Early Life Events

Question 1

First breaths

Answer 1

• Push fluid away from airway and alveoli
• Establish resting lung volume
• If not breathing use inflation breaths (five 2-3 second breaths)

Question 2

Resuscitation of the preterm infant

Answer 2

• Room temp >25^oC
• Delayed cord clamping 60 seconds
• Plastic bags
• Incubation and surfactant <29 weeks gestation

Question 3

Problems of prematurity

Answer 3

• Temperature control
• Fluid balance, feeds and nurtition
• Respiratory distress and chronic lung disease
• Infection
• Necrotising enterocolitis
• Brain haemorrhage and cysts
• Retinopathy of prematurity
• Hearing impairment
• Developmental delay

Question 4

Hypoxic ischaemic encephalopathy

Answer 4

• Low APGARS at 5 minutes
• Metabolic acidosis
• Clinical encephalopathy
• Abnormal CFAM

Therapeutic cooling significantly decreases death and disability!

Question 6

Erb’s palsy

Answer 6

• Brachial plexus injury70% recover
• X-ray clavicle and humerus
• Early physiotherapy review
• Referral to orthopedic surgery
• May result in life long morbidity

Question 7

Caput succedaneum

Answer 7

• Distribution is across suture lines
• Oedema
• Pits on pressure
• Swelling largest at birth
• Disappears within a few days

Question 8

Cephalhaematoma

Answer 8

• Does not cross suture lines
• Can be bilateral
• Not apparent immediately after birth

Question 9

Red reflex

Answer 9

• An abnormal red reflex requires an urgent ophthalmologic opinion as it may represent a cataract or a mass of abnormal tissue

Question 10

Hips

Answer 10

• 5 points:
  
  • History
  • Leg length
  • Groin/buttock creases
  • Range of abduction
  • Tests of stability

NB Dx DDH prevents life long disability

Question 11

Metabolic screening

Answer 11

• Phenyl ketonuria
• Hypothyroidism
• Cystic fibrosis
• Medium chain acyl co enzyme A deficiency (MCCAD)
• Sickle cell disease

Question 12

Neonatal jaundice

Answer 12

• Definition = total serum bilirubin (SBR) >85µmol/l
• Problem SBR >400 may cause kernicterus
• Physiological jaundice (breakdown of RBCs with shortened lifespan) after 24 hours from birth
• Treat with phototherapy

Question 13

Newborn screening

Answer 13

• Phenyl ketonuria
• Hypothyroidism
• Cystic fibrosis
• Medium chain acyl co enzyme A deficiency (MCCAD)
• Sickle cell disease
• HMC, MSUD, GAI, IVA

NB - Infants must have been on milk feeds for at least 48 hours and not had blood transfusion within last 72 hours for tests to be accurate