Healthy, sick, and preterm new-borns

Question 1

when is a baby considered term

Answer 1

37-42 weeks completed gestation

Question 2

when is a baby considered post term

Answer 2

42 weeks

Question 3

what weight should babies be at birth

Answer 3

2.5-4kg

Question 4

if a baby is LGA >4kg (large for gestational age) what can this indicate

Answer 4

gestational diabetes

Question 5

what happens to a babies body weight in the 3rd trimester

Answer 5

gain an large amount of fat - 7g of fat per day in last 4 weeks

Question 6

how much weight is a baby expected to lose in their first few days of life

Answer 6

5-10% body weight

Question 7

what are normal RR, HR and O2 sats of a new born

Answer 7

RR: 40-60 / HR: 120-140 / O2 sats: 95%

Question 8

what initial steps are given to caring for a new born (5)

Answer 8

Apgar score (>8), keep warm, keep fed, skin to skin, emotional attachment

Question 9

what screening tests are given at birth

Answer 9

new-born tip to toe examination, hearing, hip

Question 10

when is the blood spot test given and what does it test for

Answer 10

aged 5: CF, haemoglobinopathies, metabolic diseases, sickle cella anaemia

Question 11

in the head examination what is being observed

Answer 11

OFC (head circumference), suture lines, forceps mark, moulding from vaginal delivery (resolves in 24 hours), cephalmaetoma and caput succedaneum

Question 12

what is a cephalmaetoma and how do you identify it

Answer 12

bleed under the skin, never crosses suture lines, traumatic, not present at birth

Question 13

what is caput succedaneum and how do you identify it

Answer 13

fluid filled sac on skill, crosses suture lines, present at birth, not pathological

Question 14

in the mouth examination what is being observed

Answer 14

philtrum (smooth between lips and nose), palate, neonatal teeth, ebsteins pearls, suck and root reflex

Question 15

in the resp examination what is being observed

Answer 15

chest shape, grunting, breath sounds, tachypnoae

Question 16

in the cardio examination what is being observed

Answer 16

colour, O2 sats, pulses, heaves, thrills

Question 17

in the abdo examination what is being observed

Answer 17

distension, hernia, umbilicus, bile stained vomit

Question 18

in the neuro examination what is being observed

Answer 18

primitive reflexes, tone (floppy baby)

Question 19

what areas need to be examined in the tip-to-toe new born examination

Answer 19

head, eyes, ears, mouth, face, resp, cardio, abdo, GI, neuro, skin and MSK

Question 20

how would you treat haemorrhagic disease as result of an immature liver

Answer 20

Vit K IM

Question 21

what infections do you need to be aware of from a maternal history

Answer 21

Hep B/C, HIV, TB

Question 22

what is hypoxic ischaemic encephalopathy and what test at birth could indicate it

Answer 22

multi organ damage from hypoxia and a poor apgar score

Question 23

what congenital cardiac abnormalities can be seen at birth

Answer 23

tetralogy of fallout, hypoplastic heart, coaction of the aorta

Question 24

what congenital resp abnormalities can be seen at birth

Answer 24

trachea- oseophageal fistula, diaphragmatic disease

Question 25

how do you identify hypoglycaemia in a new born and what can cause it

Answer 25

unwell, hypothermic, low glycogen stores - maternal diabetes

Question 26

what are signs of dehydration in a baby

Answer 26

decreased sin tugor (elasiticity), sunken fontanelles (soft spots), dry skin and mouth, reduced UO, low BP

Question 27

what initial management is needed for a sick new born (5)

Answer 27

Temp, airway and breathing (O2), circulation (fluids and inotropes if low BP), metabolic homeostasis (glucose and acid-base), antibiotics

Question 28

what maternal factors can potentially lead to preterm babies

Answer 28

twins, smoking, teenage mums and 40+, poverty, race (black/ asian)

Question 29

what main problems to preterm babies face (3)

Answer 29

hypothermia, lung problems, nutritional problems

Question 30

how do babies lose heat

Answer 30

convection, evaporation, conduction, radiation

Question 31

why do preterm babies risk hypothermia (4)

Answer 31

low BMR, minimal muscular activity, low sub cut fat, high SA: body mass

Question 32

how are preterm babies at risk of undernutrition

Answer 32

limited fat stores, immature gut, immature metabolic pathway, increased demand

Question 33

what resp problems can preterm babies develop

Answer 33

resp distress syndrome, apnoea, bronchopulmonary dysplasia

Question 34

what causes resp distress syndrome (RDS)

Answer 34

primary pathology: surfactant and structural immaturity / secondary pathology / alveolar damage: exudate from leaky capillaries and inflamm

Question 35

what are symptoms of RDS

Answer 35

tachypnoea, grunting, intercostal recessions, nasal flaring, cyanosis

Question 36

how do you treat RDS

Answer 36

steroids, surfactant, ventilation

Question 37

what infective organisms are likely to cause early onset neonatal sepsis

Answer 37

group B strep, gram -ives

Question 38

what bacteria are likely to cause late onset neonatal sepsis

Answer 38

coag -ive staph, gram -ives, staph A