Neonatal

Question 1

What are the hearing tests used just after birth?

Answer 1

Otoacoustic emissions

Auditory brainstem response

Question 2

Describe how the otoacoustic emission hearing test works

Answer 2

Earphone produces a sound which evokes an echo form the ear if cochlear function is normal

Question 3

Describe how the auditory brainstem response test works

Answer 3

Computer analysis of EEG waveforms in response to a series of auditory stimuli

Question 4

HIE is caused by perinatal asphyxia but what causes that?

Answer 4

Excessive/prolonged contractions
Placental abruption
Ruptured uterus
Umbilical cord compression: prolapse, shoulder dystocia
Material hypo/hypertension
Intrauterine growth restriction

Question 5

How common is HIE?

Answer 5

0.5-1 in 1000 live births

Question 6

What is the neonatal management of HIE?

Answer 6

Respiratory support
Anticonvulsants
Fluid restriction 
Fluids and inotropes for hypotension
Correct hypoglycaemia/hypocalcaemia

Question 7

Describe respiratory distress syndrome

Answer 7

A deficiency in surfactant usually present in the alveoli. Increases surface tension and leads to widespread alveolar collapse and inadequate gas exchange.

Question 8

RDS is very common if the baby is less than …

Answer 8

28 weeks

Question 9

Describe the symptoms of RDS

Answer 9

Within 4 hours of birth:
Tachypnoea
Laboured breathing
Expiratory grunting
Cyanosis

Question 10

What does the CXR of RDS show?

Answer 10

Diffuse granular or ground glass appearance

Question 11

What is the management of RDS?

Answer 11

Raised ambient oxygen
Surfactant therapy - tracheal tube
CPAP or high flow nasal cannula

Question 12

What saturations are we aiming for when treating RDS?

Answer 12

91-95%

Question 13

What can we use to treat apnoea of the newborn?

Answer 13

Caffeine

Question 14

How do we close a patient ductus arteriosus?

Answer 14

Prostaglandin synthetase inhibitor

Ibuprofen

Question 15

When in a infant’s life if NEC must likely to occur?

Answer 15

First few weeks

Question 16

What are the symptoms/signs of NEC?

Answer 16

Feed intolerance
Vomiting
Distended abdomen
Blood in stools

Question 17

What will the abdo X-ray show in NEC?

Answer 17

Distended loops of bowel
Intramural gas
Thickened walls

Question 18

What is the management of NEC?

Answer 18

Nil by mouth - parental feeding

Broad spectrum antibiotics

Question 19

Brain haemorrhages occur in what percentage of low birth weight infants?

Answer 19

20%

Question 20

What imaging do we use for a suspected pre-term brain bleed?

Answer 20

Cranial ultrasound

Question 21

Where is a preterm brain haemorrhage most likely to occur?

Answer 21

Above the caudate nucleus

Fragile blood vessel

Question 22

Interventricular haemorrhage is most common at what point for neonates?

Answer 22

First 72 hours

Question 23

IVH can lead to what Complication?

Answer 23

Cerebral palsy

Question 24

What is bronchopulmonary dysplasia?

Answer 24

Infants with a chronic lung disease that require oxygen at 36 weeks gestation or 4 weeks after birth

Question 25

What does the CXR of bronchopulmonary dysplasia show?

Answer 25

Widespread Opacification | Sometimes cystic changes

Question 26

Why is it important to know if a child has bronchopulmonary dysplasia?

Answer 26

They have worse RSV infections | Need piluvisumab prophylaxis

Question 27

What percentage of newborns will become jaundiced?

Answer 27

50%

Question 28

Why do many infants become jaundiced?

Answer 28

Physiological release of Hb due to breakdown of RBCs RBC lifespan in shorter in infants Hepatic bilirubin metabolism is less efficient

Question 29

If jaundice occurs in <24 hours then it is likely to be caused by ...

Answer 29

Rhea is haemolytic disease ABO incompatibility G6PD deficiency Spherocytosis

Question 30

What type of bilirubin can be deposited in the brain?

Answer 30

Unconjugated

Question 31

What is kernicterus?

Answer 31

Unconjugated bilirubin deposited in the brain causing encephalopathy Occurs when the bilirubin exceeds the binding capacity of albumin

Question 32

What are the causes of jaundice appearing between 24 hours and 2 weeks old?

Answer 32

``` Physiological Breast milk Infection Haemolysis Bruising Polycythaemia ```

Question 33

What are the causes of unconjugated jaundice occurring >2 weeks?

Answer 33

``` Physiological/breast milk Infection Hypothyroidism Haemolysis Upper GI obstruction ```

Question 34

What are the causes of conjugated jaundice >2 weeks?

Answer 34

Bile duct obstruction | Hepatitis

Question 35

How can we treat jaundice in babies?

Answer 35

phototherapy | Exchange transfusion

Question 36

Describe development dysplasia of the hip

Answer 36

Acetabulum is shallow and does not adequately cover the femoral head therefore the joint is easily dislocated

Question 37

What are the risk factors for development dysplasia of the hip?

Answer 37

Breech birth Family hx Female Impaired limb movement

Question 38

What is DDH associated with?

Answer 38

Talipes - club foot

Question 39

What tests are performed for suspected DDH?

Answer 39

Barlow test - pushing backwards will dislocate hip | Ortolani test - a dislocated hip will not abduct fully and clunks as relocates

Question 40

When do we perform an USS if the examination is abnormal in an infant’s hips?

Answer 40

2 week

Question 41

When do we perform an USS if the baby has risk factors but a normal exam of the hips?

Answer 41

6 weeks

Question 42

What is the treatment of DDH?

Answer 42

Harness or splint worn for several months - held in flexion and abduction

Question 43

What factors increase the risk of intrauterine growth restriction?

Answer 43

``` Maternal age <16 or >35 Decreased social economic status Previous small-for-gestational-age baby Maternal substance abuse Heavy physical work during pregnancy Maternal medical disorders Maternal infection Placental dysfunction or Abruption ```

Question 44

How do we define a neonate?

Answer 44

A baby up to 28 days old

Question 45

How do we define a premature baby?

Answer 45

Born <37 weeks gestation

Question 46

Low birth weight is anything under ...

Answer 46

2. 5kg | 5. 5lb

Question 47

Very low birth weight is anything under ...

Answer 47

1. 5kg | 3. 3lb

Question 48

Extremely low birth weight is anything under...

Answer 48

1kg | 2.2lb

Question 49

A high birth weight is anything over ...

Answer 49

4. 5kg | 9. 9lb

Question 50

How many calories does 1 ounce of breast milk contain?

Answer 50

20 calories

Question 51

1 ounce is equivalent to how many millilitres?

Answer 51

30 ml

Question 52

100 ml of formula contains how many calories?

Answer 52

67

Question 53

What is the fluid requirement for a newborn?

Answer 53

150ml/kg

Question 54

What is the daily calorie requirement for a pre-term baby?

Answer 54

110-130 Calories/kg

Question 55

What is the daily calorie requirement for a term baby?

Answer 55

90-120 calories/kg

Question 56

When do we give maternal steroids?

Answer 56

If the baby is likely to be born <34 weeks

Question 57

Why are newborns predisposed to hypothermia?

Answer 57

Poor temperature regulation Lack of subcutaneous tissue Large surface area to volume ratio so lost in evaporation

Question 58

What is the definition of apnoea of prematurity?

Answer 58

The absence of breathing for >20 seconds in a premature baby

Question 59

What are the consequence of apnoea?

Answer 59

Desaturations | Bradycardia

Question 60

What is the management of apnoea of prematurity?

Answer 60

Stimulate the baby | IV or NG caffeine

Question 61

Why are neonates at increased risk of hypoglycaemia?

Answer 61

Lack of glycogen storage in the liver | Lack of fat as alternative ATP supply

Question 62

What is the management of hypoglycaemia in neonates?

Answer 62

IV 10% dextrose | Prevent fluid loss - humidify

Question 63

Why are neonates more predisposed to infections?

Answer 63

Thin skin - thinner barrier Immature immune system Premature babies get less IgG through the placenta as they spend less time in the third trimester

Question 64

When does suckling and swallowing develop?

Answer 64

34-35 weeks gestation

Question 65

NG feeding in a neonate increases the risk of ...

Answer 65

Necrotising enterocolitis

Question 66

When do we have to worry most if jaundice appears?

Answer 66

In the first 24 hours after birth

Question 67

Describe the mechanism of physiological jaundice

Answer 67

HbF has a shorter half life than normal Hb - 90 days - therefore increased haemolysis Low albumin due to low protein levels and immature liver Lack of bacteria in bowel for conversion of bilirubin to stercobilim

Question 68

What is the management of jaundice in a neonate?

Answer 68

Phototherapy - 450nm blue-green light | Exchange transfusion

Question 69

What are the features of congenital hypothyroidism?

Answer 69

``` Coarse facial features Hypotonia Large tongue Hoarse cry Umbilical hernia Constipation Prolonged jaundice ```