Neonatal/ prematurity

Question 1

Causes of elevated unconjugated bilirubin

Answer 1

Physiological (1-2 weeks)

• First 24 hours
• Due to low UGT enzyme activity at birth

Breastmilk jaundice (most common)

Infection

Haemolytic anaemia

Congenital hypothyrodism

Question 2

Investigations for prolonged physiological jaundice [8]

Answer 2

Coombs test
- Assess hameolysis

ABO typing

Haemoglobin
- Low = blood collection outside the blood vessels

Reticulocyte/ LDH count
- haemolysis

Blood smear
- spherocytes or elliptocytes = hereditary spherocytosis or elliptocytosis

G6PD
- Deficiency

TFTs

Abdominal ultrasound

Question 3

Breastfeeding jaundice

- Description

Answer 3

Causes unconjugated jaundice

Starts during first 7 days

• Due to infrequent/ inadequate breastfeeding
• Conjugated builds up in bowel and reabsorbed before being converted back to unconjugated

Question 4

Breastmilk jaundice treatment

Answer 4

1st- Increased breast milk uptake

2nd- formula feeding

Question 5

Prevention of haemolytic disease of the newborn

Answer 5

Anti-D injections in in RhD negative mother 28-weeks and 72 hours post-partum.

Question 6

Definition of prolonged jaundice

Answer 6

> 14 days in term babies

> 21 days in premature babies

Question 7

Causes of conjugated hyperbilirubinaemia

Answer 7

Biliary atresia and other bile duct obstruction

Neonatal heptatitis

Alagille syndrome

Question 8

Kernicterus

• Definition
• Signs

Answer 8

Encephalopathy caused by excess unconjugated bilirubin deposition

Signs

• lethargy
• poor feeding
• stupor
• hypotonia
• seizures

Question 9

Signs of conjugated hyperbilirubinaemia

Answer 9

• Dark urine
• Pale stools
• Poor weight gain
• Hepatomegaly

Question 10

Management of unconjugated hyperbilirubinaemia

Answer 10

1st line= Phototherapy (blue-green light)

2nd line= Exchange transfusion (if severe)

Question 11

Crigler Najjar syndrome

Answer 11

UGT deficiency leading to inability to conjugated bilirubin

- Causing unconjugated hyperbilirubinaemia

Question 12

The wavelength of light use in phototherapy to treat jaundice is…

Answer 12

460-490nm (blue-green light)

Question 13

Alagille syndrome

- Definition

Answer 13

Genetic syndrome

• Presents with characteristic facial features and cholestasis by disrupting bile flow from liver to gallbladder.
• Can progress to cirrhosis

Question 14

Breastfeeding jaundice

- Description

Answer 14

Cause of unconjugated hyperbilirubinaemia

• Due to breastmilk inhibiting conjugation
• Typically occurs in 2nd week of life

Question 15

______ is a monoclonal antibody used to prevent RSV and is recommended for ______

Answer 15

Palivizumab

- Recommended for prematurity/ chronic lung/heart disease

Question 16

All newborns should receive IM ______ to prevent bleeding

Answer 16

Vitamin K

Question 17

Blood spot screening tests for ____ congenital conditions and is taken on day ___

Answer 17

Tests 9 conditions

Taken on day 5 (to 8)

Question 18

Congenital conditions tests for in the blood spot screening

Answer 18

Sickle cell disease

Cystic fibrosis

Congenital hypothyroidism

Phenylketonuria

Medium chain ADD

Maple syrup urine disease

Isovaleria acidaemia

Glutaric aciduria type 1

Homocystin

Question 19

______ is the hearing test carried out in newborns

Answer 19

Otoacoustic emission test

- Computer generated click is played through ear piece.

Question 20

The ______ test is carried out if the otoacoustic emission test is abnormal

Answer 20

Auditory brainstem response test.

Question 21

Common causes of neonatal sepsis

Answer 21

Group B strep (most common)

E.coli

Listeria

Klebsiella

S. aureus

Question 22

Risk factors for neonatal sepsis

Answer 22

Maternal GBS vaginal colonisation

GBS sepsis in previous baby

Maternal sepsis, chorioamnionitis/ fever >38

Prematurity

p-PROM

Question 23

Red flags for neonatal sepsis

Answer 23

Confirmed/ suspected sepsis in mother

Shock

Seizure

Term, needing ventilation

Resp distress > 4 hours after birth

Question 24

Antibiotics in neonatal sepsis is indication when…

Answer 24

1 or more red flag features

2+ risk factors/ Clinical features

Question 25

Risk factors for necrotising enterocolitis

Answer 25

Low birth weight

Prematurity

Formula fed

Respiratory distress + assisted ventilation

Sepsis

PDA/ congenital heart disease

Question 26

Investigations for necrotising enterocolitis

Answer 26

Bloods

• FBC
• CRP
• Blood gas
• Blodo culture

Imaging
- Abdominal X ray

Question 27

X-ray findings in necrotising enterocolitis

Answer 27

Dilated bowel loops

Bowel wall oedema

Pnuematosis intestinalis (has in bowel wall)

Pneumoperitoneuum

Question 28

Management of necrotising enterocolitis

Answer 28

NBM, IV fluids

TPN nutrition

Antibitoics

Surgery referral

Question 29

______ describes fluid outside the cranial periosteum crossing the suture lines

Answer 29

Caput Succedaneum

Question 30

_________ describes a collection of blood between the skull and periosteum.

Answer 30

Cephalohaematoma

Question 31

Cephalohaematoma carries a risk of ______ and ______

Answer 31

Anaemai and jaundice

Question 32

Features of congenital rubella syndrome

Answer 32

Cataracts

Congenital heart disease

Hearnin loss

Learning disabilities

Question 33

Features of congenital varicella syndrome

Answer 33

Microcephaly/ Hydrocephalus

Skin contractures

Limb hypoplasia

Chorioretinitis / cataracts

Question 34

Features of congenital CMV infection

Answer 34

Growth restriction

Microcephaly

Hearing loss, vision loss

Seizures

Learning disability

Question 35

Features of congenital toxoplasmosis

Answer 35

Triad

• Intracranial calcification
• Hydrocephalus
• Chorioretinitis

Question 36

Management of symptomatic neonatal hypoglycaemia

Answer 36

Admit to neonatal unit

IV 10% dextrose