Neonatal Emergencies

Question 1

What are the main types of neonatal emergency?

Answer 1

Sepsis
Birth asphyxia
Respiratory distress
Abdo emergency
Duct-dependent cardiac issues

Question 2

What are common clinical respiratory symptoms in the neonate?

Answer 2

apnoea
gasping
recession

Question 3

What are the main features of APGAR examination?

Answer 3

Appearance
Pulse
Grimace
Activity
Respiration

Question 4

What are the 3 main causes of neonatal sepsis?

Answer 4

Congenital infection
Early onset sepsis
Late onset sepsis

Question 5

What constitutes congenital infection?

Answer 5

Present at birth

Usually infection is direct from mother

Question 6

What is early onset sepsis?

Answer 6

Onset between birth and 1 week old

infection comes from the birth canal

Question 7

What is late onset sepsis?

Answer 7

onset after 1 week old

Maternal or external source of infection

Question 8

Bacterial causes of neonatal sepsis:

Answer 8

Group B streptococcus
Listeria
Gram -ve
(present in the genital tract)

Question 9

Which antibiotics are used to treat neonatal sepsis?

Answer 9

Penicillin/Gentamicin

Cefotaxime/ampicillin

Question 10

Investigations performed for suspected Dx of neonatal sepsis?

Answer 10

blood cultures

FBC (particularly WCC and platelets)

Question 11

What are the clinical signs that may indicate neonatal sepsis?
(non-specific)

Answer 11

Fever or hypothermia
poor feeding
vomiting
pallor
tachypnoea
drowsy
irritability

Question 12

What features may be present on a CXR for a septic neonate?

Answer 12

poor aeration

increased lung markings

Question 13

What is the broad management of neonatal sepsis?

Answer 13

Resuscitate
Antibiotics
(Supportive care) ventilation, fluid rescus. coagulopathy, ionotropes

Question 14

Conditions that are associated with increased risk of birth asphyxia:

Answer 14

IUGR
Prematurity
Abnormal CTG
Abnormal fatal blood gas
difficult delivery

Question 15

What does intrapartum asphyxia increase your is of?

Answer 15

Cerebral palsy

Question 16

What are the early signs of birth asphyxia?

Answer 16

acute bradycardia or asystole at delivery

Question 17

What is the late presentation of birth asphyxia?

Answer 17

hypoxic ischemic encephalopathy

Question 18

What are the 3 grades of hypoxic ischemic encephalopathy and what do they mean?

Answer 18

Grade 1: irritability, poor feeding
Grade 2: fits, bad feeding, hypertonia
Grade 3: floppy, intractable seizures, apnoea

Question 19

What observations can be found by ultrasound in asphyxia?

Answer 19

periventricular flare
cystic leukomalacia
(white matter brain injury)

Question 20

What observations can be found by CT/MRI in asphyxia?

Answer 20

swollen basal ganglia

enhancement of white matter

Question 21

What is the time window during which effects of asphyxia are reversible?

Answer 21

< 6hr of injury

Question 22

What metabolic intervention could minimise tissue injury following asphyxia?

Answer 22

Cooling of baby

to ~35C

Question 23

What the alternative DDx for respiratory distress ?

Answer 23

Respiratory distress syndrome
Pneumothorax
Abdominal emergency
Cardiac malformation
Pneumonia

Question 24

What are predictors of respiratory distress syndrome?

Answer 24

Prematurity
Asphyxia
Cold stress
Diabetic mum
lower segment C-section (LCSC)

Question 25

What is the specific clinical sign of respiratory distress syndrome?

Answer 25

Recession | use of accessory muscles

Question 26

How do alveoli function between breaths in RDS?

Answer 26

Alveoli fully collapse between breaths, requiring massive breaths during each inspiration to-reinflate the alveoli

Question 27

What are the 4 pathophysiological components of RDS?

Answer 27

Weak chest wall excess lung liquid no blood-air approx. surfactant delivery

Question 28

What the radiological features observed on a CXR for RDS?

Answer 28

poor expansion air bronchograms ground glass appearance

Question 29

What are the predictive conditions for meconium aspiration syndrome?

Answer 29

post-term baby | asphyxia

Question 30

Predictors of abdominal emergencies inc;

Answer 30

other congenital malformations | polyhydramnios

Question 31

What are the clinical features of an abdominal emergency?

Answer 31

specific: abdo distension, bilious vomiting, obvious loops | non-specific: poor feeding, vomiting, pallor, tachypnoea, drowsy, irritability

Question 32

Type of abdominal emergency include?

Answer 32

``` NEC Malrotation Volvulus gastroschisis meconium ileum Hirshprung's diseases ```

Question 33

What is volvulus?

Answer 33

intestine twists around itself and its mesentery

Question 34

What is gastrochiasis?

Answer 34

congenital defect in which baby's intestine extend outside body cavity through hole in or near umbilicus

Question 35

What is Hirshprung's disease?

Answer 35

Congenital defect in which the nerves in the intestine are missing Constipation is the predominant symptom

Question 36

What are the main types of duct-dependent heart defects?

Answer 36

``` pulmonary atresia critical pulmonary stenosis Critical coarctation Transposition of the great arteries Hypoplastic left ventricle ```

Question 37

What does tetralogy of Fallot include?

Answer 37

VSD Right ventricular hypertrophy pulmonary artery stenosis overriding aorta

Question 38

What are the specific clinical features for duct-dependent heart defects?

Answer 38

minimal recession for cyanosis | absent femoral pulses

Question 39

What are the non-specific clinical features for duct-dependent heart defects?

Answer 39

poor feeding, vomiting, pallor, cyanosis, tachypnoea, sleepiness, irritability

Question 40

What investigations should be done to confirm duct-dependent heart defects?

Answer 40

echocardiogram | CXR

Question 41

What is the broad aetiology of neonatal emergencies?

Answer 41

an unpreparedness for birth and extra-uterine life

Question 42

What is a risk factor for transient tachypnoea of the newborn?

Answer 42

C-section

Question 43

What is transient tachypnoea of the newborn?

Answer 43

common respiratory distress disorder in newborn Symptoms usually start within the first hours after birth thought to result from delayed absorption of foetal lung fluid. It is a self-limiting condition. Risk factors include prematurity, cesarean section, and male sex

Question 44

What is intusseception?

Answer 44

invagination of one portion of bowel into the lumen of the adjacent bowel most commonly around the ileo-caecal region. usually affects infants at 6-18mo M>F

Question 45

What are the clinical features of intusseception?

Answer 45

- paroxysmal abdominal colic pain - during paroxysm the infant will characteristically draw their knees up and turn pale - vomiting - bloodstained stool: 'red-currant jelly' - is a late sign - sausage-shaped mass in RUQ

Question 46

What investigation is performed for intusseception?

Answer 46

USS | may show target-like mass

Question 47

What are the clinical features common to respiratory stress in the neonate?

Answer 47

- tachypnoea - intercostal recession - expiratory grunting - cyanosis

Question 48

What is the classical CXR for respiratory distress/surfactant deficiency in the newborn?

Answer 48

ground glass appearance | indistinct heart border

Question 49

What is the management of respiratory distress/surfactant deficiency?

Answer 49

- maternal corticosteroids to induce foetal lung maturation (during pregnancy) - oxygen - assisted ventilation - exogenous surfactant given via ET tube