Neonatal medicine

Question 1

outline the parameters by which low birth weight is classified

Answer 1

• low birth weight - <2500g
• very low birth weight - <1500g
• extremely low birth weight - <1000g

Question 2

aetiology?

Answer 2

placental insufficiency leading to IUGR

• Pregnancy induced HT
• smoking /alcohol
• maternal systemic disease
  
  • diabetes
• twin pregnancy

Question 3

differentiate between symmetrical & asymmetrical low birth weight

Answer 3

• symmetrical- proportionate ie both head & body small
  
  • 1st trimester insult: DNA insult (congenital/chromosomal anomalies)
  • permanent damage; bad prognosis
• asymmetrical- head normal growth, body small
  
  • 3rd trimester insult
  • will feed them and they’ll grow ; better prognosis

Question 4

what is the pathology of hypoxic-ischaemic encephalopathy?

Answer 4

brain injury resulting from a hypoxic-ischaemic insult

• abruption
• cord prolapse
• any cause of maternal hypoxia
• inadequate post natal circulation

Question 5

presentation of HIE?

Answer 5

• poor APGAR scores
• metabolic acidosis
• abnormal CTG before birth

Question 6

signs / symptoms of HIE?

Answer 6

• milld
  
  • hyperalert, hypotonia, poor feeding
• severe
  
  • comatose
  • severe hypotonia
  • seizures

Question 7

Ix of HIE?

Answer 7

• EEG
  
  • marked voltage suppression

Question 8

Mx of HIE?

Answer 8

• supportive
• cooling (therapeutic hypothermia)
  
  • only to >35 weeks

Question 9

complications of HIE

Answer 9

• cerebral palsy
• epilepsy
• learning difficulties
• hearing & visual impairment

Question 10

Prognosis of HIE

Answer 10

• mild- majority no sequelae
• moderate - 40% serious long term complications
• severe- 30% mortality , 50% severe disability

Question 11

what APGAR score indicates a poor outcome?

Answer 11

< 3 at 10 minutes

Question 12

outline the causes of respiratory distress in term infants

Answer 12

• meconium aspiration syndrome
• pneumonia
• pneumothorax
• Transient Tachypnoea of Newborn (TTPN)
• Persistent Pulmonary HT of Newborn (PPHN)
• diaphragatic hernia
• HF

Question 13

signs / symptoms of respiratory distress in newborn

Answer 13

• tachypnoea
• tachycardia
• hypoxia –> acidosis
• cyanosis
• grunting
• nasal flaring / head bobbing
• intercostal recession

Question 14

Ix of any neonate that present with respiratory distress?

Answer 14

• CXR
• Echo if cardiac cause / PPHN suspected

Question 15

Mx of respiratory distress in term infants? before you know cause

Answer 15

ventilation - oxygen, CPAP, invasive ventilation

Question 16

pathology of meconium aspiration syndrome

Answer 16

when meconium is passed in utero due to foetal distress, and is then aspirated during delivery causing pneumonitis

Question 17

what is seen on CXR in MAS?

Answer 17

patchy infiltrates

Question 18

Rx of MAS

Answer 18

• surfactant
• oxygen
• ventilation
• Abx

Question 19

prevention of MAS?

Answer 19

if presence of meconium stained liquor (amniotic fluid), deliver ASAP

Question 20

pathology of PPHN

Answer 20

failure of pulmonary vascular resistance to reduce after birth

Question 21

aetiology of PPHN

Answer 21

• primary
  
  • disease of pul vasculature
• secondary
  
  • lung parenchymal disease ie pneumonia
  • birth issues ie asphyxia

Question 22

signs of PPHN?

Answer 22

• R–> L shunt
• increase in pul arterial pressure

Question 23

Rx of PPHN?

Answer 23

• Nitric oxide
• Oxygen
• ECMO if severe

Question 24

Aetiology of Pneumothorax in newborn?

Answer 24

often iatrogenic via CPAP

Question 25

Pathology of TTPN?

Answer 25

delay in resorption of lung fluid, assoc w C Section

Question 26

what is seen on CXR in TTPN?

Answer 26

fluid in horizontal fissure

Question 27

Mx of TTPN?

Answer 27

resolves spontaneously in a few days