Neonatology

Question 1

Why is vitamin K given to all newborns?

Answer 1

To prevent vitamin K deficiency bleeding (vitamin K does not cross the placenta, is not readily transferred through breast milk and the neonatal gut flora is unable to synthesise it at birth).

Question 2

Which immunisation is given at birth before discharge?

Answer 2

HBV

Question 3

Which type of hyperbilirubinaemia is always pathological?

Answer 3

Conjugated hyperbilirubinaemia

Question 4

Give 3 causes of neonatal conjugated hyperbilirubinaemia.

Answer 4

1. Biliary atresia
2. Choledochal cyst
3. CF
4. Alpha-1 antitrypsin deficiency

Question 5

What is the VACTERL association?

Answer 5

Vertebral, anorectal, cardiac, renal and limb abnormalities.

Question 6

What are the two types of congenital diaphragmatic hernia?

Answer 6

Posterolateral Bochdalek Hernia (most common) and Anterior Retrosternal Morgagni Hernia

Question 7

What are the 5 most common causes of neonatal respiratory distress?

Answer 7

1. Hyaline membrane disease (premature)
2. Meconium aspiration syndrome
3. Transient tachypnoea of the newborn (c-section)
4. Pneumonia or sepsis
5. Pneumothorax

Question 8

Which reflexes are routinely tested in the neonatal examination?

Answer 8

Moro reflex
Stepping reflex
Sucking reflex
Rooting reflex
Grasp reflex
Red reflex

Question 9

Within how long from birth should a neonate:

(a) Pass urine
(b) Pass meconium

Answer 9

(a) 24 hours

(b) 48 hours

Question 10

List 3 disease that newborn infants are screened for in Australia.

Answer 10

Cystic Fibrosis (CF)
Phenylketonuria (PKU)
Hypothyroidism
Galactosemia
Sickle cell disease

Question 11

What are the elements of the APGAR score?

Answer 11

Heart rate
Respiratory rate
Muscle tone
Reflex irritability
Skin colour

Question 12

What diagnosis should be considered in a neonate with vomiting, drooling and abdominal distension?

Answer 12

Oesophageal atresia with tracheo-oesophageal fistula

Question 13

What is the major complication of unconjugated hyperbilirubinaemia?

Answer 13

Kernicterus

Question 14

Give the 5 most common causes of neonatal respiratory distress.

Answer 14

Primary surfactant deficiency (HMD)
Transient tachypnoea of the newborn
Aspiration - meconium amniotic staining
Pneumonia
Air leak - pneumothorax

Question 15

A 12 hour old baby presents with jaundice. What is the most likely cause?

Answer 15

Haemolysis

Question 16

What are the steps in neonatal resuscitation?

Answer 16

Clamp umbilical cord and transfer to cot
Dry baby vigorously
Ensure open, clear airway (+/- suction)
Check HR via umbilical cord pulse
- If >60, commence ventilation only
- If

Question 17

What is the primary concern with performing deep neonatal suction?

Answer 17

Pharyngeal stimulation of vagus nerve, causing reflex bradycardia

Question 18

What are the causes of conjugated hyperbilirubinaemia in an infant?

Answer 18

Biliary atresia
Choledochal cyst
CF
Hepatitis (CMV)
Alpha-1 anti-trypsin deficiency

Question 19

What is the name of the procedure used to correct biliary atresia?

Answer 19

Kasai procedure

Question 20

What are the first and second line therapies for chronic asthma in children?

Answer 20

Everyone has a reliever
First line:
- Low-dose ICS or
- Monteleukast or
- Cromone
Second-line:
- High-dose ICS or
- Low-dose ICS + monteleukast or
- Low-dose ICS + LABA

Question 21

What are the step-up options for treating acute asthma?

Answer 21

1. Salbutamol (via spacer or neb) + O2
2. Ipratropium bromide neb
3. IV hydrocortisone (oral given if breathing controlled)
4. PICU (IV magnesium sulphate, IV salbutamol, intubation)

Question 22

Which organisms are typically implicated in neonatal meningitis?

Answer 22

Group B streptococcus
Gram negative bacteria (e.g. e. coli)
Listeria monocytogenes