Newborn Medicine

Question 1

Maternal depression usually occur starting from when and up to?

Answer 1

starts 1st week post partum up to 6 months post partum

Question 2

Most neonates void by __ hr and approximately 95% of preterm and term infants void within ___ hr

Answer 2

12 hours, 24 hours

Question 3

Passage of meconium in term and preterm infants happen within __ hr of birth

Answer 3

48 hours

Question 4

benefits of delayed clamping of the umbilical cord

Answer 4

improve transitional circulation
increase neonatal RBC volume

Question 5

practical method of systemically evaluating infants immediately after birth

Answer 5

Apgar score
— done at 1 and 5 minutes of life

Question 6

4 mechanisms of heat loss in newborn

Answer 6

convection
conduction
radiation
evaporation

Question 7

optimal method of maintaining temperature in the stable newborn

Answer 7

skin-to-skin contact with mother

Question 8

first bath in newborn should be delayed until __ hr of life to allow full transition to extrauterine life

Answer 8

24 hours

Question 9

normal temperature range in newborn

Answer 9

36.5-37.4 C

Question 10

this is given to infants shortly after birth to prevent hemorrhagic disease of the newborn

Answer 10

1 mg of water soluble vitamin K1 (phytonadione)

Question 11

screening for hypoglycemia is performed in these infants

Answer 11

SGA
LGA
infants with GDM mothers
Preterm babies
Symptomatic

Question 12

Medical contraindications to breastfeeding

Answer 12

Galactosemia
MSUD
Phenylketonuria

Question 13

Maternal conditions that contraindicate breastfeeding

Answer 13

Infection with human T-cell lymphotropic virus types 1 and 2
Active TB
Herpes virus infection on breast
Use of or dependence on illicit drugs
Maternal treatment with some radioactive compounds

Question 14

site of origin for embryonal neurons and fetal glial cells, a highly vascular region of the developing brain where IVH in premature infants occur

Answer 14

Subependymal germinal matrix

Question 15

Indication to undergo routine cranial UTZ in premature infants

Answer 15

<32 weeks AOG
birthweight <1000 g
- with ff up UTZ at 36-40 weeks postmenstrual age to evaluate for PVL

Question 16

What are the predisposing risk factors for IVH

Answer 16

Prematurity
RDS
Hypoxia-ischemia
Exaggerated fluctuations in cerebral blood flow (Hypotensive injury, hypervolemia, hypertension)
Reperfusion injury of damaged vessels
Reduced vascular integrity
Increased venous pressure (Pneumothorax, venous thrombosis)
Thrombocytopenia

Question 17

percentage of incidence of definite neurologic sequelae in grade 1 IVH

Answer 17

15%

Question 18

What is therapeutic hypothermia

Answer 18

exposing the newborn to a temperature of 33.5 C within the 1st 6 hours after birth and be maintained for 72 hours

Question 19

what is the definition of Apnea

Answer 19

cessation of breathing for a period of >20 seconds or
cessation of breathing <20 seconds + change in tone, pallor, cyanosis or bradycardia (<80-100 bpm)

Question 20

what type of apnea is most often observed in apnea of prematurity?

Answer 20

mixed apnea

Question 21

Apnea of prematurity usually occurs in premature infants of what AOG?

Answer 21

<34 weeks

Question 22

Infants born well <28 weeks can still have apnea of prematurity up to what PMA?

Answer 22

44 weeks PMA

Question 23

risk factors for RDS development

Answer 23

Maternal DM
Multiple births
CS delivery
Precipitous delivery
Asphyxia
Cold stress
Maternal history of previously affected infants

Question 24

risk of RDS is reduced in these pregnancies

Answer 24

Chronic or pregnancy-associated hypertension
Maternal heroine use
Prolonged rupture of membranes
Antenatal corticosteroid prophylaxis

Question 25

Primary cause of RDS

Answer 25

Surfactant deficiency

Question 26

Surfactant appears in amniotic fluids between what AOG?

Answer 26

28 and 32 weeks

Question 27

Mature levels of pulmonary surfactant are present usually at this AOG

Answer 27

after 35 weeks of gestation

Question 28

characteristic findings of RDS in chest xray

Answer 28

low lung volume diffuse, fine reticular granularity of the parenchyma/“ground-glass appearance” air bronchograms

Question 29

approach of choice for the delivery room management of a preterm neonate at risk for RDS

Answer 29

prophylactic nCPAP

Question 30

most common etiology of tachypnea in the newborn

Answer 30

Transient tachypnea of the newborn (TTN)

Question 31

Major limiting factor for survical in patients with CDH

Answer 31

Pulmonary hypoplasia

Question 32

most common life-threatening emergency of the GI tract in the newborn period

Answer 32

Necrotizing enterocolitis

Question 33

this xray finding confirms the clinical suspicion of NEC and is diagnostic

Answer 33

air in the bowel or pneumatosis intestinalis

Question 34

what are the circumstance/conditions that warrants determination of the cause of jaundice

Answer 34

1. appears in the 1st 24-36 hr after birth 2. bilirubin rising at a rate faster than 5 mg/dL/24 hr 3. serum bilirubin >12 mg/dL in full term, 10-14 mg/dL in preterm 4. jaundice persists after 10-14 days after birth 5. direct bilirubin fraction is > 2 mg/dL at any time

Question 35

what are the signs/symptoms of Triple I

Answer 35

fetal tachycardia maternal leukocytosis (>15,000 cells in the absence of corticosteroids) purulent fluid from the cervical os biochemical or microbiologic amniotic fluid changes consistent with infection fever

Question 36

appropriate cutoff of hours from rupture of membrane for increased risk of neonatal infection

Answer 36

18 hours

Question 37

most common source of postnatal infections in hospitalized newborns

Answer 37

hand contamination of healthcare personnel

Question 38

rooting reflex is present at what AOG

Answer 38

32 weeks AOG

Question 39

Moro reflex is one of the primary newborn reflexes and is present at birth, it is gone by what age?

Answer 39

3-6 months

Question 40

Palmar grasp reflex is present at what age and gone by what age

Answer 40

28 weeks AOG, gone by 4 months

Question 41

Components of APGAR score

Answer 41

A - Appearance (0- pale/blue, 1- acrocyanosis, 2- pink) P - Pulse (0 - No pulse, 1 - HR <100, 2 - HR >100) G - Grimace (0- no response, 1- grimace, 2- cough/sneeze) A - Activity (0 -limp, 1 - some flexion, 2 - active motion) R - Respiratory (0- absent, 1- slow, irregular, 2-good, crying)

Question 42

factors affecting the apgar score and give a false-negative result

Answer 42

Maternal acidosis High fetal catecholamine levels Some full-term infants

Question 43

What is the usual delivery toom temperature to be maintained

Answer 43

20-25 C

Question 44

most frequently involved part of the intestine in NEC

Answer 44

distal part of ileum and proximal segment of the colon

Question 45

Syndrome vs Sequence

Answer 45

Syndrome - pattern of **multiple abnormalities** that are related by pathophysiology, resulting from a single defined etiology Sequence - consists of **multiple malformations** that are caused by a single event

Question 46

What si MR SOPA

Answer 46

Mask adjustment Reposition the head Suction secretions (oral/nasal) Open the mouth Pressure increase Alternate airway

Question 47

most important indicator of successful PPV

Answer 47

increasing heart rate

Question 48

What is DOPE

Answer 48

Displaced Endotracheal Tube Obstructed Endotracheal Tube Pneumothorax Equipment failure

Question 49

what epinepherine concentration is used for neonatal resuscitation

Answer 49

1:10,000 (0.1 mg/mL)

Question 50

Persistent absence of a detectable heart rate (APGAR score 0) at ___ minutes is a strong but not absolute predictor of mortality and serious morbidity in late preterm and term newborns

Answer 50

10

Question 51

Maternal drugs that can cause Early-onset Vit K deficiency bleeding

Answer 51

Phenobarbital Phenytoin Warfarin Rifampin Isoniazid

Question 52

3 major risk factors implicated in NEC

Answer 52

prematurity bacterial colonization of the gut formula feeding