Neonatal

Question 1

What are the Hb levels in infants?

Answer 1

17 at birth. Dips to 9 at 2m, back up to 12 by 1y

Question 2

What investigations would you perform in a jaundiced infant who is 12 hours old?

Answer 2

TORCH screen
Direct Coombs’ test
Bloods: cultures (check for GABHS), FBC, CRP, bilirubin (+split), LFTs, BLOOD GROUP, U+E (dehydration)

Question 3

Causes of conjugated jaundice?

Answer 3

Biliary atresia

Sepsis

Question 4

How is haemolytic disease treated?

Answer 4

IV immunoglobulins

Question 5

At what age should a term baby and a preterm baby be investigated for jaundice?

Answer 5

Term - 14d

Preterm - 21d

Question 6

What acid-base imbalance might you see in birth asphyxia?

Answer 6

Metabolic acidosis

Question 7

What are the symptoms of HIE?

Answer 7

Mild - staring eyes, irritable, poor feeding
Mod - tone & movement abnormalities, no feeding, seizures
Severe - no movement, seizures, multi-organ failure

Question 8

Why does resus incompatibility not present with the first pregnancy?

Answer 8

1st preg –> IgM production, cannot cross placenta

2nd preg –> IgG

Question 9

What are the potential antenatal findings of Rh incompatibility? What might you see on DCT?

Answer 9

Foetal anaemia, hydrous fetalis.

DCT –> agglutination of RBCs (same with ABO)

Question 10

Which type of haemolytic disease is more common?

Answer 10

ABO incompatibility

Question 11

When might you see Heinz bodies?

Answer 11

G6PD deficiency

Question 12

What metabolic concerns might you have with premature babies?

Answer 12

Hypoglycaemia, hypocalcaemia, E- imbalances, osteopenia

Question 13

What antenatal management can you do for a premature baby?

Answer 13

Tocolytics - suppress labour
Maternal corticosteroids (e.g. dex) if <34w

Question 14

What postnatal management can you do for premature babies?

Answer 14

Delayed cord clamping - 1 min
Put in plastic bag - prevent hypothermia
CPAP, ETT surfactant, intubation
Maintain BM - TPN

Question 15

What is a protective factor against NEC?

Answer 15

Breast milk

Question 16

What are the Sx of NEC?

Answer 16

Poor feeding, distension, bloody stools, bile stained vom

Question 17

What cells produce surfactant?

Answer 17

Type 2 pneumocytes

Question 18

What is chronic lung disease in neonates?

Answer 18

Any baby requiring O2 past 28d of life. Ventilation –> long term damage

Question 19

What are potential signs of IUGR?

Answer 19

Low growth parameters
Low amniotic fluid vol
Low foetal movements

Question 20

How can you assess for IUGR antenatally?

Answer 20

Doppler of umbilical A

Doppler middle cerebral A - blood flow redistribution to brain, away from other organs

Question 21

What defines low birth weight?

Answer 21

<2.5kg