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Flashcards in Neonatology Deck (102):
1

what is early onset infection

2

signs early onset infection

respiratory distress, apnoea, temperature instability

3

what is late onset infection

>48h after birth. from the infants environment

4

what organism most common in late onset

staph epidermidis (coag negative staph)

5

signs of neonatal meningitis

bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs

6

what % women carry group B strep

10-30%

7

in colonised mothers what are the risk factors for group B

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

8

in colonised mothers what are the risk factors for group B

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

9

signs early onset infection

respiratory distress, apnoea, temperature instability

10

what is late onset infection

>48h after birth. from the infants environment

11

predictive signs for severe illness in infant

seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5

12

signs of neonatal meningitis

bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs

13

what % women carry group B strep

10-30%

14

if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks

chlamydia trachomatis- give erythromycin for 2 weeks

15

in colonised mothers what are the risk factors for group B

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

16

symptoms of hypoglycaemia in the neonate

jittery, irritable, apnoea, lethargy, drowsy, seizures

17

management early onset infection

benzylpenicillin + gentamicin for 10-14 days

18

management late onset infection

flucloxacillin + gentamicin

19

predictive signs for severe illness in infant

seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5

20

how should high concentration glucose be administered

central venous line- to avoid extravasation into the tissue which can cause necrosis and reactive hypoglycaemia

21

if there is a delay in IV glucose in hypoglycaemia what can be given

glucagon or hydrocortisone

22

if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks

chlamydia trachomatis- give erythromycin for 2 weeks

23

when is hypoglycaemia likely

IUGR, preterm, born to mother with diabetes, large for dates baby, hypothermic, polycythaemia, ill

24

symptoms of hypoglycaemia in the neonate

jittery, irritable, apnoea, lethargy, drowsy, seizures

25

how can hypoglycaemia be prevented

early and frequent milk feeding

26

complications of kernicterus

CP, LD, deafness

27

when do you need to give IV glucose in hypoglycaemia

asymptomatic and 2 low readings (

28

causes of jaundice

rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis

29

if there is a delay in IV glucose in hypoglycaemia what can be given

glucagon or hydrocortisone

30

why do so many newborns become jaundiced

release Hb from breakdown red cells due to high Hb conc at birth; red cell life span shorter than in adults; bilirubin metabolism more immature

31

causes of jaundice >2 weeks

unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia

32

can free bilirubin cross the BBB

yes as it is fat soluble

33

acute symptoms kernicterus

lethargy, poor feeding, irritability, incr muscle tone- opisthotonus, seizures, coma

34

complications of kernicterus

CP, LD, deafness

35

what level bilirubin do infants become clinically jaundiced

>80 umol/l

36

causes of jaundice

rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis

37

how can you confirm rhesus haemolytic disease

direct coombs test

38

causes of jaundice 24h-2 weeks

physiological, breast milk jaundice, dehydration, infection, haemolysis, bruising, polycythaemia, crigler najer

39

causes of jaundice >2 weeks

unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia

40

which infants are more susceptible from damage from jaundice so require intervention quicker

preterms

41

what can exacerbate jaundice

poor milk intake and dehydration

42

management jaundice

phototherapy, exchange transfusion,

43

what does phototherapy do in jaundice

converts unconjugated bilirubin into water soluble pigment to be excreted in the urine

44

complications phototherapy in jaundice

temperature instability, macular rash, bronze discolouration of the skin

45

what can you give in rhesus haem disease or ABO incompatibility

IvIG

46

what are the signs conjugated hyperbilirubinaemia

dark urine, pale stools, hepatomegaly, poor weight gain

47

what is exchange transfusion

give via umbilical vein, take away via umbilical artery

48

complications exchange transfusion

decr pulse, apnoea, decr platelets, decr glucose, decr Na, decr Hb

49

what is resp distress syndrome

due to a deficiency in alveolar surfactant leading to alveolar collapse resp failure

50

what does hypoxia lead to in RDS

decr cardiac output, hypotension, acidosis and renal failure

51

what are the signs of respiratory distress

tachypnoea (>60/min); expiratory grunting, laboured breathing and nasal flaring, cyanosis

52

infants at risk of RDS

pre term, maternal diabetes, males, 2nd twin, Csection

53

prevention of RDS

betamethasone or dexamethasone to all women 23-35 weeks if expecting to deliver pre term

54

pulmonary causes RDS

transient tachypnoea of the newborn, meconium aspiration, pneumonia, pneumothorax, milk aspiration, persistent pulmonary hypertension of the newborn

55

non pulmonary causes RDS

congenital heart disease, metabolic acidosis, severe anaemia, intracranial birth trauma/encephalopathy, sepsis

56

what is transient tachypnoea of the newborn

due to excess lung fluid. usually resolves within 24h. more common after C section

57

what is meconium aspiration

meconium passed in utero leading to meconium stained amniotic fluid. usually pre birth. sign of fetal distress (hypoxia). rarer in pre term.

58

treatment mec aspiration

surfactant, ventilation, inhaled NO, antibiotics

59

risk factors for pneumonia in the neonate

prolonged rupture of membranes, chorioamniotis, low birthweight

60

risk factors pneumothorax in the neonate

spontaneous in 2% births, can be secondary to mec aspiration, RDS, complication of ventilation

61

when does haemorrhagic disease of the newborn happen

2-7 days postpartum

62

cause of haemorrhagic disease of the newborn

no enteric bacteria to make vitamin K

63

tests in haemorrhagic disease of the newborn

PT and PTT incr, platelets no difference

64

prevention haemorrhagic disease of the newborn

vit k 1mg IM or 2 doses oral phytomenadione. repeat in

65

treatment haemorrhagic disease of the newborn

plasma and vit K for active bleeding

66

when should term babies get back to their birth weight

all lose weight in first week. by day 7-10. in pre terms- day 14

67

potential problems with breastfeeding

latching on, cracked nipples, breast engorgement, intestinal hurry

68

potential problems with bottle feeding

incorrect reconstitution, allergy, inadequate sterilisation

69

what is tested for in the Guthrie screening

at 5-8 days. maple syrup urine disease, CF, congenital hypothyroidism, PKU, MCADD, sickle cell

70

what happens in HIE

perinatal asphyxia- gas exchange impaired or stops, cardioresp depression. hypoxia, hypercarbia, metabolic acidosis

71

causes HIE

failure gas exchange across the placenta- excessive uterine contractions, placental abruption, ruptured uterus; interrupted umbilical blood flow- compressed cord; inadequate maternal perfusion; compromised fetus- anaemia, IUGR; failure to breathe

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signs mild HIE

irritable, responds excessively to stimulation, impaired feeding

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signs moderate HIE

abnormal tone and movement, cant feed, seizures

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signs severe HIE

no normal spontaneous movement or response to pain, hypo and hypertonia. seizures, multi organ failure

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management HIE

resp support, record EEG, treat seizures, fluid restriction, vol and inotrope support, monitor BM and electrolytes

76

prognosis HIE

mild- complete recovery. severe- mortality 30-40%, >80% of survivors- neurodevelopmental disability

77

what can congenital rubella cause

18 weeks damage to the fetus is minimal

78

which is the commonest congenital infection

CMV

79

what are the features of CMV

hepatosplenomegaly, petechiae, neurodevelopmental disability

80

clinical manifestations toxoplasmosis

retinopathy, cerebral calfication, hydrocephalus

81

what can appear in congenital syphillis

rash on soles of feet and hands

82

what is erythema toxicum

neonatal urticaria. rash appears 2-3d. white pin point papules at centre of erythematous base. lesions concentrated on the trunk. goes in 24h

83

what can retinopathy of prematurity lead to

retinal detachment, fibrosis, blindness

84

risk factors for retinopathy of prem

prem, low birthweight. screen if

85

signs of IVH

seizures, bulging fontanelle, cerebral irritability. do ultrasound and CT

86

complications IVH

IQ decr, CP, hydrocephalus

87

what can decr the risk of IVH in prems

delayed cord clamping

88

what happens to pulmonary vascular resistance with the first breath

falls, rush of blood to lungs

89

what helps promote adult circulation (lungs)

inhaled NO

90

complications of mechanical ventilation neonates

pneumothorax, pulmonary haemorrhage, bronchopulmonary dysplasia, emphysema, pneumona; upper airway obsrruction; PDA, incr ICP, IVH, RoP

91

causes of neonatal seizures

HIE, infection, ICH, structural CNS lesions, metabolic (decr glucose, decr Ca, Na up or down, decr Mg)

92

treatment neonatal seizures

first line-phenobarbital. 2nd line phenytoin

93

why would the red reflex be absent

cataract, retinoblastoma

94

causes of apnoeic attacks

resp centre immaturity, aspiration, heart failure, infection, PaO2 decr, glucose decr, Ca decr, seizures, PDA, temp up or down, exhaustion, airways obstruction

95

what is NEC

inflammatory bowel necrosis

96

what is the main risk factor for NEC

prem. otherss- weigh

97

signs NEC

mild- abdominal distension. blood and mucus PR. severe- sudden distension, tenderness, shock, DIC, mucosal sloughing.

98

what is pathogneumonic for NEC

pneumatosis intestinalis (gas in gut wall seen on x ray)

99

treatment nec

stop oral feeding, culture faeces, crossmatch, give antibios- cefotaxime + vancomycin. laparotomy if progressive distension perforation

100

prophylaxis of nec

expressed breast milk, probiotics, oral antibiotics

101

presentation biliary atresia

jaundice, yellow urine, pale stools. biliary tree occlusion by angiopathy at week 3. splenomegaly. cholestasis

102

management biliary atresia

surgery- Kasai procedure and intestinal limb to drain bile from porta hepatis. if operation is late- cirrhosis. will need liver transplant in first year of life