Neonatology

Question 1

what are the three shunts in the foetal circulation?

Answer 1

1. ductus venosus
2. foramen ovale
3. ductus arteriosus

Question 2

role of ductus venosus

Answer 2

passes bloods from placenta via the umbilical vein through the liver to the IVC

Question 3

role of the foramen ovale

Answer 3

passage of blood from right to left atria

Question 4

role of ductus arteriosus

Answer 4

passes blood from the right ventricle to the aorta using the pulmonary artery

Question 5

what blood does the umbilical vein carry?

Answer 5

oxygenated

Question 6

what blood do the umbilical arteries carry?

Answer 6

deoxygenated

Question 7

what preparations for birth are made in the 3rd trimester?

Answer 7

surfactant production (type II pneumocytes)
accumulation of glycogen
accumulation of brown fat
accumulation of subcutaneous fat
swallowing of amniotic fluid to grow lungs

Question 8

preparations during labour/delivery

Answer 8

catecholamines/ cortisol increases
crying absorbs lung fluid into lymphatics
vaginal delivery squeezes lungs

Question 9

what happens to the circulation when birthed

Answer 9

pulmonary vascular resistance drops
lungs expand
systemic vascular resistance drops
prostaglandins close ducts

Question 10

what does the ductus venosus become?

Answer 10

ligamentum teres

Question 11

fate of foramen ovale

Answer 11

closes

Question 12

fate of ductus arteriosus

Answer 12

becomes ligamentum arteriosus

Question 13

respiratory complications in the new-born?

Answer 13

PPHN
meconium aspiration
TTPN
RDS
Potter's syndrome
pneumothorax
pneumonia

Question 14

other complications in the new-born

Answer 14

diaphragmatic hernia
HIE
fistula
PDA
intraventricular haemorrhage
NEC
ROP

Question 15

what is PPHN?

Answer 15

patent PDA and PFO so pulmonary vascular resistance fails to drop

Question 16

diagnosis of PPHN

Answer 16

pre and post-ductal saturation as artery that supplies upper right limb leaves aorta before PDA (high oxygenation)

positive result if more than 3% difference

Question 17

what can cause TTPN

Answer 17

C-section has no squeezing of lungs so fluid is not absorbed

Question 18

presentation of TTPN

Answer 18

tachypnoea and grunting within first 6 hours

Question 19

management of TTPN

Answer 19

screen for infection

self-limiting and transient

Question 20

what causes RDS

Answer 20

lack of surfactant

pre-terms usually

Question 21

management of RDS

Answer 21

maternal steroids

surfactant

Question 22

what is Potter’s syndrome?

Answer 22

renal agenesis

Question 23

why is Potter’s syndrome involved with the lungs?

Answer 23

no urine is produced so no amniotic fluid is swallowed leading to pulmonary hypoplasia

Question 24

what is NEC (necrotising enterocolitis)?

Answer 24

inability to handle milk and bacteria enters the blood

Question 25

what is ROP (retinopathy of prematurity)?

Answer 25

abnormal blood vessel growth in the eye

Question 26

what adaptations are made in the first few hours of life?

Answer 26

thermoregulation | glucose homeostasis

Question 27

how is heat lost?

Answer 27

radiation convection conduction evaporation

Question 28

why do newborns lose heat rapidly?

Answer 28

large SA to volume ratio

Question 29

can babies shiver?

Answer 29

no so they breakdown stored fat for heat

Question 30

what do babies use as brain fuel?

Answer 30

ketones

Question 31

what happens to glucose homeostasis at birth?

Answer 31

changes from a continuous infusion to intermittent bolus

Question 32

causes of hypoglycaemia in the new-born

Answer 32

``` increased demand (unwell) low stores (small/ premature) inappropriate endocrinology e.g. GDM or hyperinsulinaemia (mother on beta blockers) ```

Question 33

what causes physiological jaundice?

Answer 33

foetal Hb is broken down but the conjugating pathway is immature so there is an increase in unconjugated bilirubin

Question 34

when does physiological jaundice occur?

Answer 34

2-5 days

Question 35

reasons for pathological jaundice?

Answer 35

kernicterus | biliary atresia

Question 36

what is term?

Answer 36

37 weeks gestation

Question 37

what is post-term?

Answer 37

beyond 41 weeks

Question 38

when is pre-term?

Answer 38

under 37 weeks

Question 39

what scale is used to assess progression?

Answer 39

APGAR score

Question 40

what is a normal APGAR score?

Answer 40

above 8

Question 41

resuscitation in children?

Answer 41

airway is more neutral (not head tilt, chin lift) | therapeutic cooling in cerebral palsy

Question 42

types of cerebral palsy

Answer 42

``` ataxic paraplegic diplegic hemiplegic dyskinetic quadriplegic ```