Neonatal medicine

Question 1

Respiratory distress syndrome

Answer 1

Deficiency in surfactant in a mixture of phospholipid and proteins exerted by type II pneumocytes

Leads to ALVEOLAR COLLAPSE and INADEQUATE GAS EXCHANGE

Surfanct is produced > 32 weeks

Question 2

Signs of respiratory distress syndrome

Answer 2

RR >60/min 
Laboured breathing 
Chest wall recession 
Expiratory grunting 
Cyanosis

Question 3

Treatment of respiratory distress syndrome of the newborn

Answer 3

Curosurf: Surfactant therapy delivered straight to the lungs via a tracheal tube

Glucocorticoids given ANC ( after 36 weeks)

Question 4

Causes of pneumothorax in the newborn

Answer 4

Respiratory distress syndrome of the newborn
Air from the distended alveoli can enter the interstium
Pulmonary interstitial emphysema.

Dx: Transillumination with bright fibroptic light

Rx: Chest drain

Question 5

Temperature control in neonates

Answer 5

Preterm babies are especially vulnerable due to

• Large surface area
• Thin permeable skin
• Little submit fat for insulation

Need nursing at a neutral temperature range

Question 6

Patent Ductus Arterious

Clinical features and treatment

Answer 6

Shunting of the blood from left to right circulation

Presenting complaint

• Aponea
• Bradycardia
• Difficultly weaning from artificial ventilation

Rx: Close with prostaglandin synthase inhibitor or ibrufen

Question 7

Complications of respiratory distress syndrome

Answer 7

Pulmonary

• Pneumothorax
• Intersticial emphysema
• Secondary infection
• Chronic lung disease

Non-pulmonary

• Intraventricular haemorrhage
• PDA

Question 8

Define apnoea attacks of the newborn

Answer 8

Periodic respiration with some spell of very shallow breathing or complete cessation of breathing for up to 20 seconds
Due to immaturity of the respiratory centre

~20 seconds or 10 seconds with bradys

Breathing will start again with physical stimulation

Question 9

Define Necrotising Enterocolitis

Answer 9

Necrosis of the intestine involving the distal ileum or proximal colon.

Question 10

Predisposing factors for Necrotising Enterocolitis

Answer 10

Preterm birth 
IUGR
Polycyhtaemia 
PDA
Asphyxia 
Early rapid enteral feeing with formula milk

Question 11

Clinical features of NEC

Answer 11

Abdo distension
Vomiting
Bloody stools

Abdo x-rays

• Dilated thick walled static bowel loops
• No air/ no gas ( pathognomic finding)

Question 12

Management of NEC

Answer 12

Large bore nasogastric tube
Parental nutrition
Antibiotics (Penicillin, gentamicin and Metronidazole)
Surgical resection of the necroses segment.

Question 13

List the possible long term sequelae of premature infants

Answer 13

Retinopathy of prematurity
Chronic lung disease
Neurodevelopment problems

Question 14

Retinopathy of prematurity

Answer 14

Retinas are incompletely vascularised at birth 
Abnormal vascular proliferation 
Causes 
- Fibrosis
- Retinal detachment 
- Blindness 

Screening @ 6-8 weeks

Question 15

Chronic lung of prematurity

Answer 15

Bronchopulmonary dysplasia: requiring oxygen beyond 36 weeks corrected gestation or 28 days of age.

Newborns who require extra ventilation with high pressures or high concentrations

CXR: widespread opacities with patchy translucent areas

Question 16

Management of chronic lung of prematurity

Answer 16

Assisted ventilation or continuous positive airways pressure
Supplementa O2 as needed
Strict attention to nutrition
Prophylaxis against RSV

Prophlaxis: monoclonal antibody (Palivizumab)

Question 17

Intracranial lesions

Answer 17

Two forms

• Intracranial haemorrhages
• Ischaemia of the periventricular white matter

Question 18

Neurodevelopment problems following prematurity

Answer 18

Cerebral palsy 
Cognitive delay 
Visual and hearing impairment 
Seizures 
Behavioural problems 
Educational delay

Question 19

Define meconium aspiration

List the cause and the treatment

Answer 19

Passage of meconium into the amniotic fluid is triggered by foetal distress
Foetus can inhale the meconium and develop meconium aspiration syndrome.

MECONIUM ASPIRATION SYNDROME
Leads to resp distress and cyanosis

Rx: Suctioning of the thick meconium from the trachea after delivery if possible

Question 20

Persistent pulmonary hypertension of the newborn

Answer 20

High pulmonary vascular resistance
Term and post term infants
Right to left shunting of blood

Rx: 
Oxygenation 
Assisted ventilation with sedation 
Inhaled ntiric oxide 
Sildenafil ( @ clinical trial stages only)

Question 21

Treatment of Grp B strep infection

Answer 21

Sensitive to penicillin and ahminoglycosides ( gentamycin)

Question 22

Hypoglycaemia of the newborn

Answer 22

Diabetes mellitus in the mother can cause hypoglycaemia
Due to foetal hyperinsulinism

Early feeding usually prevents this

Question 23

Neonatal hyperthyroidism

Answer 23

Infants of mothers with Graves

Thyroid stimulating immunoglobulins cross the placenta

Question 24

Oesophageal atresia

Answer 24

Tracheo-oesphagal fistula is usually present

POLYHYDRAMINOS IS PRESENT

Question 25

Cleft lip and palate

Answer 25

Polygenic cause
Drugs ( anticonvulsants and methotrexate)
Surgical repair

Question 26

Causes of neonatal jaundice

Answer 26

<24hrs (usually unconjugated can rise very quickly) 
- Haemolytic disease 
Rhesus incompatibility 
ABO incompatibility 
G6PD deficiency 
Spherocytosis 
Pyruvate kinase 

• Sepsis

>24 hrs <2 weeks 
Physiological jaundice (Breast milk)
Infection 
Haemolysis 
Polychtaemia 

>2 weeks 
Unconjugated 
- Breast milk
- Infection 
- Hypothyroidism 
- Haemolytic anaemia 

Conjugated

• Biliary atresia
• Neonatal hepatitis