Neonatology

Question 1

when is a baby at term?

Answer 1

after 37 weeks completed gestation

Question 2

when is a baby considered post term?

Answer 2

after 41 weeks completed gestation

Question 3

what is a normal weight for babies?

Answer 3

2.5-4.0 kg

Question 4

what is a baby considered to be if they weigh over 4kg?

Answer 4

large for gestational age

Question 5

what is a baby considered to be if they weight under 2.5kg?

Answer 5

small for gestational age

Question 6

when is the third trimester of pregnancy?

Answer 6

from 28 weeks onwards

Question 7

what hormones increase during labour to help the baby adapt to postnatal life?

Answer 7

cortisol

adrenaline

Question 8

what score is used to assess a babies perinatal adaptation?

Answer 8

APGAR score

Question 9

what is a normal APGAR score?

Answer 9

8 or more

Question 10

what is given to prevent haemorrhagic disease of the newborn?

Answer 10

vitamin K

preferably via IM route

Question 11

why is giving vitamin K especially important in breastfed babies?

Answer 11

their milk is not fortified with vit K like formula is

higher risk of bleeding if not given vit K

Question 12

what is done if a mother has active hep B?

Answer 12

immediate vaccination on the day of birth

Question 13

what is given to particularly high risk babies who’s mothers have active hep B?

Answer 13

hep B immunoglobulin IV

Question 14

can mothers with hep C breastfeed?

Answer 14

yes

as long as hep C RNA level is low

Question 15

can mothers with HIV breastfeed?

Answer 15

only if their viral load is undetectable

Question 16

when would babies be offered the BCG vaccine?

Answer 16

if their family is high risk for TB

Question 17

what vaccines should mother’s to be receive to prevent illness in their baby?

Answer 17

pertussis

influenza

Question 18

when does the routine vaccination schedule start?

Answer 18

8 weeks

Question 19

what vaccines can be given early if the baby is high risk?

Answer 19

hep B

BCG

Question 20

when is a baby considered to be preterm?

Answer 20

born before 37 weeks gestation

Question 21

what should be delayed if a baby is born preterm?

Answer 21

clamping the umbilical cord

Question 22

how should preterm babies be kept warm?

Answer 22

in a plastic bag
under a radiant heater
wear a hat

Question 23

what do preterm babies need to help their lungs adn why?

Answer 23

lungs are more fragile

PEEP to gently inflate the lungs

Question 24

how is there an increased risk of nutritional compromise in a preterm baby?

Answer 24

limited nutrient reserves
gut immaturity
immature metabolic pathways
increased demands to meet growth needs

Question 25

what nutrition do some preterm babies who cannot feed receive?

Answer 25

total parenteral nutrition

Question 26

what are the two types of neonatal sepsis?

Answer 26

early onset | late onset

Question 27

what causes early onset sepsis?

Answer 27

bacteria acquired before or during delivery

Question 28

what causes late onset sepsis?

Answer 28

bacteria acquired after delivery

Question 29

name some causative organisms of early onset sepsis

Answer 29

group B strep | gram negatives

Question 30

name some causative organisms of late onset sepsis

Answer 30

coagulase negative staph gram negatives staph aureus

Question 31

what risks associated with prematurity increase likelihood of sepsis?

Answer 31

immature immune system | ICU environment - indwelling tubes and lines

Question 32

how is neonatal sepsis prevented?

Answer 32

hand washing care of cord infection screening

Question 33

how is neonatal sepsis managed?

Answer 33

antibiotics | supportive care measures

Question 34

what causes primary RDS?

Answer 34

surfactant deficiency and structural immaturity of the lungs

Question 35

what causes secondary RDS?

Answer 35

damage to the lungs causes by things like intubation or ventilation

Question 36

which babies are more high risk for RDS?

Answer 36

preterm

Question 37

what clinical signs may be seen in a baby with RDS?

Answer 37

``` tachypnoea grunting intercostal recessions nasal flaring cyanosis ```

Question 38

what is the natural history of RDS like?

Answer 38

gradual worsening for 2-4 days | gradual improvement

Question 39

what can be given to prevent RDS?

Answer 39

maternal steroids

Question 40

name two steroids given to mothers to prevent RDS

Answer 40

dexamethasone | betamethasone

Question 41

what treatments can be given to a baby with RDS?

Answer 41

surfactant replacement | ventilation

Question 42

name four things that are screened for on the blood spot card

Answer 42

cystic fibrosis hypothyroidism haemoglobinopathies metabolic diseases

Question 43

name five metabolic diseases screened for on the blood spot card

Answer 43

``` PKU MCADD IVA GA1 HCU ```

Question 44

name two other screening tests done in newborns

Answer 44

hearing screening | hip screening

Question 45

when is the newborn examination carried out?

Answer 45

before/around 24 hours old

Question 46

name the 7 things looked at/for in the newborn examination of the head

Answer 46

``` OFC sutures fontanelles marks moulding cephalohematoma caput succedaneum ```

Question 47

what is OFC?

Answer 47

occipital frontal circumference

Question 48

what is the importance of OFC?

Answer 48

ensures the baby has grown appropriately

Question 49

what can cause overlapping sutures?

Answer 49

moulding

Question 50

what can cause marks on a babies head during birth?

Answer 50

forceps | ventouse

Question 51

what causes moulding of a babies head?

Answer 51

being born it is normal

Question 52

what is cephalohaematoma?

Answer 52

bleeding between the bone periosteum and the epicranial aponeurosis

Question 53

where is cephalohematoma often found?

Answer 53

the parietal bones limited by suture lines

Question 54

what is caput succedaneum?

Answer 54

swelling and oedema in the outer layer of the skin

Question 55

how long does it take for caput succedaneum to settle?

Answer 55

no more than 48 hours normally

Question 56

name the 5 things assessed in the eyes in the newborn examination

Answer 56

``` size red reflex subconjunctival haemorrhage squints iris abnormality ```

Question 57

name the 5 things assessed in the ears in the newborn examination

Answer 57

``` position EAM patency tags/pits folding family history of hearing loss ```

Question 58

name the 7 things assessed in the mouth during the newborn examination

Answer 58

``` shape philtrum tongue tie palate neonatal teeth ebsteins pearls sucking reflex ```

Question 59

what can a smooth philtrum be a sign of?

Answer 59

foetal alcohol syndrome

Question 60

what is looked for when looking at the palate of a baby?

Answer 60

cleft palate

Question 61

what are ebsteins pearls and where are they found?

Answer 61

white, pearly collections of skin cells joint of the palate and the hums

Question 62

what two things are looked for in the face during the newborn examination?

Answer 62

facial palsy | dysmorphism

Question 63

what are some signs of respiratory distress in a neonate?

Answer 63

nasal flaring grunting tachypnoea in-drawing

Question 64

name 5 things assessed in the newborn examination of the heart

Answer 64

``` saturations pulses apex beat thrills and heaves heart sounds ```

Question 65

when do babies get a detailed heart scan?

Answer 65

20 weeks