Admission to NICU

Question 1

3 DDxs for neonatal resp distress [3]

Answer 1

• Transient tachypnoea of Newborn (TTN)
• Sepsis
• Meconium Ileus via aspiration

Question 2

What is TTN? [1]

Clinical features [4]

Answer 2

Transient tachypnoea of new born due to delay in clearance of foetal lung fluid
More common in C-section as birth canal doesn’t push out

• First few hours of life
• Grunting, Tachypnoea
• Increased oxygen requirement
• Normal blood gas

Question 3

How can you test [2] for and treat TTN [5]

Answer 3

CXR can spot the fluids & hyperinflation

Self limiting - 24-48 hours 
Abx
Fluids
O2
Airway support

Question 4

Risk factors of Meconium Aspiration? [4]

Answer 4

LBW
Post due date, Difficult labour
Foetal distress / hypoxia
Maternal DM, hypertension

Question 5

How would meconium Aspiration present? [7]

Answer 5

Cyanosis, Floppiness
Low APGAR score
High work of breathing + grunting
Apnoea, respiratory distress
Pneumonitis (if aspiration occurred before/during delivery)
Green/yellow amniotic fluid
Meconium staining of neonate on skin, nails

Question 6

What would do if you suspect meconium aspiration? [3]

Answer 6

Blood gas
CXR - hyperinflation, flat diaphragm & patchy, atelectasis
Septic screen jic

Question 7

Whats in a septic screen? [5]

Answer 7

FBC, U&Es, urine dipstick 
Glc
Blood culture, urine culture
CXR
LP

Question 8

How do you treat meconium aspiration? [5]

Answer 8

Endotracheal suction meconium
Intubate & ventilate
IV fluids & Abx
Surfactant
Inhaled NO 
ECMO if all else fails

Question 9

Any complications of meconium aspiration? [4]

Answer 9

Persistant Pulm HTN of Newborn (PPHN)
Infection
Surfactant dysfunction
Airway obstruction

Question 10

How can you treat neonatal hypoglycaemia? [5]

Answer 10

Enteral Feeds
IV 10% glc
Fluids
Glucagon
Hydrocortisone

Question 11

Birth Asphyxia is a serious problem in which low O2 at birth –> Multiorgan failure. What could cause it? [5]

Answer 11

• Placental problems
• Cord Prolapse
• Infection
• Neonatal Airway abnormality, anaemia
• Long, difficult delivery

Question 12

What are the phases of birth asphyxia? [2]

Answer 12

Stage 1 = cell damage occurring within minutes of no oxygen

Stage 2 or latent phase = reperfusion injury due to toxins from damaged cells (Days or weeks)

Question 13

How do you classify birth asphyxia? [3]

What is secondary phase of birth asphyxia and what does it lead to? [3]

Answer 13

Mild
Mod
Severe

Delayed injury
Secondary energy failure
Leads to hypoxic ischaemic encephalopathy

Question 14

How do you manage a baby with birth asphyxia? [5]

Answer 14

Treat seizure
Cardiac and respiratory support (O2, airway support), Fluid resus
Monitor renal and liver function
Therapeutic hypothermia
Cranial USS, MRI at 7-10 days, Neuro f/u

Question 15

Diaphragmatic hernias
Epidemiology [1]
L or R more common?
Associated with [2]

Answer 15

Male > Female

Mostly left

Also associated with pulm hypoplasia
Can be part of a syndrome

Question 16

How do you manage a diaphragmatic hernia? [3]

Answer 16

Intubate at birth
Resp support (O2, ventilation, ECMO)
Surgery

Question 17

What is Persistant Pulm HTN of Newborn (PPHN)

Answer 17

Failure to change from antenatal circulation to normal circulation resulting in hypertension

Question 18

What are the RF for hypothermia [2]

Management of newborn hypothermia [2]

Answer 18

Premature, LBW
Prolonged resus

Heated oxygen + incubator
Dry quicker warm towel and radiant heater

Question 19

What does hypothermia lead to [3]

How do you investigate hypothermia [3]

Answer 19

Increased energy and oxygen
Decreased surfactant
Metabolic acidosis as perfusion decreased

Sepsis screen
TFT
Blood glucose

Question 20

Neonatal seizures causes [7]

Answer 20

HIE secondary to hypoxia / birth asphyxia / resp difficulties
Infection
Metabolic distubance: Decreased glucose, Ca, Mg, Increased Na
Intracranial haemorrhage
Neonatal withdrawal
Kernicterus

Question 21

Features of neonatal seizures [3]

Answer 21

Most common 12-48 hours after brith
Generalised or focal
Tonic, clonic, myoclonic

Question 22

How do you treat neonatal seizure [7]

Answer 22

ABC
Treat underlying cause eg infection
Treat seizure if prolong or repeated
Cardio and respiratory support 
Monitor renal and liver function 
Fluid resus
Therapeutic hypothermia 
Follow up neurodevelopment

Question 23

Causes of neonatal hypotonia [9]

Answer 23

Sepsis
Hypothyroid
Prader-WIlli / Downs 
Maternal drugs 
HIE
Cerebral palsy 
Spina bifida
Maternal Myasthenia gravis
Spinal muscular atrophy 

DMD - but doesn’t present till later

Question 24

What are surgical causes of admission [5]

Answer 24

Oesophageal atresia
Duodenal atresia
Failure to pass stool
Abdominal wall defect
Diaphragmatic hernia

Question 25

Cyanosis in the neonatal period: peripheral

Cause

Answer 25

Peripheral cyanosis, for example of the feet and hands, is very common in the first 24 hours of life
- may occur when the child is crying or unwell from any cause

Question 26

What is acrocyanosis?
Cause?
How to differentiate from peripheral cyanosis?

Answer 26

Acrocyanosis is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet). It is a common finding and may persist for 24 to 48 hours.

• It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition [4].
• DDX: it occurs immediately after birth in healthy infants.

Question 27

How do we recognize central cyanosis?

Investigation of choice

Answer 27

Central cyanosis: concentration of reduced haemoglobin in the blood exceeds 5g/dl

The nitrogen washout test (also known as the hyperoxia test) may be used to differentiate cardiac from non-cardiac causes.

• The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken.
• A pO2 of less than 15 kPa indicates cyanotic congenital heart disease