Neonatal 2

Question 1

What does an APGAR consist of? and what’s a normal score/

Answer 1

Appearance 
Pulse
Grimace (reflex irritability)  
Activity (muscle tone) 
Respiratory rate 

Normal score is 7-10

done at 1,5 and 10 minutes

Question 2

What are the symptoms of hypoglycaemia in a new born and what are some causes?

Answer 2

<2.6mmol in neonate

Hypotonia 
Lethargy 
Jittery 
Seizures 
Spells of Apnea 

Causes:

• maternal diabetes
• low glycogen store (restricted growth)

Treatment:
- 2.5ml/kg Dextrose 10%
followed by infusion

Question 3

What is the aimed for blood glucose levels in a neonate?

Answer 3

2.6mmol

Question 4

List some risk factors for SIDS and some things that can be done to reduce the risk:

Answer 4

Sleeping on front
Smoking (maternal, around baby)

Reducing risk:

• sleep on back
• remove pillows
• Avoid over heating
• breast feed

Question 5

Why is female virtualisation very important to check in a newborn?

Answer 5

Can be a sign of congenital adrenal hyperplasia which can result in adrenal crisis as they don’t produce glucocorticoids

Question 6

If there is a positive Barlow and Ortonlani what is the next investigation?

Answer 6

Ultrasound

Question 7

What are the main causes of cyanotic heart disease?

Answer 7

1. Truncus arteries
2. Transposition of great vessels
3. Tricuspid Atresia
4. Tetrology of Fallot
5. Total anomaly of pulmonary venous return

*this is not order, just numbers help remember

Question 8

In a jaundice baby what bloods do you want?

Answer 8

Conjugated bilirubin/ total bilirubin 
Direct Coombs test 
FBC 
Reticulocytes 
Blood film 
G6PD screen 
\+
Infection screen

Question 9

What two main question do you want to ask a mother of a baby who is >2 weeks old with jaundice?

Answer 9

Pale stools?
Dark urine?

*helps establish biliary atresia

Question 10

How often should a baby be feeding?

Answer 10

Every 3-4 hours

Question 11

Is subconjunctiva haemorrhage normal in a new born?

Answer 11

Yes this can be completely normal

- needs documentation in the red book though

Question 12

What is the rash called which is benign and looks like little bits of pus underneath the skin?

Answer 12

Erythema toxicum

- baby acne

Question 13

What is the most common organism to cause early onset neonatal sepsis and what are some other common organisms?

Answer 13

Group B strep - Strep Agalalatie

E.Coli

Listeria monocytogenes

Question 14

List the common risk factors which suggest neonatal sepsis: and what should be done if one of these risk factors is identified?

Answer 14

Preterm birth

Maternal colonisation of Group B strep

Rupture of membranes > 18 hours

Maternal fever

Previous Group B infection in a baby from previous birth

Risk factor:

• start prophylaxis antibiotics - IV Benzylpenicillin
• Perform examination and investigations into infections

Question 15

What is the main x-ray feature of respiratory distress feature in the newborns?

Answer 15

Ground glass appearance

Question 16

Why is physiological jaundice so common in neonate?

Answer 16

Higher about of Hb

RBC has 70 day overturn

Liver enzyme immaturity

*some 60% of babies have jaundice

Question 17

When does biliary atresia need to be operated on by?

Answer 17

< 6 weeks

Question 18

What investigations should be done into a jaundice baby <24 hours old? and what are the side effects of UV phototherapy?

Answer 18

Bloods:

• Bilirubin level (conjugate/ unconjugated?)
• FBC - anaemia/ infection?
• Blood cultures - infection?
• Direct coombs test

Side effects of UV:

• retinal damage (should be covered)
• insensible fluid loses
• removed from mother
• diarrhoea

Question 19

What are the signs of respiratory distress of the newborn?

Answer 19

Cyanosis
Grunting
Sub-costal recession
Poor feeding

Question 20

When taking sats of a baby - where do you take them and why?

Answer 20

Right arm
- it is pre-ductus arterioles and thus gives you sats occurring in the lungs.

Often you can do a pre- and post ductus sats

Question 21

List some causes of a floppy baby:

Answer 21

Central nervous system:

• HIE
• Trisomy 21
• CNS infection
• Metabolic disease
• SMA
• hypoglycaemia

Peripheral nervous system:

• Congenital Myasthenia gravis
• Duchene muscular dystrophy
• Amino-glycoside toxicity

Question 22

What are the complications of Down’s syndrome?

Answer 22

Early:

• Congenital heart disease (AVSD)
• Hirschsprung
• Duodenal atresia
• hypothyroidism

Later:

• ALL
• Early onset Alzheimer’s
• Learning difficulties
• Epilepsy
• Conductive hearing loss
• Alanto-axial instability

Question 23

What are some of the features of hypothyroidism in a baby and what investigations are important?

Answer 23

Symptoms:

• poor feeding
• lethargy
• constipation
• prolonged jaundice

Features:

• Macroglossia
• coarse facies
• hypotonia
• Bradycardia
• goitre

Investigations:
*Guthrie test should of picked up if low TSH then:

• TFTs
• Nuclear scan of thyroid (to assess exact type)
• Pure tone audiometry (many develop sensory neuro hearing loss) - Pendred syndrome

Treatment:

• levothyroxine (started before 14 days ideally)
• follow up to assess growth and TFTs

Question 24

What is the most common enzyme defect in congenital adrenal hyperplasia? what are the two main presentations of adrenal hyperplasia?

Answer 24

21- hydroxylase deficiency

2 main presentations:
- salt losing crisis - seen in neonates

• Virilisation of females
• precocious puberty in males