Neonatal medicine Flashcards
(111 cards)
1
Q
What is necrotising enterocolitis?
A
Necrotising enterocolitis (NEC) is a serious illness in which tissues in the intestine (gut) become inflamed and start to die
2
Q
What are the symptoms of necrotising enterocoloitis?
A
- Feeding intolerance
- Blood + mucus stools
- Vomiting bile-stained fluid
- Abdominal distension which can quickly progress to abdominal discolouration, perforation and peritonitis.
- Hypotension
- Hypothermina
- Jaundice
3
Q
How is necrotising enterocolitis diagnosed?
A
Abdominal X-ray
- Pneumatosis intestinalis - intramural gas
- Bowel wall thickening, persistent bowel loops that are filled with gas
- Air both inside and outside of the bowel wall (Rigler sign)
- Air outlining the falciform ligament (football sign)
4
Q
What is the treatment for necrotising enterocolitis?
A
-
Broad spectrum antibiotics
- Penicillin, gentamicin and metronidazole
- IV feeds
- NG tube
- Laparotomy
5
Q
How can necrotising enterocolitis be prevented?
A
Erythromycin
6
Q
Why is vitamin K given to babies after birth?
A
To prevent haemorrhagic disease of the newborn
7
Q
How is vitamin K delivered to a baby after birth?
A
one off IM injection
Phytonadione
8
Q
What is haemorrhagic disease of the newborn?
A
Hemorrhagic disease of the newborn is a rare bleeding problem that can occur after birth.
9
Q
How is haemorrhagic disease of the newborn cateogrised?
A
- Early onset occurs within 24 hours of birth
- Classic onset occurs within two to seven days
- Late onset occurs within two weeks to six months
10
Q
What are the symptoms of haemorrhagic disease of the newborn?
A
Warning bleeds, which may seem insignificant
Low weight for your baby’s age
Slow increase in weight
11
Q
What babies are at risk of developing haemorrhagic disease of the newborn?
A
-
Antiseizure drugs that interfere with vitamin K metabolism
Such as phenytoin, phenobarbital, caramezepine, or primidone -
Blood thinning medications
Such as warfarin (Coumadin) or aspirin -
Antibiotics
Such as cephalosporins -
Antituberculosis medications
Such as rifampin and isoniazid
12
Q
How is haemorrhagic disease of the newborn diagnosed?
A
Blood clotting tests
13
Q
What are the steps in newborn resusitation?
A
1) Dry baby and maintain temperature
2) Assess tone, respiratory rate, heart rate
3) If gasping or not breathing give 5 inflation breaths*
4) Reassess (chest movements)
5) If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
14
Q
When does each newborn reflex stop?
A
-
Stepping
- 2 months of age
-
Moro
- 3-4 months of age
-
Rooting
- 4 months of age
-
Grasp
- 4-5 months of age
15
Q
What is the definition of hypoglycaemia?
A
There is no agreed definition of neonatal hypoglycaemia but a figure of < 2.6 mmol/L is used in many guidelines.
16
Q
What is the cause of neonatal hypoglycaemia?
A
- Preterm birth (< 37 weeks)
- Maternal diabetes mellitus
- IUGR
- Hypothermia
- Neonatal sepsis
- Inborn errors of metabolism
- Nesidioblastosis
- Beckwith-Wiedemann syndrome
17
Q
What are the features of neonatal hypoglycaemia?
A
May be asymptomatic
Autonomic (hypoglycaemia → changes in neural sympathetic discharge)‘Jitteriness’
Irritable
Tachypnoea
Pallor
Neuroglycopenic
Poor feeding/sucking
Weak cry
Drowsy
Hypotonia
Seizures
Other features may include
Apnoea
Hypothermia
18
Q
What is the management of hypoglycaemia?
A
Asymptomatic
- Encourage normal feeding (breast or bottle)
- Monitor blood glucose
Symptomatic or very low blood glucose
- Admit to the neonatal unit
- Intravenous infusion of 10% dextrose
19
Q
What are the steps for newborn resusitation?
A
- Following birth, the first step is to dry the baby maintain temperature and start the clock
- Following this you assess tone breathing and heart rate.
- If gasping or not breathing, you open the airway to give 5 inflation breaths.
- You then reassess for an increase in the heart rate. If there is no increase in the heart rate you ensure the inflation breaths you are giving are adequate by checking chest movement.
- If the chest is not moving you assume the inflation breaths are inadequate and recheck head position, consider 2-person airway control and other manoeuvers and repeat inflation breaths then look for a response.
- If the chest is moving but the heart rate is still undetectable or less than 60 beats per minute you start chest compressions at a ratio of 3 compressions to 1 inflation breath (3:1).
- You reassess heart rate every 30 seconds, and if it is still undetectable or very slow, you consider IV access and drugs.
20
Q
What is gastroschisis?
A
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
21
Q
What is the management of gastroschisis?
A
Vaginal delivery may be attempted
Newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
22
Q
What is exomphalos (omphalocoele)?
A
Abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum
23
Q
What are the disease associations with exomphalos (omphalocoele)?
A
- Beckwith-Wiedemann syndrome
- Down’s syndrome
- Cardiac and kidney malformations
24
Q
What is the management for exomphalos (omphalocoele)?
A
Caesarean section is indicated to reduce the risk of sac rupture
A staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
25
WHAT ARE THE CAUSES OF JAUNDICE IN THE FIRST 24 HOURS AFTER BIRTH?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase
26
What are the clinical features of neonatal jaundice?
Failure to thrive
Poor feeding
Other features of the underlying aetiology
27
What are the long term causes of jaundice in a newborn?
1. Biliary atresia
2. Hypothyroidism
3. Galactosaemia
4. Urinary tract infection
5. Breast milk jaundice
6. Congenital infections e.g. CMV, toxoplasmosis
28
What are the tests you can do for neonatal jaundice?
Conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
29
What is the management for nenonatal jaundice?
1. Phototherapy
2. Echange therapy
30
What are the complications of neonatal jaundice?
Kernicterus, with subsequent choreathetosis evolving in the second year of life
1. Opisthotonus
2. Spasticity
3. Convulsions
4. Mental retardation
5. Deafness
31
WHAT IS KERNICTERUS?
Kernicterus is a condition associated with high levels of bilirubin in the blood in early life that may present with severe neurological symptoms.
32
What are risk factors for kernicterus?
1. Risk factors, in addition to the obvious factor of neonatal hyperbilirubinaemia, include:
2. Occurrence in the first two weeks of life
3. Prematurity
4. Factors which increase bilirubin displacement from albumin, such as acidosis, infection, hypoalbuminaemia, hypoxia, etc.
5. Conditions which lead to massive haemolysis, in particular haemolytic disease of the newborn
33
When should kernictus be suspected in a newborn?
**Hyperbilirubinaemia**
1. A serum bilirubin level greater than 340 micromol/litre in babies with a gestational age of 37 weeks or more
2. A rapidly rising bilirubin level of greater than 8.5 micromol/litre per hour
3. Clinical features of acute bilirubin encephalopathy
34
What are the clinical features of kernicterus?
Acute features, noted from day 3 to day ten include:
1. Lethargy
2. Poor feeding
3. Hypotonia,
4. Opisthotonus
5. Convulsions
Intermediate features include:
1. Hypotonia
2. Developmental delay
Long term features, noted at 18 months, include:
1. Athetoid cerebral palsy
2. High frequency hearing loss
35
What is an umbilical granuloma?
An umbilical granuloma is an overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life.
36
What are the features of umbilical granuloma?
On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
37
What is the treatment of an umbilical granuloma?
It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
38
What are the commonest variants of cleft lip?
Isolated cleft lip (15%)
Isolated cleft palate (40%)
Combined cleft lip and palate (45%)
39
What is the pathophyisology/causes of cleft lip?
1. Polygenic inheritance
2. Maternal antiepileptic use increases risk
3. Cleft lip results from failure of the fronto-nasal and maxillary processes to fuse
4. Cleft palate results from failure of the palatine processes and the nasal septum to fuse
40
What are the problems of clept palate?
**Feeding**
Orthodontic devices may be helpful
**Speech**
With speech therapy 75% of children develop normal speech
Increased risk of otitis media for cleft palate babies
41
What is the management of cleft lip and cleft palate?
Cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
Cleft palates are typically repaired between 6-12 months of age
42
What is respiratory distress syndrome?
A baby's lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties
It usually affects premature babies
It is caused by insufficient surfactant production and structural immaturity of the lungs
43
What are the risk factors for respiratory distress syndrome?
Premature birth
Male sex
Diabetic mothers
Caesarean section
Second born of premature twins
44
What are the symptoms of respiratory distress syndrome?
1. Tachypnoea
2. Intercostal recession
3. Expiratory grunting
4. Cyanosis
45
How do you diagnose respiratory distress syndrome?
X-ray shows 'ground-glass' appearance with an indistinct heart border
46
What is the management of respiratory distress syndrome?
1. **Prevention during pregnancy**: maternal corticosteroids to induce fetal lung maturation
2. Oxygen
3. Assisted ventilation
4. **Exogenous surfactant** given via **endotracheal tube**
47
WHAT IS BRONCHOPULMONARY DYSPLASIA?
Bronchopulmonary dysplasia is a condition that may develop in some preterm infants, in which the infant remains dependent on artificial ventilation and then oxygen for several months
48
What are some causes of bronchopulmonary dysplasia?
1. Barotrauma from assisted ventilation
2. Oxygen toxicity from high inspired oxygen concentrations
3. Interruption of natural drainage by endotracheal tubes
4. Aspiration and infection
5. Hyaline membrane disease
49
What are the investigations for bronchopulmonary dysplasia?
1. X-ray
Patchy collapse and cystic changes in overinflated lungs
50
What is the treatment for bronchopulmonary dysplasia?
**Treatment aims to wean the ventilatory requirements of the infant. In doing this the following may be helpful:**
1. A course of **steroids** may be tried, provided there are no contraindications such as intercurrent sepsis
2. **Diuretics** may be used if there are features of heart failure
3. **Methylxanthines** - caffeine, aminophylline or theophylline - may be used to stimulate respiratory effort and increase diaphragmatic contractility
51
WHAT IS MECONIUM ASPIRATION?
Up to 15% of babies pass meconium during delivery, which is dangerous if aspirated. Unfortunately, birth asphyxia provokes vigorous breathing movements in the foetus which contributes to aspiration of meconium into the respiratory tree.
52
What are the symptoms of meconium aspiration?
1. Meconium may act as a ball valve - allowing air in but not out
2. Meconium is also acidic and acts as an irritant, resulting in a chemical pnemonitis. Bacteria may cause superinfection.
53
What are the investigations for meconium aspiration?
**_X-ray_**
This results in a radiographic appearance of patchy consolidation interspersed with areas of overinflation.
54
What is the management for meconium aspiration?
**The aim is prevention; firstly obstetric management to prevent the baby from passing meconium, then paediatric management to prevent aspiration.**
1. Monitoring and treatment of women with meconium-stained liquor
2. Continuous electronic fetal monitoring (EFM)
3. Amnioinfusion should not be used for the treatment of women with meconium-stained liquor
**Resuscitation of babies with meconium-stained liquor**
1. Fetal blood sampling (FBS)
2. Suctioning of the nasopharynx and oropharynx prior to birth of the shoulders and trunk should not be carried out
3. The upper airways should only be suctioned if the baby has thick or tenacious meconium present in the oropharynx
4. if there has been significant meconium staining and the baby is in good condition, the baby should be closely observed for signs of respiratory distress.
55
WHAT IS HYPOXIC ISCHAEMIC ENCEPHALOPATHY?
Birth asphyxia may be the result of intrauterine asphyxia, occurring at 1 to 2 per 1000 deliveries.
56
What are the causes of hypoxic ischaemic encephalopathy?
1. Maternal asphyxia - lung, heart disease
2. Poor uterine perfusion - shock, posture, vascular disease
3. Disease and separation of the placenta
4. Interruption of the cord, for example prolapse
5. Foetal anaemia and heart failure
57
What are the clinical features of hypoxic ischaemic encephalopathy?
**Immediate**
1. Neurologic - encephalopathy, irritability and abnormal tone
2. Pulmonary - haemorrhage, RDS
3. Renal - tubular necrosis, with acute renal failure
**Long term effects**
1. Brain damage, cerebral palsy, mental handicap
2. Fits, hyperactivity, and learning difficulties
58
What is the management for hypoxic ischarmic encephalopathy?
1. Full resuscitation is required, and weaned only when blood gases are normal.
2. Ventilation should be considered as appropriate
3. Acidosis should be corrected
4. Convulsions may be managed with phenobarbitone, using second line drugs if the fits are not controlled.
5. Clotting should be measured and abnormality corrected with fresh frozen plasma or platelets.
59
WHAT IS TORCH INFECTION?
T oxoplasmosis
O ther, which refers to syphilis and HIV infection principally, but may also refer to gonorrhoea and varicella
R ubella
C ytomegalovirus
H erpes, and also hepatitis
60
What are the clinical features common to TORCH infections?
1. Low birthweight
2. Preterm delivery
3. Anaemia, thrombocytopaenia
4. Hepatitis with jaundice and hepatosplenomegaly
5. Seizures
6. Microcephaly
7. Mental handicap
8. Encephalitis
9. Failure to thrive
61
What are some salient features of toxo, rubella and cyto?
Toxoplasmosis causes neurological damage, cerebral calcification, hydrocephalus and chorioretinitis
Rubella causes congenital heart disease - principally patent ductus arteriorus and pulmonary stenosis - mental retardation, retinopathy, cataract, glaucoma, purpura and microcephaly
Cytomegalovirus causes in 10 to 20% hydrops, chorioretinitis and microcephaly, and in 80 to 90% less specific mental handicap and visual and hearing problems in later life
62
What is the screening for TORCH?
NHS Infectious Diseases in Pregnancy Screening (IDPS) Programme
as part of this programme, all pregnant women in England should be routinely offered screening for hepatitis B, HIV, syphilis and susceptibility to rubella, early in pregnancy
63
WHAT IS OESOPHAGEAL ATRESIA ASSOCIATED WITH?
It is often associated with a tracheo-oesophageal fistula.
64
What is the most common anatomical finding in oesophageal atresia?
1. The most common situation is with a blind end oesophagus with a fistula just proximal from the distal oesophagus just proximal to the carina.
2. The trachea is in communication with the lower end of the oesophagus, ie the portion that should have continued from the point of the blind pouch.
65
How does oesophageal atresia happen?
The oesophagus and trachea are formed by septal division of the caudal part of the foregut by the seventh week of gestation.
Atresia results from a posterior deviation of the septum.
66
What are the clinical features of oesophageal atresia?
Clinical presentation is of a child unable to swallow saliva, bubbling fluid from the mouth, who chokes on the first feed. The bubbling occurs within 20 minutes of birth.
There is a high incidence of aspiration pneumonia, either from the oesophageal pouch into the trachea, or in the presence of a tracheoesophageal fistula via the fistula into the trachea.
67
What are the investigations of oesophageal atresia?
To confirm a case of oesophageal atresia, a size 10 French gauge soft rubber catheter is passed into the oesophagus through the mouth. It cannot be passed more than 10-12cm from the gums in cases of atresia.
Investigations to confirm the diagnosis include chest and abdominal radiographs. With a tracheo-oesophageal fistula, for example, air is noted in the stomach and small intestine. It is not advisable to use contrast media because of the risk of aspiration should there be a fistula.
Chest radiology may also reveal cardiac anomalies, and an echocardiogram is probably indicated, since the surgeon needs to know that the aorta is on the correct side.
68
What are some conditions associated with oesophageal atresia?
1. Tetralogy of Fallot and other cardiac abnormalities
2. Ano-rectal agenesis
3. Other intestinal atresias
4. Skeletal anomalies
5. Renal anomalies
69
What is the management of oesophageal atresia?
A baby with oesophageal atresia or tracheo-oesophageal fistula should be nursed with a tube providing continuous suction drainage of the oesophageal pouch.
Medical management involves rehydration and correction of any electrolyte imbalance or hypoglycaemia. If there is an aspiration pneumonia then this should be treated with antibiotics.
Surgical correction of the abnormality is made by an end-to-end anastomosis through a right thoracotomy in the bed of the fifth rib. The azygous vein is doubly ligated, divided, and the mediastinal pleura incised. If a fistula is present, it is divided at its entrance into the trachea and sewn shut. The proximal pouch is then mobilized and the end-to-end anastomosis is established.
70
WHAT IS BILIARY ATRESIA?
Congenitally acquired condition in which the biliary tree become progressively sclerosed and occluded.
The main intrahepatic ducts become obliterated and death occurs in 98% of individuals by two years old if untreated.
71
What are the clinical features of biliary atresia?
About one-third of patients are jaundiced at birth. In all, jaundice is present by the end of the first week and deepens progressively.
Other features include:
1. Pale stools, indicating obstruction
2. Dark urine
3. Pruritus
4. Often hepatomegaly and splenomegaly
72
What are the investigations for biliary atresia?
1. Increased conjugated bilirubin
2. Elevted transaminases
3. Liver ultrasound
4. Liver biopsy
73
What is the treatment for biliary atresia?
1. Kasai procedure - hepatoportoenterostomy
74
WHAT IS GESTATIONAL DIBAETES?
Gestational diabetes is diabetes that develops during pregnancy
75
What are the risk factors for gestational diabetes?
1. BMI of \> 30 kg/m²
2. Previous macrosomic baby weighing 4.5 kg or above
3. Previous gestational diabetes
4. First-degree relative with diabetes
5. Family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
76
What are the symptoms of gestational diabetes?
For most women, gestational diabetes doesn't cause noticeable signs or symptoms.
Increased thirst and more-frequent urination are possible symptoms.
77
What are the complications with gestational diabetes?
1. Excessive birth weight
2. Early (preterm) birth
3. Serious breathing difficulties
4. Low blood sugar (hypoglycemia). Severe episodes of hypoglycemia may cause seizures in the baby.
5. Obesity and type 2 diabetes later in life.
6. Stillbirth.
78
What is the diagnosis for gestational diabetes?
1. **Oral glucose tolerance test (OGTT)**
* Done around 24 to 28 weeks
* Fasting glucose is \>= 5.6 mmol/l
* 2-hour glucose is \>= 7.8 mmol/l
79
What is the treatment for gestational diabetes?
\< 7 mmol/l
Trial of diet and exercise should be offered
If glucose targets are not met within 1-2 weeks
Altering diet/exercise metformin should be started
If glucose targets are still not met
Short-acting Insulin should be added to diet/exercise/
\>= 7 mmol/l
Insulin should be started
6-6.9 mmol/l
Evidence of complications such as macrosomia or hydramnios, insulin should be offered
80
WHAT IS GROUP B STEPTOCOCCUS INFECTION?
Group B strep (streptococcus) is a common bacterium often carried in the intestines or lower genital tract.
The bacterium is usually harmless in healthy adults. In newborns, however, it can cause a serious illness known as group B strep disease.
81
What is the causative organism for group B streptococcus disease?
Streptococcus agalacticae
82
What are the symptoms of group B streptococus disease?
Fever
Difficulty feeding
Sluggishness and a lack of energy (lethargy)
Difficulty breathing
Irritability
Jaundice
83
What babies are at risk of developing group B streptococus disease?
1. Prematurity
2. Prolonged rupture of the membranes
3. Previous sibling GBS infection
4. Maternal pyrexia e.g. secondary to chorioamnionitis
5. The mother previously delivered an infant with group B strep disease
84
What prevention is given to mothers when at risk of delivering a group B streptococus baby?
1. IV antibiotics (benzylpenicillin or erthyromycin) during labour
2. No point giving it before as has a chance of coming back
85
How is group B streptococus diagnosed?
Swab between 35 and 37 weeks of pregnancy
86
What is the treatment for group B strepococus?
1. IV antibiotics
2. Benzylpenicillin
87
WHAT IS LISTERIA INFECTION?
Neonatal listeriosis presenting in the first week has a high mortality. About 20% of fetuses infected with Listeria are still born.
88
What foods is listeria found in?
1. Soft ripened cheeses such as brie, camembert and blue vein types
2. Pate
3. Cooked-chilled meals and ready to eat poultry, unless thoroughly heated before they are eaten
89
What are the clinical features of listeria infection?
1. Bronchopneumonia
2. Meningitis
3. Conjunctivitis
4. Skin rash
5. Late-onset disease usually presents as meningo-encephalitis in a baby who was initially healthy at one to four weeks.
90
What are the investigations for listeria infection?
1. Mother - blood cultures
2. Neonate - sepsis screen, with surface swabs, gastric aspirate
3. In addition, the products of conception such as the placenta may be swabbed
91
What is the treatment of listeria infection?
1. IV ampicillin
2. IV aminoglycoside
This should be continued for at least five days.
92
WHAT IS HSV ENCEPHALITIS?
Herpes simplex (HSV) encephalitis is a common topic in the exam. The virus characteristically affects the temporal lobes - questions may give the result of imaging or describe temporal lobe signs e.g. aphasia.
93
What are the clinical features of HSV encephalitis?
1. Fever, headache, psychiatric symptoms, seizures, vomiting
2. Focal features e.g. aphasia
3. Peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis
94
Which HSV virus causes encephalitis and which lobes are affected?
1. HSV-1 is responsible for 95% of cases in adults
2. Typically affects temporal and inferior frontal lobes
95
What are the investivagations for HSV encephalitis?
1. CSF: lymphocytosis, elevated protein
2. PCR for HSV
3. CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
4. MRI is better
5. EEG pattern: lateralised periodic discharges at 2 Hz
96
What is the treatment for HSV encephalitis?
1. IV Acyclovir
97
WHAT IS NEONATAL HYPERTHYROIDISM?
This uncommon condition results from transplacental passage of stimulating IgG TSH-receptor antibodies to the infant from a mother with a past or current history of Graves' disease.
98
What are the clinical features of neonatal hyperthyroidism?
1. Goitre
2. Exophthalmus
3. Failure to thrive
4. Fever
5. Often marked tachycardia and cardiac failure if treatment is delayed
99
What is the management for neonatal hyperthyroidism?
1. The condition is often self-limiting since the maternal immunoglobulins have a half-life of about three weeks in the infant.
2. Short term treatment with carbimazole and propranolol may be life saving.
3. Thyroid function tests should be regularly monitored in affected babies.
100
WHEN SHOULD APGAR SCORE BE ASSESSED?
1, 5 and 10 minutes
101
What is common for a neonate in the first 10 minutes of life?
Cyanosis
102
WHAT IS TRANSIENT TACHYPNOEA OF THE NEWBORN?
Transient tachypnoea of the newborn (TTN) is the commonest cause of respiratory distress in the newborn period.
It is caused by delayed resorption of fluid in the lungs
103
When is transient tachpnoea of the newborn?
It is more common following caesarean sections, possibly due to the lung fluid not being 'squeezed out' during the passage through the birth canal
104
What are the investigations of transient tachypnoea of the newborn?
1. Chest X-ray
* Hyperinflation of the lungs and fluid in the horizontal fissure.
105
What is the management for transient tachypnoea of the newborn?
1. Observation, supportive care
2. Supplementary oxygen may be required to maintain oxygen saturations
106
WHAT SHOULD EVIDENCE OF BOWEL SOUNDS IN A RESPIRATORY EXAM OF A NEONATE IN RESPIRATORY DISTRESS SHOULD MAKE YOU CONSIDER?
Congential diaphragmatic hernia
107
What is the treatment of a congenital diaphragmatic hernia?
Intubation and ventilation
108
WHAT ARE THE CAUSES FOR NEONATAL SEPSIS?
1. Group B strep
109
What are the symptoms for neonatal sepsis?
1. **Respiratory distress - MSOT COMMON**
2. Tachycardioa
3. Apnoea
4. Jaundice
110
WHAT DOES CONGENITAL CYTOMEGALOVIRUS PRESENT WITH?
1. Hearing loss
2. Low birth weight
3. Petechial rash
4. Microcephaly
5. Seizures
111
WHAT ARE THE SYMPTOMS OF CONGENITAL RUBELLA SYNDROME?
1. Sensorineural deafness
2. Congenital cataracts
