Quiz 2

Question 1

What is the likely cause of bleeding from the umbilical cord in a neonate on day 5?

Answer 1

Vitamin K deficiency

Bleeding from the umbilical cord on day 5 is consistent with late vitamin K deficiency bleeding (VKDB), especially in infants who didn’t receive prophylaxis at birth.

Question 2

What is the most important indicator of fluid status in the neonate?

Answer 2

Weight

Weight is the most reliable indicator of total body water and fluid status in neonates, particularly after the first week of life.

Question 3

If a 31-week gestation infant weighs 1,800 grams and requires IV fluids at 80 mL per kilo per day, what is the IV rate?

Answer 3

6 mL/hr; GIR cannot be calculated without dextrose concentration.

The calculation is (80 × 1.8)/24 = 6 mL/hr, and GIR requires dextrose %, which isn’t provided.

Question 4

What should be done for a 36-week 3200g infant presenting with lethargy and poor feeding at 4 days old?

Answer 4

Obtain electrolytes and start IV at 80 mL/kg/day

Lethargy and poor urine output indicate dehydration and possible hypernatremia, with an 18.75% weight loss.

Question 5

How do penicillins work?

Answer 5

Weakening the cell wall for cell lysis

Penicillins bind to PBPs and interfere with peptidoglycan cross-linking, leading to cell wall breakdown and bacterial lysis.

Question 6

What type of organisms does vancomycin work best against?

Answer 6

Gram-positive

Vancomycin inhibits cell wall synthesis in gram-positive bacteria and cannot cross the outer membrane of gram-negative bacteria.

Question 7

What should be monitored in a neonate treated with ganciclovir?

Answer 7

CBC with differential

Ganciclovir can cause bone marrow suppression; monitoring granulocytes and platelets is essential.

Question 8

In a neonate being treated with Amphotericin B, what should be monitored?

Answer 8

Renal function

Amphotericin B is highly nephrotoxic; monitoring renal function and electrolytes is important.

Question 9

What additional antibiotic should be considered for a neonate with NEC who is on vancomycin and gentamicin?

Answer 9

Metronidazole

Metronidazole provides anaerobic coverage necessary for intraabdominal infections like NEC.

Question 10

Which antibiotic should be used to treat a chlamydia infection?

Answer 10

Erythromycin

Erythromycin treats intracellular infections like chlamydia; tetracycline is contraindicated in neonates.

Question 11

What is the recommended treatment for a newborn with hepatosplenomegaly and jaundice suspected to have HSV?

Answer 11

Acyclovir

Acyclovir is the first-line antiviral for neonatal HSV, commonly presenting with vesicular lesions.

Question 12

In suspected E. coli meningitis, what should be added to ampicillin?

Answer 12

Cefotaxime

Cefotaxime provides effective gram-negative coverage with good CNS penetration; standard for neonatal meningitis treatment.

Question 13

What is the first-line treatment for systemic Candida infection?

Answer 13

Fluconazole

Fluconazole inhibits ergosterol synthesis in fungal cell membranes and is first-line for systemic candidiasis.

Question 14

Which antibiotic should be reevaluated for a neonate on gentamicin and indomethacin for PDA?

Answer 14

Gentamicin

Both gentamicin and indomethacin are nephrotoxic; their combined use increases the risk for renal injury.

Question 15

How would you describe Beyfortus (nirsevimab) to a parent?

Answer 15

It’s a monoclonal antibody injection that protects babies from severe RSV illness by blocking the virus from infecting cells.

Nirsevimab provides passive immunity by binding to the RSV fusion protein, preventing viral cell entry.

Question 16

Parenteral nutrition requires calories that are: _______ than enteral nutrition.

Answer 16

Less

TPN bypasses digestive losses, so fewer calories are needed for equivalent metabolic support.

Question 17

What influences triglyceride levels the most during TPN?

Answer 17

Rate of infusion

Faster lipid infusions increase triglyceride levels due to slower clearance; slower rates result in lower levels.

Question 18

What is the most likely cause of cholestasis in a 28-week infant on TPN for 2 weeks?

Answer 18

Lack of enteral feedings

Lack of enteral stimulation leads to bile stasis and parenteral nutrition-associated cholestasis.

Question 19

When starting TPN for a 26-week 980g infant, start amino acids at: _______.

Answer 19

3 grams per kilo

Amino acids are started at 3–4 g/kg/day to prevent catabolism in preterm infants.

Question 20

What can Vitamin A deficiency cause?

Answer 20

Blindness

Vitamin A deficiency is the leading cause of preventable blindness in children due to its role in visual and epithelial health.