Neonatal medicine - term

Question 1

Neonatal life support - describe the sequence of resuscitation

Answer 1

1) Unresponsive? Shout for help!
2) Dry the baby
3) Check airway and breathing - give 5 rescue breaths
4) Check circulation - HR, brachial/femoral pulses
5) Start chest compressions - 3 compressions : 1 resuce breath (tips of two fingers)

Question 2

Describe the APGAR scoring system

Answer 2

A - activity
P - pulse
G - grimace
A - appearance
R - respiration

Each indicator is given 0, 1 or 2 points (max score is 10)

Activity:

• Absent = 0
• Flexed limbs = 1
• Active = 2

Pulse:

• Absent = 0
• <100/min = 1
• > 100/min = 2

Grimace:

• No response to stimulation = 0
• Minimal response to stimulation = 1
• Prompt response to stimulation = 2

Appearance:

• Blue or pale = 0
• Pink body, blue peripheries = 1
• Pink = 2

Respiration:

• Absent = 0
• Slow and irregular = 1
• Vigorous cry = 2

Question 3

Describe the interpretation of the APGAR score

Answer 3

• Score of 7-10 is normal

- Anything below this is concerning

Question 4

When should APGAR scoring be performed?

Answer 4

1, 5 and 10 minutes after birth

Question 5

The newborn heel-prick test is also known as…

Answer 5

• Guthrie test

- Newborn blood spot test

Question 6

When is the newborn heel-prick test performed?

Answer 6

5-9 days

Question 7

How many conditions does the newborn heel-prick test screen for?

Give 4 examples

Answer 7

9 conditions, including:

• Congenital hypothyroidism
• Cystic fibrosis
• Sickle cell
• PKU (phenylketonuria)

Question 8

What are the ToRCH infections?

Answer 8

To - toxoplasmosis
R - rubella
C - CMV
H - HSV

Question 9

Give 4 causes of respiratory distress in term infants

Answer 9

• Transient tachypnoea of the newborn (TTN)
• Infection
• Meconium aspiration
• Congenital diaphragmatic hernia

Question 10

Describe the pathophysiology of transient tachypnoea of the newborn

Answer 10

Delay in resorption of lung fluid after birth

Question 11

Give 1 risk factor for developing transient tachypnoea of the newborn

Answer 11

Caesarean section

Question 12

Describe the investigation/diagnosis of transient tachypnoea of the newborn

Answer 12

• Diagnosis of exclusion (r/o other differentials first)

- CXR may show fluid in horizontal fissure

Question 13

Describe the management and prognosis of transient tachypnoea of the newborn

Answer 13

• Oxygen and ventilatory support may be required

- Condition usually settles within 1st day of life

Question 14

What is the most significant risk factor for meconium aspiration?

Answer 14

Risk increases with greater gestational age

Question 15

Are there any signs which would point towards a diagnosis of meconium aspiration?

Answer 15

Presence of meconium/dark green staining of liquor

Question 16

Describe the management of meconium aspiration

Answer 16

• Suctioning

- Oxygen and ventilatory support may be required

Question 17

Are there any risk factors for neonatal infection/sepsis?

Answer 17

• Maternal infection (usually Group B strep)
• Prolonged rupture of membranes - PROM (more than 18 hours between ROM and onset of labour)
• Prematurity

Question 18

Describe the investigation and management of neonatal infection/sepsis

Answer 18

Investigation:
- Septic screen (FBC, CRP, blood cultures, urine dip, LP)

Treatment:
- 1st line: benzylpenicillin + gentamicin

Question 19

What are the clinical signs on examination of a congenital diaphragmatic hernia?

Answer 19

On auscultation of the chest there is:

• Displacement of apex beat/heart sounds (to the right side)
• Poor air entry (left lung)
• Tinkling bowel sounds

Question 20

Describe the immediate and definitive management of diaphragmatic hernia

Answer 20

Immediate:
- Intubation and ventilation

Definitive:
- Surgery

Question 21

Describe the classification of birth injuries (3 categories)

Answer 21

1) Soft tissue injuries:
- Head
- Bruises/abrasions

2) Nerve palsies:
- Brachial plexus (Erb’s palsy)
- Facial nerve palsy

3) Fractures:
- Clavicle

Question 22

What are the differentials for swelling of the head in a newborn?

Answer 22

• Caput succedaneum

- Cephalohaematoma

Question 23

Describe the clinical features, management and prognosis of caput succedaneum

Answer 23

Clinical features:

• Present at birth
• Typically forms over vertex and crosses suture lines

Management:
- Conservative

Prognosis:
- Resolves within days

Question 24

Describe the clinical features, management and prognosis of cephalohaematoma

Answer 24

Clinical features:

• Typically develops several hours after birth
• Most commonly in the parietal region, doesn’t cross suture lines

Management:
- Conservative

Prognosis:
- May take months to resolve