Neonatal Med

Question 1

What is Hypoxic Ischaemic Encephalopathy (HIE)?

Answer 1

During perinatal aspyhxia gas exchange is reduced giving hypoxia and metabolic acidosis. This reduces tissue perfusion giving hypoxic injury to the brain and other organs

Question 2

What are some causes of Hypoxic Ischaemic Encephalopathy?

Answer 2

Uterine Contractions
Placental Abruption
Ruptured Uterus
Umbilical blood flow obstruction
Maternal Hypotension/Hypertension
Compromised Fetus - IUGR, Anaemia
Failure to breathe at birth

Question 3

How will a neonate with mild Hypoxic Ischaemic Encephalopathy present?

Answer 3

Irritable
Excessively responsive
Hyperventilation
Hypertonia
Impaired feeding

Question 4

How will a neonate with moderate Hypoxic Ischaemic Encephalopathy present?

Answer 4

Marked movement abnormalities
Hypotonia
Seizures
Cannot feed

Question 5

How will a neonate with severe Hypoxic Ischaemic Encephalopathy present?

Answer 5

No normal spontaneous movements
No response to pain
Multi-organ failure

Question 6

What is the recommended management for confirmed Hypoxic Ischaemic Encephalopathy?

Answer 6

Respiratory support
Anticonvulsants for seizures
Fluid restriction for transient renal impairment
Voulme and Inotrope support for hypotension
Monitoring and treatment of electrolyte imbalance
Induced hypothermia is associated with improved outcomes

Question 7

What is Necrotising Enterocolitis?

Answer 7

Necrosis of a section of bowel in a newborn

Question 8

Why are neonates more vulnerable to Necrotising Enterocolitis?

Answer 8

Preterm bowel is vulnerable to ischaemic injury and bacterial invasion, making NEC more likely

Question 9

Which formulation of milk increases the risk of developing Necrotising Enterocolitis?

Answer 9

Cows milk formula

Question 10

What are some clinical signs of Necrotising Enterocolitis?

Answer 10

Feed intolerance
Bile-stained vomiting
Abdominal distension requiring mechanical ventilation
Fresh PR bleed

Question 11

Which investigation is appropriate for suspected Necrotising Enterocolitis?

Answer 11

AXR

Question 12

What may be seen on an AXR with Necrotising Enterocolitis?

Answer 12

Distended bowel loops
Thickening of bowel wall
Gas in Portal Venous tract

Question 13

What is the recommended management of confirmed Necrotising Enterocolitis?

Answer 13

Stop oral feed
Broad spectrum Abx covering both Aerobic and Anaerobic
TPN
Surgery if perforation

Question 14

What are some potential complications of Necrotising Enterocolitis?

Answer 14

Development of strictures
Malabsorption due to surgical resection
Poor neurodevelopmental outcome

Question 15

Why is neonatal jaundice so common?

Answer 15

High Hb concentration at birth leads to excessive haemolysis
Red cell lifespan is shorter in infants
Hepatic bilirubin metabolism is less efficient in first few days of life

Question 16

What may neonatal jaundice indicate?

Answer 16

Haemolytic anaemia
Errors of metabolism
Liver disease

Question 17

What is the serious complication of untreated neonatal jaundice?

Answer 17

Kernicterus

Question 18

What is Kernicterus?

Answer 18

Encephalopathy secondary to unconjugated bilirubin being deposited in the brain

Question 19

What are some causes of Jaundice in first 24h following birth?

Answer 19

Rh Haemolytic disease
ABO incompatibility - Coombs/DAT +ve
G6PDH Deficiency
Spherocytosis
Congenital infection
Sepsis

Question 20

What are some causes of jaundice within 2d-2w of birth?

Answer 20

Normal physiology - infant adapting
Breast milk jaundice
Dehydration
Infection

Question 21

What are some causes of jaundice after 2w of birth?

Answer 21

Biliary atresia
Breast-milk jaundice
Infection
Congenital hypothyroidism

Question 22

What are the treatment options available for acute neonatal jaundice?

Answer 22

Phototherapy

Exchange transfusion

Question 23

How does Phototherapy help with neonatal jaundice?

Answer 23

UV light converts unconjugated bilirubin into a water-soluble pigment that is renally excreted

Question 24

When is exchange transfusion the recommended treatment for neonatal jaundice?

Answer 24

If serum bilirubin reaches dangerous levels, the entire circulating volume is transfused.

Question 25

What is Neonatal Sepsis?

Answer 25

Sepsis demonstrated withihn 48-72h of life

Question 26

What are causes of Neonatal Sepsis?

Answer 26

Ascending infection in mother with Chorioamnitis Perinatal contact in birth canal Haematogenous spread of maternal infection

Question 27

What are some causative organisms of neonatal jaundice?

Answer 27

``` Group B Strep. E.Coli Coagulase -ve Strep H.Influenzae Listeria ```

Question 28

If a mother is found to be carrying Group B Strep in her genital tract, how should this be managed?

Answer 28

Empirical Abx

Question 29

What are some risk factors for development of neonatal sepsis?

Answer 29

``` Previous Group B Strep infection of baby Known current Group B Strep PROM/Pre-term birth Suspected/Confirmed ROM for >18h in Pre-term child Intrapartum Fever >38 degrees Suspected/confirmed Chorioamnitis ```

Question 30

What are some Red Flag signs for potential neonatal sepsis?

Answer 30

Parental Abx given to mother for confirmed/suspected infection for 24h either before/after birth Suspected/confirmed infection of another child in multiple pregnancy

Question 31

When should neonatal sepsis treatment be initiated?

Answer 31

Either 1 Red Flag sign or any 2 non red-flag signs are present

Question 32

What are some symptoms of neonatal sepsis?

Answer 32

``` Altered behaviour Altered muscle tone Abnormal HR Signs of RDS Hypoxia Jaundice at <24h age Apnoea Signs of Encephalopathy Temperature anomaly Unexplained bleeding Metabolic acidosis Local signs of infection ```

Question 33

What are some red flag signs suggestive of neonatal sepsis?

Answer 33

RDS >4h after birth Seizures Signs of Shock Need for mechanical ventilation if term baby

Question 34

What are some potential differentials for suspected neonatal sepsis?

Answer 34

TTN RDS Haemolytic disease of the Newborn

Question 35

Which investigations are appropriate for suspected neonatal sepsis?

Answer 35

FBC CRP Cultures prior to Abx LP if ?Meningitis/likely source of infection

Question 36

What is the recommended management for Neonatal Sepsis?

Answer 36

IV Benzylpenicillin and Gentamicin

Question 37

When should antibiotics for neonatal sepsis be stopped at 36h?

Answer 37

If cultures have returned as negative Clinical suspicion is low Clinical condition/CRP are reassuring

Question 38

If blood cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?

Answer 38

7-10 days

Question 39

If CSF cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?

Answer 39

14 days

Question 40

If blood cultures for suspected neonatal sepsis return as negative but CRP is still rising, how long should the child receive Abx for?

Answer 40

5 days