Common neonatal problems

Question 1

Discuss transient tachypnoea of the new born
-Definition (1)
-Cause (2)
-Diagnosis (2)
-Management (4)

Answer 1

1. Definition
   Incomplete removal of fluid from fetal lungs
2. Causes
   Decreased thoracic squeeze at delivery
   Diminished respiratory effort
3. Diagnosis
   -Signs of respiratory distress: elevated RR, nasal flaring, grunting, chest wall retraction
   -CXR with streaked appearance, fluid in horizontal fissure
4. Management
   -Monitor oxygen sats and blood gases
   -CPAP if increased WOB
   -Oxygen if O2 sats low
   -Tube feeding to avoid aspiration
   -Consider Abx if concern for pneumonia

Question 2

Discuss neonatal jaundice
-Definition (1)
-Incidence (2)

Answer 2

1. Definition
   -Serum bilirubin levels >50mcgmol/L
2. Incidence
   -60% term babies
   -80% preterm babies

Question 3

Discuss neonatal jaundice
-Causes <24hrs of age (5)
-Causes 24hrs - 2 weeks of age (7)
-Causes > 3weeks of age (3)

Answer 3

1. Causes at <24hrs of age
   -Rh disease
   -ABO incompatibility
   -G6PD deficiency
   -Hereditary spherocytosis
   -Congenital infections
2. Causes 24hrs to 2 weeks of age
   -Physiological
   -Breastmilk jaundice
   -Haemolytic
   -Infection
   -Bruising
   -GI obstruction
   -Metabolic disorders
3. Causes if >3 weeks old
   Can be conjugated or unconjugated
   Unconjugated: Breast milk, hypothyroidism
   Conjugated: Biliary atresia

Question 4

Discuss neonatal jaundice
-Investigations (7)
-Management (4)

Answer 4

1. Investigations
   Check bilirubin level
   -transcutaneous / serum
   -Plot bilirubin level on gestation chart
   -Conjugated vs unconjugated if >3 weeks old
   Assess for cause
   -FBC, CRP, septic screen
   -DCT
   -Metabolic screening
   -Abdominal USS
2. Management
   -Most self resolve
   -Encourage enteral feeding
   -Treat underlying cause - Abx, surgery etc
   -Photo therapy - UV light converts unconjugated bilirubin to harmless isomers

Question 5

Discuss neonatal hypothermia
-Impact of hypothermia
-Signs of hypothermia
-Management of hypothermia

Answer 5

1. Impact of hypothermia
   -Increase O2 demand and energy consumption leading to hypoxia, metabolic acidosis, hypoglycemia
2. Signs of hypothermia
   -Cool extremeties
   -Vasoconstriction
   -CNS depression
3. Management
   -Keep baby warm and dry with clothing, skin to skin, incubator

Question 6

Discuss neonatal hypoglycemia
-Definition (1)
-Incidence (2)
-Causes (3 groups)
-Neurodevelopmental consequences (1)

Answer 6

1. Definitions
   - <2.6mmol/L
2. Incidence
   -2:1000
   -Most common cause of term babies admission to NICU
3. Causes
   -Increased glucose usage (hypothermia, sepsis, acidosis, HDN)
   -Reduced glucose storage - IUGR, prematurity
   -Inhibition of glucose breakdown - maternal beta blockers
4. Neurodevelopmental consequences - 3.5 times higher chance of CP

Question 7

Discuss neonatal hypoglycemia
-Signs (6)
-Who to screen (6)
-Treatment

Answer 7

1. Signs
   Jitteriness, apnoea, hypothermia, poor tone, lethargy, seizures
2. Who to screen
   <10th centile, <2.5kg,
   >95th centile, >4.5kg
   Infants with diabetic mothers
   Preterm babies
   Unwell babies
   Babies who are symptomatic of hypoglycemia
3. Treatment
   Manage hypothermia
   Treat underlying cause
   Commence oral feeding
   Give dextrose gel if BSL 1.2-2.5
   Give IV dex if BSL <1.2 or no improvement with PO management

Question 8

Discuss neonatal infection / Sepsis
-Types (2)
-Causes of each type (3 for each type)
-Common causative agents (3)

Answer 8

1. Types
   Early onset sepsis <72hrs
   -Transplacental - CMV, VZV, Rubella, Parvo
   -Chorioamnionitis - GSB, E.coli
   -Birth canal - GBS, Chlamydia, HVS, Hep B&C
   Late onset sepsis >72hrs
   -Nonsocomial
   -Community acquired
   -Birth canal
2. Common causative agents
   -Strep
   -Staph
   -E.coli

Question 9

Discuss risk factors for early onset sepsis (6)

Answer 9

-Prematurity
-LBW (1.5kg)
-PROM / PPROM
-Fetal distress without adequate explanation
-Maternal fever
-Foul smelling amniotic fluid or baby

Question 10

Discuss developmental hip dysplasia
-Incidence (1)
-Definition (1)
-Diagnosis (2)
-Management (3)

Answer 10

1. Incidence
   -1-2:1000
2. Definition
   -Congenitally shallow hip sockets resulting in a loose femoral head and easy dislocation
3. Diagnosis
   -Barlow and Orotlini’s manouvres
   -USS
4. Management
   -Ortho referral
   -Pavliks harness
   -May require surgery if late Dx or Palviks harness unsuccessful