Neonates

Question 1

What is the compression to ventilation ratio for newborn resuscitation?

Answer 1

3:1

Question 2

How long should cord clamping be delayed for following complete delivery?

Answer 2

Cord clamping should be delayed for at least 1 minute

Question 3

Should you attempt to aspirate meconium from the nose and mouth of an unborn infant while the head is still on the perineum?

Answer 3

NO

Question 4

What are the 3 fetal ducts which should close/ constrict in the perinatal period?

Answer 4

Ductus venosus

Foramen ovale

Ductus arteriosus

Question 5

What happens to circulating prostaglandin levels after birth?

Answer 5

Circulating prostaglandins drop

Question 6

What does the ductus arteriosus become?

Answer 6

The ligamentum arteriosus

Question 7

What does the ductus venosus become?

Answer 7

The ligamentum teres

Question 8

Why does persistent pulmonary hypertension of the newborn occur?

Answer 8

The ductus arteriosus remains open, causing shunting of blood from the RV to the descending aorta, causing hypertension

Question 9

What are the management options for persistent pulmonary hypertension?

Answer 9

Ventilation and oxygen

Nitric oxide

Sedation

Inotropes

ECLS

Question 10

What factors make newborns susceptible to heat loss and hypothermia in the first few hours of life?

Answer 10

Wet when born

Large surface area

No shivering

Main source of heat production is the breakdown of brown fat (this is not efficient in the first 12 hours of life)

Question 11

Why are small for dates/ preterm babies most susceptible to hypothermia?

Answer 11

They have lower stores of brown fat, little subcutaneous fat and a large surface area

Question 12

Describe the changes in glucose homeostasis in newborns

Answer 12

Drop in insulin, increase in glycogen

Mobilisation of hepatic glycogen stores for gluconeogenesis

Ability to use ketones as brain fuel

Question 13

Why does physiological anaemia occur in newborns?

Answer 13

Adult Hb is synthesised more slowly than fatal Hb is broken down

Question 14

Why does physiological jaundice occur?

Answer 14

Liver enzyme pathways are present but immature

Breakdown of fetal Hb causes a rise in unconjugated bilirubin

Question 15

What is considered a normal weight for a neonate?

Answer 15

2.5kg to 4kg

Large for gestational age >4kg
Small for gestational age <2.5kg

Question 16

When is considered term?

Answer 16

37- 41 weeks

Question 17

What is the apgar score used for?

Answer 17

The apgar score is a measure of perinatal adpation scored out of 10

Normal is >8

Question 18

What does APGAR stand for?

Answer 18

Alertness, pulse, grimace (reflexes), activity (muscle tone), respiration

Question 19

What respiratory bacterial infection are neonates at risk of?

Answer 19

Group B streptococcus infection

Question 20

What is hydrops fetalis?

Answer 20

Widespread oedema

Question 21

What is potter’s syndrome?

Answer 21

Kidney failure causes oligohydramnios (lack of amniotic fluid) which causes abnormal features in the newborn

Question 22

How does respiratory distress syndrome present?

Answer 22

Tachypnoea
grunting 
nasal flaring 
intercostal recessions 
cyanosis

Question 23

What is the underlying pathology behind RDS?

Answer 23

Surfactant deficiency and structural abnormalities

Question 24

When does retinopathy usually present in newborns?

Answer 24

6-8 weeks following delivery

Question 25

When does necrotising enterocolitis present?

Answer 25

After the baby has had its first milk as there is then substrate in the bowel - this will be within the first couple of weeks of life

Question 26

How does necrotising enterocolitis present?

Answer 26

Causes an infection in the bowel wall which can involve necrosis and abscess formation

Feeding intolerance, abdominal distension, blood stools

May be fatal or result in small gut syndrome

Question 27

What is meconium ileus?

Answer 27

Blockage to the passage of meconium through the bowel due to poor quality of the meconium

Question 28

When and how does meconium ileus present?

Answer 28

Presents in the first 24-48 hours

Abdominal distension and vomiting

Question 29

What would be the x-ray appearance in a newborn with meconium ileus?

Answer 29

Colon appears narrow and thin - meconium has not been passed and therefore the bowel has never been used before

Question 30

What is jejunal atresia?

Answer 30

Obstruction in the wall of the bowel

Question 31

When and how does jejunal atresia present?

Answer 31

Occurs within 24 hours of birth

Distended abdomen
Initially keen to feed but keeps vomiting

Question 32

When and how does malrotation present?

Answer 32

Occurs 3-7 days after birth

Peritoneal signs
Haemodynamic instability
GREEN VOMIT

Question 33

How does an inguinal hernia present?

Answer 33

More common in males

Bulge lateral to the pubic tubercle

Question 34

What does pneumo peritoneum mean?

Answer 34

Free air in the abdomen

Question 35

What treatment should neonates born to epileptic mothers be given?

Answer 35

IM vitamin K 1mg

Question 36

Describe how/ why the foramen oval closes after birth

Answer 36

Immediately after the birth the umbilical arteries spasm in response to the difference in temperature between the outside world and the uterine environment. This greatly reduces venous return to the heart. Pressure in the right atrium decreases which leads to closure of the foramen ovale.