Neonates

Question 1

What is early onset neonatal sepsis?

Answer 1

Sepsis occurring within the first 48-72 hours of life?

Question 2

What is the most frequent cause of severe neonatal infection?

Answer 2

Group B strep

Question 3

What is group B strep?

Answer 3

Gram positive coccus in chains

Question 4

What are some risk factors for early onset neonatal sepsis?

Answer 4

Invasive group B strep infection in previous baby, maternal GBS in current pregnancy, prelabour rupture of membranes, preterm birth, intrapartum fever higher than 38, suspected chorioamniotiis

Question 5

What are some clinical indicators suggestive of early onset neonatal sepsis?

Answer 5

Respiratory distress starting >4 hours after birth, seizures, signs of shock,, feeding difficulties, tachycardia or bradycardia, hypoxia, jaundice within 24 hours of birth, apnoea, temperature abnormalities

Question 6

What are some differentials of early onset neonatal sepsis?

Answer 6

Transient tachypnoea of the new born, respiratory distress syndrome, meconium aspiration, haemolytic disease of the newborn

Question 7

How is early onset neonatal sepsis managed?

Answer 7

IV benzylpenicillin with gentamicin

Continue for 7-10 days if blood cultures are positive or up to 14 days if CSF is also positive

Question 8

How is early onset neonatal sepsis investigated?

Answer 8

FBC, CRP, blood cultures, LP

Question 9

What causes physiological neonatal jaundice?

Answer 9

Due to increased red blood cell breakdown and immature liver not able to process high bilirubin concentrations

Question 10

What is the natural history of physiological neonatal jaundice?

Answer 10

Starts at day 2-3, peaks at day 5 and usually resolves by day 10

Question 11

What are the causes of pathological neonatal jaundice?

Answer 11

Haemolytic disease of the newborn, G6PD deficiency, dehydration, infection, breast milk jaundice, biliary atresia

Question 12

What are some risk factors for pathological hyperbilirubinaemia?

Answer 12

Prematurity, low birth weight, previous sibling required phototherapy, exclusively breast fed, jaundice <24 hours, infant of diabetic mother

Question 13

How could pathological neonatal jaundice present?

Answer 13

Yellowing of skin and sclera, drowsy, altered muscle tone, poor urine output

Question 14

How is neonatal jaundice investigated?

Answer 14

Transcutaneous bilirubinometer, serum bilirubin, blood group, DCT, FBC, U+Es, infection screen, LFTs, TFTs

Question 15

How can neonatal jaundice be managed?

Answer 15

Phototherapy, exchange transfusion, IVIG

Question 16

What complication can arise from neonatal jaundice?

Answer 16

Kernicterus - bilirubin is neurotoxic and can accumulate in CNS gram matter causing irreversible neurological damange

Question 17

What is the definition of extreme preterm?

Answer 17

Before 28 weeks

Question 18

What is the definition of very preterm?

Answer 18

28 to 32 weeks

Question 19

What is the definition of moderate to late preterm?

Answer 19

32 to 37 weeks

Question 20

What are some reasons for prematurity?

Answer 20

Pre-eclampsia, severe IUGR, PPROM, placental abruption, severe infection, no identifiable cause

Question 21

What are some risk factors for premature delivery?

Answer 21

Previous preterm delivery, multiple pregnancy, smoking, infections, diabetes, hypertension, physical injury, being underweight or overweight during pregnancy

Question 22

How is a premature baby investigated?

Answer 22

FBC, U+Es, blood cultures, CRP, blood group and DAT, blood gas, CXR, AXR, CrUSS

Question 23

How can RDS in a neonate be managed?

Answer 23

Exogenous surfactant administration, endotracheal intubation and mechanical ventilation, CPAP, NIPPV, high flow oxygen, caffeine administration for apnoeas

Question 24

What medication can be given to close a PDA?

Answer 24

Indomethacin or ibuprofen

Question 25

How can retinopathy of prematurity be managed?

Answer 25

Avoid excessive oxygen exposure, screening for ROP by ophthalmology team, laser treatment if indicated

Question 26

Describe the results of the EPICure 2 study

Answer 26

Infants born at 22 weeks - 1/3rd will have no or mild disability By 26 weeks - 75% have no or mild disability

Question 27

What are some complications of prematurity

Answer 27

Retinopathy of prematurity Respiratory distress syndrome which can lead to chronic lung disease Neonatal sepsis Intraventricular haemorrhage Necrotising enterocolitis Hypoglycaemia and electrolyte abnormalities

Question 28

What should be covered in the NIPE?

Answer 28

General condition - colour, how they handle, birth marks etc Head - shape, circumference, fontanelles Mouth - sucking reflex, tongue, palate, cyanosis Count fingers and toes, look at palmar creases Genitals and anal patency Eyes - red reflex Check heart sounds and femoral pulses Palpate testes Check hips - Barlow (posterior force, adduct) and ortolans (push anteriorly and abduct)

Question 29

What conditions are looked for on the blood spot test?

Answer 29

Congenital hypothyroidism, sickle cell disease, cystic fibrosis (measures trypsin), metabolic disorders (maple syrup urine disease, homocystinuria, phenylketonuria etc)

Question 30

How and when are hearing problems screened in babies?

Answer 30

Ideally hearing tested in the first 4-5 weeks, can be done up to 3 months Automated otoacoustic emission or auditory evoked brainstem response

Question 31

What future condition is kernicterus associated with?

Answer 31

Athetoid cerebral palsy

Question 32

How does phototherapy work for jaundice?

Answer 32

Blue-green 450-460nm fluorescent light converts bilirubin to soluble

Question 33

What murmur is heard in PDA?

Answer 33

Continuous machinery murmur

Question 34

What are the acyanotic congenital heart defects?

Answer 34

VSD, ASD, PDA, coarctation of the aorta

Question 35

What are some cyanotic congenital heart defects?

Answer 35

Tetralogy of Fallot, transposition of the great arteries, hypo plastic left heart syndrome

Question 36

What are some clinical features of NEC?

Answer 36

Crying too much or silent, fever, bruised, distended abdomen, feed intolerance, vomiting, haematochezia

Question 37

What will be seen on the CXR in NEC?

Answer 37

Pneumatosis intestinalis (intramural gas)

Question 38

How is NEC managed?

Answer 38

NBM, antibiotics, NG free drainage, IV fluids, maybe surgery

Question 39

When do alveoli form?

Answer 39

32 weeks

Question 40

What are some signs of respiratory distress in the newborn?

Answer 40

Cyanosis, high RR, tracheal tug, intercostal and subphrenic recessions, head bobbing

Question 41

What will be seen on the CXR in respiratory distress syndrome?

Answer 41

Ground glass appearance, air bronchogram

Question 42

When should a newborn be back to it's birth weight?

Answer 42

By 3 weeks (should not lose >10% of BW)

Question 43

What are the neonatal fluid requirements?

Answer 43

Birth to day 1 - 50-60ml/kg/day Day 2 - 70-80ml/kg/day Day 3 - 80-100ml/kg/day Day 4 - 100-120ml/kg/day Day 5-28 - 120-150ml/kg/day

Question 44

What are the fluid requirements of a baby after 28 days?

Answer 44

0-10kg - 100ml/kg/day 10-20kg - 50ml/kg/day >20kg - 20ml/kg/day

Question 45

What is the pathophysiology of respiratory distress syndrome?

Answer 45

Deficiency of alveolar surfactant which leads to atelectasis and possible respiratory failure

Question 46

What is bronchopulmonary dysplasia?

Answer 46

Defined as a persistent oxygen requirement after 28 postnatal days or 36 weeks corrected gestational age (whichever is later)

Question 47

What are some early and late sequelae of bronchopulmonary dysplasia?

Answer 47

Early - ventilator dependence, pulmonary hypertension, tracheobronchomalacia, feeding problems, GORD Late - lower IQ, cerebral palsy, asthma and exercise limitation