Neonatology

Question 1

Where is surfactant produced?

Answer 1

From type 2 alveolar cells

Question 2

What is the function of surfactant?

Answer 2

Reduces the surface tension of fluid in the lungs, this keeps the alveoli inflated and maximises the surface area of the alveoli.
This reduces the force needed to expand the alveoli during inspiration and promotes equal expansion of all alveoli in inspiration

Question 3

When is surfactant produced?

Answer 3

Between weeks 24 and 34 of gestation

Question 4

What are some physiological issues in neonatal resuscitation?

Answer 4

Babies have a large surface area to weight ratio so lose heat quickly
They are born wet so lose heat quickly
Can be born through meconium and may have this in their mouth or airway

Question 5

What are the principles of neonatal resuscitation?

Answer 5

Warm the baby
Calculate the APGAR score
Stimulate breathing
Inflation breaths
Chest compression

Question 6

What position do you put a neonates head in during resuscitation?

Answer 6

A neutral position, a towel can be placed under the shoulders to keep it neutral

Question 7

What is the APGAR score measured out of?

Answer 7

0-10

Question 8

What are the different scores relating to appearance in the APGAR score?

Answer 8

0- blue/pale centrally
1- blue extremities
2- pink

Question 9

What are the different scores relating to pulse in the APGAR score?

Answer 9

0- absent
1- <100
2- >100

Question 10

What are the different scores relating to grimmace (response to stimulation) in the APGAR score?

Answer 10

0- no response
1- little response
2- good response

Question 11

What are the different scores relating to activity (muscle tone) in the APGAR score?

Answer 11

0- floppy
1- flexed arms and legs
2- active

Question 12

What are the different scores relating to respiration in the APGAR score?

Answer 12

0- absent
1- slow/irregular breathing
2- strong/crying

Question 13

What are some benefits of delayed umbilical cord clamping, allowing fetal blood from the placenta to enter the baby’s circulation?

Answer 13

Improved haemoglobin, iron stores, blood pressure and a reduction in intraventricular haemorrhage and necrotising enterocolitis

Question 14

What injection will babies have shortly after to birth to prevent bleeding?

Answer 14

Vitamin K, as babies are born vitamin K deficient

Question 15

What conditions are screened for on the day five heel prick?

Answer 15

Sickle cell, CF, hypothyroidism, phenylketonuria, MCADD, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1, homocystin

Question 16

What is the moro relfex?

Answer 16

When rapidly tipped backwards the arms and legs will extend

Question 17

What is the suckling reflex?

Answer 17

Placing a finger in the mouth will prompt the baby to suck

Question 18

What is the rooting reflex?

Answer 18

Tickling the cheek will cause them to turn towards the stimulus

Question 19

What is the grasp reflex?

Answer 19

Placing a finger in the palm will cause the baby to grasp

Question 20

What is the stepping reflex?

Answer 20

When held upright and the feet touch a surface they will make a stepping motion

Question 21

What are some features that would make you suspect hypoxic ischaemic encephalopathy?

Answer 21

An event occurs that could lead to hypoxia, acidosis pH<7 on umbilical artery blood gas, poor APGAR scores

Question 22

What are some causes of HIE?

Answer 22

Maternal shock, intrapartum haemorrhage, prolapsed cord, nuchal cord (cord wrapped around baby’s neck)

Question 23

What are features of mild hypoxic ischaemic encephalopathy?

Answer 23

Mild: poor feeding, General irritability, responds excessively to stimulation, may have staring of the eyes and hyperventilation

Question 24

What can be used to help protect the brain from hypoxic injury?

Answer 24

Therapeutic hypothermia

Question 25

What is therapeutic hypothermia in regard to neonatal care?

Answer 25

Active cooling of baby using cooling blankets and hats with a target temperature of between 33-34 degrees. This is continued for 72 hours then they are carefully warmed over 6 hours

Question 26

What does therapeutic hypothermia reduce the risk of?

Answer 26

Cerebral palsy, neurodevelopmental delay, blindness and death

Question 27

What are features of moderate hypoxic ischaemic encephalopathy?

Answer 27

Marked abnormalities of movement, hypotonia, poor feeding as cannot suck, may have seizures

Question 28

What are features of severe hypoxic ischaemic encephalopathy?

Answer 28

No normal spontaneous movements or response to pain, hypotonia, prolonged seizures, apnoeas, signs of multi-organ failure

Question 29

What is necrotising enterocolitis?

Answer 29

When part of the bowel becomes necrotic in neonates, it is a life threatening emergency that can lead to bowel perforation, peritonitis and shock

Question 30

What are some risk factors for developing necrotising enterocolitis?

Answer 30

Very low birth weight or early prematurity, formula feeds, RDS, sepsis, congenital heart disease

Question 31

How will a neonate with necrotising enterocolitis present?

Answer 31

Intolerance to feeds, bilious vomiting, distended tender abdomen, absent bowel sound, blood in stools, unwell child

Question 32

What blood results would we want to do in a child with necrotising enterocolitis?

Answer 32

FBC CRP- raised with inflammation Metabolic acidosis on capillary blood gas Blood culture for sepsis

Question 33

What would be seen on AXR with necrotising enterocolitis?

Answer 33

Dilated loops of bowel and bowel wall oedema Pneumatosis intenstinalis- air in the bowel wall which is sign of NEC Pneumoperitoneum Gas in the portal veins

Question 34

How is necrotising enterocolitis managed?

Answer 34

Keep nil by mouth, IV fluids, parenteral nutrition and antibiotics. NG tube can be inserted to drain fluid and gas from stomach and intestines Surgical removal of dead bowel

Question 35

What are some features of neonatal hypoglycaemia?

Answer 35

Autonomic: jittery, irritable, tachypnoeic Neuroglyopenic: poor feeding, hypotonia, drowsiness, seizures, Apnoea, hypothermia

Question 36

What is the management for a neonate with hypoglycaemia who is asymptomatic?

Answer 36

Encourage normal feeding and monitor blood glucose

Question 37

What is the management for a neonate with hypoglycaemia who is symptomatic or has a very low blood glucose?

Answer 37

Admit to NNU and give 10% dextrose IV infusion

Question 38

What are some causes of hypoglycaemia in neonates?

Answer 38

Prematurity, maternal diabetes mellitus, hypothermia, IUGR, sepsis, errors of metabolism, nesidioblastosis, beckwith-weidemann syndrome

Question 39

what are features of foetal alcohol syndrome?

Answer 39

microcephaly, thin upper lip, small eye openings, absent philtrum, low IQ, cardiac abnormalities