Neonatal Symposium

Question 1

describe how the first breath after birth occurs?

Answer 1

hypoxic conditions trigger the respiratory centres which creates low pressure in the lungs and increases blood flow and reduces the fluid in the lungs

Question 2

what is the normal heart rate in babies?

Answer 2

120-160

Question 3

state some ways of measuring resp rate in babies?

Answer 3

blood gas determination
transcutaneous PCO2/O2 measurement
capnography
tidal volume

Question 4

what is the normal RR in babies?

Answer 4

30-60

Question 5

is babies BP lower or higher than adults?

Answer 5

lower

70/44

Question 6

can new borns shiver ?

Answer 6

no

Question 7

after birth how much weight loss is classed as normal ?

Answer 7

10%

Question 8

what is weight loss in new borns caused by?

Answer 8

shift of interstitial fluid to intravascular
dieresis
- slower GFR, reduced Na reabsorption, decreased ability to concentrate urine
increased insensible water loss

Question 9

does Hb increase or decrease after birth in the first 10 weeks?

Answer 9

decreases until week 10

Question 10

after week 10, what is produced in the body to increase Hb?

Answer 10

erythropoietin

Question 11

state some skin colours of newborns?

Answer 11

jaundice
pallor
cyanosis
plethora

Question 12

what is plethora?

Answer 12

redness due to excess blood

Question 13

at what level of deHb does cyanosis occur?

Answer 13

more than 5g/dl of deoxyhaemoglobin

Question 14

state some skin rashes of newborns

Answer 14

milia
infections
sebaceous naevus

Question 15

what is milia ?

Answer 15

white papules on nose due to hyperplastic sebaceous glands due to the effect of transplacental hormones

Question 16

do sebaceous naevus have any complications?

Answer 16

risk of malignant change so consider elective removal

Question 17

state some different birth marks?

Answer 17

capillary haemangiomas 
mixed haemangioma 
mongolian blue spots 
port wine spots 
stork marks 
cafe au lait spots

Question 18

if there are many large cafe au lait spots what DD should be considered?

Answer 18

neurofibromatosis

Question 19

do capillary haemangioma need treatment?

Answer 19

no they disappear

Question 20

what can cause stork marks to flare up?

Answer 20

crying

- gradually fades by 2 yrs

Question 21

what causes cafe au lait spots?

Answer 21

melanin in melanocytes

Question 22

what glucose level is hypoglycaemia?

Answer 22

<2.6mmol/l

Question 23

what risk groups of hypoglycaemia?

Answer 23

premature newborns with low birth weight
diabetic mothers
hypothermia
sepsis

Question 24

state some symptoms of hypoglycaemia in new borns

Answer 24

irritable 
hypothermia 
lethargy 
hypotonia 
vomiting 
seizures

Question 25

what problems can arise with tongue tied new borns/

Answer 25

feeding | - may require frenotomy

Question 26

what evaluating respiratory function what can be measured?

Answer 26

``` RR respiratory effect - retractions colour of skin O2 sats ```

Question 27

state three causes of resp problems in new borns

Answer 27

laryngomalacia trachaemalacia bronchomalacia

Question 28

state four locations where retraction of breathing can occur>

Answer 28

subcostal substernal suprasternal intercostal

Question 29

what is the main DD for cyanosis?

Answer 29

sepsis

Question 30

what investigations should be done for cyanosis ?

Answer 30

``` ECG BP O2 sats CXR Echo ```

Question 31

what is Chonanal atresia

Answer 31

nasal obstruction

Question 32

what signs are seen in pierre robin sequence ?

Answer 32

small jaw with tongue obstruction and possible cleft palate

Question 33

what examining the eyes of a newborn what always has be looked for?

Answer 33

red reflex

Question 34

what is the rare eye cancer that has no red reflex ?

Answer 34

retinoblastoma

Question 35

what is chordee?

Answer 35

ventral curvature of the penis

Question 36

what is hypospadias?

Answer 36

urethra opens in wrong place

Question 37

are inguinal hernias common ?

Answer 37

yes

Question 38

what investigations should be done for ambigious genitilia?

Answer 38

serum electrolytes and glucose chromosome analysis pelvis and abdo US (to look for testis or ovaries) serum testosterone

Question 39

what is Cephalohaematomas ?

Answer 39

hemorrhage of blood between the skull and the periosteum | - contained between sutures

Question 40

what is Caput succedaneum ?

Answer 40

Subcutaneous fluid with poorly defined margins under the scalp caused by pressure to the presenting part of scalp to the dilated cervix

Question 41

state the two brachial plexus palsies?

Answer 41

erbs | klumpkes

Question 42

what is medial deviation of the foot called?

Answer 42

varus

Question 43

what is lateral deviation of the foot called?

Answer 43

valgus

Question 44

Does talipes require treatment ?

Answer 44

just PT

Question 45

state four ways in which heat can be lost?

Answer 45

convection conduction evaporation radiation

Question 46

what causes developmental dysplasia of the hips?

Answer 46

shallow acetabulum resulting in femur slipping out of the socket

Question 47

state some risk factors for DDH?

Answer 47

``` breech >36 weeks female 1st child large birth weight multiple birth ```

Question 48

what two tests can be done for DDH?

Answer 48

ortolani | barlow

Question 49

is barlow or ortolani more gentle?

Answer 49

ortolani

Question 50

what happens during the ortolani test ?

Answer 50

• abduction of the hip while applying anterior force on the femur to reduce the joint

Question 51

what happens during the barlow test ?

Answer 51

• adduction of the hip while applying posterior force on femur to promote dislocation

Question 52

what is 21 trisomy?

Answer 52

downs

Question 53

what is 18 trisomy?

Answer 53

edwards

Question 54

what is 13 trisomy?

Answer 54

patau

Question 55

state some features of downs syndrome?

Answer 55

``` hypotonia cardiac defect learning problems thyroid problems dysmorphism ```

Question 56

as well as ortolani and barlow test, what else can be examined for DDH?

Answer 56

leg length general movements of the legs groin creases US

Question 57

state some causes of preterm labour?

Answer 57

``` maternal smoking, pre eclampsia foetal chromosomal condition, infection placental abruption twin twin sydrome hypoglycaemia polycythaemia ```

Question 58

state some complications of being born premature?

Answer 58

``` respiratory distress syndrome broncho-pulmonary dysplasia intraventricular haemorrhage post-haemorrhagic hydrocephalus PDA necrotising entero-colitis ```

Question 59

state some long term problems of being pre term

Answer 59

reduced growth obesity ischaemic heart disease polycythaemia

Question 60

what is the treatment for RDS?

Answer 60

antenatal steroids surfactant early extubation

Question 61

what is the treatment for IVH?

Answer 61

antenatal steroids

Question 62

what is a complication of polycythaemia?

Answer 62

Increased blood flow and the lungs want low blood flow so increase resistance and when muscles start to form, pulmonary stenosis can occur

Question 63

what is periventricular leucomalacia ?

Answer 63

ischemia of the white matter adjacent to the lateral ventricles.

Question 64

what is the prognosis of periventricular leucomalacia

Answer 64

very poor

Question 65

what is the treatment for jaundice in newborns?

Answer 65

blue light therapy

Question 66

state some organisms that can cause sepsis ?

Answer 66

``` group B strep E coli listeria coag negative staph haemophilus influenza ```

Question 67

state 3 risk factors for sepsis ?

Answer 67

PROM maternal pyrexia maternal group strep B carriage

Question 68

what investigations should be done for sepsis ?

Answer 68

FBC, CRP, blood culture, blood gases, CXR

Question 69

what is the treatment for sepsis?

Answer 69

penicillin and gentamicin

Question 70

what are some complications of sepsis?

Answer 70

DIC shock and hypotension meningitis pneumonia

Question 71

state some risk factors for meconium aspiration ?

Answer 71

post date maternal DM/hypotension difficult labour

Question 72

what is the management of Hypoxic ischaemic encephalopathy ?

Answer 72

* Treat seizures * Supportive (resp and cardio) * Fluid restriction * Monitor for renal and liver failure * Baby cooled to 33 degress for 72 hours then slowly rewarmed over 12 hours

Question 73

state some causes of failure to pass stool?

Answer 73

* Constipation * Large bowel atresia * Imperforate anus * Hirschsprungs disease * Meconium ileus

Question 74

what condition is meconium ileum associated with?

Answer 74

CF

Question 75

what gender are diaphragmatic hernias associated with?

Answer 75

Males

Question 76

what is the purpose of ductus arteriosus?

Answer 76

Protects lungs against circulatory overload

Question 77

what is the purpose of ductus venosus?

Answer 77

Foetal blood vessel connecting the umbilical vein to the IVC

Question 78

what is miliaria?

Answer 78

immature sweat glands obstruction

Question 79

what is the commonest organism to cause skin infections?

Answer 79

staph aureus