Neonatal Care

Question 1

What is the management of symptomatic or severe neonatal hypoglycaemia?

Answer 1

Admit to neonatal unit and give 10% dextrose IV

Question 2

What is the general cutoff for hypoglycaemia in the neonate?

Answer 2

< 2.6 mmol/L

Question 3

What are the classical findings of patent ductus arteriosus in the neonate and how is this managed?

Answer 3

Presentation: heaving apex beat, subclavicular thrill, continuous ‘machinery-like’ murmur
Initially acyanotic (descending aorta -> PT) however if left untreated will reverse (pulmonary HTN = reverse flow)
Mx: Indomethacin in the postnatal period

Question 4

What are the classical findings of fetal alcohol syndrome?

Answer 4

Microcephaly
Short palpebral fissures (small eye openings)
Thin upper lip
Absent philtrum (dimple above the lip)
various cardiac abnormalities
Reduced IQ

Question 5

How should jaundice in the initial 24 hrs post-delivery be managed?

Answer 5

Jaundice < 24hrs of birth = ALWAYS PATHOLOGICAL!!
Potential causes;
- Rhesus haemolytic disease
- ABO incompatibility
- Hereditary spherocytosis
- Glucose 6-phosphodehydrogenase

Question 6

What is the typical presentation of whooping cough / bordatella pertussis and how should it be managed?

Answer 6

Initial viral upper resp symptoms in the catarrhal phase
Then paroxysms of coughing with inspiratory whoop - may be associated with post-paroxysm vomiting and apnoea in neonates
Suspect if cough is present for 14 days + with any of the above features

Neonates < 6 months with suspected whooping cough should be admitted.
Oral macrolide (erythromycin, azithromycin, clindamycin) can be given if within 21 days of cough onset

Question 7

What are the classical abnormalities associated with congenital syphilis?

Answer 7

Saddle nose
Sensorineural deafness
Encephalopathy
Limb anormalities
Neonatal death

Question 8

What is the classical presentation of choanal atresia?

Answer 8

Choanal atresia = when the posterior aspect of the nasal airway is blocked by either soft tissue or bone (can be unilateral or bilateral)

Bilateral choanal atresia typically presents early in neonate as they are obligate nose breathers

=
Cyanosis worse when feeding and improved when crying

Mx: surgical fenestration to restore patency

Question 9

At what level bilirubin is jaundice defined?

Answer 9

jaundice = serum bilirubin >30mmol/L

Question 10

What is the definition of stillbirth?

Answer 10

Baby born dead 24+0 weeks plus

Question 11

What is the definition of miscarriage?

Answer 11

Death in utero < 24 weeks

Question 12

What is the definition of neonatal death?

Answer 12

Death in the first 28 days of life
(early neonatal death = first 7 days
late neonatal death = 7-28 days)

Question 13

How is the perinatal mortality rate calculated?

Answer 13

Stillbirths + EARLY neonatal deaths (<7 days)
per 1,000 births after 24 wks

Question 14

What is the definition of a puerperal death?

Answer 14

A Maternal death in the initial 6 weeks postpartum

Question 15

What is the definition of the maternal mortality rate?

Answer 15

Deaths of women in pregnancy, labour or 6-weeks post-partum / the total number of pregnancies

Question 16

What is the most common cause of early-onset neonatal sepsis in the UK?

Answer 16

Group B strep
(black race is a risk factor for GBS neonatal sepsis)

Question 17

Early v late neonatal sepsis?

Answer 17

Early onset - < 72 hrs - 75% is Group B Strep sepsis

Late onset - 7 - 28 days - staph epidermidis, pseudomonas aeruginosa, klebsiella, enterobacter, listeria

Question 18

1st line abx for suspected neonatal sepsis?

Answer 18

IV BenPen & Gentamicin

Question 19

What are the Toby criteria for therapeutic cooling of neonates?

Answer 19

Must be 36/40+ and 1800g +
Must have been an acute perinatal traumatic event OR APGAR score 5 or less at 10 mins OR requiring 10 mins+ positive pressure ventilation
Severe metabolic acidosis on cord gases / gases < 1 hr of birth
evidence of moderate-severe hypoxic Ischaemic encephalopathy (reduced consciousness / seizures/ reduced tone etc)

Question 20

What is acrocyanosis?

Answer 20

Peripheral circulation in neonates in the first 24 - 48hrs in the hands & feets in otherwise healthy neonates
(caused by benign vasomotor changes)

Question 21

Most common cause of ambiguous genitalia in the neonate?

Answer 21

Congenital adrenal hyperplasia

(adrenal glands unable to synethesise corticosteroids normally, ^ brain stimulation to adrenal glands = corticosteroids remain low but sex hormone production in adrenals ^^ = ^ sex hormones (= development of male sex characteritics in girls or early in boys) & low corticosteroids (on the severe end of the spectrum can present w/ a v unwell neonate with low Na and glucose)

Question 22

What is the typical presentation of coarctation of the aorta?

Answer 22

Infancy - heart failure ~ day 5 as PDA starts to close (growth failure, tachypnoea, weak femoral pulses)

Adult (missed) - hypertension, radio-femoral delay, mid-systolic murmur & apical click heard best over back, notching of the inferior border of the ribs.

(Association with Turner’s syndrome)

Question 23

What is the national auditory testing programme for neonates?

Answer 23

For all neonates - oto-acoustic emission test

If fail this or if they’ve spent > 48 hrs in special care then = automated auditory brainstem response testing

Question 24

Presentation of Klumpke’s palsy v Erb’s palsy?

Answer 24

Erb’s Palsy = UPPER brachial nerve plexus damaged = ‘waiter’s tip - adducted, internally rotated arm

Klumpke’s palsy = LOWER brachial nerve plexus injury = damage to the intrinsic muscles of the hand

Question 25

Differentials for scalp swelling in the neonate?

Answer 25

Caput succedaneum - swelling present at birth, crosses suture lines, resolves within a few days.

Cephalohaematoma - develops several hours post-birth, does NOT cross suture lines, can take several weeks to resolve.
= bleed between skull and periosteum
5-25% may have associated skull fracture

Subgaleal haemorrhage - develops several hours post-birth, fluctuant swelling that CROSSES SUTURE lines

Question 26

When is the heel-prick test done and what conditions does it test for?

Answer 26

5-8 days post-birth

Tests for:
- Congenital hypothyrodism
- Cystic fibrosis
- Sickle cell disease
- Phenylketonuria
- Maple syrup urine disease
- MCADD

Question 27

What is the typical presentation of congenital diaphragmatic hernia?

Answer 27

Abdominal contents push up through the diaphragm, normally on the left, causing pulmonary hypoplasia on the left and displacing the heart to the right

Presents with respiratory distress in the newborn with tingling bowel sounds in the thorax

Mx: intubate and ventilate, NG tube insertion to decompress