Neonatal

Question 1

What are the RF of NEC?

Answer 1

Preterm
Hyperosmolar feeding
Inf, ABX use
Gut ischemia e.g. hypoxia, polycythemia

Question 2

What is the age of onset of NEC?

Answer 2

Term: 7d
Preterm: 14d
Extreme preterm: 21d

Question 3

What are the S/S of NEC?

Answer 3

General: poor feeding, lethargy, tachypnea, bradycardia, unstable temperature
Abdominal distention, everted umbilicus, dusky abdominal skin
Fecal blood

Question 4

How to Ix NEC?

Answer 4

AXR: intramural gas, portal venous gas, pneumoperitoneum

Question 5

How to Mx NEC?

Answer 5

NPO, TPN, fluid, NG tube suction
Broad-spectrum ABX: amp + gen + mtz
Surg

Question 6

What are the Cx of NEC?

Answer 6

Acute: perforation, peritonitis, septicemia, shock, DIC

Long term: short gut syndrome, TPN-related cholestasis, FTT

Question 7

What is prolonged jaundice?

Answer 7

Term: 14d
Preterm: 21d

Question 8

What are the causes of prolonged jaundice?

Answer 8

Breast milk
GI: biliary obst, neonatal hepatitis syndrome, GI obst
Inf (UTI)
Endocrine: congenital hypothyroidism

Question 9

What is early onset jaundice?

Answer 9

Within 24hr

Question 10

What are the DDx of early onset jaundice?

Answer 10

Unconjugated: hemolysis -> G6PD, Rh, ABO incompatibiltiy
Conjugated: inf -> congenital, early onset sepsis

Question 11

What is intermediate onset jaundice?

Answer 11

Between 2d & 2w

Question 12

What are the DDx of intermediate onset jaundice?

Answer 12

Physiological
Breast milk (ihb), breast-feeding (dehydration)
Hematoma, polycythemis
Liver disorder
Inf (UTI)

Question 13

What is BPD?

Answer 13

O2 dependence at 36w of gestation or 28d post natal age

Question 14

How to Ix BPD?

Answer 14

CXR: cystic & fibrotic changes, widespread areas of opacification

Question 15

How to Mx BPD?

Answer 15

O2 supplement
Steroid (IV dexamethasone)
General: high calorie diet, restrict fluid + diuretics

Question 16

What is considered significant conjugated hyperbilirubinemia?

Answer 16

Conjugated (direct) >20% of total

Question 17

What is kernicterus?

Answer 17

Encephalopathy caused by deposition of unconjugated bilirubin in BG

Question 18

What are the S/S of kernicterus?

Answer 18

Lethargy, poor feeding, seizure, ophisthotonus

Question 19

What are the Cx of kernicterus?

Answer 19

Choreoathetoid CP, SNHL

Question 20

What are the S/S of neonatal sepsis?

Answer 20

Fever / hypothermia
Apnea, bradycardia
Poor feeding, vomiting

Question 21

What is the cause of physiological jaundice?

Answer 21

Decreased glucoronyl transferase activity

Increased RBC turnover but immature liver function

Question 22

What is cephalohematoma

Answer 22

Epidural bleeding
Confined by sutures
Resolves spontaneously
Higher risk in ID

Question 23

What is caput succadenum?

Answer 23

Edema of scalp at subdural layer
Crosses sutures
Resolves spontaneously
Higher risk in prolonged labour & vacuum extraction

Question 24

What is subgaleal hemorrage?

Answer 24

Between periosteum & aponeurosis
Diffuse swelling, massive blood loss b/c large potential space
Mx: resuscitate, monitor, FFP
Higher risk in vacuum extraction

Question 25

What are the effects of GDM on neonate?

Answer 25

Macrosomia Polycythemia HypoCa -> jittery, apnea

Question 26

What is Erb’s palsy?

Answer 26

C5-7 nerve root injury

Question 27

What are the S/S of Erb’s palsy?

Answer 27

Waiter’s tip sx | Asymmetrical moro reflex & limb movement

Question 28

How to Mx Erb’s palsy?

Answer 28

Reassure (resolve by 3mo) | PT (prevent contracture)

Question 29

What is the cause of ARDS?

Answer 29

Surfactant deficiency (e.g. preterm, GDM)

Question 30

What are the S/S of ARDS?

Answer 30

Respiratory distress within 4hr of delivery

Question 31

How to Ix ARDS?

Answer 31

CXR: diffuse reticulogranular ground glass appearance w/ air bronchograms SpO2, ABG

Question 32

How to Mx ARDS?

Answer 32

O2 supp Surfactant Assisted ventilation e.g. CPAP, BiPAP Supportive care

Question 33

How to prevent ARDS?

Answer 33

AN steroids if risk of preterm <34w

Question 34

What is CDH?

Answer 34

Herniation of abdominal viscera into chest -> pulmonary hypoplasia

Question 35

How to Dx CDH?

Answer 35

AN: morphology scan PN: PE, AXR/CXR

Question 36

What are the Sx of CDH?

Answer 36

Barrel chest Scaphoid abdomen Asymmetrical chest expansion CN despite respiratory support

Question 37

How to Ix CDH?

Answer 37

AXR/CXR - bowel loop in thorax, x bowel loop in abdomen - shifting of heart shadow, NG tube, ET tube, umbilical arterial catheter

Question 38

How to Mx CDH?

Answer 38

NG tube suction Intubation (low pressure ventilation to prevent PTX) Surg