Neonatology

Question 1

What is hypoglycaemia defined as in neonates?

Answer 1

BM <2.6

Question 2

What puts a newborn at risk for hypoglycaemia and hypothermia?

Answer 2

preterm; SGA; LBW; infants of diabetic mothers; intraprtum asphyxia or needed resus at birth; maternal beta-blocker use

Question 3

What is the main cause of neonatal jaundice?

Answer 3

physiological

Question 4

What does dark urine indicate?

Answer 4

increased conjugated bilirubin

Question 5

What do pale stools indicate?

Answer 5

cholestasis- need to rule out obstruction

Question 6

What effect does TPN have on jaudnice?

Answer 6

can cause direct hyperbilirubinaemia after >2weeks

Question 7

What are the causes of neonatal aundice?

Answer 7

physiological; blood group incompatibility; other haemolytic disorders; sepsis; liver disease; metabolic disorders

Question 8

Why does physiological jaundice happen?

Answer 8

increased production; decreased uptake and binding by hepatocytes; decreased conjugation; decreased excretion; increased enteroheptic circulation of bilirubin

Question 9

Under what time from birth is jaundice always pathological?

Answer 9

<24 hours

Question 10

What is jaundice <24 hours from birth usually caused by?

Answer 10

haemolysis with excessive production of bilirubin

Question 11

What are the causes of haemolysis <24 hours of age?

Answer 11

ABO incompatibility; Rh immunisation; sepsis; other blood group incompatibilities; red cell defects

Question 12

What should be considered as a cause of jaundice in a baby <24 hours old if there is >15% conjugated bilirubin?

Answer 12

hepatits

Question 13

What investigations should be done for early pathological jaundice?

Answer 13

total and conjugated serum bilirubin conc.; maternal blood group and antibody titres; babys blood group ; direct antigolbulin test; FBC and blood film; CRP; TFTs: LFTs

Question 14

What is the function of the direct antiglobulin test?

Answer 14

detects antibodies on the baby’s red cells

Question 15

What are the causes of too high serum bilirubin jaundice?

Answer 15

mild dehydration/insufficient milk supply; haemolysis; breakdown of extravasated blood; polycythaemia; infection; increased enterohepatic circulation

Question 16

When is physiological jaundice too long?

Answer 16

> 10 days; esp. >2 weeks (>21 days for preterm)

Question 17

What is the cause of persistent unconjugated hyperbilirubinaemia?

Answer 17

breast milk jaundice; continued poor milk intake; haemolysis; infection; hypothyroidism

Question 18

What is the usual cause if jaundice suddenly reappears after the infant has gone home?

Answer 18

haemolyssi

Question 19

What type of hypobilirubinaemia is always abnormal?

Answer 19

conjugated hyperbilirubinaemia

Question 20

What causes persistnet conjugated hyperbilirubinaemia?

Answer 20

hepatitis; biliary atresia

Question 21

What can cause hepatitis ina neonate?

Answer 21

infection or metabolic disorder

Question 22

What is the cause of kernicterus?

Answer 22

unconjugated bilirubin crosses the BBB which is toxic to the brain

Question 23

What is kernicterus characterised by?

Answer 23

death of brain cells and yellow staining esp. in the grey matter of the brain

Question 24

What are the signs of acute bilirubin encephalopathy?

Answer 24

lethargy; poor feeding; temperature instabilit;y hypotonia; opisthotonos; spasticity and seziures

Question 25

What is opisthotonos?

Answer 25

arching of the head, neck and back

Question 26

What level of unconjugated bilirubin is at risk of leading to kernicterus?

Answer 26

>340micromol/L

Question 27

What increases the risk of developing kernicterus?

Answer 27

preterm; asphyxia; acidosis; hypoxia; hypothermia; meningitis; sepsis; decreased albumin binding

Question 28

What is the treatment for jaundice

Answer 28

adequate hydration; phototherpay; exchange transfusion

Question 29

How often should a baby with jaundice be breastfed for the first few days?

Answer 29

8-12 times per day

Question 30

When does physiological jaundice tend to set in?

Answer 30

day 2

Question 31

When does physiological jaundice tend to resolve?

Answer 31

day 10-14

Question 32

What is the function of phototherapy in jaundice?

Answer 32

converts trans-bilirubin to the more water soluble cis-form which is excreted in bile without conjugation

Question 33

What are the SEs of phototherapy?

Answer 33

dehydration; skin rash; eye damage

Question 34

What can cause conugated jaundice?

Answer 34

biliary atresia; TPN; hypothyroidism; a1 antitrypsin; galactosaemia; CF; Down;s syndrome

Question 35

What should be suspected in an asymptomatic infant in which jaundice occurs after 8 days of age?

Answer 35

UTI

Question 36

How does the appearance of jaundice differe between conjugated and unconjugated hyperbilirubinaemia?

Answer 36

unconjugated- more yellow compared with conjugated- more green

Question 37

How is gestational age related to hyperbilirubinaemia?

Answer 37

risk of unconjugated hyperbilirubinaemia is inversely proportional to GA

Question 38

What 3 factors contribute to the development of TTN?

Answer 38

delayed resoprtion of fetal lung fluid; pulmonary immaturity and milk surfactant deficiency

Question 39

What are the risk factors for developing TTN?

Answer 39

elective C/S; male sex; macrosomia; excessive maternal sedation; prolonged labour; birth asphyxia; fluid overload to mother; maternal asthma; delayed clamping of umbilical cord; breech; polycythaemia; diabetes; prematurity; maternal substance abuse; LBW

Question 40

What is tachypnoea defined as in infants?

Answer 40

>60 breaths/min

Question 41

What is the differential diagnosis of TTN?

Answer 41

pneumonia/sepsis; heart disease; RDS; cerebral hyperventialtion; metabolic disorders; polycythaemia

Question 42

What can cause cerebral hyperventilation?

Answer 42

meningitis or hypoxis-ischeamic insult (CNS lesion cause over stimulation of th resp centre)

Question 43

What metabolic disorders can cause tachypneoa?

Answer 43

hypothermia; hyperthermia; hypoglycaemia

Question 44

Why may materal dibaetes cause polycythaemia?

Answer 44

poor control during pregnnacy leads to chornic fetal hypoxia which may result in increased neonatal erythroepoeisis

Question 45

What are the risk factors for developing polycythaemia?

Answer 45

high altitude; delayed cord clamping; high-risk delivery; enhanced fetal erythropoeisis- fetal hypoxia--placental inusfficiency and endocrine disorders; genetic trisomies

Question 46

What can cause placental insufficiency?

Answer 46

materanl hypertensive disease; abruptio placentae; postmatiruty; cyanotic congenital heart disease; IUGR; maternal smoking

Question 47

Why do endocrine disorders cause fetal hypoxia and increased erythropoiesis?

Answer 47

increased metabolism--increased oxygen consumption

Question 48

Which endocrine disorders are implicated in polycythaemia?

Answer 48

maternal diabetes; congential thyrotoxicosis; congenital adrenal hyperplasia; secondary hyperinsulinism

Question 49

What are the perinatal RF for neonatal sepsis?

Answer 49

Group B strep colonisation; PROM (>18hours); signif GBS bacteuria; maternal temp >38 degrees during labour; chorioamnionitis; sustainined intraprtum fetal tachy; prior delivery of infant with GBS disease

Question 50

What investigations should be doen for neonatal sepsis?

Answer 50

blood cultures; LP; urine culture; BM; FBC; CRP

Question 51

What are the most common causes of neonatal sepsis?

Answer 51

GBS; e.coli; s. aureus; enterococcus; staph. epi; klebsiella

Question 52

What is the treatment for new delivered baby with sepsis?

Answer 52

benzylpenicillin and gent

Question 53

What is given to babies with central catheters for sepsis in the NICU?

Answer 53

vanc and fluclox