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Peer Teaching Notes Flashcards

1
Q

What is the bilirubin cycle?

A
  • Hb broken down to unconjugated bilirubin (haemolysis)
  • Unconjugated bilirubin + albumin-> insoluble in water
  • Travels to liver-> where conjugated
  • Conjugated soluble + excreted by small intestine or into liver then back to blood (come out via kidneys)
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2
Q

What are pathological causes of jaundice that present within 24 hours of life?

A
  • Haemolytic disease of the newborn (rhesus disease)
  • ABO incompatibility
  • Red cell anomalies-> G6PD, congenital spherocytosis
  • Congenital infection-> TORCH
  • Haematoma
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3
Q

What are the congenital diseases listed by the TORCH mnemonic?

A
  • Toxoplasmosis
  • Other-> syphilis, varicella, mumps, parvovirus, HIV
  • Rubella
  • Cytomegalovirus
  • Herpes simplex
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4
Q

What are pathological causes of jaundice that present between 24 hours and 14 days of life?

A
  • Increased bilirubin due to shorter RBC lifespan
  • Decreased conjugation by immature hepatocytes
  • Absence of gut flora-> impede elimination of bile pigment
  • Breastfeeding
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5
Q

What are pathological causes of jaundice that present for over 14 days in neonates (prolonged jaundice) and are due to unconjugated bilirubin?

A
  • Sepsis-> UTI, meningitis
  • Breastfeeding
  • Hypothyroidism
  • Neonatal hepatitis
  • Hepatic enzyme deficiency
  • Enclosed bleeding
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6
Q

What are pathological causes of jaundice that present for over 14 days in neonates (prolonged jaundice) and are due to conjugated bilirubin?

A
  • Sepsis-> TORCH
  • TPN
  • Galactosaemia
  • Cystic fibrosis
  • Alpha-1 antitrypsin deficiency
  • Biliary atresia
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7
Q

When is jaundice in neonates always pathological?

A

If presents within <24 hours of life

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8
Q

What is the pathophysiology of haemolytic disease of the newborn?

A
  • RhD -ve mum delivers RhD +ve baby
  • Leak of foetal red cells into her circulation may cause production of anti-D IgG antibodies-> isoimmunisation
  • Sensitisation events-> threatened miscarriage, APH, mild trauma, amniocentesis, CVS, ECV
  • Subsequent pregnancy-> cross placenta + cause disease
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9
Q

What are some sensitisation events that can trigger haemolytic disease of the newborn?

A

Threatened miscarriage, APH, mild trauma, amniocentesis, CVS, ECV

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10
Q

How is haemolytic disease of the newborn detected?

A
  • Screening-> indirect Coombs test

- D-antibodies-> identify -ve mums who aren’t sensitised and stop disease from happening

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11
Q

When is anti-D given in pregnancy?

A
  • 28 weeks +/- 34 weeks
  • Contains antibodies-> get rid of +ve antigens in blood before mum produces own
  • May be given after sensitising events
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12
Q

What should happen if mum is rhesus -ve but already has antibodies?

A
  • Monitor antibody level
  • US baby-> check complication signs
  • Take blood from baby-> anaemia + need for transfusion
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13
Q

What are the serious complications of haemolytic disease of the newborn?

A
  • Hydrops fetalis
  • Polyhydramnios
  • Post natal-> SC oedema, pericardial effusion, pleural effusion, ascites, hepatosplenomegaly
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14
Q

What is hydrops fetalis?

A

Often life-threatening condition in which foetus has excess fluids around the heart, liver and abdomen

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15
Q

How might neonatal jaundice be investigated?

A
  • FBC
  • Enzyme assays
  • Blood film
  • Infection screening
  • Direct Coombs test
  • Transcutaneous bilirubin
  • LFTs
  • Serum bilirubin
  • TORCH screen
  • Blood group
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16
Q

How might neonatal jaundice be managed?

A
  • UV phototherapy

- Exchange transfusion

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17
Q

What is the definition of full term?

A

40 weeks

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18
Q

What is the definition of premature?

A

<37 weeks

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19
Q

What is the definition of low birth weight?

A

<2500g

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20
Q

What is the definition of very low birth weight?

A

<1500g

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21
Q

What is the definition of extremely low birth weight?

A

<1000g

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22
Q

What is the definition of small for gestational age?

A

Weight below 10th centile at any gestational age

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23
Q

What is symmetrical intrauterine growth restriction?

A

All growth parameters are symmetrically small

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24
Q

What is asymmetrical intrauterine growth restriction?

A

Weight centile is less than length + head circumference centile

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25
What causes symmetrical intrauterine growth restriction?
- Insult in early pregnancy - Chromosomal abnormalities - Constitutionally small
26
What causes asymmetrical intrauterine growth restriction?
- Insult late in pregnancy | - Placental insufficiency
27
What type of intrauterine growth restriction is higher risk?
Asymmetrical
28
What can cause a baby to be small for gestational age?
- Poverty - Twins - Small parents - Congenital infection - Constitutionally small - Placental insufficiency - Smoking - Hypertension - CVD - Diabetes - Pre-eclampsia
29
What can cause prematurity?
- Unknown - PMH of prematurity - Malnutrition - Poverty - Smoking - GU infection - Chorioamnionitis - Pre-eclampsia - Polyhydramnios - Twins - Diabetes - Uterine malformation - Placenta praevia/abruption - PROM - Accidentally induced labour
30
How should a baby born very prematurely (eg 27 weeks) be managed?
- Paediatrician must be present - Room at 26 degrees - Don't dry baby - Put under heaters - Place in plastic bag
31
What are the components of the APGAR score?
- Appearance (skin colour) - Pulse rate - Grimace reflex - Activity (muscle tone) - Respiration
32
What are the different scores for the components of APGAR?
- Appearance (skin colour)-> blue/pale all over (0), blue at extremities (1), no cyanosis (2) - Pulse rate-> absent (0), <100bpm (1), >100bpm (2) - Grimace reflex-> no response to stimulation (0), grimace on suction/aggressive stimulation (1), cry on stimulation (2) - Activity (muscle tone)-> none (0), some flexion (1), flexed arms + legs that resist extension (2) - Respiration-> absent (0), weak/irregular/gasping (1), strong + robust cry (2)
33
What is respiratory distress syndrome?
Lack of surfactant causes respiratory issues in newborn
34
What are the signs of respiratory distress syndrome?
- Grunting - Head bobbing - Tachypnoea - Intercostal recession - Nasal flaring
35
How is respiratory distress syndrome managed?
- Intrapartum steroids (dexa or betamethasone)-> help lungs develop - Delayed cord clamping - Oxygen - Intubate + ventilate if needed - Surfactant-> down ET tube
36
How much fluids are neonates typically prescribed for a bolus?
20ml/kg
37
How are maintenance fluids calculated and prescribed in paeds?
- 100ml/kg/day for first 10kg weight - 50ml/kg/day for second 10kg of weight - 20ml/kg/day for weight over 20kg
38
How much maintenance fluids would a 45kg 12 year old girl be prescribed?
- 100ml x 10kg= 1000ml - 50ml x 10kg = 500ml - 20ml x 25kg = 500ml - 2000mls in 24 hours = 83ml/hour
39
What are some differentials for a collapsed neonate?
- Hypoglycaemia - Hypothermia - Sepsis - Dehydration - Coronary Heart Disease
40
What would a normal LP result consist of?
- Pressure 5-20 - Looks normal - Protein normal - Glucose normal - Gram stain normal - WCC normal
41
What would a bacterial LP result consist of?
- High pressure - Turbid/cloudy - High protein - Low glucose - Positive gram stain (usually) - High WCC
42
What would a viral LP result consist of?
- Normal or mild increased pressure - Clear appearance - Low/normal protein - Glucose normal - Normal gram stain - High glucose CSF:serum ratio - WCC high
43
What would a fungal/TB LP result consist of?
- Fibrin web appearance - Low to normal protein - Low glucose - High WCC - Monocytes
44
What is an example of a group B streptococcus?
Strep agalactiae-> gram positive
45
How is group B streptococcus infection transmitted?
Colonise vaginal + GI tracts in healthy women-> can give to baby through birth
46
What is the most frequent cause of early onset (<7 days) infection in neonates?
group B streptococcus
47
What are the signs and symptoms of group B streptococcus infection?
- Temperature change - Tachycardia - Respiratory-> grunting, nasal flaring, accessory muscles, tachypnoea, apnoea - Behaviour-> poor/reduced feeding, lethargy - Skin-> rash, mottled, jaundice - Abdominal-> vomiting, abdo distension, diarrhoea, abdo pain, knees up to chest
48
What is pre-natal group B streptococcus infection (GBS)?
Baby infected during pregnancy
49
What is early onset group B streptococcus infection (GBS)?
Infected within first week of life
50
What is late-onset group B streptococcus infection (GBS)?
Infected with GBS after 1 week to several months of age
51
How is group B streptococcus infection managed?
- Intrapartum antibiotic prophylaxis - Testing when RFs present + infection - Aware of GBS +ve mums-> monitor for risks, 14 days antibiotics, observation, head circumference measurement
52
Differential diagnoses for non-blanching rash?
- Sepsis - Meningococcal septicaemia - Non-accidental injury
53
What are the risk factors for Non-accidental injury?
- Birthweight <2500g - Maternal age <30 - Unwanted pregnancy - Stress - Poverty
54
When should Non-accidental injury be suspected?
- Disclosure by child - Odd incongruous story - Delayed presentation - Multiple presentation with injuries - History inconsistent with child's development - Efforts to avoid exam - Unexplained fractures - Any injury in baby - Buttock or perineum injury - Facial injury-> torn lingual frenulum, retinal haemorrhage, bulging fontanelle - Cigarette burns - Finger mark bruising (petechiae) - STIs
55
What investigations could be done in suspected Non-accidental injury?
- Skeletal survey - Coagulation - CT/MRI head - Ophthalmology
56
What is the definition of weight faltering?
Weight falling through centile spaces, low weight for height or no catch-up from low birth weight
57
What is the definition of growth faltering?
- Crossing down through length/height centiles as well as weight - Low height centile or less than expected from parental
58
What can cause faltering growth?
- Increased requirement - Inadequate retention of food - Impaired suck/swallow - Psychosocial deprivation - Inadequate availability of food - Chronic illnesses leading to anorexia - Malabsorption - Failure to utilise nutrients
59
What are some investigations for FTT?
- FBC - Urinalysis - U+Es - LFTs - Coeliac screen - Sweat test (CF)
60
What can cause a positive sweat test?
- Cystic fibrosis - Malnutrition - Adrenal insufficiency - Hypothyroidism - Hypoparathyroidism - G6PD
61
What does the neonatal blood spot test screen for?
- Cystic fibrosis - Congenital hypothyroidism - Sickle cell disease - 6 inborn errors of metabolism-> inc phenylketonuria
62
When is the neonatal blood spot test done?
Between day 5 and 8 of life
63
What happens after a neonatal blood spot test?
- Affected-> direct referral to paeds - Get all results within 6 weeks - Recorded in red book
64
What are the investigations for cystic fibrosis?
- Genetic tests - Sweat test-> high chloride + low sodium - Sinus X ray + CT - CXR - CT thorax - Spirometry - Sputum microbiology
65
What causes cystic fibrosis?
Mutation on CFTR gene on chromosome 7
66
What effect does cystic fibrosis have?
Dehydration of secretions affecting systems relying on these eg lungs + pancreas
67
What mode of inheritance is cystic fibrosis?
Autosomal recessive
68
What effects does cystic fibrosis have on the lungs?
- Thick mucous-> chronic inflammation + infections - Neutrophilic airway inflammation - Organisms-> s.aureus, H.influenzae, S.pneumoniae, P.aeruginosa
69
What are some of the signs of cystic fibrosis?
- Clubbing - Crackles - Wheeze - Cyanosis - Frequent infections - FEV1-> obstructive - Meconium ileus
70
How is cystic fibrosis managed?
- Avoid other CF patients-> may spread infections - Lung physio-> 3x daily - Exercise - Prophylactic antibiotics-> double dose if unwell - High calorie + high fat diet - Creon-> enzymes for digestion - Lung transplant
71
How does cystic fibrosis affect the GI system?
- Malabsorption-> need more energy through food - Steatorrhoea-> malabsorption - Thickened pancreas secretions-> block movement of enzymes + cause damage to pancreas ('itis) - Atrophy + progressive fibrosis of exocrine glands - Neonates-> meconium ileus, rectal prolapse
72
Which vitamins are fat soluble?
ADEK
73
What are some complications of cystic fibrosis?
- GI obstruction - Impaired glucose tolerance - GI obstruction - Liver failure - Osteoporosis - Fragility fractures

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