is the benefit of EMG electrodes in the EEG montage?

A
  • To differentiate seizure types (myoclonic, tonic, spasms)
  • Can aid in lateralization
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22
Q

Limited EEG study
(Reasons why / benefits)

A
  • Therapeutic hypothermia protocol
  • Setups done out-of-hours
  • Prolonged recordings (>24 h)
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23
Q

Full head EEG study

A
  • Investigate seizures
  • Investigate neonatal epileptic encephalopathy
  • Better characterization of severely abnormal background in TH
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24
Q

Timebase of neonatal EEG

A

15mm/s

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25
Information needed before starting neonatal EEG (5)
Age of baby Time of birth History of pregnancy issues History of birth Medication
26
What does APGAR score stand for?
Appearance (skin colour) Pulse rate Grimace Activity (tone) Respiratory effort
27
What is the purpose of APGAR score?
Used to help guide need for immediate treatment
28
When is APGAR done and how are the results interpreted?
Done: 1/5 mins Results: 7+ normal 4-6 low <= 3 critically low
29
Patient’s post menstrual age
Gestational age + chronological age
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Parts of ECG Analysis (5)
Rate - Fast (broad/ narrow)/slow - Regular/ irregular Rhythm Axis Intervals and voltages Repolarisation
36
Normal Features in Paediatric ECG (7)
Sinus tachycardia when sick Sinus arrhythmia Isolated PACs + PVCs Narrow QRS 2:1 Wenkebach during sleep Notched T waves in V2/V3 Notched P waves V2/V3 in older children
37
3 Key Features of Normal Sinus Rhythm
P before every QRS QRS after every p Normal p wave axis
38
Congenital Heart Disease Death Incidence
0.8 per 1,000 births
39
How does CHD present? (6)
* Antenatal screening * Postnatal pulse oximetry screening * Cardiogenic shock- low output state * Incidental finding * Discharge exam * Cardiac failure
40
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42
Name the embryonic stage: Primitive Gut Tube -> respiratory system
Early embryonic stage
43
Name the embryonic stage: Respiratory Diverticulum -> bifurcates in two buds = primary bronchi
Week 4
44
Name the embryonic stage: Pseudoglandular Stage (bronchopulmonary segment will become a specific portion of the lung - the lungs resemble the development of tubuloacinar glands)
Weeks 8-16
45
Name the embryonic stage: Canalicular Stage (the respiratory bronchioles develop)
Weeks 16-26
46
Name the embryonic stage: Terminal Sac Stage (Alveoli Develop)
>26 Weeks
47
4 Factors Affecting Breathing
Chemical (chemoreceptors in the carotid arteries and the aorta) Mechanical (foetal chest compression during birth – reduces the negative pressure) Thermal (skin thermoreceptors - change in temperature) Sensory factors (tactile skin receptors)
48
Surfactant
Naturally produced at end of 2nd & 3rd trimester 90%lipids 10%proteins Purpose: Lowers the surface tension at the air-water interface in the alveoli
49
Causes for resp complications of newborn (3)
- Delayed adaptation (maladaptation) - Exiting conditions (surgical or congenital anomalies) - Acquired conditions
50
Most common cause of respiratory distress in term newborns?
Transient Tachypnoea of Newborn (TTN)
51
4 Term Newborn Resp Pathology
Transient Tachypnoea of Newborn (TTN) Meconium Aspiration Syndrome (MAS) Persistent Pulmonary Hypertension of the Newborn (PPHN) Pneumothorax
52
2 Preterm Newborn Resp Pathology
Respiratory Distress Syndrome (RDS) Chronic Lung Disease
53
What is TTN and what effect does it have? (1,2)
Delay in clearance of lung fluid (after c-section) - Low pressure on the thorax - Low reabsorption of alveolar fluid via Na channels in the lung epithelium due to low circulating catecholamines
54
How long does TTN usually take to settle?
24-48 hrs
55
How can TTN be managed? (2)
O2 therapy Respiratory support (HF, CPAP)
56
What does TTN look like on an XRay? (2)
Fluid in the horizontal fissure Streaky infiltrates with hyperinflation and peripheral haziness
57
What does MAS look like on XRay? (3)
Hyperinflation Course diffuse patchy consolidations on both sides. Some subtle pleural fluid on both sides (arrowheads)
58
What is involved in aspiration of meconium in MAS? (3)
Mechanical obstruction Chemical pneumonitis Inactivation of surfactant
59
Who is at increased risk of MAS?
postdates newborns (>42 weeks)
60
How can MAS be managed? (4)
O2 therapy Respiratory Support Surfactant therapy NO therapy/ECMO
61
What is PPHN?
Pulmonary hypertension leading to right-to-left shunt
62
Causes of PPHN (5)
Birth asphyxia Meconium aspiration Sepsis Diaphragmatic hernia Primary disorder – less common
63
Presentation of PPHN
cyanosis, difference in pre- and post-ductal saturations
64
Management of PPHN (6)
O2 therapy Mechanical ventilation support Circulatory support Surfactant therapy NO therapy or sildenafil – pulmonary vasodilator ECMO
65
Diagnosis of PPHN (2)
XRay or Echo
66
Management of pneumonia (2)
antibiotic treatment respiratory support
67
Most common cause of neonatal pneumonia
Group B streptococcal infection (GBS)
68
Risk factors for neonatal pneumonia (4)
Prolonged rupture of the membranes (PROM) Maternal infection Fever Chorioamnionitis
69
What does pneumonia look like on XRay? (3)
Bilateral perihilar streaking Atelectasis of the right middle lobe, probably due to mucus impaction of the bronchus Position of the nasogastric catheter indicating mediastinal shift
70
What is a pneumothorax?
Free air in pleural cavity
71
How can a pneumothorax be managed? (3)
respiratory support (O2 therapy, mechanical ventilation) spontaneous resolution needle aspiration/chest drain
72
Risk factors for respiratory distress syndrome (5)
Prematurity Maternal diabetes mellitus Sepsis Hypoxemia and acidemia Hypothermia
73
Natural course of RDS? (2)
Getting worse over 24-72hrs Improvement with antenatal steroids
74
How can RDS be managed? (4)
Antenatal steroids Postnatal surfactant therapy (prophylaxis/rescue) O2 therapy Respiratory support (prevention of alveolar collapse): HF, CPAP, MV
75
What is bronchopulmonary dysplasia?
Chronic lung disease
76
bronchopulmonary dysplasia (definition)
O2 requirements at 28 days of life or at 36 weeks corrected
77
Who is at risk of neonatal chronic lung disease?
low birthweight infants (20-30%)
78
What is a major cause of mortality & morbidity in low birthweight infants?
Chronic lung disease
79
How can neonatal chronic lung disease be managed? (5)
Respiratory support Nutritional support Corticosteroids Diuretics Sildenafil if PPHN
80
Name 2 respiratory neonatal congenital anomalies and surgical conditions
Choanal Atresia Congenital Diaphragmatic Hernia
81
How can Congenital Diaphragmatic Hernia be managed? (4)
Intubate and ventilate from birth Pass NG tube Support for PPHN Surgical repair
81
How can Choanal Atresia be managed?
Oral airway Surgical correction
82
What is the best predictor of survival in PPHN?
Cardiac function
83
Diagnosis of PPHN (6)
History and Physical Exam Pre and post ductal saturation Labile or profound hypoxaemia Differential cyanosis Chest XRay ECHO
84
TAPSE
tricuspid annular plane systolic excursion Systolic longitudinal displacement of the lateral tricuspid annulus towards the apex, measured using M-mode echocardiography in the apical four-chamber view to assess right ventricular function
85
General management for PPHN (5)
- Normothermia - Noise and stress reduction - Sedation - Normalise pH - Ventilatory Management
86
Therapeutic intervention for PPHN (6)
- Optimise Ventilation - Oxygen - Surfactant - Nitric Oxide - Haemodyamic Considerations - Corticosteroids
87
What are the 3 Functional Properties of Lungs Addressed by Routine PFTs?
1. Airflow (inspiratory & expiratory) 2. Lung Volumes & Capacities (TLC, RV, FRC) 3. Alveolar-Capillary Gas Transfer (CO uptake over time)
88
Abnormalities in these 3 functional properties of lungs addressed by routine PFTs?
1.Obstructive ventilatory 2. Restrictive ventilatory 3. Gas transfer limitations or impairments
89

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