Neonates

Question 1

Is neonatal jaundice more common in breast or bottle-fed babies?

Answer 1

Breast-fed

Question 2

What is meant by pathological neonatal jaundice?

Answer 2

< 24 hrs after birth

Question 3

What is meant by prolonged neonatal jaundice?

Answer 3

> 2 weeks in term baby or > 3 weeks in pre-term

Question 4

Give causes of pathological jaundice.

Answer 4

Sepsis
Rhesus / ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency

Question 5

Why does physiological jaundice occur?

Answer 5

Due to a number of factors including immature liver function and fragile RBCs

Question 6

Give causes of prolonged neonatal jaundice.

Answer 6

Biliary atresia
Hypothyroidism
UTI
Breast milk jaundice
Galactosaemia
Prematurity
Congenital infections

Question 7

What is the normal volume of amniotic fluid for a term birth?

Answer 7

~600mls

Question 8

What is meant by neonatal hypoglycaemia?

Answer 8

BM < 2.6 in first 24h of life or < 3 thereafter

Question 9

Give some risk factors for neonatal hypoglycaemia.

Answer 9

Diabetic mothers
Small/large for dates
Preterm

Question 10

Give some causes of neonatal hypoglycaemia.

Answer 10

Hyperinsulinism
Endocrine disorders
Metabolic conditions
Sepsis

Question 11

What is the immediate treatment for mild neonatal hypo?

Answer 11

Breast feed

Question 12

What is the most common cause of persistent neonatal hypoglycaemia?

Answer 12

congenital hyperinsulinism

Question 13

Which drug taken in late pregnancy may increase the risk of kernicterus?

Answer 13

Sulphonamides

Question 14

What are the components of newborn screening in the UK?

Answer 14

Physical Exam
Newborn bloodspot
Newborn hearing screening

Question 15

Which conditions does the newborn bloodspot screen for?

Answer 15

Cystic fibrosis, congenital hypothyroidism, sickle cell disease, MCADD, PKU, MSUD, IVA, GA1, homocystinuria

Question 16

What is the first-line test used in newborn hearing screening?

Answer 16

Automated otoacoustic emission test

Question 17

If a baby does not pass the first newborn hearing screening test, which test is used?

Answer 17

Automated auditory brainstem response

Question 18

What is the largest component of surfactant?

Answer 18

Phosphatidylcholine

Question 19

What is the main risk factor for neonatal sepsis?

Answer 19

Prematurity

Question 20

What is the most common cause of early-onset neonatal sepsis?

Answer 20

GBS

Question 21

Give common causes of late-onset neonatal sepsis.

Answer 21

Staph epi, Klebsiella, Pseudomonas, Enterobacter

Question 22

What investigations would typically be done in a neonatal sepsis screen?

Answer 22

Bloods & gas
Blood & urine cultures
LP

Question 23

What is the empiric antibiotic treatment for neonatal sepsis?

Answer 23

IV benpen and gentamicin

Question 24

What are the key risk factors for NEC?

Answer 24

Prematurity/ low birth weight
Formula-fed
Sepsis
CHD
Ventilated

Question 25

What are the key features of NEC on AXR?

Answer 25

Dilated/thickened bowel loops Pneumatosis (gas in bowel wall) Pneumoperitoneum Gas in portal veins

Question 26

What is the immediate management for NEC?

Answer 26

Refer to Paeds Surgeons Make NBM, IVF, TPN, insert NGT and treat with antibiotics

Question 27

Parietal bone swelling, does not cross suture lines suggests...

Answer 27

Cephalohaematoma

Question 28

Boggy swelling crossing suture lines suggests...

Answer 28

Caput seccundum

Question 29

What is the target growth velocity for a baby receiving adequate nutrition?

Answer 29

15g/kg/day

Question 30

Lung hypoplasia and poor cartilage development suggests...

Answer 30

Jeune Syndrome

Question 31

What are common causes of neonatal rash?

Answer 31

Erythema neonatorum toxicum Acne neonatorum Milia Miliaria

Question 32

How long does neonatorum toxicum typically take to resolve?

Answer 32

5 - 14 days

Question 33

Dermal melanosis / Mongolian blue spot tends to resolve by what age?

Answer 33

6 years

Question 34

What is the natural history of a port wine stain / naevus flammeus?

Answer 34

Tend to get thicker and darker over time

Question 35

What is the recommended treatment for port wine stain?

Answer 35

Early laser therapy

Question 36

Pink/red birthmark darker on child crying suggests...

Answer 36

Naevus simplex / salmon patch

Question 37

What is the natural history of salmon patches?

Answer 37

95% regress by age 2

Question 38

If treatment is indicated for an infantile haemangioma, what medical treatment may be considered?

Answer 38

Beta blockers

Question 39

What is meant by 'early' neonatal hypoglycaemia?

Answer 39

< 48h of age

Question 40

Give causes of early neonatal hypoglycaemia.

Answer 40

HIE, diabetic mother, small babies

Question 41

Capillary haemangiomas are formed from...

Answer 41

Proliferating endothelial cells

Question 42

What is the main protein in breast milk?

Answer 42

Whey

Question 43

Boiling milk can lead to...

Answer 43

Thiamine deficiency

Question 44

Which study supports neonatal saturations 91-95%

Answer 44

BOOST IIH

Question 45

How should HR be measured in a neonate?

Answer 45

Stethoscope

Question 46

Which antenatal problem is associated with renal agenesis?

Answer 46

Oligohydramnios

Question 47

What is the standard treatment for persistent pulmonary HTN of the newborn/>

Answer 47

Inhaled NO

Question 48

Neonate with vesicular rash, coagulopathy and hepatomegaly suggests...

Answer 48

Disseminated herpes simplex infection

Question 49

When does surfactant production begin in-utero?

Answer 49

~ 24 weeks

Question 50

Which hormone contributes to RDS in babies of diabetic mothers?

Answer 50

IGF-1

Question 51

Which babies need screening for retinopathy of prematurity?

Answer 51

Born before 31 weeks or birth weight < 1.5kg

Question 52

For babies born before 31 weeks, when should screening for ROP take place?

Answer 52

Within week 31 or at 4 weeks post-natal age (whichever is later)

Question 53

Scaphoid abdomen suggests...

Answer 53

Congenital diaphragmatic hernia

Question 54

Failure of which structure to regress causes Meckel's diverticulum?

Answer 54

Vitelline duct

Question 55

Duodenal atresia occurs due to...

Answer 55

Recanalisation error

Question 56

Cyanotic baby, pink when crying suggests...

Answer 56

Choanal atresia

Question 57

Which breastmilk component aids with iron metabolism?

Answer 57

Lactoferrin

Question 58

Which breastmilk component helps to regulate metabolism?

Answer 58

Leptin

Question 59

Maternal active herpes disease at which point in pregnancy is potentially most detrimental to the foetus?

Answer 59

1st trimester

Question 60

Anhydramnios with resp distress suggests...

Answer 60

Pulmonary hypoplasia

Question 61

What are the 5 stages of embryonic lung development?

Answer 61

Embryonic > Pseudoglandular > Canalicular > Saccular > Alveolar

Question 62

Where are pre-ductal sats measured?

Answer 62

Right hand

Question 63

Where are post-ductal sats measured?

Answer 63

Foot

Question 64

What are normal values for pre and post ductal sats?

Answer 64

Both > 95%, differential of <3 %

Question 65

A pre and post ductal sats differential suggests...

Answer 65

Mixing of arterial and venous blood through duct

Question 66

How should infants with CDH be managed at birth?

Answer 66

Intubation and ventilation

Question 67

What is the most prevalent condition tested for on the Guthrie card?

Answer 67

Congenital hypothyroidism

Question 68

At what gestational age does the skin mature?

Answer 68

34 weeks

Question 69

What is the main cause of ROP?

Answer 69

Hyperoxaemia

Question 70

Which antibiotic should be added if early-onset neonatal sepsis is found to be gram negative?

Answer 70

Cefotaxime