Neonatology Flashcards

Flashcards based on Neonatology lecture notes

What is the Neonatal mortality rate?

Deaths of live-born infants within the first 4 weeks after birth per 1000 live births.

What is considered a Stillbirth?

Infant born with no signs of life ≥24 weeks of pregnancy.

What is the normal OFC (occipitofrontal circumference) at birth?

35 ± 2 cm

When does the Anterior Fontanelle typically close?

9 - 18 months

When does the Posterior Fontanelle typically close?

Birth - 2 months

Why is it important to check for the Red Reflex

Examine all newborns for screening of congenital cataract.

What is Ophthalmia neonatorum?

Red eyes + discharge in the first 48 hours of life due to gonococcal infection, needs immediate treatment.

What are Epstein's pearls?

Cyst on palate/gum that is self-resolving.

What is Choanal atresia?

Failure of completion of Bucco nasal membrane breakdown in early fetal life (can be bony or membranous).

How is Choanal atresia diagnosed?

Inability to pass NGT, confirmed by CT scan.

What congenital malformations is Choanal atresia associated with (CHARGE)?

Coloboma, Heart defect, Retardation of growth / development, Atresia of nasal choanae, Genital abnormalities, Ear deformity

How long does it take for the Umbilical stump to slough down?

Dry and sloughs down between 7 - 10 days of age.

What is the content of the Umbilical cord?

2 artery and 1 vein (single A &V may associated with congenital renal anomalies).

What causes Vaginal mucoid or bloody discharge in newborn girls?

Due to maternal hormonal withdrawal (oestrogen) - spontaneously resolves.

What are the Differential Diagnosis for delayed passage of meconium?

Anal atresia, Hirsch sprung disease, Meconium ileus (CF), Organic obstruction (IO)

What are the Differential Diagnosis for delayed passage of urine?

Renal agenesis, Renal outlet obstruction, Shocked neonate

What is the normal birth length?

50cm

What is the Physiological weight loss in newborns?

10% of birth weight in the 1st 3-5 days age.

What is the description/comments of Milia?

White papule on the nose, cheeks, due to obstruction of sebaceous gland (retention cyst) resolve spontaneously.

What is the description/comments of Neonatal Acne?

Multiple-yellowish white papules - Located over the nose, cheek due to normal physiological response to maternal hormones

What is the description/comments of Port-wine stain (naevus flammeus)?

Present from birth and usually grows with the infant. It is due to a vascular malformation, it may be associated with intracranial vascular anomalies (Sturge-Weber syndrome), or (Klippel-Trenaunay syndrome).

What can be a part of Clinical Neonatal screening?

General Look & inspection, Eyes (red reflex), Nose (NGT): Choanal atresia Mouth (finger): cleft palate, sucking reflex, Ears (hearing screening test): deafness, Heart (pulse oximeter): critical CHD, Umbilical stump & cord, Genitalia male or female (ambiguous), Femoral pulse palpation (COA), Ortolani & Barlow test (DDH), Anus (imperforate anus), Back & spine (NTD)

What are the disorders screened for in the UK newborn blood spot screening?

congential hypothyroidism, sickle cell and thalassaemia, cystic fibrosis, phenylketonuria, MCAD, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type, homocystinuria.

What constitutes high-risk deliveries that should be attended by a pediatrician?

1. Preterm deliveries 2. Caesarean section delivery 3. Meconium-stained amniotic fluid 4. Maternal diabetes 5. Diminished fetal activity or known fetal malformation 6. Multiple gestation - polyhydramnios or oligohydramnios

What are the initial Resuscitation steps for newborns?

Dry the newborn, Suction the mouth then nose gently, Evaluate of the newborn by APGAR scoring system

How to manage Apnea of prematurity?

Airways management, oxygen, ambu bag ventilation, CPAP, MV if recurrent, Prevention: caffeine citrate (respiratory stimulant)

What is the Clinical picture of RDS?

progressive signs of RD in preterm babies usually at delivery or within 4 hours of birth.

How to manage RDS?

NICU care, respiratory support according to severity, surfactant endotracheal 2-4 doses

How to prevent RDS?

Antenatal steroids and Immediate surfactant in extremely premature babies.

What is Bronchopulmonary dysplasia (Chronic lung disease)?

Infants who still have an oxygen requirement at a post-menstrual age of 36 weeks.

What is the Clinical presentation of Persistent Ductus Arteriosus (PDA)?

bounding pulse –wide pulse pressure-continuous systolic murmur.

How to manage Persistent Ductus Arteriosus (PDA)?

PG synthetase inhibitors ibuprofen or paracetamol- if failed: surgical ligation or occlusive device by catheterization.

When does Intra-ventricular haemorrhage (IVHS) usually occur?

Occur within the first 72 hours of Life due to fragile network of blood vessels (germinal matrix).

What is the Treatment of Periventricular Leukomalacia (PVL)?

Supportive as cerebral palsy

How to prevent Retinopathy of prematurity (ROP)?

Use the least possible 02, for the least possible duration,

What are the early signs of Necrotizing enterocolitis (NEC)?

Vomiting (Bilious), Feeding Intolerance, Abdominal distension, Bloody stool, Temperature instability, Jaundice, Apnea Bradycardia, Lethargy -Hypoperfusion and shock

How to prevent Necrotizing enterocolitis (NEC)?

Ovoid aggressive feeding and Breastfeeding decreases incidence of NEC.

What defines Hypothermia?

body temperature <35 C

How to prevent heat loss in newborn infants?

Raise temperature of ambient air in incubator, clothe, including covering head avoid draughts and , nurse on heated mattress.

Why Increase risk of Infection in newborns?

1- Immature Immune system (cellular + humoral) 2- Low transplacental maternal antibodies 3- Invasive procedures in admission (nosocomial) eg UVC, MV

Why Anemia may present in newborns?

Short Life span of RBC, low iron store, frequent sampling, inadequate erythropoietin response

How Liver and kidneys immaturity affects newborns?

Immature Liver, enzyme & Low storage leads to hypoglycemia, Indirect jaundice, hypoalbuminemia. Electrolytes imbalance, hypotension, dehydration, ARF.

What defines Post maturity babies?

Baby born ≥42 weeks of gestation

Birth weight > 90th centile for GA (large for date).

Large for Gestational Age (LGA)

What is the cause of Large for Gestational Age (LGA)?

constitutional or familial, Infant of diabetic mother

What is the complication of Large for Gestational Age (LGA)?

birth injury, Hypoglycaemia, Polycythemia

What is the incidence of multiple births?

Twins occur naturally in the UK in about 1 in 90, triplets in about 1 in 8000, quadruplets about 1 in 700,000 deliveries.

What are the types of IUGR?

Symmetrical IUGR and Asymmetrical IUGR

What is the cause of Asymmetrical IUGR?

Maternal Disease and Placental Insufficiency

How to manage Intrauterine Growth restriction (IUGR)?

Attention to thermal care and blood sugar

What does TORCH stand for?

Toxoplasmosis, Other (syphilis – parvovirus 19 – HIV - HBV - Herpes zoster), Rubella, CMV, HSV

What are the General Features of TORCH infections?

LBW, Hepatosplenomegaly - Lymphadenopathy, Anemia or Thrombocytopenia, Neutropenia, petechial rash, Hepatitis, Convulsions – microcephaly – chorioretinitis, Neurodevelopmental delay, MR

How to prevent Rubella infection

Rubella vaccine before pregnancy

How to prevent Toxoplasmosis infection

Avoid contact to cat & their faeces during pregnancy

How to prevent Herpes Simplex infection

C.S delivery to mother with HSV infection

What are the Signs of Respiratory distress in newborn?

Tachypnea RR increase 60 breath/min, Acting ala nasi, Recession, Grunting, Cyanosis

What is the main cause of RDS?

Surfactant deficiency

What is Surfactant?

Is naturally occurring substance, synthesized by pneumocyte II.

What is the Function of Surfactant?

Reduce surface tensions within the alveoli Prevent collapse of alveoli at the end of expiration Improve lung compliance

What is the Complication of Congenital diaphragmatic hernia?

Pulmonary hypoplasia

Definition of Neonatal apnea:

Cessation of breathing ≥ 20 seconds or any duration if associated with bradycardia & cyanosis

How to manage Neonatal apnea:

Check position (obstructive apnea) & repositioning

What baby traits lead to Birth injuries:

LGA, Prematurity, Malpresentation

What mother conditions lead to Birth injuries:

Prolonged labor, Contracted pelvis

What the Physician procedure lead to Birth injuries:

Instrumental delivery

What is Cephalo hematoma description?

Sub periosteal blood collection
Localized (Not cross the suture)
Film, Linear fracture 15 – 20%
Anemia and Jaundice
Resolve within weeks
No treatment

What is the Complication of Cephalo hematoma?

Anemia and Jaundice

What are Tonic Seizures?

rigid posturing of extremities & trunk that may be focal or generalized

What are Myoclonic jerks?

Brief focal or generalized jerks of extremities or body mainly in distal ms. groups

What is Haemorrhagic Disease of Newborn?

Bleeding disorder in newborn due to deficiency of vitamin K dependent coagulation factors II, VII, IX, X

What kind of prescription should all newborns receive?

All newborns should receive vitamin K at birth

What are Risk factors for Developmental dysplasia of the hip:

Female sex, First born child Positive Family history Breech presentation, More on Left side, Neuromuscular disorder, NTD

What is Asymmetrical skin creases in the thigh & pelvis of Developmental dysplasia of the hip:

bilateral skin creases in the thigh & pelvis

What kind of gait in Developmental dysplasia of the hip:

Waddling in walking

What are different kind of Treatment of Developmental dysplasia of the hip:

Hip spica or pavlik harness.
Operation

What causes jaundice?

Biliary atresia

What causes the Metabolic

Hypoglycemia
Hypo Ca
Hypo Mg
Hypo Na /hyper Na

How to investigate Non-conjugated hyperbilirubinemia is detected in negative case:

Blood film
Enzyme assay
Osmotic fragility test
Septic screen

How to investigate conjugated type

Liver function tests
Liver Scan & abdominal ultrasound
Liver biopsy
Metabolic screen
TORCH screen
Septic screen

Rhesus incompatibility

Occur when the mother is Rh negative, and the baby is Rh positive

Phototherapy

The need for Rx is determined by plotting the
total bilirubin level on graph of bilirubin
against age in hours this will determine if

What is Conjugated Hyperbilirubinemia

Is defined as an increased level of direct bilirubin > 15% of total BiL or more than

2 mg/dl

Biliary Atresia

Progressive fibrosis and obliteration of the extrahepatic and intra-hepatic biliary tree which lead to obstruction of the biliary flow, if untreated chronic Liver failure develops and death occurs within 2 years

What are bthe ypes Biliary Atresia:

Obliteration of common bile duct.
Atresia of hepatic duct.
Atresia of Rt and Lt hepatic ducts

What are Incidence Biliary Atresia birth:

1: 15000 live births

Clinical Picture Biliary Atresia birth: Early:

Jaundice (in the 1st 2 weeks of Life) but may delayed 2-8 weeks
Dark urine pale stool

How do the types Liver biopsy Biliary Atresia occur:

Invasion of portal tract by fibrous tissue + intact architecture

Treatment of Biliary Atresia

Kasai operation (hepatoportoenterostomy) and Successful if performed < 60

Stage 1 (Mild)

Normal

What are the nerve roots involved in Duchenne-Erb's Palsy?

C5, C6 (Upper)

What are the nerve roots involved in Klumpke's Palsy?

C7, C8, T1 (Lower)

Describe the arm posture in Duchenne-Erb's Palsy.

The arm is adducted, internally pronated with flexed fingers (waiter's tip posture).

Describe the arm posture in Klumpke's Palsy.

Elbow in flexion, supination and extension (claw hand).

What reflexes are absent/preserved in Duchenne-Erb's Palsy?

Absent Moro reflex, preserved grasp reflex.

What reflexes are absent/preserved in Klumpke's Palsy?

Absent grasp reflex, preserved Moro reflex.

What is the associated nerve palsy with Duchenne-Erb's Palsy?

Phrenic nerve palsy (C4, C5).

What is the associated nerve palsy with Klumpke's Palsy?

Horner syndrome (T1).

What is the treatment for Duchenne-Erb's Palsy?

Physiotherapy.

What is the treatment for Klumpke's Palsy?

Physiotherapy.

What is the prognosis for Duchenne-Erb's Palsy?

Full recovery occurs in more than 90% of cases within 3 months. Should be referred to an orthopedic or plastic surgeon if not resolved by 2-3 months. Most recover by 2 years.