Neonatology

Question 1

How long does the neonatal period last?

Answer 1

28d

Question 2

What are milia and how should they be treated?

Answer 2

1-2mm pearly, white papules caused by retention of keratin in dermis
Will resolve spontaneously

Question 3

Describe erythema toxicum:

Answer 3

Harmless red blotches often with central white pustule

Question 4

What is cradle cap?

Answer 4

Large, greasy yellow or brown scales on scalp

Question 5

Describe a port-wine stain:

Answer 5

Vascular malformation of superficial dermal capillaries

Pink to deep red/purple patches, often unilateral with distinct cut off

Question 6

Describe (Mongolian) blue spots:

Answer 6

Blue lesion present at births, usually on buttocks or base of spine

Question 7

What causes petechial and subconjunctival haemorrhages in neonate?

Answer 7

Suffusion of face during delivery

Question 8

What are some important causes of sticky eye in the neonate to rule out?

Answer 8

Ophthalmia neonatorum or chlamydia

Question 9

How can laryngomalacia present?

Answer 9

Stridor, feeding difficulties, choking, poor weight gain

Question 10

How can neonatal jaundice be primarily investigated?

Answer 10

Transcutaneous bilirubin levels can be measured by midwives

Question 11

What are some physiological causes of jaundice in the neonate?

Answer 11

Increased bilirubin production due to shorter RBC lifespan
Decreased bilirubin conjugation due to hepatic immaturity
Absence of gut flora impeded elimination of bile pigment
Exclusive breastfeeding

Question 12

What are some causes of jaundice within 24h of birth?

Answer 12

Sepsis
Rhesus haemolytic disease
ABO incompatibility
Red cell anomalies (spherocytosis, G6PDH def.)

Question 13

What are some causes of prolonged jaundice in neonates?

Answer 13

Breastfeeding
Sepsis
Hypothyroidism
CF
Biliary atresia (yellow urine, pale stools)
Galactosemia, congenital infections, haemolysis

Question 14

How should bilirubin levels be used to decide management in neonatal jaundice?

Answer 14

Plot SBR on personalised NICE graph to decide if treatment is required

Question 15

What are the management options for neonatal jaundice requiring treatment?

Answer 15

Phototherapy and exchange transfusion

Question 16

How does phototherapy work in treating neonatal jaundice?

Answer 16

Uses light energy to convert bilirubin to soluble products that can be excreted

Question 17

What are some side effects of phototherapy for neonatal jaundice?

Answer 17

Eye damage, diarrhoea, fluid loss, separation from mother

Question 18

How does exchange transfusion work in treating neonatal jaundice?

Answer 18

Uses warmed blood, 160ml/kg, to remove bilirubin

Given ideally via umbilical vein IVI

Question 19

What is kernicterus?

Answer 19

Acute bilirubin encephalopathy with lethargy, poor feeding, hypertonicity, shrill cry

Question 20

What are some long term consequences of kernicterus?

Answer 20

Athetoid movements, deafness and lower IQ

Question 21

When can a leak of fetal red cells into the maternal circulation occur?

Answer 21

Threatened miscarriage
APH
Trauma
Amniocentesis + CVS
ECV

Question 22

What is the cause of respiratory distress syndrome in a newborn?

Answer 22

Deficiency in alveolar surfactant leads to atelectasis and re-inflation with each breath exhausts baby leading to resp failure

Question 23

What are some signs of respiratory distress syndrome?

Answer 23

Increased work of breathing within 4h of birth
Tachypnoea
Grunting
Nasal flaring, intercostal recession
Cyanosis

Question 24

How can respiratory distress syndrome be prevented?

Answer 24

Betamethasone/dexamethasone offered to those at risk of pre-term delivery from 23-35 weeks

Question 25

What O2 sats should be aimed for when treating respiratory distress syndrome and why?

Answer 25

85-93% to reduce risk of retinopathy and bronchopulmonary dysplasia

Question 26

What is the causes of bronchopulmonary dysplasia?

Answer 26

Barotrauma, oxygen toxicity and airway infections, as a result of prolonged ventilation + O2

Question 27

What can cause pulmonary hypoplasia?

Answer 27

Oligohydramnios, PROM, diaphragmatic hernia

Question 28

What are some signs of necrotising enterocolitis?

Answer 28

``` Abdo distension Blood/mucus PR Tenderness Shock, DIC Mucosal sloughing Pneumatosis intestinalis ```

Question 29

What is the cause of haemorrhagic disease of the newborn?

Answer 29

No enteric bacteria to make vit K so get bleeding/bruising, raised PT and PTT

Question 30

What is the cause of transient tachypnoea of the newborn? When is it more commonly seen?

Answer 30

Delayed resorption of fluid in the lungs | More common following C-sections

Question 31

What is the first step in neonatal life support?

Answer 31

Dry and stimulate baby and place under radiant heat

Question 32

What scoring system is used in neonatal life support?

Answer 32

AGPAR

Question 33

What is the definition for chronic lung disease in newborns?

Answer 33

Requiring oxygen for >28 days

Question 34

What are some signs of intraventricular haemorrhage and why is it more common in premature babibes?

Answer 34

Seizures, bulging fontanelles, cerebral irritability | BVs unsupported

Question 35

Describe retinopathy of prematurity:

Answer 35

Disorganized growth of retinal blood vessels which may result in scarring and retinal detachment Can be due to O2 toxicity or hypoxia

Question 36

What is the treatment for retinopathy of preamturity?

Answer 36

Diode laser therapy

Question 37

When should newborns be screened for retinopathy of prematurity?

Answer 37

Screen at 30-31 weeks if ≤27 weeks or at 28-35 days of life

Question 38

What are the likely causative organisms of early onset (within 48h) neonatal sepsis?

Answer 38

GBS, E. coli, Listeria

Question 39

What are the likely causative organisms of late onset neonatal sepsis?

Answer 39

Coagulase negative staph, S. aureus, E. coli, GBS

Question 40

Describe some ways in which neonatal sepsis may present:

Answer 40

Labile temperature, lethargy, poor feeding, resp distress, collapse, DIC

Question 41

What are some risk factors for early onset neonatal sepsis?

Answer 41

ROM >18h, maternal infection, mother GBS carrier, | preterm labour, fetal distress, breaks in neonatal skin

Question 42

What are some risk factors for late onset neonatal sepsis?

Answer 42

Central lines, catheters, congenital malformations, | severe illness, malnutrition, immunodeficiency

Question 43

What antibiotics should be given in early onset neonatal sepsis?

Answer 43

Broad spec e.g. benpen + gent

Question 44

What antibiotics should be given in late onset neonatal sepsis?

Answer 44

Broad spec e.g. flucloxacillin + gent

Question 45

What are some cause of hypotonia in the newborn?

Answer 45

``` Sepsis Hypoglycaemia Dehydration, poor nutrition Hypoxic-ischemic encephalopathy Myopathy Maternal drugs ```

Question 46

What are some advantages to breastfeeding?

Answer 46

``` Less insulin resistance, HTN and obesity Protect from infection Promote growth of enteric bacteria Contraceptive Protection from breast cancer Bonding ```

Question 47

What are some problems associated with breastfeeding?

Answer 47

Breast engorgement, breast abscess, sore nipples, mastitis

Question 48

Describe standard infant formula milk:

Answer 48

Cow’s milk humanised by reducing solute load and | modifying fat, protein and vitamin content

Question 49

Describe follow on formula milk:

Answer 49

Protein is casein based rather than whey (used in standard), delaying stomach emptying and allowing less frequent feeds

Question 50

Why is hydrolized formula milk used?

Answer 50

Cows’ milk allergy

Question 51

How much milk do babies need a day?

Answer 51

150ml/kg/day | Usually over 4-6 feeds

Question 52

Describe weaning and when it should occur:

Answer 52

Introduce solids at 6 months by offering finger food with or without purée

Question 53

What does APGAR stand for?

Answer 53

``` Activity Pulse Grimace Appearance Respiration ```

Question 54

What is a normal APGAR score?

Answer 54

7+