Neonatal medicine

Question 1

What does the TORCH infection screen include

Answer 1

Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19)
Rubella
Cytomegalovirus
Herpes
HIV

Question 2

What can Toxoplasmosis infection cause during pregnancy to the child

Answer 2

• Hydrocephalus
• Intracranial calcification
• Chorioretinitis
• Neurological damage

Question 3

What is RDS

Answer 3

Respiratory distress caused by a lack of surfactant production

Question 4

What are the clinical signs of RDS

Answer 4

From birth to 4 hours:
•	Tachypnoea with a RR of over 60 breaths/min
•	Recession – subcostal or intercostal
•	Cyanosis
•	Nasal flaring
•	Expiratory grunting

Question 5

What would you see on x ray in RDS

Answer 5

Ground glass appearance

Question 6

What is the treatment and management for RDS

Answer 6

Glucocorticoids given antenatally if birth predicted before 37 weeks
artificial surfactant therapy via endotracheal tubes
Oxygen
CPAP via nasal cannulae

Question 7

What can RDS develop into

Answer 7

Chronic lung disease of prematurity - officially needing oxygen at 36 weeks corrected age (manage with oxygen)

Question 8

What are the causes of jaundice in the first 24 hours

Answer 8

Rhesus haemolytic disease of the newborn
ABO incompatibility
G6PD deficiency
Spherocytosis

Question 9

What is rhesus haemolytic disease of the newborn

Answer 9

When Rh negative mother exposed to Rh-positive infant/ blood transfusion.

Question 10

What is ABO incompatibility

Answer 10

Mismatch between maternal and foetal blood group

Question 11

What are the causes of jaundice between 2 days to 2 weeks

Answer 11

Physiological jaundice
Breast milk jaundice 
infection
excess haemolysis 
bruising
polycythemia

Question 12

What are the causes of jaundice after 2 weeks

Answer 12

Unconjugated:
Physiological or breast milk
jaundice
Infection (particularly urinary tract)
Hypothyroidism
Haemolytic anaemia, e.g. G6PD
deficiency
High gastrointestinal obstruction,
e.g. pyloric stenosis
Conjugated (>25 μmol/L):
Bile duct obstruction
Neonatal hepatitis

Question 13

What are causes of unconjugated jaundice in a neonate

Answer 13

Physiological or breast milk
jaundice
Infection (particularly urinary tract)
Hypothyroidism
Haemolytic anaemia, e.g. G6PD
deficiency
High gastrointestinal obstruction,
e.g. pyloric stenosis

Question 14

What are the causes of conjugated jaundice in neonates

Answer 14

biliary atresia

neonatal hepatitis

Question 15

What is Kernicterus

Answer 15

• Encephalopathy resulting from deposits of unconjugated bilirubin in the basal ganglia and brainstem nuclei
• Free bilirubin can pass the blood-brain barrier

Question 16

How would you treat jaundice in a neonate

Answer 16

• Phototherapy – first line

* Exchange transfusion – used if phototherapy fails

Question 17

What are the clinical signs for biliary atresia

Answer 17

• Persistent neonatal jaundice – predominantly conjugated hyperbilirubinaemia
• Dark urine
• Pale stools
• Failure to thrive
• Malabsorption
• Enlargement of liver and spleen
• Tendency to bleed due to vitamin K deficiency

Question 18

What is the treatment for biliary atresia

Answer 18

The Kasai procedure before the age of 6 weeks.

Further liver biopsy by the age of 20.

Question 19

What are the key risk factors for necrotising enterocolitis

Answer 19

Prematurity
Infection
Congenital heart defects 
perinatal hypoxia
early feeding with formula milk

Question 20

What are the clinical features of necrotising enterocolitis

Answer 20

• apnoea
• Bilious vomiting
• Distended shiny abdomen
• Haemodynamic instability

Question 21

What would you see on X-ray in necrotising enterocolitis

Answer 21

dilated, thick walled bowel loops, free air or intramural gas

Question 22

What is the treatment and management for necrotising enterocolitis

Answer 22

Medical:
• Nil by mouth, NG tube on free drainage
• Parental nutrition or IV dextrose
• Antibiotics: penicillin, gentamycin and metronidazole
Surgical:
• Surgical resection of necrotic bowel might be required in severe cases/perforation has occurred
• Infant can be left with short gut syndrome – risk of malnutrition