19 Neonatology 3

Question 1

How does the heart develop in infants?

Answer 1

begins to develop towards the end of the third week
Heart starts to beat at the beginning of the fourth week
Critical period of heart development is from day 20- day 50 after fertilisation

Question 2

What is the job of the ductus arteriosus in a fetus?

Answer 2

Protects lung against a circulatory overload
Allows the right ventricle to strengthen
Carries low oxygen and saturated blood

Question 3

What is the job of the ductusvenosus?

Answer 3

Foetal blood vessel connecting the umbilical vein to the IVC

Blood flow regulated via sphincters carries mostly oxygenated blood

Question 4

What are the normal vital signs of a newborn?

Answer 4

BP- 70/40
RR- 30-60
HR- 120-160BPM

Question 5

How do babies thermoregualte themselves?

Answer 5

Newborn babies lack shivering thus need metabolic production of heat
Brown fat is well innervated by sympathetic neurons and cold stress leads to lipolysis an heat production

Question 6

How do babies lose heat

Answer 6

If the environment around them is cold
When exposed to moving air
Evaporation from water on the skin
Heat loss to the surfaces the babies lie on

Question 7

How can you assess if a baby is breathing?

Answer 7

Difficult to assess spontatneous breathing
Research rather than clinical devices
Blood gas
Flow volume loo
Capnogrpahy

Question 8

What is physiological jaundices complications?

How are they treated?

Answer 8

Appears on the 2nd to 3rd day of life. Lasts until the 10th

At high concentrations bilirubin can lead to kernicterus
Blue light converts bilirubin to water soluble form and increase oxidation

other main therapy is exchange transfusion

Question 9

How is fluid balance affected in premature infants?

Answer 9

less body fat
Increased kidney loss due to reduced GFR, reduced Na reabsorbtion
Decreased ability to concentrate or dilute urine
Increased insensible water loss

Question 10

What is meant by the term physiological anaemia of the newborn?

Answer 10

RBC production is 10% of in uterus
Increased eryropoetin production as baby matures in the womb

Premature babies are born with reduced erythropoesis
Can also have anemia through infection or blood letitng

Question 11

What is the threshold for hypoglycaemia?

Who is at risk of hypoglycaemia?

Answer 11

Blood sugar less than 2.0 mmol/l

Premature babies
Perinatal stress
Macrosomnia/trimming syndrome 
Hypothermia
Sepsis

Question 12

What are the signs of hypoglycaemia

Answer 12

Jittireness

Temperature instability

Lethargy

Poor feeding

Question 13

What are the adverse outcomes of hypoglycaemia?

Answer 13

Seizures

Apnoea, irregular breathing

Vomiting

Question 14

Why do babies get cold?

Answer 14

Lose heat through evaporation
Lose heat through conduction (the material they lie on)
Convection- Lose heat from draughts
Radiation- loss hear from cold things in the vicinity

Question 15

How do you resuscitate a baby?

Answer 15

Dry quickly

Remove wet lines

Use warm towels blankets and put on a hat

ABC

Question 16

Why is breast feeding good?

Answer 16

Less risk of leukaemia

Allergy development is reduced

Increased antibodies

Form microbiome (skin to skin)

More sustenance

Question 17

What is heamorrhagic disease of the newborn?

Answer 17

Babies are born vitamin K deficient

Without Vitamin K they would get large GI bleeds and intracranial bleeds

Give Vit K injection

Question 18

Green vomiting equals?

Answer 18

Obstruction until proven otherwise

Bilious vomiting

Question 19

What areas do retractions occur in laboured breathing?

Answer 19

Subcostal

Sub sternal

Intercostal

Suprasternal

Question 20

Discuss cleft lips?

Answer 20

Failure of the maxillary and medial nasal processes to fuse

Associated with cleft palate

Do ECHO and hearing test

Question 21

What do you look for in the baby’s eyes when they are born?

Answer 21

Cataracts- lens opacification, if undirected leads to blindness

Retinoblastoma- rare eye cancer which is treated successfully if picked up early

Both present with loss of red eye reflex

Question 22

What is pseudomenstraution?

Answer 22

Baby gets menstrual bleeding after oestrogen withdrawl

Question 23

What’s us urate?

Answer 23

Crystals in the babies urine, look orange. Can be mistaken for blood

Question 24

What is a suspicious spinal dimple

Answer 24

If the dimple is large,

off midline,

high or with other cutaneous maker (e.g. hairy tuft)

Go onto do spinal imaging

Question 25

What are cephaloheamatomas?

Answer 25

Bilateral swelling on one ore both sides of the head

Caused by heamorrhage beneath the pericardium

Not to do with intercranial bleeding, will resolve within a week

Question 26

What are talipes?

Answer 26

Club foot

Can you manipulate feet? Is it fixed? Manipulated- physio Fixed- ortho

Babies with significant talipes may have DDH

Question 27

What is developmental dysplasia of the hip?

Answer 27

Slipping of the acetabulum?

Can either be dislocated

Higher risk in girls and newborns

Question 28

What tests do yiu do for developmental dysplasia of the hip?

Answer 28

Barlows Test- hands on babies knees, bring into midline, push backwards. Does hip dislocate

Ortolans Test- do straight after, put hand on femoral head and abduct hip. If hip did dislocate then it will pop back in

Question 29

How do you treat DDH?

Answer 29

Pavlik harness- left on for 6 months and not taken off

Need surgery if it doesn’t resolve