Neonatology Flashcards

Question

Breast feeding in first few days of life?

Answer 1

Colostrum produced by breast in first few days, then replaced by milk. Colostrum has high protein and Ig content. Breast feeding intervals gradually lengthen from 2-3 hours to approx 4-hourly schedule.

Answer 2

Galactosaemia HIV ``` Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxic drugs Amiodarone Psychiatrics drugs - lithium, benzodiazepines Abx - ciprofloxacin, tetracycline, chloramphenicol, sulphonamides. ```

Answer 3

Reduced infection, atopy, constipation, maternal breast cancer, sudden infant death syndrome. Convenient, promotes bonding between mum and baby.

Answer 4

Volume of intake uncertain. Transmission of some drugs. Nutrient deficiencies (vit D, vit K). Failure to establish breast feeding results in emotional upset and guilt.

Answer 5

Sleepy baby Difficulty latching Cracked nipples Poor milk supply

Answer 6

Incorrect reconstitution -> electrolyte abnormalities. Over feeding -> reflux and vomiting Inadequate sterilisation -> gastroenteritis.

Answer 7

Symmetrical Chromosomal disorders Congenital infections

Answer 8

``` Asymmetrical Pre-eclampsia Increased maternal age Smoking Multiple pregnancy ```

Answer 9

``` Death Hypoxia Hypothermia Hypoglycaemia (low fat and glycogen stores) Polycythaemia NEC. ```

Answer 10

Antepartum maternal IV benzylpenicillin to women in preterm labour or with previous GBS pregnancy. High vaginal swab offered at 35-37 weeks to detect GBS. Women with pyrexia during labour given IV benzylpenicillin At-risk neonates are given benzylpenicillin.

Answer 11

Gestational age <38 weeks (premature babies). Small for date babies. Previous sibling with neonatal jaundice requiring phototherapy. Mothers intention to breastfeed exclusively. Visible jaundice in first 24 hours of life.

Answer 12

Normal rise in bilirubin, causing mild yellowing of skin and sclera from day 2-7 and usually resolves completely by 10 days. Baby remains otherwise healthy and well.

Answer 13

First 24 hours - pathological - excessive haemolysis - rhesus incompatibility, ABO incompatibility, G6PD deficiency, pyruvate kinase deficiency, hereditary spherocytosis. 2 days to 2 weeks: - physiological - breast milk jaundice - UTI - Excess haemolysis, bruising or polycythaemia Prolonged jaundice >14 days - always investigate biliary atresia needs urgent surgery. - uncongugated - breast milk jaundice, UTI, excess haemolysis - conjugated - biliary atresia, neonatal hepatitis, alpha-1 antitrypsin deficiency.

Answer 14

Haemolysis, anaemia, jaundice Severe cases - foetal hydrops and death. Rhesus status now screened antenatally, and anti-D Ig given to rhesus neg mothers.

Answer 15

Anaemia, jaundice, positive direct antiglobulin test (haemolysis). Less severe than rhesus incompatibility.

Answer 16

Destruction or absence of extra hepatic biliary tree. Rare but life-threatening, so much always investigate prolonged jaundice (urgent surgery). Prolonged jaundice - dark urine, pale stools. Failure to thrive as disease progresses due to: - malabsorption - enlargement of liver and spleen Bleeding tendency might develop due to vitamin K deficiency. Abdominal USS, liver biopsy, cholangiography. Kasai surgical procedure - ideally <6 weeks. Prognosis - often requires transplant by aged 20.

Answer 17

``` Conjugated fraction FBC TFT, LFT, U&E, blood film Blood group of mum and baby Coombs test Urine culture. ```

Answer 18

Plot serial bilirubin measurements on a treatment threshold graph within 2 hours in all babies with suspected or obvious jaundice in first 24 hours of life, and when bilirubin levels exceed threshold, initiate treatment. Phototherapy - blue light breaks down bilirubin in the skin Exchange transfusion - used if phototherapy doesn't work - involves removing some of baby's blood and swapping it with donor blood.

Answer 19

Complication of unconjugated hyperbilirubinaemia. Can deposit in basal ganglia and cerebellum, causing bilirubin encephalopathy. Early signs - lethargy and hypotonia Later signs - seizures, irritability, hypertonia.

Answer 20

Delayed resorption of fluid in lungs. Most common following C sections, possibly due to lung fluid not being squeezed out during passage through birth canal. CXR shows hyperinflation and fluid in horizontal fissure. Management - supplementary oxygen may be required. Usually settles within 1-2 days.

Answer 21

Present at birth or develop over 4 hours ``` Tachycardia Tachypnoea Intercostal and subcostal recession Accessory muscles Expiratory grunting Cyanosis/reduced o2 sats. Nasal flare Grunting ```

Answer 22

``` Male sex Diabetic mothers C-section Second born of premature twins Prematurity: - 50% of infants born at 26-28 weeks - 25% of infants born at 30-31 weeks ```

Answer 23

Chest X-ray - ground-glass appearance, indistinct heart border, air bronchogram. Antenatal management - maternal corticosteroids induce foetal lung maturation. Foetal management - - artificial surfactant therapy via ET - oxygen Assisted ventilation.

Answer 24

RDS babies can develop chronic lung disease, due to need of prolonged assisted ventilation with high pressures and high concentrations of oxygen. Defined as requiring oxygen beyond 36 weeks corrected gestation age or 28 days of age. CXR - widespread opacities with patchy translucent areas. Respiratory support - CPAP, oxygen, mechanical ventilation Steroids to wean from ventilatory support Strict nutrition

Answer 25

Bronchiolitis - therefore prophylaxis against RSV required - palivizumab.

Answer 26

``` Salmon patches (stork mark) - flat red/pink patches on baby's eyelids, neck or forehead at birth. Most common. Fades within a few months. ``` ``` Infantile haemangioma (Strawberry birth mark) - Red raised marks. Increase in size first 6 months, then shrinks and disappears around 7 years of age. Only treat if blocks aiways. ``` ``` Capillary malformation (port wine stain) - flat red purple marks. Face chest and back - usually affects one side of body. Sensitive to hormones, may become more noticeable around puberty, pregnancy and menopause. ```

Answer 27

Cafe-au-lait spots - coffee coloured. Can have one or two. If more than 6 appear by time child is 5, neurofibromatosis should be excluded. Mongolian blue spots - blue-grey or bruised-looking birthmarks, present from birth. - commonly on dark skinned people. Over lower back or buttocks. Looks like bruise. Congenital melanocytic nevi (congenital mole) - large brown/black moles present from birth. Overgrowth of pigmented cells. Becomes smaller and darker. Risk of developing cancer low, but risk increases the larger it is.

Answer 28

Breech presentation Cephalopelvic disproportion Macrosomia Instrumental delivery

Answer 29

Bruising Cephalohaematoma Brachial plexus injury - eg erbs palsy, especially following shoulder dystocia. Facial palsy - especially following forceps delivery, often resolves spontaneously, may cause feeding difficulties. Clavicle fracture - most common fracture Subaponeurotic haemorrhage - rare but life-threatening. - haematoma between skull periosteum and scalp galea aponeurosis, caused by instrumental delivery. Can result in large volume of blood loss and haemodynamic instability.

Answer 30

Swelling on newborn head, more common following prolonged, difficult deliveries. Due to bleeding between periosteum and skull -> does not cross suture lines. Parietal region most common. Develops several hours after delivery and may take up to 3 months to resolve. Jaundice may occur as Bloods in haematoma gets broken down. Self limiting, but may require drainage.

Answer 31

Familial Low and middle income countries Possible lack of access to sufficient nutritious foods, alcohol, drugs, poor access to healthcare. Advanced maternal age Exposure to pesticides or chemicals in pregnancy. Maternal infections. Maternal nutritional status (folate deficiency)

Answer 32

Ingestion of raw or undercooked meat, or from oocytes in faeces of infected cats. Transmission more likely if seroconversion occurs later in pregnancy. But more serious disease occurs if transmission in first trimester. ``` Features: Chorioretinitis Hydrocephalus Asymptomatic Intracranial calcification Neurological damage (including cerebral palsy). ```

Answer 33

``` Antibody test (IgG passes transplacentally from mum). Neurological exam and ophthalmological exam of retina in at risk neonates. ``` CT brain with IV contrast or MRI brain.

Answer 34

Pyrimethamine plus sulfadiazine plus calcium folinate for 12 months.

Answer 35

``` SNHL Congenital cataracts and glaucoma Congenital heart disease - PDA, pulmonary stenosis Growth retardation Hepatosplenomegaly Salt and petter chorioretinitis Cerebral palsy ```

Answer 36

Always consider in growth-restricted neonates with SNHL. | IgM antibodies are raised in women recently exposed to virus.

Answer 37

No longer screened at booking. If mother tested and has no immunity, should be advised to keep away from people who have rubella. Non-immune mothers should be offered MMR vaccine in post-natal period.

Answer 38

``` IUGR Early onset jaundice Hepatosplenomegaly Thrombocytopenia Microcephaly Purpuric skin lesions SNHL Intracranial calcification Chorioretinitis. ```

Answer 39

Cerebral palsy Epilepsy Learning difficulty

Answer 40

``` Virus isolation (urine and saliva) Specimens of viral isolation must be taken within 3 weeks of birth ``` Treat with gangciclovir.

Answer 41

Risk highest if mother acquired HSV during 3rd trimester. Fever, seizures, lethargy, sepsis, vesicular blisters of skin/eye/mucous membranes. CSF or serum HSV PCR testing. Eye/mouth/nasopharynx/rectal cultures Manage with acyclovir for 21 days if disseminated/CNS disease Manage with acyclovir for 14 days if disease limited to skin/mucous membranes

Answer 42

Maternal antiretroviral therapy in pregnancy. Elective C-section if detectable viral load. (vaginal delivery if viral load undetectable) Give antiretroviral therapy to neonates for first 6 weeks. Avoid breast feeding.

Answer 43

Scars, lesions, malformed digits and limbs, eye defects, learning disabilities. Severe neonatal varicella - if mother gets infection near time of delivery, foetus receives high viral load but little maternal antibodies -> increased risk of infection and death.

Answer 44

If doubt mother has had chicken pox, check ab's in maternal blood. Non-immune - give varicella zoster Ig ASAP. Effective up to 10 days post exposure. If pregnant women with chickenpox present within 24 hours - give oral acyclovir. Neonates exposed in high-risk period should be treated with varicella zoster Ig.

Answer 45

Early congenital syphilis - presents before 2 years of age - prematurity, IUGR, highly infectious rhinitis, hepatosplenomegaly, skin rash, osteochondritis, neurological symptoms. Late congenital syphilis - presents after 2 years of age - craniofacial malformation, dental abnormalities, interstitial keratitis, deafness, neurosyphilis.

Answer 46

Serology at first antenatal booking appointment. Repeated syphilis serology in third trimester and at delivery if serology was positive. Foetal USS - hepatomegaly, ascites, hydrops. Infants born to mothers with syphilis require a non-treponemal blood test. Dark-field microscopy on lesions or nasal discharge.

Answer 47

First line for neonates - IV aqueous benzylpenicillin or IM procaine benzylpenicillin. Pregnant women should be treated with benzylpenicillin All pregnant women who have syphilis should be tested for HIV.

Answer 48

Common rash in neonates -> blotchy red spots on skin with overlying white or yellow papule or pustules. Does not cause any discomfort to infant. Appears in up to half of term neonates, usually 2-5 days after birth, and resolves within 2 weeks of life. No treatment indicated, as eruption is transient and self-limiting.

Answer 49

Premature birth Congenital causes - herpes, jaundice, ifnections Congenital hypothyroidism Down syndrome Beckwith-Wiedemann syndrome Temporary conditions - diarrhoea, ear infection, coughs and colds, teething.

Answer 50

``` Not fed in over four hours Fever Vomiting after feeding Vomiting blood Persistent and worsening cough Constant crying Bloody stool Wheeze Becoming unresponsive to touch. ```

Answer 51

Treat underlying cause. Change feeding schedule - smaller, more frequent meals. Change feeding formula - breast to bottle.

Answer 52

All pregnant women should have antenatal screening for HBsAg -> babies born to positive mothers should have hep B vaccine within 24 hours of birth. - Baby should also receive hepatitis B-specific Ig, unless mother is known to be anti-HBe positive.

Answer 53

Acute or subacute brain injury due to perinatal asphyxia. Acute injury caused by hypoxia, repercussion injury occurs 6-72 hours later. Mild - lethargy followed by period of hyper-alertness with irritability but normal tone. Impaired feeding for 1-2 days. No focal signs or seizures. Good prognosis. Moderate - hypotonia with reduced movements and consciousness. Seizures may be seen. Variable prognosis. Severe - Coma with absence or spontaneous movement and reflexes. Seizures usually seen and may be frequent. Prognosis poor.

Answer 54

Bloods - U&E, cardiac enzymes, LFTs, clotting screen, ABG Imaging - MRI brain, cranial USS, echo Additional - EEG, hearing test, retinal and ophthalmic examination Metabolic or mixed acidosis in umbilical artery sample. Apgar score 0-3 for longer than 5 minutes Neonatal neurological signs (seizure, coma, hypotonia) Multiple organ involvement.

Answer 55

``` Interventions needed within 6 hours of initial hypoxic insult to prevent repercussion injury (can occur 6-72 hours later). Total body cooling Respiratory support Anticonvulsants for seizures Fluid restriction Circulatory support with inotropes. ``` Cerebral function monitoring for seizures and neurological function. MRI and electroencephalogram may reveal cystic lesions or cerebral atrophy.

Answer 56

Reduces risk of neurodisability - induce hypothermia for 72 hours followed by gradual rewarming to protect the brain from reperfusion injury.

Answer 57

Brain - HIE Heart - hypoxic cardiomyopathy, hypotension Lungs - persistent pulmonary hypertension Gut - ileus and necrotising enterocolitis Kidneys - acute tubular necrosis Blood - DIC

Answer 58

Preterm infants, due to lack of brown fat, little muscle activity and high body surface area to volume ratio.

Answer 59

Radiant heat Ambient temperature and humidity Insulation with clothing (including a hat) Plastic bags - effectively steaming the baby.

Answer 60

Neonates pass meconium before delivery -> respiratory distress in new born as result of meconium in trachea. Occurs in immediate neonatal period. More common in post-term deliveries.

Answer 61

``` Maternal hypertension Pre-eclampsia Chorioamnionitis Smoking Substance abuse ```

Answer 62

If thick meconium causing obstruction, suction meconium from trachea under direct vision after delivery. Most cases are due to aspiration in utero, cannot be prevented by suction at delivery.

Answer 63

Hirschsprung's disease - requires surgery Meconium ileus/cystic fibrosis - enema, IV fluids, surgery Meconium plus syndrome - requires rectal stimulation and enema Anorectal malformations - dilatation, surgery Small left colon syndrome - enema, colostomy.

Answer 64

Baby doesn't breathe for >20 seconds. More common in premature babies than full-term, due to immaturity of respiratory centre of brain, occurring days 2-7 of life. More common when in REM sleep. Often idiopathic in premature babies, but almost always pathological in term infants. May be followed by bradycardia.

Answer 65

>34 weeks - need cardio-resp/sats monitoring if unstable. <34 weeks - monitoring for first week of life or until absence of apnoeic episodes for at least 7 days. Apnoea monitors used in perinatal nurseries to alert staff when to act on apnoea. Prone position reduced apnoea of prematurity.

Answer 66

First line - oral/IV caffeine. Given routinely <34 weeks neonates. Smooth muscle relaxant and cardiac muscle and CNS stimulant. If this doesn't work - high flow nasal cannula. Then nasal CPAP Last resort - mechanical ventilation.

Answer 67

Sepsis and cardiac disease. Both present as shock.

Answer 68

Hypothermia, respiratory distress, poor pulses.

Answer 69

Initial evaluation and resuscitation - high flow O2, IV access, 20ml/kg normal saline, abx

Answer 70

ABG, FBC, U&E, glucose, LFTs, clotting, blood cultures, consider LP CXR, ECG if tachycardic. Ammonia (if seizures/encephalopathy)

Answer 71

Hyperinsulinism Inadequate hepatic glycogen stores - prematurity, IUGR. Increased glucose use (hypothermia, sepsis) Reduced glycogenolysis, gluconeogenesis (inborn errors of metabolism, adrenal insufficiency.

Answer 72

``` Maternal DM Prematurity IUGR Hypothermia Neonatal sepsis Inborn errors of metabolism Neisioblastosis (beta cell hyperplasia) Beckwith-Wiedemann syndrome ```

Answer 73

Mental retardation Recurrent seizures Developmental delay Personality disorders

Answer 74

``` Asymptomatic Hypotonia Lethargy, apathy Poor feeding Seizures, jitteriness Congestive heart failure Cyanosis Apnoea Hypothermia Tachycardia ```

Answer 75

Serum or plasma glucose levels Serum insulin Urine - first-voided urine dipstick for ketones Screen for metabolic errors.

Answer 76

Early feeding of newborn with breastmilk or formula NG/IM/IO/IV 10% dextrose IV 10% dextrose drip if hypoglycaemia is recurrent Surgery if appropriate (eg pancreas resection).

Neonatology Flashcards

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