This or That - Neonates

Question 1

Neonatal Jaundice

< 24hrs

Physiological or Haemolytic

Answer 1

Haemolytic

<24 hrs can only be caused by congenital infection and haemolytic

Question 2

Neonatal Jaundice

< 24 hrs, haemolytic picture, splenomegaly

ABO or Hereditary spherocytosis

Answer 2

Hereditary spherocytosis

FH will be giveaway. Spherocytes on blood film.

Tx:

For anaemia: blood transfusions
For splenomegaly: Folic Acid, Splenectomy (in mod-severe disease)

Post splenectomy, give immunisations for encap bacteria (Men, Hib, Strep), lifetime penicillin

Question 3

Neonatal Jaundice

Pale stool, dark urine

Answer 3

Biliary Atresia

OR other obstructive cause

Question 4

Neonatal Jaundice

Very high unconjugated billirubin

Answer 4

Criggler-Najjar

Question 5

Neonatal Rash

Non-itchy rash in nappy area, started on scalp - yellow and scaly

Seborrhoeic Dermatitis or Nappy Rash

Answer 5

Seborrhoeic Dermatitis

Nappy rash is a reaction from the irritant effect of urine. However, if other infectious signs or ‘satellite lesions’ (red plaque surrounded by smaller red spots), consider candida infection

Question 6

Jittery Baby

Mother had GDM

Answer 6

Hypoglycaemia

Question 7

Resp Distress

Amniotic fluid was an odd colour (should be clear), baby was in resp distress

Tachypnoea of Newborn or Meconium Aspiration

Answer 7

Meconium Aspiration

Aspiration due to foetal distress, causing foetal expulsion of meconium in utero. More common in preterm and late gestation (40+)

Question 8

Resp Distress

Labour started 1 day after membranes were ruptured

Meconium Aspiration or Pneumonia

Answer 8

Pneumonia

Prolonged rupture of membranes increases chances of picking up an infection in genital tract (GBS, E. Coli)

Start Abx immediately - Tazocin + Vanc.

If suspect Chamydial pneumonia, investigate, give Erythromycin

Question 9

Resp Distress

Mother has GDM. Ground glass appearance on x ray.

Pneumonia or RDS

Answer 9

Respiratory Distress Syndrome

Deficiency of surfactant. Pre-term (esp <28 wks) and GDM

Mx
Oxygen support
Steroids and Surfactant

Question 10

Resp Distress

Neonate with RDS is on oxygen, but has sudden reduced breath sounds and desaturation

Chest Drain or Increase O2

Answer 10

Chest Drain

Pneumothorax 2ndary to ventilation. ~10% to ventilated babies. Infants should be ventilated at lowest possible pressure.

Question 11

Resp Distress

C Section. No other remarkable findings.

Meconium Aspiration or Tachypnoea of Newborn

Answer 11

Transient Tachypnoea of Newborn

Most common cause. Diagnosis of exclusion