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Specialties > Paeds Written - NEONATES > Flashcards

Paeds Written - NEONATES Flashcards

1
Q

Guthrie screening conditions

A 
Congenital hypothyroidism
Sickle cell disease
Cystic fibrosis
Inherited metabolic disease
- Phenylketonuria
- Homocystinuria
- Etc.
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2
Q

Newborn method of hearing test

A

Automated/evoked otoacoustic emissions test

  • computer generated click played through earpiece
  • soft echo/emission = healthy cochlea
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3
Q

2nd line hearing test for newborns

A

Auditory brainstem response test

- performed if abnormal Otoacoustic emissions test

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4
Q

APGAR score components

A 
Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
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5
Q

APGAR scores for these babies:

  1. HR 106, blue extremities, active movement, weak cry, grimace
  2. HR 98, weak cry, floppy, blue extremities, no grimace
A
  1. 2 + 1 + 2 + 1 + 1 = 7 = Good state

2. 1 + 1 + 0 + 1 + 0 = 3 = Very low

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6
Q

Rate of chest compressions in neonatal resus?

A

3: 1
compressions: breaths

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7
Q

1st step for term baby that is gasping / not breathing

A

5 inflation breaths (air)

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8
Q

Acceptable pre-ductal SpO2 for neonates

A

2 mins - 65%
5 mins - 85%
10 mins - 90%

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9
Q

Risk factors for surfactant deficiency

A 
Premature
Male
C section
diabetic mother
2nd born of premature twins
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10
Q

Diagnostic signs on imaging for Surfactant deficiency/RDS?

A

CXR –> ground glass appearance, indistinct heart border

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11
Q

Tx for surfactant deficiency?

A

Exogenous surfactant (CuroSurf) via ET tube
Assisted ventilation - CPAP
Oxygen

Preventative = maternal antenatal corticosteroids

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12
Q

Antenatal corticosteroid course?

A

24mg dexamethasone IM in 2 divided doses of 12mg 24 hours apart OR 4 divided doses of 6mg 12 hours apart

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13
Q

Evidence of Transient tachypnoea of the newborn (TTN) on imaging

A

Hyperinflation of lungs

Fluid in horizontal fissure

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14
Q

Intervention required for Transient Tachypnoea of Newborn (TTN)

A

Observation + supportive care

?Oxygen supplementation to maintain sats

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15
Q

What factors warrant a neonatal assessment (if meconium observed during delivery) ?

A 
RR >60
Grunting
HR < 100 or >160
Cap refill >3 seconds
Temp >38 (or >37.5 on 2 occasions 30 mins apart)
Sats <95%
Central cyanosis
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16
Q

Pathophysiology of Persistent Pulmonary HTN in neonate?

A

High pulmonary vascular resistance causes right to left shutting within lungs and at atrial & ductal level

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17
Q

Evidence of persistent pulmonary HTN (of neonate) on CXR?

A

Normal sized heart

Some pulmonary oligaemia (local reduction in blood perfusion)

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18
Q

Levels of treatment used for meconium aspiration?

A

Meconium fluid but no Hx GBS –> observation

Sx of infection –> IV ampicillin + IV gentamicin

Severe –> oxygen , non invasive ventilation e.g. CPAP

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19
Q

Key criteria/feature that suggests Chronic lung disease of prematurity / Bronchopulmonary dysplasia?

A

Oxygen requirement/dependence after 36 weeks corrected/adjusted age OR 28 days after birth

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20
Q

Medications that can be given in Chronic lung disease of prematurity/Bronchopulmonary dysplasia?

A

Corticosteroids - reduce lung inflammation
- BUT limit use D/T concerns about Neuro development

Diuretics - reduce excess fluid in lungs

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21
Q

Causes of perinatal asphyxia (causing HIE)

A

Failure of gas exchange across placenta - placental abruption

Interruption of umbilical blood flow - shoulder dystocia causing cord compression

Inadequate placental perfusion - maternal hypotension

Compromised foetus - IUGR

Failure to breathe at birth

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22
Q

Most important treatment for HIE

A

Therapeutic cooling / hypothermia

  • reduce to 32-36 for 24 hours
  • only Tx shown to reduce death & disability
  • only if >36 weeks gestation!
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23
Q

features of mild Hypoxic ischaemic encephalopathy

A 
Irritable
Responds excessively to stimulation
Hypertonia
Staring eyes
Hyperventilation

Complete recovery expected

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24
Q

Features of moderate Hypoxic ischaemic encephalopathy

A

Abnormal movement
Hypotonia
Cannot feed
Seizures

Good long tern prognosis if fully resolved by 2 weeks old
Otherwise bad prognosis

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25
Q

Features of severe hypoxic ischaemic encephalopathy

A

NO normal movement or response to pain
Fluctuating muscle tone (hypo –> hyper)
Prolonged/refractory seizures
+/- multi organ failure

30-40% mortality
Over 80% have Neuro-disability if not cooled

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26
Q

1st line Tx for Retinopathy of prematurity

A

Laser photocoagulation

or cryotherapy

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27
Q

Most appropriate way of checking bilirubin:

  • <24 hours
  • 2 days - 2 weeks
  • > 2 weeks
A

<24 hours = serum BR (can assume total BR = uBR)

2 days - 2 weeks = transcutaneous BR
- but check with serum BR if >250

> 2 weeks = split BR (cBR and uBR)

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28
Q

Clinical features of kernicterus

A 
Abnormal muscle tone - arched back
Lethargy
Poor feeding
High pitched cry
Seizures, coma
Irritability
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29
Q

Thresholds for phototherapy in neonates

A 
Term = 350 total serum BR
Premature = 120 total serum BR
30
Q

Thresholds for exchange transfusion in neonates

A

Term = 450 total serum BR

Premature = 230 total serum BR

31
Q

Management for neonate with blood glucose 0.8mmol/L

A

If symptomatic or <1mmol/L (very low):

Admit to neonatal unit
+ start 10% dextrose infusion

32
Q

Treatment for asymptomatic hypoglycaemic baby (capillary glucose 2.1)

A

Encourage normal feeding - breastfeeding or formula

Monitor blood glucose

33
Q

RF for prolonged / severe hypoglycaemia as neonate:

A 
Premature
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Others: Nesidioblastosis, Nechwith-Wiedemann syndrome
34
Q

Hypoglycaemia - clinical features

A

Autonomic

  • jitteriness
  • tachypnoea
  • pallor
  • irritable

Neuroglycopenic

  • poor feeding/suck
  • weak cry
  • drowsy
  • hypotonia
  • seizures

Other

  • apnoea
  • hypothermia
35
Q

Most common organisms of Early onset Neonatal sepsis

A

Group B strep

E coli

36
Q

Most common organism in Late onset neonatal sepsis

A

staph. epidermidis

Gram -ves

  • pseudomonas
  • klebsiella
  • enterobacter

Fungi

37
Q

Most common presentation of neonatal sepsis

A

Respiratory distress (85%)

  • grunting
  • nasal flaring
  • tachypnoea
  • accessory muscle use
38
Q

Treatment levels for Neonatal sepsis

A

Only 1 minor RF = regular observations for 24h

2+ minor RF or 1 red flag = Abx + full septic screen

39
Q

Red flags for possible neonatal sepsis

A

suspected or confirmed infection in another baby (if multiple pregnancy)

parenteral abx given to mum during labour or in 24h before or after birth

  • for suspected invasive bacterial infection
  • NOT prophylaxis for GBS

resp distress starting >4 hr after birth

Seizures

Need for mechanical ventilation AT TERM

Signs of shock

40
Q

Minor RF for neonatal sepsis

A

Previous baby with GBS infection

Premature

LBW

Maternal: current GBS colonisation, current bacteriuria, inrapartum temp >38, ROM >18h, current infection incl chorioamnionitis

41
Q

Abx treatment for suspected/confirmed neonatal sepsis

A

IV benzylpenicillin + gentamicin

42
Q

Requirements for stopping Abx in suspected neonatal sepsis

A

CRP <10

Negative blood culture at presentation

Negative blood culture again at 48h

43
Q

Evidence of Necrotising enterocolitis (NEC) on imaging

A

Abdo XR

Pneumatosis intestinalis (intramural gas) !!!
Portal venous gas
Dilated bowel loops
Bowel wall oedema
Rigler sign - air inside & outside bowel wall
Football sign - air outlining Falciform ligament

44
Q

Management of NEC

A

Barrier nursing
NG tube decompression
Total bowel rest + TPN
Abx - cefotaxime + vancomycin

Surgical R/v + If perforation –> laparotomy

45
Q

Clinical presentation of Erb’s palsy

A

Adduction + internal rotation of arm
Pronation of forearm
‘Waiter’s tip’

46
Q

Pathophysiology of Erb’s palsy

A

Damage to brachial plexus

Usually a result of shoulder dystocia

47
Q

Positional vs True talipes ON EXAMINATION

A

Positional = foot CAN be fully dorsiflexed to touch front of lower leg + normal size foot

True talipes equinovarus (club foot)

  • cannot be fully dorsiflexed to touch front of lower leg
  • heel rotated inward ‘varus’
  • heel in plantar flexion ‘equinus’
  • entire foot inverted + supinated feet
  • affected foot is shorter
  • affected side calf muscles thinner
48
Q

Treatment of positional talipes

A

Physiotherapy

49
Q

Treatment options for True Talipes Equinovarus

A

Mild-moderate = Ponsetti method (plaster casting + bracing)

Severe = surgery

50
Q

Associations with Aplasia Cutis Congenita

A

Trisomy 13 - Patau
Setleis syndrome
4p syndrome

Teratogens during pregnancy e.g. carbimazole (antithyroid medication)

51
Q

Management of aplasia cutis congenita

A

Conservative wound care - most lesions re-epithelialise spontaneously

Surgical repair (large lesion)

52
Q

Features of Foetal Alcohol syndrome

A 
Microcephaly
Smooth/absent philtrum
Hypoplastic upper lip
IUGR, growth retardation
Low IQ, learning difficulties
Cardiac malformations
Epicanthic folds
Short palpebral fissure

Withdrawal - irritable, tremors, hypotonic

53
Q

Risk factors for cleft lip/palate

A

Maternal benzodiazepine use

Maternal anti epileptic use

54
Q

Timing of definitive surgery for cleft lip/palate

A

3 months for lip

6-12 months for palate

55
Q

Complication of cleft lip/palate

A

Increased risk secretory otitis media

Possible airway problems - ‘Pierre-Robin sequence’

56
Q

Most common congenital diaphragmatic hernia type?

A

Left postero-lateral Bochdalek hernia

57
Q

Presentation of congenital diaphragmatic hernia

A

Respiratory distress

Bowel sounds on auscultation of chest

58
Q

Prognostic factors in congenital diaphragmatic hernia

A

Liver position
- liver herniation into thorax = more severe, lower survival

Lung-to-head ratio

  • numeric estimate of size of foetal lungs
  • > 1 = better outcome
59
Q

Gold standard Ix for Oesophageal atresia/Trache-oesophageal fistula

A

Gastrograffin swallow

60
Q

Presentation of Oesophageal atresia/Trache-oesophageal fistula

A

Choking
Cyanotic spells after aspiration

+ associated with other developmental issues

61
Q

Definitive Tx for Biliary atresia

A

Kasai procedure

  • Dissection of abnormalities
  • Creation of distinct ducts
  • Anastomosis formation
62
Q

Clinical features of Biliary atresia

A

Jaundice >14 days
Dark urine, pale stools
Growth + feeding issues
Hepatomegaly +/- splenomegaly

Cardiac murmur (if associated cardiac abnormality)

63
Q

LFTs in Biliary atresia

A

High conjugated bilirubin

Raised transaminases - GGT most raised

64
Q

Types of Biliary atresia

A

Type 1 = proximal ducts patent, common duct obliterated

Type 2 = atresia of cystic duct, cystic structures found in porta hepatis

Type 3 = atresia of left and right ducts to level of portal hepatis (>90%)

65
Q

Management of small bowel atresia

A

A-E approach to stabilise neonate
+/- NG decompression

Surgery - primary anastomosis +/- Ladd procedure if malrotation present

66
Q

Associations with Duodenal atresia

A

Down syndrome
Congenital cardiac abnormalities
Polyhydramnios (impaired swallow)

67
Q

Difference between duodenal and jejuna/ileal atresia on imaging

A

Abdo XR

Duodenal = 'double bubble' sign
Jejunal/ileal = air fluid levels
68
Q

Low vs High anorectal anomaly

A

Low = anus closed over, in different position OR narrower than usual + fistula to skin

High = bowel has closed end, does not connect with anus, usually associated with bladder/urethral/vaginal fistula

69
Q

Management of anorectal malformation

A

Surgical correction by 9 months

- ‘Anorectoplasty’ + loop stoma

70
Q

Risk factors for Sudden Infant Death Syndrome

A 
Front sleeping baby
Male
LBW
Premature
Maternal smoking
Microenvironment - pillows, duvet, heat
71
Q

Protective factors for Sudden Infant Death Syndrome

A

Dummies
Breast feeding
Room sharing

72
Q

Medico-legal considerations in Sudden Infant Death Sydrome

A

Police + Coroner always called in any case of unexpected death

Police Child Protection team also involved

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