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Week 1 Flashcards

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1
Q

Name the two predominant proteins found in infant formulas and breastmilk

A

Casein and Whey

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2
Q

When should cow/goat milk formula be given?

A

For patients who are not breastfed should be given as sole source of nutrition for first 6 months and then alongside complementary food for the next 6 months

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3
Q

What formula should babies with cows milk protein allergens receive?

A

Extensively hydrolysed formula

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4
Q

What is the POV of the WHO on follow-up formula?

A

It is unnecessary

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5
Q

What is the significant difference of anti-reflux milks?

A

Thickened milk to prevent GORD

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6
Q

What is the replacement carbohydrate for lactose in lactose-free milk?

A

Glucose syrup or maltodextrin

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7
Q

Identify some of the signs of congenital and primary lactose intolerance

A

abdominal pain, diarrhoea, flatulence and/or bloating after ingestion of food containing
lactose

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8
Q

Name a paediatric condition that can cause secondary lactose intolerance

A

Gastroenteritis

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9
Q

Which two types of milk are recommended for babies from 0-12 months old? What types are only used under medical supervision?

A

Breastmilk
cow/goat milk formula
Specialised formulas e.g. partially hydrolysed, anti-reflux, lactose free, comfort milk

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10
Q

On average how many times should a child be breastfed/formula fed per day until 6 months?

A

7-8 times at the beginning cutting down to 4 by 6 months. Also the recommended portion and daily portion increases from around 500ml to 1000ml

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11
Q

When are additional fluids recommended for babies?

A

If the baby is unwell or dehydrated

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12
Q

What is the definition of a preterm, term and post-term baby?

A

preterm- birth before 37 weeks gestation
term- birth after 37 but before 41 weeks gestation
post-term- birth after 41 weeks gestation

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13
Q

What is the normal birthweight and what is considered LGA and SGA?

A

Small for Gestational Age- <2.5kg
Normal weight- 2.5-4.0kg
Large for Gestational Age- >4.0kg

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14
Q

During uterine contractions in labour a very ______ environment is created making it a dangerous time for the mother and baby. The presence of ________ haemoglobin helps to counteract this

A

Hypoxic

Foetal

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15
Q

Identify some of the factors that make labour difficult for the child

A

Hypoxic environment
prolonged labour extends period in this environment
placental insufficiency
growth restriction or excess

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16
Q

Name the score used to measure perinatal adaptation.

A

Apgar score (out of 10) score greater or equal to 8 is normal

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17
Q

Name the vitamin given almost immediately to a newborn baby. What disease is it used to prevent?

A

Vitamin K given IM/ oral if parents disagree

Haemorrhagic disease of the newborn

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18
Q

Identify 6 infections that should be asked about in the maternal history

A 
Hepatitis B- if so given early vaccine
Hepatitis C
Syphilis
Group B Streptococcus
HIV
TB- if so given BCG early
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19
Q

Name two vaccines that new mothers are given

A 
Maternal Pertussis (Whooping cough)
Influenza
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20
Q

What does the blood-blot screening card screen for?

A

Cystic fibrosis- screen for immunoreactive trypsin (if positive then further genetic test)
Sickle cell disease
Congenital hypothyroidism- Thyroid function testing
haemoglobinopathies
metabolic diseases

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21
Q

In addition to blood-spot screening tests what other screening tests are there for newborns?

A

Newborn Examination
Hearing screening
Hip screening- mainly clinical but further USS maybe

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22
Q

What is cephalohematoma and Caput succedaneum?

A

cephalohematoma- collection of blood between the periosteum and one or more of the skull bones (mainly parietal) which is most commonly found in infants delivered using forceps/suction/under pressure
Caput succedaneum- Temporary swelling of the soft parts of the head of a newly born infant.

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23
Q

What is the red reflex used to check?

A

If a baby has congenital cataracts

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24
Q

What contact is essential after birth?

A

It is essential for a newborn baby to have immediate skin to skin contact with the mother/father

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25
Identify three benefits of breastfeeding for newborns
Reduced: incidence of dental caries malocclusion otitis media
26
Identify 6 possible benefits of breastmilk
``` Reduced: incidence of infections severity of allergies, asthma, wheeze Sudden Infant Death Syndrome Childhood and adulthood Obesity Childhood Leukaemia UC and CD ```
27
Identify three benefits of breastfeeding for mothers
``` reduced: Breast and ovarian cancers Cardiovascular disease Osteoporosis T2DM and obesity ```
28
What disease contraindicates breastfeeding? How is this catered for in NHS Tayside?
HIV | Given a card which covers 1 year supply of milk formula
29
What is the area around the nipple called?
Areola
30
The hormone ________ binds to its receptor sites on the ___________ of the alveolus. Milk collects in the __________ sacs. The milk exits when the __________ cells contract.
Prolactin Lactocytes Alveolar Myo-epithelial
31
At what point in gestation does colostrum production begin?
16 weeks gestation
32
What is the effect of progesterone before a baby is born?
During pregnancy progesterone suppresses milk production until the baby is born
33
Increasing the _______ of breastfeeding ________ milk production.
Frequency | increases
34
If breastfeeding is ineffective identify some possible consequences for the mother and child
``` Mother: Sore nipples engorgement mastitis low milk production loss of confidence ``` ``` Child: Feed very frequently frustration poor weight gain jaundice hypernatraemia ```
35
While breast milk is high in _____ protein _____ _____ protein in formula milk can increase the risk of Juvenile onset diabetes
Whey | Cow's milk
36
What is the name of the initial stools of a newborn child
Meconium
37
What is expressed breast milk?
Breast milk that is expressed by hand or using a pump
38
What is tongue tie/ankyloglossia? How is it treated?
Where a baby has an abnormal lingual frenulum which restricts tongue movement. Frenotomy
39
What is meconium ileus? What diseases is this a sign of?
Where the meconium obstructs the small intestines | Cystic fibrosis
40
If a new-born baby is vomiting green fluid what should be your assumption until proven otherwise?
Have Malrotation and volvulus
41
What period counts as the neonatal period?
First 27 days of life
42
What are the 5 factors that are scored in the Apgar score?
``` Appearance (skin colour)- checking for cyanosis Pulse- should be above 100bpm Grimace (reflex irritability) Activity (muscle tone) Respiration ```
43
What is the normal temperature for a baby?
36.5-37.4
44
What is hypoxic ischaemic encephalopathy?
A multisystem neonatal disorder where there is multiorgan damage due to tissue hypoxia. Presents with low Apgar score
45
Name the two most common respiratory conditions in normal term babies
Transient Tachypnoea of the new-born | Pneumothorax
46
What is hydrops fetalis and what are the most common causes?
Severe oedema of a new-born baby. Mainly because of Rhesus disease or chromosomal defects. Have a swollen liver and severe abdominal swelling
47
What is inhaled nitic oxide used to treat in new-borns?
Persistent Pulmonary Hypertension of the New-born
48
Identify some of the risk factors that are related to prematurity
``` Smoking, alcohol, illicit drug use Social deprivation Increased maternal age Increased preterm caesarean sections Abnormally shaped uterus Multiple pregnancies IVF Poor nutrition <6 months between pregnancies High BP, diabetes, miscarriages and abortions ```
49
Identify 4 considerations necessary for preterm infants
Keep warm delayed cord clamping gentle lung inflation Oxygen saturation monitoring
50
Why is thermal regulation ineffective in preterm babies?
Low Basal Metabolic Rate Minimal Subcutaneous fat insulation Minimal muscular activity High Ratio of Surface area to body mass
51
Why are preterm babies at increased risk of nutritional compromise?
Limited nutrient reserves Gut immaturity Immature metabolic pathways Increased nutrient demands
52
What is the ductus arteriosus?
A blood vessel in the unborn child connecting the pulmonary artery directly to the ascending aorta thus bypassing the pulmonary circulation
53
Name a GI disease that is most common in preterm babies
Necrotising enterocolitis
54
What is the difference between LOS and EOS?
Early Onset Sepsis- Due to bacteria acquired before/during delivery, most likely group B strep Late Onset Sepsis- Mainly due to bacteria acquired after delivery, most likely Staph aureus
55
What does RDS stand for? What causes this condition?
Respiratory distress syndrome | Surfactant deficiency
56
Identify some of the signs and symptoms of Respiratory distress syndrome in preterm babies
``` Rapid, Laboured, shallow breathing grunting Nasal flaring cyanosis worst in days 2/3 ```
57
Name the three treatments for RDS
Antenatal steroids ventilation surfactant
58
What volume of blood to babies generally have?
300ml
59
What is a normal blood glucose level in a newborn baby?
Greater than or equal to 2.6mmol/L
60
What is the neonatal abstinence score used to determine?
Whether a newborn suffers from neonatal abstinence syndrome.
61
Define neonatal abstinence syndrome
The signs and symptoms exhibited by a newborn baby due to drug withdrawal when the baby has been exposed to addictive drugs through maternal substance abuse/misuse
62
Identify some of the signs and symptoms of NAS
``` High pitched crying convulsions tremors frequent yawning poor feeding sucking of fists Diarrhoea Vomiting Sweating Nasal stuffiness tachypnoea ```
63
What drug is administered to hypoglycaemic neonates?
Buccal dextrose gel
64
Haem is converted to ___________ by Haem ____________. ____________ is then converted to Bilirubin by _______ __________.
Billiverdin Haem oxygenase Billiverdin reductase
65
Define jaundice
Yellowing of the eyes and skin as a result of excess billirubin in the bloodstream
66
What is the most common cause of jaundice in newborns? And what is the most common reason for this?
Physiological jaundice | Decreased conjugation of billirubin
67
What is the most common cause of early pathological jaundice (<24hrs)?
Haemolysis due to one of the following: ABO incompatibility Rh immunisation Sepsis Rare cause of early jaundice= hepatitis
68
What are the fontanelles?
Fibrous membranes between the bones of the calvarias of neonates. 4 fontanelles: posterior, anterior, mastoid, sphenoidal
69
Identify three ways that HIV transmission from mother to child can be reduced
Anti-retroviral treatment for mother and infant Caesarean section avoidance of breastfeeding
70
Identify two benefits of colostrum
It contains high levels of immune proteins and so helps colonise the baby with normal bacteria that do not pose a risk of infection. It also has a laxative effect which helps infants pass meconium and prevent jaundice.
71
Name the two hormones which are higher during breastfeeding
Prolactin- stimulates lactation | Oxytocin- stimulates milk ejection from the breast
72
Should up to 10% weight loss of a newborn baby be a concern?
No is quite normal and physiological
73
What are the main causes of jaundice in children who are <24 hours old?
Haemolysis- ABC/Rhesus incompatibility Sepsis Hepatitis
74
What investigations should be recommended for patients who present with jaundice who are <24 hours old?
Serum bilirubin concentrations Maternal blood group, antibodies Coombs test- babies blood group
75
Identify 5 causes of Persistent Unconjugated Hyperbilirubinemia
``` Breast milk jaundice poor milk intake Haemolysis infection hypothyroidism ```
76
Name a possible endpoint complication of Persistent Uncomplicated jaundice
Kernicterus- Death of brain cells and yellow staining due to toxic unconjugated bilirubin
77
Name two possible causes of persistent conjugated hyperbilirubinemia
Hepatitis | Biliary atresia
78
Identify some of the signs and symptoms of mastitis
erythematous, hot, tender breast fever fatigue breast abscess (complication)
79
Identify three genetic tests of babies in-utero
Chorionic Villus atrophy Amniocentesis Non-Invasive Pre-natal Testing (NIPT) Tests for foetal DNA in maternal bloodstream
80
What makes chorionic villus sampling a possibly flawed result?
Placental cells can exhibit Confined Placental Mosaicism- some cells exhibit trisomy but not found in baby (Foetus)
81
What are the gestation boundaries for abortion in the UK?
24 weeks in the UK | Only after 24 weeks if the mother's life is at risk or if there is a serious abnormality in the child
82
If the unborn child has a family history of Haemophilia when is it appropriate for them to have a genetic test?
Have NIPT if the child is a boy
83
What is floppy baby also known as? What causes this?
Hypotonia, neuromuscular diseases, chromosomal abnormalities
84
If a baby presents with hypotonia, how would you tell on examination whether it is a central problem or a motor neuron problem?
``` Central- Normal strength Normal/increased Deep tendon Reflexes (DTR) Possible seizures dysmorphic features, reduced alertness ``` ``` Motor Neuron Problems reduced strength reduced/absent DTRs fasiculations alert ```
85
If a baby presented with hypotonia how would you tell on examination whether it is a muscular problem or a nerve problem?
Muscle- proximal>distal weakness | Nerve- distal>proximal weakness
86
What tests are recommended for a child presenting with hypotonia following examination?
Bloods- check for infection, CK levels, Genetics, metabolic disease MRI/USS brain EEG and EMG (electroencephalogram and Electromyography)
87
With regards developmental milestones what is the difference between the Median Age and Limit Age
Median age- the age when 50% of the population achieve a skill Limit age- age when skill should have been acquired by 97.5% of children
88
Name the four areas of development
Gross motor Fine motor and vision Language and hearing Social behaviour and play
89
Gross motor development occurs in a __________ direction
Cephalocaudal | From head to trunk
90
Name 5 different primitive reflexes
``` Rooting and sucking Plantar and palmar grasp Moro reflex ATNR- known as fencing reflex for when turns head Stepping and placing ```
91
Define developmental delay
Failure to meet the appropriate developmental milestones for child's chronological age
92
What are the three variants of developmental disorders?
Delay e.g. Downs (either global- multiple areas of development or specific- one area) Deviation e.g. Autism spectrum disorder Regression e.g. Rett's syndrome
93
Identify 7 red flags for development
``` Loss of skills at any age asymmetry of movement Hypertonia/hypotonia Unable to walk by 18 months (check CK) No speech by 18 months Concerns regarding hearing/vision at any age Not reaching for objects at 6 months Unable to sit unsupported at 12 months ```
94
Identify some problems associated with Down's syndrome
``` Cardiac problems Sleep apnoea visual impairment hearing impairment growth impairment Thyroid dysfunction ```
95
Give three signs and symptoms of Duchenne's muscular dystrophy
Gower's sign- proximal weakness of the pelvic girdle muscles Pseudo-hypertrophic calves Progressive lumbar lordosis
96
Name two conditions which are examples of motor developmental delay
Cerebral palsy | Duchenne's muscular dystrophy
97
Identify four different presentations of spastic cerebral palsy
Quadriplegic- both arms and legs diplegic- both legs and elsewhere paraplegic- both legs hemiplegic- one side arm and leg
98
Identify some of the signs/symptoms of oculocutaneous albinism
Fair skin/ light hair colour photophobia nystagmus lack of iris and retinal pigmentation
99
Identify two conditions which are examples of sensory deficit/delay
Oculocutaneous albinism | Preacher-Willi syndrome
100
Identify the three components of the autism triad
Deviation/delay in: communication social interaction flexibility of thought and imagination Also sensory issues
101
What does OFC stand for
Occipitofrontal Circumference
102
What is microcephaly?
A small head
103
What does CGH stand for?
Comparative genomic hybridisation
104
Griffiths and Bayley's are examples of what?
Developmental assessments
105
What is ADOS?
An assessment scale for Autism

Child and Family (3 decks)

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