CPS Fetus & Newborn

Question 1

Name 3 risk factors for neonatal brachial plexus palsy.

Answer 1

• Humeral fracture, clavicle fracture, shoulder dystocia
• Maternal diabetes, forceps or vacuum assisted delivery, episiotomy, fetal or birth asphyxia, macrosomia (>4.5kg) and LGA

Question 2

Which types of brachial plexus injuries have higher rates of spontaneous recovery?

Answer 2

Type I & II = Classic Erb’s (C5-6), Extended Erb’s (C5-7)
I: Absent shoulder abduction, ext. rot., elbow flex., and forearm supination
II: As above + absence of wrist and digital extension

Question 3

At what time point should a nerve repair be considered for infants with brachial plexus injury?

Answer 3

Overall, the current evidence overwhelmingly supports nerve repair for infants with deficits as early as 3 months, with low rates of reported adverse events.

Question 4

What might be considered in the differential diagnosis for neonatal brachial plexus injury?

Answer 4

Differential diagnoses to be considered include: pseudoparesis (i.e., pain secondary to humeral fracture or to an infection of the bone, joints, soft tissue, or vertebra); myotonia congenita (a form of arthrogryposis multiplex congenita (AMC)); anterior horn cell injury (e.g., congenital cervical spinal atrophy, congenital varicella syndrome); and pyramidal tract or cerebellar lesions

Question 5

When should an infant with brachial plexus palsy be referred for specialist assessment?

Answer 5

If they have incomplete recovery of any upper extremity movement at 1 month; this suggests nerve injury beyond neuropraxia
-Specialist team should include: PT/OT, and surgery (plastics/ortho)

Question 6

What are the features of a classic Erb’s palsy (C5-C6)?

Answer 6

Absent shoulder abduction, external rotation, elbow flexion, and forearm supination (Waiter’s tip)

• Biceps reflex absent
• Palmar grasp present

Question 7

What are the features of a C5-T1 palsy?

Answer 7

Total palsy; complete flaccid paralysis (flail extremity) involving all plexus roots
Can occur with Horner’s/oculosympathetic paresis (miosis, ptosis, ipsilateral facial anhidrosis which indicates sympathetic chain involvement
Can also have phrenic n. palsy and elevated hemidiaphragm

Question 8

What is the criteria for cooling in an infant with HIE?

Answer 8

• Term and late preterm (≥36 weeks GA) with HIE who are ≤ 6 hours old and meet treatment criteria for A OR B, and also meet criteria C
  
  • A: cord pH ≤ 7.0 or base deficit ≥-16, OR
  • B: pH 7.01 to 7.15 or base deficit -10 to -15.9 on cord gas or blood gas within 1 hour AND
    
    • history of acute perinatal event (such as cord prolapse, placental abruption, or uterine rupture) AND
    • Apgar score ≤5 at 10 minutes or at least 10 minutes of PPV
  • C: evidence of moderate-to-severe encephalopathy, demonstrated by the presence of seizures OR at lease one sign in three or more of the six categories shown below

Question 9

What are the contraindications to cooling in HIE?

Answer 9

Moribund infants or with major congenital/genetic abnormalities where no aggressive tx is planned
Severe IUGR
Infants with clinically significant coagulopathy
Infants with evidence of severe head trauma or intracranial bleeding
Relative contraindication may be isolated intracranial bleeding

Question 10

What is the transfusion threshold for a premature infant in the first week of life on support?

Answer 10

115g/L

Question 11

What is the transfusion threshold for a premature infant in the first week of life NO support?

Answer 11

100g/L

Question 12

What is the transfusion threshold for a premature infant in the second week of life on support?

Answer 12

100g/L

Question 13

What is the transfusion threshold for a premature infant in the second week of life NO support?

Answer 13

85g/L

Question 14

What is the transfusion threshold for a premature infant in the third week of life NO support?

Answer 14

75g/L

Question 15

What is the transfusion threshold for a premature infant in the third week of life on support?

Answer 15

85g/L

Question 16

When should a premature infant in the NICU receive the rotavirus vaccine?

Answer 16

At 6 weeks of chronological age but not later than 8 months at or following D/C (weight in hospital vaccine with risk of shedding in NICU)

Question 17

What is Denys Drash Syndrome?

Answer 17

AbN kidney function (cong. nephropathy), B/L Wilms tumour, D/O of sexual development in males (N genitalia in females)
-Onset of proteinuria in infancy progresses to nephrotic syndrome and ESRD by 3 years of age

Question 18

What is WAGR?

Answer 18

Wilms tumor, aniridia, GU malformations, retardation

Question 19

How is granulation tissue at the umbilical stump managed?

Answer 19

Silver Nitrate cautery

Question 20

What supplement should a vegan mom be taking if breastfeeding?

Answer 20

Vitamin B12

-Also at risk for Iron and Zinc deficiency but this is less common

Question 21

How can you differentiate Klumpke’s from Erb’s palsy?

Answer 21

Klumpke’s C8/TI
-Biceps reflex intact
-Absent grasp reflex
Compared to Erb’s: biceps reflex is absent, palmar grasp present

Question 22

A 1 day old infant has a glucose of 2.1 and is jittery. What do you give to treat?

Answer 22

D10W bolus 2mL/kg over 15 min and check blood glucose after 30 min

Question 23

How long after delivery is an infant at risk for perinatal transmission of HSV?

Answer 23

6 weeks

Question 24

What are the indications for infant ROP screening?

Answer 24

• <31 weeks regardless of BW
• BW <1250g
• Any more mature infants believed to be at high risk of ROP

Question 25

When should ROP screening start?

Answer 25

Infants born @ 22-27 weeks: 31 weeks corrected, for everyone else: @ 4 weeks of life

Question 26

You diagnose an infant with neonatal pustular melanosis. What do you tell the parents?

Answer 26

Pustules generally last 2-3 days and hyperpigmented macules often persist for several weeks to months. No Rx required. Lesions self-resolve.

Question 27

You diagnose an infant with erythema toxicum. What do you tell the parents?

Answer 27

No treatment is needed. Lesions self-resolve, generally in 5-14 days.

Question 28

A baby has seborrheic dermatitis (Cradle Cap). How do you treat it?

Answer 28

Treatment is not required. Scales from scalp can be removed with mineral oil and soft toothbrush.

Question 29

What do you expect on an pre and post ductal PaO2/SaO2 for an infant with PPHN?

Answer 29

Post ductal PaO2 will be lower due to R to L shunting through the ductus

Question 30

Should preterm infants be immunized based on corrected or chronological age?

Answer 30

Chronological

Question 31

What are the benefits of delivering surfactant to neonates?

Answer 31

Decrease need for ventilation support, risk of pulmonary air leak, increased likelihood of survival w/o BPD

Question 32

Who should receive surfactant?

Answer 32

Infants with RDS whose O2 requirements exceed FiO2 0.5, and early surfactant should be given for infants with increasing severity of RDS. May also be considered in MAS, pulmonary hemorrhage.

Question 33

What anatomical anomalies are associated with an elevated maternal AFP?

Answer 33

Neural tube defects (ex. spina bifida, anencephaly)
Omphalocele
Gastroschisis

Question 34

What other anatomical anomaly is associated with gastroschisis?

Answer 34

Intestinal atresia - it is NOT associated with extraintestinal anomalies.

Question 35

What is in your differential diagnosis for late onset hemorrhagic disease of the newborn?

Answer 35

Cholestasis: malabsorption of Vit K (biliary atresia, *cystic fibrosis, hepatitis)
Abetalipoprotein deficiency
Idiopathic in Asian breastfed infants
Warfarin ingestion

Question 36

A mother has a baby with a history of meningomyelocele and is now planning for her next pregnancy. What do you recommend?

Answer 36

For women with a family history of NTD or other health complications, the SOGC recommends increasing dietary intake of folate-rich foods and daily supplementation with multivitamins (including 5 mg of folic acid) at least three months before conception and continuing 10 to 12 weeks postconception.