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Neonatology Flashcards

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1
Q

what is early onset infection

A
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2
Q

signs early onset infection

A

respiratory distress, apnoea, temperature instability

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3
Q

what is late onset infection

A

> 48h after birth. from the infants environment

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4
Q

what organism most common in late onset

A

staph epidermidis (coag negative staph)

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5
Q

signs of neonatal meningitis

A

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

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6
Q

what % women carry group B strep

A

10-30%

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7
Q

in colonised mothers what are the risk factors for group B

A

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

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8
Q

in colonised mothers what are the risk factors for group B

A

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

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9
Q

signs early onset infection

A

respiratory distress, apnoea, temperature instability

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10
Q

what is late onset infection

A

> 48h after birth. from the infants environment

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11
Q

predictive signs for severe illness in infant

A

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

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12
Q

signs of neonatal meningitis

A

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

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13
Q

what % women carry group B strep

A

10-30%

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14
Q

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

A

chlamydia trachomatis- give erythromycin for 2 weeks

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15
Q

in colonised mothers what are the risk factors for group B

A

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

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16
Q

symptoms of hypoglycaemia in the neonate

A

jittery, irritable, apnoea, lethargy, drowsy, seizures

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17
Q

management early onset infection

A

benzylpenicillin + gentamicin for 10-14 days

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18
Q

management late onset infection

A

flucloxacillin + gentamicin

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19
Q

predictive signs for severe illness in infant

A

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

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20
Q

how should high concentration glucose be administered

A

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

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21
Q

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

A

glucagon or hydrocortisone

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22
Q

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

A

chlamydia trachomatis- give erythromycin for 2 weeks

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23
Q

when is hypoglycaemia likely

A

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

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24
Q

symptoms of hypoglycaemia in the neonate

A

jittery, irritable, apnoea, lethargy, drowsy, seizures

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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
72
signs mild HIE
irritable, responds excessively to stimulation, impaired feeding
73
signs moderate HIE
abnormal tone and movement, cant feed, seizures
74
signs severe HIE
no normal spontaneous movement or response to pain, hypo and hypertonia. seizures, multi organ failure
75
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

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