Neonatology

Question 1

What can hypoxia in a newborn lead to?

Answer 1

Hypoxic -ischaemic Encephalopathy (HIE)

Question 2

What are the 5 main things to do (in order) during neonatal resuscitation?

Answer 2

1. Warm the baby,
2. Calculate APGAR Score at 1, 5 and 10 mins,
3. Stimulate breathing while checking airway,
4. Inflation breaths with ventilation breaths,
5. Chest compression if HR <60.

Question 3

What does APGAR Score stand for?

Answer 3

Appearance
Pulse
Grimmace (responsiveness)
Activity
Respiration
2pt each, score 10 = good.

Question 4

What is the most common cause of neonatal sepsis?

Answer 4

GBS - Group B Streptococcus.

Question 5

What are red flags for neonatal sepsis?

Answer 5

Maternal sepsis

Seizures, shock, respiratory distress - can all present within 4 hours postpartum.

Question 6

What investigations should you do if suspected neonatal sepsis?

Answer 6

Culture -> FBC + CRP -> Lumbar puncture -> Abx

Recheck CRP after 24hrs
Recheck blood culture after 36 hrs
Recheck CRP after 5 days if didn’t go beneath 10.

Question 7

What Abx will you give in suspected neonatal sepsis?

Answer 7

Benpen and gentamycin.

Question 8

What is a treatment method for hypoxic-ischaemic encephalopathy?

Answer 8

Therapeutic hypothermia to 33/4 over 72 hours and then reheated over 6 hours.

Question 9

What prophylaxis can be given if prematurity is expected of less than 24 weeks gestation?

Answer 9

Vaginal progesterone

Cervical cerclage

Question 10

What medication can be given to help limit the possibilities of complications in an expected pre-term pregnancy?

Answer 10

1. Tocoloysis with nifedipine
2. Maternal corticosteroids
3. IV Magnesium sulfate (if <34 weeks to protect brain)
4. Delayed cord clamping

Question 11

How can apnoea of prematurity be managed?

Answer 11

Apnoea monitors, tactile stimulation of breathing and IV Caffeine (prevention)

Question 12

What screening is in place for retinopathy of prematurity?

Answer 12

Born <32 weeks
Birth weight <1.5Kg

Screen fortnightly.

Question 13

How is Respiratory Distress Syndrome managed in neonates?

Answer 13

Antenatal steroids - dexamethasone (mother)

Endotracheal surfactant via endotracheal tube (baby)

Question 14

How does necrotising enterocolitis normally present?

Answer 14

Green vomit (bile),
distended and tender abdomen,
blood in stool,
absent bowel sounds.

Question 15

What investigations would you do for necrotising enterocolitis?

Answer 15

FBC, CRP, ABG, blood culture (sepsis).

Abdominal x-ray.

Question 16

What is likely to be seen in an abdominal x-ray of a patient with suspected necrotising enterocolitis?

Answer 16

Dilated loops of bowel, bowel wall oedema, pneumatosis intestinalis (gas in the bowel wall), pneumoperitoneum.

Question 17

What complication could arise after a child with NEC is treated?

Answer 17

After surgery short bowel syndrome could occur.