neonates

Question 1

what does an apgar score predict?

Answer 1

how much medical attention a baby is going to need

Question 2

why do babys not usually score 10

Answer 2

their hands and feet are pale, but will pinked up as circulation established

Question 3

a score of what is normal?

Answer 3

7

Question 4

what does APGAR stand for

Answer 4

appearance 
pulse 
grimace 
activity 
respiratory effort

Question 5

in a child less than 1, what should blood pressure, RR, and heart rate be?

Answer 5

HR 110-160
RR 30-40
blood pressure 70-90 (systolic)

Question 6

what test is taken from the heel at day 5 to check for things like CF?

Answer 6

guthrie skin prick

Question 7

what else does the guthrie skin test check for

Answer 7

♣	PKU  phenylketonuria. 
♣	IVA  isovaleric acidaemia. 
♣	HCU   homocysteinuria. 
♣	MSUD  Maple syrup urine disease. 
MCADD  medium chain acyl-CoA dehydrogenase deficiency

Question 8

who does hearing checks in hospital ? in community >

Answer 8

in hospital before discharge by midwife

in community within 4 weeks by health visitor

Question 9

when are the post natal baby checks carried out

Answer 9

6-8 weeks by the GP

Question 10

when are pre terms examined ?

Answer 10

6 weeks after expected date of delivery and not at six weeks gestation, at this point they should be at same developmental level

Question 11

who needs to be at the delivery of a pre term?

Answer 11

neonatologist

Question 12

why is cord cutting delayed in pre term?

Answer 12

can be delayed for up to 3 minutes to encourage maternal metal transfusion

Question 13

what does delayed cord cutting reduce the risk of?

Answer 13

need for transfusion and reduce risk of RDS, hypoxia and associated complications

Question 14

hypothermia management: deliver baby in a room of what temperature?

Answer 14

26 degrees

Question 15

what do you wrap baby in ?

Answer 15

plastic bag or towel

Question 16

you would place hypothermic baby in incubator. an incubator is an independent risk of?

Answer 16

infection

Question 17

what do you give to mothers before delivery to prevent RSD?

Answer 17

steroids (x2 doses, 12 hours apart)

Question 18

presentation of RDS?

Answer 18

tachypnoea
increased work of breathing
onset of symptoms from minutes - hours after birth
symptoms do not resolve after 24 hours like TTN

Question 19

investigations for RDS?

Answer 19

02 is low

x ray shows ground glass appearance

Question 20

management of RDS

Answer 20

surfactant and ventilation

Question 21

how can you ventilate in RDS?

Answer 21

intubate

CPAP

Question 22

broncho pulmonary dyplasia - what is it?

Answer 22

long term comp associated with ventilation of babies largely in the context of RDS due to a combination of barotrauma and oxygen toxicity

Question 23

how would bronchopulmonary dysplasia present?

Answer 23

hypoxia and difficulty weaning off ventilator

Question 24

is the damage that accord from BPD reversible?

Answer 24

no

Question 25

what is apnoea of pre maturity?

Answer 25

gaps between breaths of over 20 seconds | may require ventilation due to risk of hypoxia

Question 26

pathophysiology of apnea of pre maturity?

Answer 26

breathing centres in brain not fully developed , baby "forgets" to breath

Question 27

inflammatory necrosis of the intestine thought to be associated with gut immaturity.

Answer 27

necrotizing enterocolitis

Question 28

how would necrotising enterocolitis present?

Answer 28

poor feeding mucous and blood stained diarrhoea abdominal distension and tenderness

Question 29

what do you see in the bowel wall?

Answer 29

pneumostasis intestinalis (air cysts(

Question 30

management of NE?

Answer 30

stop feeding, supportive care and abx | or surgical removal of part of the bowel

Question 31

in peri ventricular haemorrhage, where does intra cranial haemorrhage start ?

Answer 31

germinal matrix

Question 32

when does per ventricular haemorrhage usually startt?

Answer 32

usually within first day of life

Question 33

outcome of peri ventricular haemorrhage?

Answer 33

variable mortality but most associated with long term neurological problems

Question 34

what causes birth asphyxia?

Answer 34

reduction of oxygen supply and accumulation of co2 due to cessation of blood supply to the foetus at time of delivery

Question 35

how does asphyxia present ?

Answer 35

bradycardia and low apgar score

Question 36

management of asphyxia?

Answer 36

recitation with oxygen

Question 37

what is CNS complication of birth asphyxia?

Answer 37

hypoxic ischaemic encephalopathy

Question 38

early and late sepsis defined as?

Answer 38

``` early = within 48 hours late = after 48 hours ```

Question 39

causitive organisms of early and late sepsis?

Answer 39

early is coli and group B strep | late is listeria and staph

Question 40

management of sepsis in a a newborn?

Answer 40

benxylpenicillin and gentamycin

Question 41

treatment of pneumonia in newborn?

Answer 41

amoxicillin

Question 42

what is Opthalmia neonatorum caused by?

Answer 42

passage of chlamydia from mother to baby

Question 43

what STI do symptoms develop more quickly in? gonorrhoea or chlamydia?

Answer 43

gonorrhoea (gone up tubes faster)

Question 44

whats the main risk factor for developing TTN?

Answer 44

c section (don't get the squeeze of vaginal delivery to get rid of fluid in the lungs)

Question 45

how does TTN present?

Answer 45

a rr of over 60

Question 46

most cases of TTN resolve within?

Answer 46

24 hours

Question 47

meconium stained amniotic fluid then respiratory distress following delivery

Answer 47

meconium aspiration syndrome

Question 48

when does baby usually pass meconium

Answer 48

within 24 hours

Question 49

management of MAS?

Answer 49

suctioning and supportive care

Question 50

o yanosis, respiratory distress pulmonary odemea. o Oedema: sacral, ankle, peri orbital. o Hepatosplenomegaly. in newborn?

Answer 50

heart failure

Question 51

persistent pulmoary hypertension caused by?

Answer 51

a failure of fetal circulation. get right to left shunting of blood and get cyanosis and loud S2

Question 52

care for pulmonary hypertension ?

Answer 52

inotropes to increase systemic pressure while fetal circulation naturally adapts

Question 53

when are inborn errors of metabolism screened for?

Answer 53

day 5

Question 54

what is haemorrhagic disease of the newborn caused by?

Answer 54

vitamin K deficiency

Question 55

prevention of haemorrhagic disease of the newborn/

Answer 55

vitamin K injection at birth (given by midwife)

Question 56

what is kernicterus ?

Answer 56

rare type of brain damage that occurs with jaundice

Question 57

most common cause of seizures in newborn?

Answer 57

hypoxic ischaemic encephalopathy

Question 58

management of seizures in neonates?

Answer 58

phenobarbitol and phenytoin

Question 59

pshysiological jaundice occurs after?

Answer 59

24 hours

Question 60

bilirubin level in physiological jaundice?

Answer 60

under 200

Question 61

why do you get accumulation of bilirubin in the blood?

Answer 61

RBC have a shorter lifespan | reduced ability of the liver to conjugate bile and for gut to eliminate it

Question 62

what is pathological jaundice defined as?

Answer 62

jaundice that occurs within 24 hours

Question 63

causes of pathological jaundice?

Answer 63

sepsis haemorrhagic disease of the newborn red cell incompatibility inherited (G6PD, spherocytosis)

Question 64

what is prolonged jaundice defined as?

Answer 64

jaundice that lasts more than 14 days

Question 65

what is plotted to help choose between two potential management options?

Answer 65

babies age and bilirubin levels

Question 66

what are the two management options?

Answer 66

phototherapy and exchange transfusion

Question 67

how does phototherapy work?

Answer 67

baby placed in incubator with UV light source | this helps to break down to products that don't require conjugation for release

Question 68

what does exchange transfusion involve

Answer 68

removing blood with high bilirubin levels and replacing it with normal blood

Question 69

in prolonged jaundice, need to investigate for inherited conditions such as?

Answer 69

G6PD galactoseamia hypothyroidism

Question 70

what is kernicterus

Answer 70

bilirubin iduced encephalopthy

Question 71

management of kernicterus

Answer 71

exchange transfusion and phototherapy

Question 72

long term outcomes ?

Answer 72

deafness and reduced IQ