Neonates

Question 1

What is the most common cause of neonatal apnoeas?

Answer 1

Apnoea of prematurity

• Immaturity of the brain’s respiratory centre*
• Onset from days 2-7*

Question 2

Why are some neonates given caffeine citrate?

Answer 2

Prevention of apnoea

All infants < 30 weeks and symptomatic infants 30-34 weeks

Question 3

What is the leading cause of perinatal death in infants in Australia?

Answer 3

Congenital anomalies

Question 4

How is development dysplasia of the hip treated in children < 6 months?

Answer 4

Bracing with a Pavlik harness

Question 5

Which tests are used on the hips during a newborn examination?

Answer 5

Barlow’s test

Ortolani maneuver

Question 6

What is Barlow’s test?

Answer 6

Attempting to dislocate a neonate’s hip, assessing for DDH

Adduct the hip while applying posterior pressure

Question 7

What is Ortolani’s maneuver?

Answer 7

Testing whether the hip has been dislocated with the Barlow test

Abduct the leg and feel for a clunk as the femoral head relocated into the acetabulum

Question 8

What is the minimal age for recieving the Fluvax?

Answer 8

6 months

Question 9

What is the definition of extreme prematurity?

Answer 9

< 26 weeks

Question 10

What are the significant morbidities associated with extreme prematurity?

Answer 10

IVH

Periventricular leukomalacia

Necrotising enterocolitis

Bronchopulmonary dysplasia

Retinopathy of prematurity

Infection

Neurodevelopmental impairment

Question 11

What is the Guthrie test?

Answer 11

Newborn heel prick

Question 12

What is periventricular leukomalacia?

Answer 12

A white matter injury or periventricular necrosis followed by cyst formation

Leads to spastic diplegia

Caused by ischaemic insult

Question 13

How are neonates with a subluxable hip managed?

Answer 13

US at 6 weeks

Question 14

How are children with a dislocatable hip managed?

Answer 14

Paediatric orthopaedic referral

Question 15

Which gender is at a greater risk of DDH?

Answer 15

Female (4x)

Question 16

How common is hip instability at birth?

Answer 16

1:100

Question 17

How common is a dislocated hip at birth?

Answer 17

1:1000

Question 18

Which hip is more commonly affected by DDH?

Answer 18

Left (75%)

Due to the position of the hip in relation to the mother’s spine

Question 19

What are the two most significant risk factors for DDH?

Answer 19

1. Breech presentation
2. Family history
   * 6 week US for all infants in the above categories*

Question 20

Which screening tests are used for DDH in infants older than 3 months?

Answer 20

1. Restricted abduction (most sensitive)
2. Leg length discrepancy
3. Asymmetric thigh and gluteal skin folds

Question 21

What are each of the APGAR score points given for?

Answer 21

A - Appearance (skin colour)

P - Pulse

G - Grimace (reflex irritability)

A - Activity (muscle tone)

R - Respiration

Question 22

Why might infants of diabetic mothers have polycythemia?

Answer 22

Hyperglycaemia → stimulates EPO production

Also causes mortality and metabolic acidosis

Question 23

What vitamin is administered at birth?

Answer 23

Vitamin K

To prevent vitamin K deficiency bleeding/haemorrhagic disease of the newborn

Question 24

Why do newborns have low vitamin K?

Answer 24

Newborn livers do not effectively utilise vitamin K

Low vitamin K in breastmilk

Poor placental transfer

Question 25

What is the definition of neonatal hypoglycemia?

Answer 25

BSL \< 2.6 mmol/L

Question 26

What is the significance of a base deficit in a cord gas?

Answer 26

Suggests a metabolic component in a child with acidosis ## Footnote *May suggest longer term/more severe acidosis*

Question 27

In between which layers of the scalp does a cephalohematoma occur?

Answer 27

Below the periosteum, above the skull

Question 28

In between which layers of the scalp does a subgaleal haematoma occur?

Answer 28

In between the periosteum of the skull and the aponeurosis

Question 29

How are cephalohaematomas and subgaleal haematomas clinically distinguished?

Answer 29

Subgaleal haematomas cross suture lines

Question 30

Up to what gestational age are antenatal corticosteroids given?

Answer 30

\< 35 weeks ## Footnote *When birth is expected in the next 7 days, or even within 24 hours*

Question 31

What is the definition of low birth weight?

Answer 31

\< 2500g Low: \< 2500 Very low: \< 1500 Extremely low: \< 1000

Question 32

What is the definition of very low birth weight?

Answer 32

\< 1500 g Low: \< 2500 Very low: \< 1500 Extremely low: \< 1000

Question 33

What is the definition of extremely low birth weight?

Answer 33

\< 1000 g Low: \< 2500 Very low: \< 1500 Extremely low: \< 1000

Question 34

What is the definition of extreme prematurity?

Answer 34

\< 28 weeks

Question 35

What is the primary pathogenic mechanism of anaemia of prematurity?

Answer 35

Poor EPO production

Question 36

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

Answer 36

GBS

Question 37

How might an infant with NEC present?

Answer 37

Feed intolerance Bilious vomiting/high gastric aspirates Bloody stools Abdominal distension and/or tenderness Ileus/decreased bowel sounds Temperature instability Apnoea and bradycardia Shock

Question 38

What are the most common complications of NEC?

Answer 38

Intestinal strictures Short gut syndrome

Question 39

How is colostrum different to breast milk?

Answer 39

2x protein Lower in fat and carbohydrate Less energy dense

Question 40

What is the pathophysiology of breastfeeding jaundice?

Answer 40

Insufficient breast milk intake → lack of calories and inadequate quantities of bowel movements to remove bilirubin from the body → increased enterohepatic circulation → increased reabsorption of bilirubin from the intestines

Question 41

What is the pathophysiology of breast milk jaundice?

Answer 41

Increased concentration of **B-glucuronidase** in breast milk → **increased deconjugation and reabsorption** of bilirubin → persistence of physiologic jaundice ## Footnote *Continue feeds and use phototherapy if required*

Question 42

What is a staccato cough characteristic of?

Answer 42

Neonatal chlamydia infection ## Footnote *Low sensitivity*

Question 43

Is conjugated or unconjugated jaundice associated with kernicterus?

Answer 43

Unconjugated ## Footnote *Unconjugated bilirubin crosses the BBB*

Question 44

An inability to conjugate bilirubin describes which condition?

Answer 44

Crigler-Najjar Deficiency of UDP-glucuronosyltransferase (UGT1A1)

Question 45

An inability to move conjugated bilirubin from the hepatocyte to the bile cannaliculi describes which condition?

Answer 45

Dubin-Johnson syndrome Defective MRP2 transporter

Question 46

What is the target SpO₂ after birth?

Answer 46

1 minute: 60-70% 5 minute: 80-90% 10 minute: 85-90%

Question 47

Why might neonates have head-bobbing with respiratory distress?

Answer 47

Recruitment of the SCM pulls on the head

Question 48

What are some absolute contraindications to breastfeeding?

Answer 48

Maternal HIV, active TB or active herpes lesions on breast Ilicit drug use Maternal chemotherapy or radiotherapy Galactosemia

Question 49

What are the effects of intrapartum opioid use on the neonate?

Answer 49

Respiratory depression and drowsiness that can last several days

Question 50

What is Klumpke's palsy?

Answer 50

Brachial plexus injury to C7-T1 Claw hand, absent palmar grasp reflex, Horner's syndrome

Question 51

Jaundice that persists beyond how long in a neonate needs an escalation of management?

Answer 51

Term: 14 days Preterm: 21 days