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Flashcards in Paediatrics Deck (143)
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1

What defines a pre term baby?

Born before 37 weeks gestation

2

How do you assess a baby when they are born?

Breathing, heart rate, colour, tone and response to stimulation
APGAR score

3

How do you keep premature babies warm when they are first born?

Keep the baby warm using a plastic bag under a radiant heater

4

What might a baby with respiratory distress syndrome look like?

Tachypnoea, grunting, cyanosis
Flaring of alae nasi
Intercostal and subcostal retractions

5

What management may be required for a baby with respiratory distress syndrome?

May need oxygen, CPAP (generate pressure below vocal cords to inflate lungs) or ventilation

6

What cardiovascular problems may be present in a premature baby?

Cardiovascular: ductus venosus and foramen ovale need to close
Hypotension: heart not pumping properly, not enough blood volume
Patent ductus arteriosus: Blood flow back into pulmonary system, increase stress on lungs, compliance of lungs change, need more pressure to inflate

7

What is a Qp/Qs ratio? And what is it used to measure?

Left to right shunt resulting in fully oxygenated blood recirculating through the lungs
Qp: pulmonary flow
Qs: systemic flow
Normal ratio of 1 because volume to lungs is equal to volume systemically
In patient with left to right shunt, Qp/Qs is greater than 1

8

What can be used to help close a patent ductus arteriosus?

Surgery: ligation, manually or with intravascular coils
NSAIDs: prostaglandin e2 keeps the duct open so block this with indomethacin or ibuprofen

9

If a pre term baby weighs below 1500g, what nutritional management should be given?

Total parenteral nutrition

10

Why are pre term babies prone to sepsis?

T and b cells, Opsonins and complement immature, bugs which dont make us ill, will make them ill

11

What signs might be visible that a pre term baby has necrotising enterocolitis?

Feeding intolerance
Abdominal distension
Bloody stools
Increased gastric residuals: volume of fluid remaining in stomach during enteral nutrition feeding

12

When are intraventricular haemorrhages most likely to happen in pre term infants?

First 7-14 days

13

Why are pre term infants particularly prone to intraventricular haemorrhage?

Blood vessels in brain are not fully developed and are fragile

14

What are the different grades of intraventricular haemorrhage?

Grade 1-2: smaller amount of bleeding, most of the time, no long term problems
Grade 3-4: more severe bleeding, blood presses on (3) or directly involves (4) brain tissue. Blood clots can form and block the flow of CSF which can lead to hydrocephalus

15

What are symptoms of intraventricular haemorrhage?

Apnoea
Changes in BP and heart rate
Decreased muscle tone
Decreased reflexes
Excessive sleep
Lethargy
Weak suck
Seizures or other abnormal movements

16

What tests can be done to check for intraventricular haemorrhage?

All babies born before 30 weeks should have an ultrasound of the head in 1-2 weeks of life
Second screen around the time baby was due to be born

17

What is Cystic periventricular leukomalacia?

White matter brain injury characterised by necrosis of white matter near lateral ventricles, decreased blood flow or oxygen to this region, damage to glial cells
Premature infants at highest risk
Motor control problems, developmental delays, develop cerebral palsy or epilepsy later in life

18

What increases risk of peri ventricular leukomalacia occurring?

If baby has had intraventricular haemorrhage
Uterine infections
Premature rupture of membranes
Premature babies
Very low birthweight babies

19

What problems do pre term babies encounter after delivery?

Get cold even faster
Have more fragile lungs
Don’t breathe effectively
Have fewer reserves

20

What percentage of babies born at 25 weeks or below develop cerebral palsy?

20%
Disabling cerebral palsy: 12%

21

What long term neurodevelopmental outcomes are common in pre term babies?

Cerebral palsy/ motor delay
Cognitive impairment/ learning difficulties
Speech, hearing, visual impairment
Epilepsy
Behavioural – ADHD, autism

22

How do we improve outcomes for pre term babies?

Antenatal magnesium sulfate
Antenatal corticosteroids
Better neonatal care
Research

23

What is magnesium sulfate used for in pre term infants?

IV before birth reduces risk of cerebral palsy and motor dysfunction in preterm infants

24

You are undertaking normal newborn screening examination on 30 hours old newborn infant on postnatal ward. You note that baby appears jaundiced. What History would you take?

How many weeks gestation?
What birth weight?
Was the delivery normal and vaginal?
Apgar scores at 1 min and 5 min
Has baby breast fed satisfactorily?
Was the pregnancy uneventful?
What is mother's blood group?
Did antenatal serology show anything?
Has baby passed stools/urine? Meconium? What colour?
Are parents both well?
Have they had previous pregnancies/babies? Any problems with these?

25

You are undertaking normal newborn screening examination on 30 hours old newborn infant on postnatal ward. You note that baby appears jaundiced. On examination he was not dehydrated, however he was visibly jaundiced. He was not bruised. There was no splenomegaly but the liver was palpable 1 cm below the costal margin in the mid-clavicular line. There were no other positive findings. What are possible diagnoses?

Physiological jaundice: breakdown of foetal haemoglobin as it is replaced with adult haemoglobin, immature metabolic pathways of the liver which are unable to conjugate and excrete bilirubin as quickly as an adult
Pathological jaundice: lasting >2 weeks, if jaundice doesn't clear with phototherapy, other causes considered - biliary atresia, progressive familial intrahepatic Cholestasis, bile duct paucity, alagille syndrome, alpha 1-anti trypsin deficiency

26

What 3 important tests would you do on a recently delivered baby with jaundice?

Transcutaneous bilirubinometer: measures bilirubin levels
Blood groups: group and DCT (direct Coombs test for autoimmune haemolytic anaemia)
FBC/blood film for haemolysis

27

What management would you use for a recently delivered baby with jaundice?

Monitor bilirubin, ensure feeding, phototherapy (helps conjugation process)

28

On the post natal ward you performed a routine newborn screening examination on a 2 day old female newborn baby and noted a loud systolic murmur. What further history would you take?

Family history of heart defects?
Foetal anomaly scan show anything?
Normal vaginal delivery?
Any previous pregnancies/babies?
How many weeks gestation was baby born at?
Apgar scores at 1 min and 5 min
Birth weight?

29

On the post natal ward you performed a routine newborn screening examination on a 2 day old female newborn baby and noted a loud systolic murmur. On examination the child was peripherally cyanosed. The respiratory rate was 60 and heart rate was 140 per minute. There were no added sounds on auscultation of the lungs. Heart sounds were normal. There was an obvious systolic murmur loudest at the left sternal edge. Femoral pulses were easily felt and the liver was palpable 1 cm below the costal margin. What is the likely diagnosis?

Patent ductus arteriosus

30

What tests would you do on a recently delivered baby with a systolic murmur heard loudest on the left sternal edge?

Pulse oximetry: looking for mixing of deoxygenated and oxygenated blood
Right arm: pre ductal
Left arm: pre or post ductal
Legs: post ductal sats
Want them to be bigh and not much difference between the pre and post
Testing for patent ductus arteriosus