Common neonatal problems

Question 1

Name a few adaptations of a newborn

Answer 1

Cardirespiratory transition
establishment of feeding and nutrition
metabolic adaptation
temperature maintenance

Question 2

what is meconium?

Answer 2

bile stained intestinal secretions, intestinal cells and debris
dark green colour
passed within 24 hours after birth
change of stools after 2-3 days of milk feed
yellow milk stool after 4-6 days of milk feed

Question 3

When do infants pass urine?

Answer 3

95% of infants pass urine in the first 24hours of life

99% of infants pass urine in the first 48 hours

Question 4

What causes the pink staining of urine?

Answer 4

urate crystals

Question 5

how do fetus obtain nutrients?

Answer 5

transplacental route

Question 6

what promotes lactogenesis?

Answer 6

withdrawal of progesterone and eostrogen
prolactin secretion
suckling at the breast causes prolactin production and oxytocin secretion

Question 7

what is colustrum and what are its main components?

Answer 7

secretion from the breast in the first 72 hours
high in protein, immonuglobulins and white cells
low in volume

Question 8

what are common problems of feeding?

Answer 8

reluctance: cleft palate, pre term baby (infant of diabetic mother), difficult delivery
Tongue tie: short lingual frenulum
wind 
colic
crying
poor weight gain/ excessive weight loss

Question 9

what is bilous vomiting?

Answer 9

requires prompt assessment

Question 10

what are blood stained vomits due to?

Answer 10

swallowed maternal blood

Question 11

when is jaundice abnormal in a neonate?

Answer 11

first 24 hours of life

Question 12

what causes pathological jaundice in neonates?

Answer 12

immune haemolysis

non immune heamolysis

Question 13

give examples of immune haemolysis

Answer 13

RhD

ABO incompatablity

Question 14

give examples of non immune heamolysis

Answer 14

G6PD deficiency

congenital sphercytosis

Question 15

when is jaundice normally seen in neonates

Answer 15

after 24 hours

Question 16

how is jaundice assessed?

Answer 16

serum bilirubin
mother and baby blood group
direct Coomb's test
FBC
Blood film

Question 17

how is jaundice treated?

Answer 17

blue light phototherapy

exchange transfusion

Question 18

What causes prolonged jaundice?

Answer 18

CONJUGATED
intrauterine infection
biliary atresia
prolonged TPN

UNCONJUGATED
breast milk jaundice
hypothyroid

Question 19

What is breast milk jaundice?

Answer 19

unconjugated jaundice
persists beyond 2 weeks and up to 6 weeks
could be due to breast milk beta glucoronidase or increased enterohepatic circulation

Question 20

How do neonates adapt to ‘fast feed cycle’ (glucose homeostasis)?

Answer 20

interruption of transplacental supply of glucose leads to decrease in insulin secretion and increase in glucagon and adrenaline
Glycogenolysis and gluconeogenesis is activated
Plus lipolysis and ketogenesis
neonatal brain uses ketones more efficiently than glucose

Question 21

what is the defintion of hypoglycaemia?

Answer 21

<2.6 mmol/L

Question 22

Which infants are at risk of hypoglycaemia?

Answer 22

infant of diabetic mother
IUGR
Perinatal hypoxia-ischaemia
sepsis

Question 23

What are the symtpoms of hypoglycaemia?

Answer 23

pallor
jitteriness
difficulty feeding
hypotonia
tachypnea
abnormal cry

Question 24

how is hypoglycaemia treated in neonates?

Answer 24

breast feed
if low then use formula feed
dextrose infusion

Question 25

what causes respiratory failure/ distress in a neonate?

Answer 25

meconium aspiration
transient tachypnae of newborn
sepsis

Question 26

what causes persistent pulmoary hypertension of a newborn?

Answer 26

failure of transition from fetal to neonatal circulation
sick baby with hypoxia
associated with meconium aspiration

Question 27

what is the treatment for respiratory failure?

Answer 27

respiratoy support
O2
pulmonary vasodilator

Question 28

how are cardiac murmurs in a neonate assessed?

Answer 28

circulatory collapse
heart failure
absent or weak femoral pulse