prematurity

Question 1

classification of prematurity based on GA

Answer 1

i. Late preterm = GA 34-37 weeks
ii. Moderate preterm = GA 32-<34 weeks
iii. Very preterm = GA 28-<32 weeks
iv. Extremely preterm = <28 weeks

Question 2

classification of prematurity based on weight

Answer 2

i. LBW = <2500g
ii. VLBW = <1500g
iii. ELBW = <1000g

Question 3

Rx if prem delivery is expected

Answer 3

tocolytic e.g. CCB nifedipine
Abx - benpen for GBS
MgSO4 for neuroprotection (if <30w)
steroids for respprotection (all <37w)

Question 4

pathogenesis of ROP

Answer 4

initial insult > injury to new vessels
disruption of normal angiogenesis > retinal oedema from leaky vessels > haemorrhage

Question 5

spastic diplegia = what basically

Answer 5

PVL

Question 6

SGA vs FGR

Answer 6

SGA = infants with BM <10th centile for gestational age
FGR = estimated fetal weight <10th centile

Question 7

what syndrome causes asymmetric IUGR

Answer 7

Russell-Silver = asymmetric growth impairment (head size is normal)

Question 8

what is the barker hypothesis

Answer 8

IUGR increases risk of t2dm, insulin resistance, HTN, obesity, cvd, stroke

Question 9

how does a foetus get vit D

Answer 9

1,25 dihydroxyvitamin D DOES NOT cross placenta
placental 24-hydroxylase, changes it to 24,25 dihydroxyvitamin D3 (a less active metabolite than its precursor)

Question 10

which of the following causes neonatal withdrawal? which are teratogenic? which doesn’t reduce growth?
- nicotine
- alcohol
- THC
- opiates
- cocaine

Answer 10

withdrawal: alcohol, opiates (methadone > heroin), cocaine
teratogenic: alcohol, cocaine
THC only one that doesnt affect fetal growth

Question 11

maternal smoking increases risk of

Answer 11

SIDS
T2DM
obesity
HTN
dyslipidaemia
behaviour / cognition / psychiatric issues

Question 12

subcutaneous fat necrosis - appears like?

Answer 12

firm, indurated nodules and plaques on the back, buttocks, thighs, forearm and cheeks
Nodules and plaques may be erythematous, flesh coloured or blue

Question 13

where are the following bleeds?
1. Caput
2. Cephalhaematoma
3. Subgaleal
4. Extradural
5. Subdural
6. Subarachnoid

Answer 13

1. Caput – CT and aponeurosis
2. Cephalhaematoma – periosteum and bone
3. Subgaleal – aponeurosis and periosteum
4. Extradural – periosteum/outer dura and bone
5. Subdural – dura and arachnoid
6. Subarachnoid – arachnoid and pia

Question 14

caput succedanaeum vs cephalohaematoma

Answer 14

caput can cross midline, cephalo does not

Question 15

cx of cephalohaematoma

Answer 15

calcification > deformity
25% underlying fracture
E.Coli infection

Question 16

why important to differentiate a subgaleal

Answer 16

massive blood loss risk - its not bound by periosteum so can just bleed into the epidural space

Question 17

subgaleal vs caput/cephalohaematoma

Answer 17

vs cephalo: subgaleal will expand, not bound by suture lines
vs cephalo: boggy, not firm
vs caput: caput is biggest at birth

Question 18

most common fracture vs long bone fracture in delivery

Answer 18

clavicle most common
humerus most common long bone

Question 19

presentation of erb’s palsy

Answer 19

1. Limp arm in “waiter’s tip” position – arm held in adduction, elbow extended and forearm pronated with wrist flexed
2. Absent biceps jerk
3. +/- phrenic nerve involvement with diaphragmatic palsy in 5%

Question 20

erb vs klumpke’s palsy

Answer 20

erb - c5-c7
klumpke - C8-T1: clawhand, wristdrop, no grasp

Question 21

MOA of phototherapy

Answer 21

converts toxic native Z bilirubin to lumirubin (E bilirubin), a isomer that the kidneys can excrete

Question 22

what kind of CP does kernicterus cause

Answer 22

choreoathetoid CP

Question 23

NAS normally onset on what day

Answer 23

day 3***

Question 24

naloxone in NAS - comment

Answer 24

NOOO can induce rapid withdrawal&raquo_space; seizures

Question 25

symptoms of NAS

Answer 25

CNS: high pitched cry, hypertonia, tremors, seizures ANS: excoriation, diaphoresis, temp instability GIT: poor feed, uncoordinated suck, vomits, excoriation

Question 26

umbilical granuloma - what? presents as? NTBM

Answer 26

low-grade infection of umbilical stump Presents soon after cord separation as red, friable granulation tissue in region of umbilicus. Discharge of urine or faeces from umbilicus suggests Urachal or Vitello-intestinal duct anomalies

Question 27

congenital clouding of cornea - most common cause - infectious cause - stupid exam cause

Answer 27

most common = congenital glaucoma infectious = herpes / rubella all MPS

Question 28

duodenal atresia, think what syndrome

Answer 28

T21

Question 29

indomethacin and NEC - comment

Answer 29

• Indomethacin increases risk of spontaneous perforation but NOT NEC

Question 30

nitric oxide and B12- comment

Answer 30

prolonged NO suppresses liver enzymes >> inactivates B12 >> B12 neuropathy/myelopathy/encephalopathy

Question 31

at what gestation does nutritive sucking occur

Answer 31

Between 32 weeks gestation and term, infants learn to coordinate sucking and swallowing with breathing, and develop adaptive aerodigestive protective mechanisms

Question 32

some ddx for neonatal hypertension

Answer 32

renal - congenital: pckd, obstructive - acquired: AKI, nephrocalcinosis vascular - thrombi, RAS resp = BPD endocrine = CAH, hyperthyroid

Question 33

define hydrops fetalis

Answer 33

2 or more abnormal fetal fluid collections i. Ascites ii. Pleural effusion iii. Pericardial effusion iv. Skin oedema = late sign of fetal hydrops

Question 34

etiology of hydrops fetalis

Answer 34

immune (20%) non-immune (80%) - cardiovascular 40% - anaemia 30% - metabolic - other: lymphatic obstructive issues, hypoproteinaemia

Question 35

causes of raised antenatal AFP

Answer 35

Abdominal wall defects, renal disease, materno-fetal bleed, annular pancreas, duodenal atresia, epidermolysis bullosa

Question 36

clinical tetrad of chronic kernicterus

Answer 36

1. Sensory neural hearing loss. 2. Dental enamel hypoplasia. 3. Choreoathetoid cerebral palsy. 4. Oculomotor paresis of upward gaze.

Question 37

explain paradoxical cyanosis in choanal atresia

Answer 37

when the infant begins crying, they unconsciously begin mouth breathing, usually leading to the signs of respiratory distress and cyanosis to disappear.