Neonatology

Question 1

T/F. Healthy breastfed infants cannot become jaundiced

Answer 1

False. Physiological jaundice occurs in 30-50% of healthy, term infants

Question 2

When does physiological jaundice occur?

Answer 2

Day 2/3 of life
Peaks day 3
Resolves by day 10

Question 3

Why does physiological jaundice occur?

Answer 3

Due to immaturity of fetal liver, which is unable to remove bilirubin quickly enough, causing hperbilirubinaemia

Question 4

When does breastfeeding jaundice occur?

Answer 4

First week of life, when breastfeeding is being established

Question 5

What is intrapartum asphyxia? What are the criteria for diagnosis?

Answer 5

It is a rare but serious complication of labour with immediate consequences and possible longer term impairment, that results from hypoxia that occurs prior to, during or just after delivery.

Essential criteria (3) includes:
1. Intapartum metabolic acidosis evidenced by ph<7.0 and base excess of 12/more
2. Severe or moderately severe hypoxic ischaemic encephalopathy in an infant >34wks
3. CP of the spastic quadriplegic or dystonic type

Additional criteria (5):
1. Low apgar 6/less for >5min OR delayed onset of respiration
2. Multiorgan involvement, esp renal failure
3.Sudden rapid deterioration in FHR pattern
4.Acute cerebral abnormality (seen one army imaging)
5. A sentinel hypoxic event occurring immediately before or during labour

Question 6

What are the components of the AGAR score?

Answer 6

Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (tone)
Respiratory effort

Question 7

What is facial nerve palsy associated with? Clinical features? Treatment?

Answer 7

Forceps delivery

Inability to close eye and lack of lower lip depression on the affected side

Tx: eye patch and artificial tears

Question 8

What are the commonest enzyme deficiencies assoc. with congenital adrenal hyperplasia?

Answer 8

21-hydroxylase (90%)
11-beta-hydroxylase
3-beta-hydroxysteroid dehydrogenase

Question 9

What is salt losing CAH characterised by?

Answer 9

Low sodium
Elevated K+
Low cortisol

Question 10

What type of inheritance is assoc. with CAH?

Answer 10

Autosomal recessive

Question 11

T/F. CAHis associated with absent uterus, fallopian tubes and blind ending vagina.

Answer 11

False. That describes Androgen insensitivity

CAH causes ambiguous genitalia but the internal reproductive organs are PRESENT.
Clinical findings include:
1. Clitoral enlargement
2. Fusion of genital folds
3. Thickening and eugosjty of the labia majora (to resemble the scrotum)

Question 12

T/F. Males have ambiguous genitalia

Answer 12

False. Males may go unrecognized and present later with precocious puberty.

Salt wasting is life threatening if not recognized in male infants

Question 13

Which hormones are increased in CAH?

Answer 13

ACTH
Androstenedione
17-hydroxyprogesterone
Progesterone
Testosterone

Question 14

What are the features of necrotizing enterocolitis?

Answer 14

Lethargy
Vomiting
Abdominal distension
Hypotonia
Apnea
Bloody diarrhea- late feature

Abd xray:
Distended bowel with
- mucosal oedema
- intramural/portal venous/intraperitoneal gas
** portal venous gas is a poor prognostic sign

Question 15

Which conditions is necrotizing enterocolitis assoc. with?

Answer 15

• Prematurity/PPROM
• Prolonged labour
• Hypoxia
• Respiratory distress
• severe IUGR
• umbilical a. catheterization

** is LESS common in breastfed neonates

Question 16

Mortality rate assoc. with necrotizing enterocolitis?

Answer 16

20% if medically treated
30% if surgically treated

Question 17

Risk of ischaemic colonic strictures assoc. with necrotizing enterocolitis?

Answer 17

30% risk in survivors