Neonates

Question 1

How would you investigate Brachial nerve palsy?

Answer 1

chest x-ray to r/o a clavicle or humeral fracture or diaphragmatic palsy

Question 2

What are the 3 types of brachial nerve palsy? What berve roots are effected?

Answer 2

Erb’s palsy = C5, C6, +/- T1
Klumpke’s palsy = C8, T1
Total palsy C5-T1

Question 3

What is the difference in clinical presentation of Erb’s and Kumpke’s palsy?

Answer 3

Erbs: arm is adducted and internally rotated with elbow extended, forearm is in pronation and wrist is flexed
Klumpke: Claw hand. a/w horners

Question 4

What is first line treatment of Erb’s Palsy?

Answer 4

Rest and careful hadnling for 1-2 weeks, then physiotherapy.
70-80% resolution in 6 weeks.

Question 5

Which babies get screened for ROP?

Answer 5

<32 weeks gestational age or < 1501 g birth weight

Question 6

What is treatment for ROP?

Answer 6

Laser ablation
Intraocular injections of anti-VEGF agents such as bevacizumab for central ROP

Question 7

In neonate with absent thymic shadow, what do you need to consider?

Answer 7

Di George Syndrome!

Question 8

Define stillbrith

Answer 8

fetus delivered at or after 24+0 weeks gestational age showing no signs of life.

Question 9

Define neonatal death

Answer 9

Live born baby (born at 20+0 weeks gestational age or later, or with a birth weight of 400 g or more where an accurate estimate of gestation is not available) who died before 28 completed days after birth.

Question 10

Define perinatal mortality rate

Answer 10

stillbirths + deaths within the first week per 1000 live births and stillbirths

Question 11

Define neonatal mortality rate

Answer 11

deaths of live-born infants within the first 4 weeks after birth per 1000 live births.

Question 12

Define low, very low, extremely low birth weight ?

Answer 12

Low <2500g
Very Low <1500g
Extremely Low <1000g

Question 13

What immunglobulins can cross placental barrier?

Answer 13

IgG

Question 14

What do pregnant women need to avoid eating and why?

Answer 14

Unpasteurized dairy products + pate - listeria
Tuna/ oily fish -mercury
Cat piss - toxoplasma
Liver- Vitamin A

Question 15

Foetal alcohol syndrome is associated with what cardiac abnormality?

Answer 15

VSD

Question 16

What antibodies are now mainly responsible for haemolytic disease of the newborn?

Answer 16

anti-Kell and anti-c.

Question 17

What antibodies affect baby if Mum has Graves?

Answer 17

Trabs

Question 18

What are features of congenital syphilis?
When baby affected?

Answer 18

rash and desquamation of the soles of the feet and hands and metaphyseal bone lesions in infancy.
Anti­biotic treatment given more than four weeks before delivery prevents congenital infection

Question 19

What is test for dislocatable hip?

Answer 19

Barlow
adduct hip, apply pressure on the knee, direct force posteriorly

Question 20

What is test for dislocated hip?

Answer 20

Ortolani’s
Flex hips and knees to 90degrees
place anterior pressure on greater trochanters
abduct the legs

Question 21

When and why is mag sluf given to pregnant ladies

Answer 21

Giving birth < 32 weeks gestation
reduces likelyhood of cerebal palsy

Question 22

What cells make surfactant?

Answer 22

type 2 epithelial cells.
it’s made of phospholipids (85%) and proteins (10%)

Question 23

what is the pathophysiology of RDS?

Answer 23

Decrease in pulmonary surfactant, a compliant chest wall and a higher surface tension at the alveolar surface.

Question 24

what is first line pharmacological treatment for PDA?

Answer 24

ibuprofen

Question 25

Define Grade 1IVH

Answer 25

germinal matrix haemorrhage with or without IVH (less than 10% of ventricle filled with blood)

Question 26

Define Grade 2 IVH

Answer 26

IVH (10%–50% of ventricle filled with blood), typically without ventricular dilation.

Question 27

Define Grade 3 IVH

Answer 27

IVH (greater than 50% of ventricle filled with blood) typically with ventricular dilation

Question 28

Define Grade 4 IVH

Answer 28

periventricular haemorrhagic infarction

Question 29

what type of cranial uss abnormality is mostly a/w cp?

Answer 29

bilateral, occipital or parietal cystic periventricular leukomalacia confers a very high risk of cerebral palsy, with two thirds to three quarters developing cerebral palsy.

Question 30

what does osteopenia/ rickets of prematurty look like on lab analysis?

Answer 30

normal/ high ca2+, LOW po4-, HIGH ALP

Question 31

What is rythmic foetal movements in late pregnancy pathagnomic for?

Answer 31

Non- ketotic hyperglycaemia Glycine in CSF

Question 32

What are the cirteria for establishing neonatal brain death?

Answer 32

Absent brain stem reflexes Absent motor responses No respiratory response to hypercarbia (60mmHg CO2)

Question 33

What are the preconditions for using the criteria for neonatal brain death?

Answer 33

The patient is comatose and mechanically ventilated for apnoea. The diagnosis of structural brain damage has been established or the immediate cause of coma is known (2008 AoMRC's Code of Practice2) and, in particular: Drugs are not the cause of coma; Neuromuscular blockade has been demonstrably reversed; Hypothermia does not exist (temperature >34oC); There is no endocrine or metabolic disturbance that could be the primary cause of unconsiouness If usffocated, need to wait 24h