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Neonates Flashcards

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1
Q

Ways to reduce the risk of SIDS

A 
Breastfeeding
Ensuring babies are not too hot
Use of dummies
"Back to sleep" 
"Feet to foot" - ensuring the baby's feet touch the end of the cot
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2
Q

Preterm infants require Fe supplementation T/F

A

True - iron stores are laid down in the third trimester

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3
Q

In a neonate at about what age do the blood vessels reach the peripheral retina?

A

1 month

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4
Q

What is the classic presentation of renal vein thrombosis in a neonate secondary to dehydration?

A

Triad of:
gross haematuria
thrombocytopenia
enlarged kidneys

Note: usually anticoag is not used in treatment of unilateral thrombosis but it might be used in bilateral

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5
Q

In a full term male infant with undescended testes after how long is spon descent rare?

A

Spon descent is rare after 6 months

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6
Q

In preterm infants 70% of undescended testes are on the left T/F

A

F - 70% on the right

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7
Q

Risk factors for neonatal death and still birth

A 
Low SES
African race
Male infant
Nullip or multip (3rd and subsequent)
Non singleton
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8
Q

Classic finding for Hirschprung disease on contrast enema in neonate?

A

Transition zone typically in the sigmoid colon

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9
Q

Developmental dysplasia of the hip is more common in males or females? Which hip is more commonly affected?

A

More common in females 6:1
More common in left hip
Both hips affected in 1/3 of cases

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10
Q

Treatment of haemorrhagic disease of the newborn (vit K def) with active bleeding?

A

IV vit K + FFP

Note: IV vit K works faster than IM. FFP is given as even IV vit K does not work fast enough

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11
Q

When does haemorrhagic disease of newborn usually present and how? RFs?

A

2- 7 days of life (can be later in those with malabs)
GI bleed, bleeding from umbilical stump and bruising
Those who did not receive vit K + breastfeed are most at risk

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12
Q

What is the main protein in breast milk?

A

Whey

Note: is is more digestible than cow’s milk protein, casein. Breast milk contains low levels of vitamins K but higher levels of vitamins A, C and E (compared to cow’s milk)

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13
Q

A rate of increase of bilirubin above 6.5 micro mol/L per hour is a RF for kernicterus T/F

A

F - above 8.5

Other RFs:
Bili > 340 in infant with GA > 37 wks
Clinical features of acute bilirubin encephalopathy

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14
Q

2 day old infants with rhythmic focal myoclonic jerks at a rate of 1-3/sec what pathology

A

Early onset hypocalcaemia

Note: may be followed by a generalised seizure

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15
Q

Acetylsalicylic acid is C/I in when breastfeeding T/F

A

T - AKA aspirin

Due to risk of Reye’s and may inhibit plt fxn in infant

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16
Q

How many calories are found in mature breast milk

A

70kcal/100ml

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17
Q

In which congenital infection are the eye defects unilateral?

A

Varicella zoster - can have unilateral microphthalmia, chorioretinitis, cataract - development in involved dermatome

Other features - skin scarring in a dermatomal distribution, limb hypoplasia, microcephaly, developmental delay, dysfunction of the bowel and bladder sphincters

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18
Q

Ideal weight increase of a newborn / day

A

15g/kg/day

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19
Q

What is the most common cause of hydrops fetalis?

A

Fetomaternal haemorrhage

Other causes: paroxysmal SVT, Turner syndrome, congenital infections

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20
Q

A rubella non immune mother contracts the disease at 30 weeks, what is the % risk of congenital rubella?

A

0%

Note: 8-10 weeks - 90%; 11 -16 weeks - 10 -20%; > 16 weeks- nearly nil

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21
Q

By how many weeks gestation is surfactant produced?

A

22 - 24 weeks

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22
Q

By how many weeks gestation does complete alveolisation occur?

A

28 weeks

Note: lung development is not complete until 7 yrs old

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23
Q

Indications for operative intervention in acute NEC?

A

Absolute: pneumoperitoneum; failure of medical mgmt with worsening of clinical situation 48 hours into the onset of disese
Relative: peritonism; palapable mass; discolouration of abdo; fixed abdo loops on serial radiographs

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24
Q

Typical presentation of bilateral choanal atresia

A

Infant will develop resp distress as it is an obligate nose breather, cyanosis at rest but will regain colour when they cry as they open their mouth

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25
IVH without ventricular dilatation is grade 2 T/F
True Grade 1: ependymal (germinal matrix) Grade 2: IVH w/o dilatation Grade 3: IVH w dilatation Grade 4: parenchymal
26
Prognosis of grade 1 and 2 IVH is good T/F
True - likely no long term side effects Grade 3: possible impairment on the contralateral side depending on degree of dilatation Grade 4: likely motor impairment on contralateral side
27
What is the most common bone to fracture during labour and delivery?
Clavicle
28
What proportion of still births are attributable to congenital abnormalities?
Less than 10%
29
Initial investigation in a infant with suspected fetal alcohol syndrome?
CMA - want to rule out other aetiologies
30
How does protein and carb content vary in colostrum compared to mature breast milk?
Colostrum has high protein and lower carbs
31
Compare the timing of neonatal vs perinatal deaths?
Neonatal - death within first 28 days of life Perinatal - still births plus death within 1st 7 days of life Note: still birth = in utero death after 24 weeks gestation
32
How to differentiate neonatal alloimmune thrombocytopenia from neonatal autoimmune thrombocytopenia?
In allo immune the maternal plts will be normal and infants will be low In auto immune both the maternal and infant plts will be low Note: alloantibodies are against a certain foetal platelet antigen that the baby inherits from the father but is absent in the mother. In autoimmune it is the mother who has the autoimmune disease.
33
Up until what age can a newborn hearing screen be carried out?
12 weeks
34
What is the earliest age at which weaning from formula/breast milk can start?
17 weeks
35
In an infant with congenital heart block what is the most likely antibodies that crossed the placenta from the mother?
Anti Ro/Anti La
36
In persistent pulmonary hypertension in neonates signs of heart failure are often present T/F
F - signs of heart failure are often absent
37
Pulmonary hypertension can be associated with birth asphyxia and sepsis T/F
T
38
Defn of polycythemia in neonate and when it needs to be treated?
Venous blood haematocrit > 65% is diagnostic Should be treated if > 70% or symptomatic
39
Lab abnormalities in IUGR baby
Hypoglycaemia Neutropenia Thrombocytopenia Polycythaemia (secondary to chronic hypoxia)
40
What type of IG are rheusus antibodies?
IgG Note: these are the only antibodies that can Go across the placenta
41
When is amniocentesis and chorionic villus sampling typically done?
Amniocentesis from 15 weeks onwards | Chorionic villus sampling from 11 - 13 6/7 weeks
42
What is the best way to measure blood pressure in an infant?
Doppler auscultation
43
What is the definition of broncho pulmonary dysplasia?
Need for resp support > 28 days or past 36 weeks gestation
44
Most infants who are born SGA will achieve catch up growth T/F
T - 80% will
45
Facial nerve palsy is common in neonates due to birth trauma, what is the mgmt?
Usually requires no treatment and will resolve on it's own in 2 months
46
For how long is an infant's creatinine indicative of the maternal creatinine?
First 2 days of life
47
What are the two most important aims of mgmt in a baby born with gastroschisis?
Prevention of fluid and heat loss --> wrap the defect in cling film
48
Survival rates of babies born at 21, 22 and 23, 24, 26 weeks respectively
``` 21 - 0% 22 - 10% 23 - 40% 24 - 60% 26 - 80% ```
49
Most common cause of subgalael haematoma?
Ventouse extraction
50
Bleed between the peri osteum and scalp aponeurosis is called
subgalael haematoma General develop between 12 hours to 3 days after birth
51
Subcutaneous fat necrosis of the newborn is usually present at birth T/F
F - usually develops in the weeks following delivery and resolves by 6 - 8 weeks of age Presents as a firm tender subcut nodule with an overlying dusky purple discolouration
52
Complication of subcut far necrosis of the newborn?
Hypercalcaemia
53
Cephalohaematoma or caput crosses suture lines?
Caput crosses
54
Which takes longer to resolve caput or cephalohaematoma?
cephalohaematoma - weeks to months | caput - days
55
How long does the grasp reflex last?
Hands - until about 5-6 months | Feet - 9-12 months
56
Advanced maternal age is a risk factor for SIDS T/F
F - maternal age < 20 yrs is a major maternal risk factor for SIDS. The 2nd major maternal factor is smoking Note: other pregnancy complications that increase risk placenta previa, placental abruption, premature ROM and elevated maternal alpha feet protein
57
The majority of natal teeth are due to premature eruption of the primary deciduous teeth - T/F
T - more than 90% Note: they should only be removed if they are supernumerary (this needs to be confirmed by X-ray)
58
Natal tooth eruption is a common finding in newborns T/F
F
59
What type of hyperbiliruninaemia is often present in infants of diabetic mothers?
Un conjugated
60
In the absence of any clinical findings all females born breech should under go hip ultrasound at 6 weeks T/F
T - risk if hip dysplasia in breech females is 12%
61
Risk factors for renal vein thrombosis?
``` Perinatal asphyxia Septic shock Dehydration Congenital hypercoag states Maternal DM ```
62
Caudal regression syndrome is associated with what maternal condition?
Maternal DM Note: a spectrum of structural defects of the sacral region
63
What commonly causes diaphragmatic paralysis? What other injury is it commonly associated with ?
Injury to C3-5 nerve roots | Brachial plexus injury is associated in 90%
64
Infant born with murmur consistent with VSD and meningomyelocele, what antiHTN medication did the mother take?
ACEi They are also associated with renal and limb anomalies and pulm hypoplasia
65
In an infant born with a single umbilical artery what is the recommended initial investigation?
A thorough physical exam recognising an increased risk of congenital anomalies Note: 25% of infants with single umbilical artery have anomalies : 20% of anomalies are renal however USS kidney is no longer routinely recommended
66
Non blanching bluish fluctuant swelling in the mouth lateral to the midline which displaces the tongue. What pathology and what treatment?
Ranula | Tx: complete surgical excision in continuity with the associated glands
67
Bohn nodules typically location and appearance?
Alveolar ridge in neonate | Whitish/clear inclusion cysts
68
Where are mucoceles typically located?
Buccal mucosa along the occlusal plane
69
Harlequin color change in common in normal healthy neonates T/F
T - occurs in approx 10% of healthy newborns
70
What medications are associated with gastroschisis?
Vasoactive substances - cocaine, nicotine, pseudoephedrine Note: pasthophys - vascular accident involving the right umbilical vein or right omphalomesenteric artery that leads to ischaemic necrosis or the abdominal wall, allowing bowel to enter into the amniotic cavity
71
What differentiates Apert from Crouzon syndrome clinically?
Apert have limb abnormality (syndactyly) and Crouzon do not Note: both have craniosynostosi and ocular proptosis Saethre-Chotzen syndrome is another craniosynostosis syndrome with syndactyly
72
Preterm birth is a risk factor for hip dysplasia. T/F
F - they have a decreased risk
73
Features of neonatal behavioural syndrome due to maternal SSRI use?
``` Hypothermia + hypoglycaemia Emesis + frequent stools Feeding difficulty Poor sleep Agitated/jittery Abnormal tone Seizures ```
74
Jaundice within the first 24 hours of life is normal T/F
F - jaundice before 48 hours is pathologic and requires a work up
75
Which infant in twin twin transfusion is at highest risk of hyperbilirubinaemia?
The larger (recipient) twin - due to an increased haemoglobin load
76
In twin twin transfusion fetal hydrops can occur in both infants T/F
T - in the donor due to anaemia and in the recipient due to polycythaemia
77
Indications for surgery for an umbilical hernia?
1. Symptomatic 2. Still present at 5-6 yrs of age 3. Increases in size between 1-2 yrs old
78
When can a mother with Hep B initiate breast feeding?
Immediately Do not need to wait until after vaccines
79
What is often the first clinical finding in a pt with congenital hypothyroidism?
Prolonged physiologic jaundice Note: due to delayed maturation of glucuronide conjugation. Other features: umbilical hernia, poor feeding, wide open fontanelle
80
Findings in child > 8 -10 weeks with developmental hip dysplasia?
+ Galeazzi sign ( asymmetry in the height of the knees) Limited abduction of hip + Trendelenburg (in ambulatory child)
81
Indications for GBS prophylaxis in a mother with unknown carrier status?
One of < 37 weeks gestation ROM > 18 hours Intrapartum temp > 100.4 (38) Note: if prophylaxis was indicated but not received or inadequate and infant is term with ROM > 18 hours, limited eval (bcx and CBC) with 48 hours monitoring is recommended
82
What drugs are associated with early onset haemorrhage disease of newborn?
AEDs - phenytoin, barbiturates, carbamazepine AntiTB - rifampin, isoniazid Vit K antagonists - warfarin
83
Infants who are IUGR are at risk for what pathology as adults?
Metabolic syndrome Hypertension Non alcoholic fatty liver (but not cirrhosis) Reduced cognitive executive functioning
84
What is the most common presentation of cerebral infarction?
Seizures within the first 3-4 days of life Note: hypotonia and resp irregularities may be seen in the days to weeks

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