Fetus and Newborn

Question 0

Despite adequate resuscitation (intubated, chest compressions), a newborn still has HR < 60 bpm. What is the next thing to do?

a. Check ET
b. Give epinephrine IV or Intrathecal

Answer 0

B. give epinephrine

NTP: Pediatric advanced life support bradycardia algorithm

heart rate less than 60 beats/min with poor perfusion is an indication to begin chest compressions. If despite adequate oxygenation and ventilation, bradycardia persists, give epinephrine

providers should assess and treat factors known to cause bradycardia, referred to collectively as the 6 Hs (hypoxia, hypovolemia, hydrogen ions [acidosis], hypokalemia or hyperkalemia, hypoglycemia, hypothermia), and 4 Ts (toxins, tamponade, tension pneumothorax, and trauma [causing hypovolemia, intracranial hypertension, cardiac compromise or tamponade])

Question 1

Newborn screening is best done:
​a. after 24 hours
​b. after 72 hours
​c. At birth
​d. Anytime

Answer 1

​a. after 24 hours

Question 2

Which reason will make repair of neonatal tongue-tie valid?

a. Interference with feeding
b. possible interference with speech

Answer 2

a. interference with feeding
b. possible interference with speech - for an older child, this may be the answer, but for neonatal tongue-tie, interference with feeding makes repair justified

CH 307 Common lesions of the Oral Cavity
“Ankyloglossia or “tongue-tie” is characterized by an abnormally short lingual frenum that may hinder the tongue movement but rarely interferes with feeding or speech. The frenum may spontaneously lengthen as the child gets older. If the extent of the ankyloglossia is severe, speech may be affected and surgical correction indicated”

CH 88.2 Care of the Newborn
“ankyloglossia is rarely a reason for cutting it. If there are problems with feedings (breast or bottle) and the frenulum is short, frenulotomy may be indicated.”

Question 3

Newborn with HIE (mahaba ang case description, di ko na maalala), what is the most important diagnostic approach?

a. MRI
b. CT scan
c. EEG
d. MRI + EEG

Answer 3

a. MRI

*Nelson’s:
UTZ – limited utility in HIE in the term infant, preferred in preterms
CT - limited ability to identify cortical injury during the 1st few days of life
MRI – preferred imaging modality because of increased Sn and Sp early in the disease and its ability to outline topography of the lesion.
aEEG – (amplitude integrated EEG) promising modality to determine which infants are at highest risk for significant brain injury, good reliability, a positive predictive value of 85%, and a negative predictive value of 91-96% for infants who will have adverse neurodevelopmental outcome. Helpful in prognostication, not diagnosis.

Question 4

Mother was diagnosed with chorioamnionitis on delivery of her baby. Baby had an APGAR of 8,8, term, but was noted to be tachypneic with RR > 60. What is your approach to management?

a. CBC, CXR
b. CBC, Blood CS x 2, CXR
c. CBC, Blood CS x 2, CXR, start antibiotics
d. CBC, Blood CS x 2, Lumbar tap, CXR, start antibiotics

Answer 4

c. CBC, Blood CS x 2, CXR, start antibiotics

NTP 19th:
Diagnostic evaluation (including blood culture) is indicated for asymptomatic infants born to mothers with chorioamnionitis. All symptomatic infants should be treated with antibiotics after blood cultures are obtained. There is controversy over whether an LP is necessary for all term infants with suspected early-onset sepsis. If the blood culture result is positive or if the infant becomes symptomatic, LP should definitely be performed.

Question 5

Mother was given high doses of Vitamin B6 for morning sickness during pregnancy. Her baby then developed neonatal seizures. What is the diagnosis for the seizures?

a. B6 deficiency
b. B6 excess
c. B6 dependence

Answer 5

c. B6 dependence
* Nelson’s 18th: Infants of mothers who have received large doses of pyridoxine during pregnancy are at increased risk for seizures from pyridoxine dependence.

Question 6

Newborn on initial physical examination was found to exhibit a “clunk” on one of your hip maneuvers. What will you do?

a. Do a hip ultrasound
b. Do a hip CT scan
c. Refer to Ortho

Answer 6

a. Do a hip ultrasound

Nelson’s 18th: In infants younger than 6mos of age, the acetabulum and proximal femur are cartilaginous and not visible on plain radiographs and are best visualized with ultrasonography.

Question 7

Giving which drug during pregnancy will lead to cleft lip in the baby?

a. Valproate
b. Coccaine
c. Phenytoin
d. Prednisone

Answer 7

d. Prednisone
* Nelson’s 18th: See Table 96-3 Agents acting on pregnant women that may adversely affect the structure or function of the fetus and the newborn

Prednisone - oral clefts
Valproate - CNS (spina bifida), facial and cardiac anomalies, limb defects, impaired neurologic function
Cocaine/crack - Microcephaly, LBW, IUGR, behavioral disturbances
Phenytoin - Congenital anomalies, IUGR, neuroblastoma, bleeding (vitamin K deficiency)

Question 8

A mother asked about circumcision for her newborn baby boy. What will you advise her?

a. There is no support for routine Circumcision during the newborn period.
b. It decreased penile cancer.
c. It is a safe procedure with no complications.

Answer 8

a. There is no support for routine Circumcision during the newborn period.
* PPS

Question 9

Which of the following measurements are not consistent with a fullterm newborn?

a. Birth weight of 3.2kg
b. Height of 47cm
c. HC of 35cm
d. CC of 35cm

Answer 9

d. CC of 35cm

Question 10

66. A mother with gestational DM was worried about her baby, who had symptomatic hypoglycemia. What will you advise her?
    a. Brain development will be normal
    b. Baby will have a higher risk for developing DM in adulthood
    c. Baby will need to be restricted on sugar in his diet.

Answer 10

b. Baby will have a higher risk for developing DM in adulthood
* Nelson’s 18th: The subsequent incidence of DM in these infants is increased compared to the general population

Question 11

A preterm who is purely breastfed has to be given vitamin supplementation because:
a. LBW infants are found to have higher energy needs
b. Volume of Breastmilk ingested will not be able to provide adequate nutrients in the first weeks of life.
c.

Answer 11

LBW and preterm infants should be given supplemental vitamins.
Decreased fat absorption with increased fecal fat loss may be associated with decreased absorption of vitamin D, other fat-soluble vitamins, and calcium in premature infants.

Question 12

For a 5 day old with HIE, who already coded twice, when should you stop aggressive measures? (actually mas mahaba ang description ng case – basta fulfills brain death criteria in 2 separate examinations—)

a. 12 hours apart
b. 24 hours apart
c. 48 hours apart

Answer 12

c. 48 hours apart- 1wk to 2 mos

a. 12 hours apart- >1yr old
b. 24 hours apart – 2mos to 1 yr old
c. 48 hours apart- 1wk to 2 mos

Nelson’s 18th: see table 67-1 Age specific criteria for brain death and 67-2 Diagnosis for brain death
The recommended length of this period of observation varies by age.
1 wk to 2 mos - 2 exams, 48h apart
2 mos to 1 yr - 2 exams, 24h apart
>1yr - 2 exams, 12h apart

If the cause of the coma is hypoxic-ischemic brain injury and the first exam is performed shortly after the insult, a period of at least 24 hr is recommended before the second exam.

Question 13

Which of the following has the highest hypoglycemia (ito yung term nila)

a. Preterms
b. IDM
c. Low birth weight infant
d. Asphyxiated infant

Answer 13

No answer given

Question 14

Risk Factor for NEC: 
A. prematurity 
B. 
C. 
D.

Answer 14

A prematurity
Nelson’s 19 th edition:
Many factors may contribute to the development of a necrotic segment of intestine, gas accumulation in the submucosa of the bowel wall (pneumatosis intestinalis), and progression of the necrosis to perforation, peritonitis, sepsis, and death. The distal part of the ileum and the proximal segment of colon are involved most frequently; in fatal cases, gangrene may extend from the stomach to the rectum. Although NEC is a multifactorial disease primarily associated with intestinal immaturity, the concept of ―risk factors‖ for NEC is controversial. The triad of intestinal ischemia (injury), enteral nutrition (metabolic substrate), and bacterial translocation has classically been linked to NEC. The greatest risk factor for NEC is prematurity. The disorder probably results from an interaction between loss of mucosal integrity due to a variety of factors (ischemia, infection, inflammation) and the host’s response to that injury (circulatory, immunologic, inflammatory), leading to necrosis of the affected area. Coagulation necrosis is the characteristic histologic finding in intestinal specimens. Clustering of cases suggests a primary role for an infectious agent. Various bacterial and viral agents, including Escherichia coli, Klebsiella, Clostridium perfringens, Staphylococcus epidermidis, astrovirus, norovirus, and rotavirus, have been recovered from cultures. Nonetheless, in most situations, no pathogen is identified. NEC rarely occurs before the initiation of enteral feeding and is much less common in infants fed human milk. Aggressive enteral feeding may predispose to the development of NEC.

Question 15

An evanescent, lacy, reticulated red and/or blue cutaneous vascular pattern appears over most of the body surface when baby is exposed to cold 
A. Cutis marmorata
B. Mongolian spots 
C. 
D. Harlequin color change

Answer 15

A. NTP19 Ch 639
Diseases of the Neonate
Cutis Marmorata
When a newborn infant is exposed to low environmental temperatures, an evanescent, lacy, reticulated red and/or blue cutaneous vascular pattern appears over most of the body surface. This vascular change represents an accentuated physiologic vasomotor response that disappears with increasing age, although it is sometimes discernible even in older children. Cutis marmorata telangiectatica congenita is clinically similar, but the lesions are more intense, may be segmental, are persistent, and may be associated with loss of dermal tissue, epidermal atrophy, and ulceration.

Question 16

Ominous sign of HMD 
A. Tachypnea 
B. Apnea 
C. Grunting 
D. Retractions

Answer 16

B Ch 95 Respiratory Tract Disorders

Apnea and irregular respirations are ominous signs requiring immediate intervention.

Question 17

A neonate was born. He was to at P95 with seizure noted. PE was normal. Hgt was 30mg/dl

a. Diabetes Mellitus
b. Graves Disease

Answer 17

? not Graves because babies are IUGR
not DM because infants are hyperglycemic & SGA p. 1969
looks like infant of Diabetic mother but it was not part of the choices
forgot the other choices

Question 18

A neonate born limp, cyanotic face, pale trunk, gasping, weak pulses, no response on suctioning.What is the APGAR score?

Answer 18

Appearance – 0
Pulse – 1
Grimace – 0
Activity – 0
Resp – 1

Answer – 2

Question 19

A neonate was born full term, NSD noted to be tachypneic with grunting. Upon giving O2 at

Answer 19

Transient tachypnea of the newborn

Question 20

A neonate on the 3rd day of life developed jaundice. Normal other findings

Answer 20

Physiologic jaundice

Question 21

A neonate born with thick meconium staining, metabolic acidosis, tachypneic…

Answer 21

Meconium Aspiration syndrome

Question 22

16. Delayed separation of the umbilical cord is due disorder of
    a. B lymphocytes
    b. T lymphocytes
    c. complement
    d. phagocyte function

Answer 22

d. phagocyte function p. 714

Question 23

When jaundice occurs within the 24 hours of life

Answer 23

? it is presumed to be hemolytic unless proven otherwise

p. 599 Anemia on first few days of life almost frequently a result of hemolytic disease of the newborn.

Question 24

In Trisomy 18, what is responsible for the anomalies and death of the infant?

a. single umbilical artery
b. patent urachus
c. omphalomesenteric duct

Answer 24

single umbilical artery p. 608

Question 25

27. Parental smoking increases risk for
    a. SIDS
    d. neurobehavioral disorder

Answer 25

a. SIDS. Maternal smoking during pregnancy significantly increases the risk for SIDS.
p. 1380 box 360-2
Cigarette smoking also causes LBW for gestational age p.541 table 85-3

Question 26

30. A neonate was born pre-mature 2.4 kg. Px is now 2.8 kg and is 1 month old. What will you give?
    a. Tell them to bring px back after 1 month
    b. BCG only
    c. Hepa B only
    d. BCG and Hepa B

Answer 26

d. p. 1182 ….One exception of this recommendation is Hepa B vaccination of those born to HBsAg negative mothers with LBW (i.e. < 2 kg). Initiation of vaccination in this case should be delayed until the infant is 1 month of age.

Question 27

31. Px was delivered to a mother with active untreated TB. What will you do
    b. Separate from the mother, start INH
    c. continue breastfeeding, start INH

Answer 27

c. p. 971 Nelson, p.73 TB concensus
INH therapy for newborns has been so effective that separation of the mother and infant is no longer considered mandatory. Separation should occur only if the mother is ill enough to require hospitalization, she has been or is expected to become non-adherent with her tx or there is strong suspicion that she has drug resistant TB.

Question 28

46. A newborn with shoulder adducted, internally rotated and pronated.

Answer 28

Erb Duchene, paralysis of C5C6 p.565

Question 29

47. A neonate was treated for NEC. What is the indication for performing laparotomy?
    a. failure to respond to medical mx
    b. abdominal distention
    c. gastric retention

Answer 29

a. failure to respond to med mx. P. 591

Question 30

48. A neonate was noted to be jaundice on the 30th HOL with bilirubin of 10 mg/dl. On the 36th HOL, bilirubin rose to 23 mg/dl. What will you do?
    a. double volume exchange transfusion
    b. parital exchange transfusion
    c. intermittent photo
    d.

Answer 30

a. ???

Question 31

61. A patient with Bronchopulmonary dysplasia should not be sent home with…
    a. oxygen
    b. diuretics
    c. bronchodilators
    d. glucocorticoids

Answer 31

d? Glucocorticoids are not recommended p.582

Question 32

A hyperthyroid mother was advised to resume her anti-thyroid drug, methimazole. She is currently breastfeeding her 1 month-old child. What should she do?
​a. continue breastfeeding
​b. stop breastfeeding and shift to a milk formula

Answer 32

B. (p. 160 and 541, Nelson’s). Anti-thyroid medications, lithium, anti-cancer agents, isoniazid, recreationally abused drugs, chloramphenicol, metronidazole, sulfonamides, anthraquinone-derivative laxatives and phenindione are contraindicated for breastfeeding mothers. Temporary cessation of breastfeeding should be considered.

Question 33

A 2 week-old neonate has been on total parenteral nutrition since a day old.  What is the most common metabolic complication of total parenteral nutrition?
​a.  essential fatty acid deficiency
​b.  hypernatremia
​c.  hypocalcemia
​d.  increased liver enzymes

Answer 33

D. (p.1333, Nelson’s). Liver dysfunction is the major factor limiting effective long-term use of TPN.

Question 34

Absence of the distal femoral epiphysis is suggestive of:
​a.  congenital adrenal hyperplasia
​b.  osteogenesis imperfecta
​c.  congenital hypothyroidism
​d.  congenital dysplasia of the hips

Answer 34

C. (p.1877, Nelson’s). Manifestations are as follows: birthweight and birthlength are normal, but sl. Increased head circumference (due to myedema of the brain), prolonged jaundice, feeding difficulties, constipation, cold and mottled skin, slow pulses.