Neonatal

Question 1

Birth injuries

Answer 1

Brachial plexus palsy (waiter tip/ Erb)
C4-6: grasp intact ass with ipsilateral diaphragmatic hernia

Klumpke palsy (claw hand) C7-T1: no grasp, ass with horner syndrome

Clavicular fracture: Unilateral moro reflex

Caput succedaneum: cross suture line, diffuse edema

Cephalohematoma: ass with skull fracture (parietal mostly), doesn’t cross suture line , can cause jaundice

Question 2

Normal Neonatal Findings:

Answer 2

1- lanugo hair
2- Epstein pearls
3- Mongolian spot
4- Milia (inclusion cyst)
5- neonatal acne (high maternal androgen)
6- congenital torticollis
7- hemangioma (doesn’t appear at birth)
8- Salmon patch (Bilateral)
9- Erythema toxicum: yellow-white papules with red base (contain eosinophil)
10- Breast engorgement and galactorrhea (maternal prolactin)
11- mastitis neonatorum
12- vaginal bleeding (estrogen withdrawal)

Question 3

Neonatal findings that need treatment

Answer 3

1- Cystic hygroma: macrocystic lymphatic malformation, ass with turner or noonan syndrome
2- Port wine stain (Sturge Weber): Unilateral, ass with intracranial extension
3- Impetigo or Pyoderma neonatorum

Question 4

Neonatal findings ass with other diseases

Answer 4

1- Aniridia , hemihypertrophy, Beckwith Weidman, need periodic renal US ass with Wilms tumor
2- Coloboma (hole in the eye) ass with charge syndrome : Coloboma, Heart defects, Atresia of nasal choanae, Retardation of growth or development, Genitourinary abnormalities, Ear deafness
3- periauricular tag/pit: sometimes with hearing loss or genitourinary anomalies (Renal US)
4- Bifid Uvula: submucus cleft palate
5- Single Umbilical artery: 75% normal but 25% may be ass with cardiac (M.C do ECHO), GI, Renal, skeletal
6- leukocorea: MCC retinoblastoma
*** chlamydia conjunctivitis doesn’t cause leukocorea

Question 5

Diaphragmatic hernia

Answer 5

M.C left side
Bochdalik (pleuroperitoneal fold)
Morgagni (space of larry)
Treatment: Intubation then surgical correction
Suspect when cyanosis and RD become worse with face mask

Question 6

Most common postop comp of gastroschisis and omphalocele surgical correction

Answer 6

Prolonged ileus so patient need TPN

Question 7

Phenylketonuria

Answer 7

Defect in phenylalanine hydroxylase enzyme
High Phenylalanine low Tyrosine
Accumulation of phenylalanine in CNS
Normal at birth
Seizure, microcephaly, hyperactive, blue eyes, fair skin, mental retardation, eczema, musty odor of sweat and urine
Tx: phenylalanine free diet, no breastfeeding

Question 8

Galactosemia

Answer 8

AR
Deficiency in galactose 1 phosphate uridyl transferase

Hypoglycemia, direct jaundice, liver failure, E.coli sepsis, hepatomegaly, catarct, mental and growth retardation

Dx: reducing substances in urine, increase G1P
Tx: lactose free diet and no breastfeeding

Question 9

Phototherapy

Answer 9

For indirect hyperbilirubinemia only

Bronze baby syndrome if direct

Question 10

Neonatal sepsis

Answer 10

MCC GBS
Tx penicillin & aminoglycoside
If meningitis vanco & 3rd gen cephalosporin

Question 11

Developmental milestones

Answer 11

Page 18

Question 12

Physical growth

Answer 12

Weight double at 4 months and triple at 1 year
Height double at 4 years
1st year +25cm
2nd year +12 cm
Triple at 12 years
HC: 1st year +12 cm

Posterior fontanelle closes at 0-6 months
Anterior fontanelle close at 14-18 months
Causes of late closure: hydrocephalus, hypothyroidism, down, rickets

Question 13

RDS

Answer 13

Hypoxemia labs: hyapercapnea & respiratory acidosis
Cxray: ground glass appearance, atelactasis
Tx PEEP OR CPAP , best (surfactant)

Question 14

TTN

Answer 14

MCC of RD in newborns
Pathophysio: persistent pulmonary fluid after delivery
Self limited

Question 15

Direct jaundice causes

Answer 15

1- biliary atresia (appear after 1 week)
2- galactosemia
3- choledochal cyst
4- tyrosinemia
5- cystic fibrosis 
6- TPN
7- sepsis
8- TORCH
9- hypothyroidism

Question 16

Indirect jaundice causes (pathological)

Answer 16

1- RH or ABO incompatiblity
2- polycythemia
3- prematurity
4- TTTS
5- infant of DM Mother
6- IUGR
7-genetic hemolytic anemia( G6PD, pyruvate kinase def, spherocytosis, elliptocytosis)

Question 17

NEC

Answer 17

Transmural intestinal necrosis (mostly affect ileum and ascending colon)
Major risk is prematurity
Other RF: polycythemia, umbilical artery catheterization (exchange transfusion), enteral feeding esp if rapid (formula) **breast milk is protective, blood transfusion, asphyxia, CHD, drugs (theophylline, NSAID)

S&S: bloody stool, abd distension
Abd xray: pneumonia intestinalis
Labs: low WBC , dec platelets, metabolic acidosis
Comp: sepsis (E.coli), bowel necrosis, perforation
Signs of perforation: abd wall erythema, gas in portal vein, thrombocytopenia
Tx: stop enteral feeding , IV fluid and electrolyte correction, ab, NG tube, surgery if perforation

Question 18

Neonatal seizure causes

Answer 18

MCC 1- hypoxic Ischemic encephalopathy 
2- Intraventricular intracranial hmg
3- hypoglycemia, hypocalcemia, hypomagnesmia, hypo or hypernatremia
4- vit b6 def (pyrodoxine)
5- some Inborn errors of metabolic disorders
6- maternal drug abuse
7- neurocutaneous disease
8- kernicterus
9- lidocaine toxicity
10- TORCH, meningitis or encephalitis 

MC TYPE subtle seizure abnormal eye or mouth movements, apnea, pedaling, tonic posture of limbs

Tx: 1st benzo (diazepam, lorazepam) then phenytoin or phenobarbital

Question 19

TORCH

Answer 19

P 28