Neonatology

Question 1

Cephalohematoma

Answer 1

o Subperiostal/parieto-occipital
o Associated with hairline fractures
o Can result in anemia and jaundice but rarely require transfusion
o Differential: caput succedaneum

Question 2

Subgaleal hemorrhage

Answer 2

o Rare; more frequent with instrumental delivery
o Mortality up to 25%
o Blood collects in space between galea aponeurotic and periosteum of skull
o Hypovolemia, hypotension, shock, DIC, seizures
o Rx: blood products

Question 3

What are the Brachial Plexus injuries

Answer 3

o Traction or avulsion of cranial nerve roots
 Erb’s palsy C5-C6 (Waiter’s tip deformity)
 Klumpke’s palsy C8-T1 (claw hand deformity; Horner’s if T1 sympathetic roots)
o Treatment: 88% resolved by 4 months; 93% resolve by 2 years

Question 4

Neonatal RDS
Risk factors
Pathophysiology
Onset and timing
XR findings
Treatment:

Answer 4

o Risk factors: PTD, maternal DM, hydrops, perinatal asphyxia
o 80% at 27 weeks
o Pathophysiology: delayed surfactant synthesis superimposed on immature lung
o Tachypnea, subcostal and intercostals retractions, nasal flaring, expiratory grunting
o Onset: 1-2 hrs postnatally (peak severity 2-3 days)
o XRAY: reticulogranular pattern; similar to GBS pneumonia
o Tx: nutrition, thermal regulation, acid/base balance, fluids, correction of anemia, surfactant

Question 5

What is transient tachypnea
XR findings and timing of symptoms

Answer 5

o Distress in term or near term infants; modest O2 requirements
o XRAY: (different from RDS); difficult to differentiate from pneumonia or meconium aspiration
o Resolution: 48 hours

Question 6

Meconium aspiration syndrome
and Therapy

Answer 6

• Meconium Aspiration Syndrome:
  o Occurs in IUGR or postdates, infection
  o No single FHR pattern predictive (may occur prior to labor)
  o Oropharyngeal suctioning and amnioinfusion for thick mec do NOT REDUCE RISK
  o Therapy: Ventilation, antibiotics, surfactant, ecmo/NO

Question 7

What is damaging asphyxia?

Answer 7

• Profound acidemia (pH < 7)
• Apgar 0-3 for > 5 minutes
• Neurologic sequelae (seizures, hypotonia)
• Multiorgan system dysfunction

Question 7

What is damaging asphyxia?

Answer 7

• Profound acidemia (pH < 7)
• Apgar 0-3 for > 5 minutes
• Neurologic sequelae (seizures, hypotonia)
• Multiorgan system dysfunction

Question 8

What are the criteria for intrapartum HIE

Answer 8