Neonatology 2

Question 1

A 3 day old neonate is brought into the paediatric assessment unit due to purulent discharge from his eyes + swollen eyelids.

How would you assess + manage this patient?

Answer 1

1. Urgent swab of discharge to microbiology.
2. Give single dose IM/IV CEFOTAXIME for possible gonococcal infection whilst awaiting swab results
3. If results suggest chlamydia give:
   - PO/IV ERYTHROMYCIN 14 days
   - PO AZITHROMYCIN 3 days (2nd line)

Question 2

You review a neonate who was born 12hrs previously and notice a swelling on his head. What is your differential for neonatal head lumps and how would you distinguish?

Answer 2

1. CAPUT SUCCEDANEUM
   - oedema of presenting part
   - skin swelling not limited by suture lines (crosses midline)
   - presents right after delivery and resolves over days
2. CEPHALOHAEMATOMA
   - bleeding between bone + periosteum
   - fluctuant swelling limited by suture lines
   - presents right after delivery and resolves over weeks
3. SUBAPONEUROTIC HAEMATOMA
   - bleeding between aponeurosis + periosteum
   - fluctuant swelling not limited by suture lines that may shift with movement
   - develops 12-72hrs after delivery
   - can cause rapid loss of intravascular volume (tachycardia, pallor) and may require fluid resuscitation and surgical evacuation

Question 3

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. What is your differential diagnosis?

Answer 3

1. Transient tachypnoea of the newborn
2. Respiratory distress syndrome
3. Congenital heart defects e.g. TOF, TGA
4. Congenital resp. defects e.g. diaphragmatic hernia, choanal atresia

Question 4

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. TTN is diagnosed. How would you manage him?

Answer 4

Assess requirement for respiratory support and consider:

• supplement O2 or CPAP
• witholding feeds during episodes of tachypnoea

Question 5

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. You suspect RDS. How would you diagnose and manage him?

Answer 5

Diagnosis:

• CXR: bilateral ground glass appearance + air bronchograms
• SpO2 + blood gas monitoring

Management:

• delivery room resuscitation as required
• respiratory support e.g. high-flow nasal cannulae, CPAP, intubation + ventilation
• surfactant therapy via catheter or ETT