Neonatology

Question 1

Calories in breast milk

Answer 1

67kcal/ 100ml

Question 2

Time to introduce solids

Answer 2

after 17wks

no later than 26 wks

Question 3

Whole pasteurised cow’s milk

Answer 3

from 1 year

full fat until 5 yrs

Question 4

How does phototherapy work

Answer 4

converts unconjugated bilirubin into harmless water soluble pigment
excreted in urine

Question 5

Late onset (>48 hrs) infection cause

Answer 5

staphylococcus epidermidis

Question 6

Late onset neonatal infection management

Answer 6

flucloxacillin and gentamicin

Question 7

Rubella infection features

Answer 7

sensori neural deafness
cong. cataracts
cong. heart disease (PDA)
glaucoma

Question 8

Taxoplasmosis features

Answer 8

congenital calcification
chorioretinitis
hondrocephalus

Question 9

Cytomegalovirus features

Answer 9

growth retardation

purpuric skin lesion

Question 10

Define caput succedaneum

Answer 10

beyond the margins of the sutures

resolves within few days

Question 11

Cephalheamatoma

Answer 11

bleeding within the periosteum
confined within suture margins
resolves over few weeks

Question 12

Newborn screening

Answer 12

Cystic fibrosis 
Congenital hypothyroidism 
Haemoglobinopathies 
6 inborn errors of metabolism 
-Phenalketouria, PKU 
-Medium chain anyl-CoA dehydrogenase deficiency, MCAD
-Glutaric acuduria type 1, GA1
-Isovaleric academia 
-Homocystinuria 
-Maple syrup disease

Question 13

When is newborn blood spot screening performed

Answer 13

day 5-7

Question 14

Phenylketouria

Answer 14

learning difficulties
seizures
microcephaly

Question 15

MCAD: Medium chain acetyl-CoA dehydrogenase deficiency

Answer 15

rapidly progressive encephalopathy
collapse after prolonger fast
-> non-ketotic hypoglycaemia

Question 16

Glutaric acuduria type 1

Answer 16

macrocephaly w/ encelopathic crisis at 6-18 m

-> dystonic-dyskinetic movement disorder

Question 17

Isovaleric academia

Answer 17

metabolic acadaemia +/- hyperammonaemia

Question 18

Homocystinuria

Answer 18

marfanoid appearance 
learning difficulties 
lens dislocation 
osteoporosis 
thromboembolism

Question 19

Maple syrup urine disease

Answer 19

progressive encephalopathy

Question 20

Prematurity definition

Answer 20

<37 wks

Question 21

very preterm define

Answer 21

28 to 32 wks

Question 22

extremely preterm define

Answer 22

<28 wks

Question 23

management of apnoea, bradycardia and desaturations in premature babies

Answer 23

caffeine

CPAP

Question 24

Neonatal respiratory distress syndrome cause and pathophysiology

Answer 24

surfactant deficiency
reduced surface tension
widespread alveolar collapse
inadequate gas exhange

Question 25

Neonatal RDS prophylaxis

Answer 25

antenatal glucocorticoids | stimulate surfactant production

Question 26

Neonatal RDS clinical features

Answer 26

``` at delivery or within 48hrs tachypnoea >60 chest wall recessions nasal flaring expiratory grunting (creates positive airway pressure) cyanosis ```

Question 27

Neonatal RDS CXR finidings

Answer 27

diffuse frantumar or ground glass appearance air bronchograms indistinct heart boarder

Question 28

Preterm brain injury pathophysiology

Answer 28

periventricular and intraventricular haemorrhages are common in preterm babies ischaemia with re-perfusion injury free radical injury -> increased arterial flow (hypoxia, hypercapnia, HTN) -> reduced venous flow (heart failure) => increased gradient across the wall of capilaries ---> vessel rupture

Question 29

Define periventricular leukomalacia, PVL

Answer 29

white matter brain injury following heamorrhage - > flare on USS - > risk of spastic diplegia

Question 30

Which babies are screened for retinopathy?

Answer 30

<1500g birthweight <32 wks gestation -> weekly ophthalmology review

Question 31

Necrotising enterocolitis

Answer 31

bacterial invasion of ischaemic bowel wall

Question 32

Necrotising enterocolitis clinical features

Answer 32

``` feeds not tolerated milk aspirated from stomach vomiting distented abdo +/- fresh blood in stools ```

Question 33

Necrotising enterocolitis Xray

Answer 33

dilated bowel loops thumb printing transmural gas +/- gas in portal tract and pneumoperitoneum

Question 34

Necrotising enterocolitis Rx

Answer 34

parental nutrition broad spec abx repair perforations