Neonatology

Question 1

When does the development of the CVS start in the foetus?

Answer 1

Toward the end of the 3rd week

Question 2

When does the heart start to beat in the foetus ?

Answer 2

Beginning of the 4th week

Question 3

When is the critical period of heart development ?

Answer 3

From day 20-50 after fertilization

Question 4

How does the foetus receive oxygenated blood ?

Answer 4

Via the umbilical vein - Ductus Venosus

Question 5

How does the blood get to the foetal left atrium?

Answer 5

Foramen Ovale

Question 6

How does the blood get to the right ventricle in the foetus ?

Answer 6

Patent ductus Arteriosus

Question 7

What is the oxygen saturation in the foetal body ?

Answer 7

60-70%

Question 8

What are the 3 main roles of the ductus arteriosus ?

Answer 8

Protects lungs against circulatory overload.
Allows the right ventricle to strengthen.
Carries low oxygen saturated blood.

Question 9

What are the 3 main roles of the Ductus Venosus ?

Answer 9

Foetal blood vessel connecting the umbilical vein to the IVC.
Blood flow regulated via sphincter.
Carries mostly oxygenated blood.

Question 10

What is the normal blood pressure for a new born of 1 hr in age ?

Answer 10

70/44

Question 11

What is the normal blood pressure for a new born of 1 day in age ?

Answer 11

70(+/-/9)/42( +/- 12)

Question 12

What is the normal blood pressure for a new born of 3 days in age ?

Answer 12

77 (+/-12)/49 (+/-10)

Question 13

What is the normal respiratory rate for a full term new born ?

Answer 13

30-60

Question 14

What is the normal heart rate for a full term new born ?

Answer 14

120-160bpm

Question 15

New born babies lack the shivering thermo genesis, true or false?

Answer 15

True

Question 16

When does physiological jaundice occur in the new born ?

Answer 16

DOL 2-3

Dissapears within 7-10 days

Question 17

What is a normal weightloss in a new born and what is this due to ?

Answer 17

up to 10% is normal due to:
Shift of interstitial fluid to intravascular
Diuresis

Question 18

What are the causes of being small for dates ?

Answer 18

Maternal pre-eclamptic Toxemia (PET)
Chromosomal (Edwards Syndrome)
Infection (CMV)
Twin pregnancy

Question 19

What are the common problems with babies who are small for their date ?

Answer 19

Perinatal Hypoxia
 Hypoglycaemia
 Hypothermia
 Polycythaemia
 Thrombocytopenia
 Hypoglycaemia
 Gastrointestinal problems

Question 20

What are the long-term issues in babies who are small for their date ?

Answer 20

Hypertension
Reduced growth
Obesity
Ischemic heart disease

Question 21

How do you prevent RDS during pregnancy ?

Answer 21

Antenatal steroids

Question 22

How is it treated post-natally ?

Answer 22

Surfactant

Question 23

What is broncho-pulmonary displasia ?

Answer 23

Infection via ETT
O2 Toxicity
Inflammatory changes

Question 24

How do you treat broncho-pulmonary displasia?

Answer 24

Patience
Nutrition
Steroids

Question 25

How do you prevent intraventricular haemorrhage (IVH) in neonates ?

Answer 25

AN steroids | Drainage

Question 26

What is the physiology occuring in a patent ductus arteriosus ?

Answer 26

There is additional blood to the pulmonary circulation - creating lung oedema. This stealing from the systemic circulation causes systemic ischaemia

Question 27

What are the consequences of a patent ductus arteriosus ?

Answer 27

Worsening of resp. symptoms and retention of fluids and GI problems

Question 28

What is Necrotising entero-colitis (NEC) ?

Answer 28

Ischaemic and inflammatroy changes. | Necrosis of the bowel

Question 29

How do you treat NEC ?

Answer 29

Surgical intervention required and antibiotics and parenteral nutrition

Question 30

What are signs of sepsis in a neonate ?

Answer 30

``` Baby pyrexia or hypothermia Poor feeding Lethargy Early jaundice Tachypnoea Hypo Floppy Asymptomatic ```

Question 31

What is the management for presumed sepsis in a baby ?

Answer 31

``` Septic screen and blood gas. Consider CXR. IV penicillin and gentamicin. Adding metronidazole if surgical/abdominal concerns. Fluid management Monitor vital signs. ```

Question 32

Top 5 bacteria which causes neonatal sepsis ?

Answer 32

``` Group B Strep. E. Coli Listeria Coag-neg staph. Hamophilus Influenzae. ```

Question 33

Name the most common congenital infections in neonates

Answer 33

``` ToRCH: Toxoplasmosis Rubella CMV Herpes ```

Question 34

How does Transient Tachypnoe of the New born (TTN) present and how is it managed ?

Answer 34

``` Presents within the first few hours of life: Grunting Tachypnoea Oxygen requirement Normal gases Delay in clearance of foetal lung. ``` Management: Supportive, antibiotics, fluids, O2 and airway support

Question 35

What are the symptoms of Meconium aspiration ?

Answer 35

``` Cyanosis Increased work of breathing Grunting Apnoea Floppiness ```

Question 36

What investigations should be done for a baby who has suspected inhaled Meconium ?

Answer 36

Blood gas Septic screen CXR

Question 37

What is the treatment for aspiration of Meconium ?

Answer 37

``` Suction below cords Airway support (Inutbation and ventilation) Fluids and antibiotics Surfactant NO or ECMO ```

Question 38

What investigations would you do for a blue baby ?

Answer 38

``` Examination and history Sepsis screen Blood gas and BM CXR Pulse oximetry ECG Echo ```

Question 39

What are some differential diagnoses for 'blue baby' ?

Answer 39

Tetralogy of fallots Tricuspid atresia Pulmonary atresia

Question 40

What are some of the causes of birth asphyxia?

Answer 40

``` Placental problem Difficult delivery Umbilical cord problem Infection Neonatal airway problem Neonatal anemia ```

Question 41

What is the 1st stage of Asphyxia ?

Answer 41

Within minutes without O2 | Cell damage occurs with lack of blood flow and O2

Question 42

What is the 2ns stage of Asphyxia ?

Answer 42

Reperfusion injury Can last days or weeks. Toxins are released from damaged cells

Question 43

How do you manage Hypoxic Ischaemic Encephalopathy ?

Answer 43

``` Supportive Fluid restriction Monitor for liver and renal failure. Respiratory support. Cardiac support. Treat seizures. Therapeutic hypothermia. ```

Question 44

What are some of the cuases of failure to pass stool ?

Answer 44

``` Constipation Large bowel atrsia Imperforate anus +/- fistula Hirschsprungs disease. Meconium ileus (think CF) ```