NEonatal presenations 2

Question 1

3 DDxs for neonatal resp distress

Answer 1

• Transient tachypnoea of Newborn (TTN)
• Sepsis
• Meconium Ileus

Question 2

What is ttn?

Answer 2

a delay in clearing foetal lung fluids

Looks like grunting, tachypnoea, O2 requirement but normal gasses

Question 3

How can you test for and treat TTN?

Answer 3

CXR can spot the fluids & hyperinflation

O2, airway support, fluid and maybe Abx

Question 4

What could lead to Meconium Aspiration?

Answer 4

Post-date
Maternal DM or HTN
Difficult Labour

Question 5

How would meconium Aspiration present?

Answer 5

Cyanosis
High work of breathing + grunting
Apnoea
Floppiness

Question 6

What would do if you suspect meconium aspiration?

Answer 6

Blood gas
CXR - hyperinflation, flat diaphragm & patchy areas of collapse

Also do a septic screen in case

Question 7

Whats in a septic screen?

Answer 7

FBC
U&Es
Glc
Blood culture
CXR
LP
Urine dipstix & culture

Question 8

How do you treat meconium aspiration?

Answer 8

Suction the meconium
Intubate & ventilate
IV fluids & Abx
Surfactant
NO or ECMO

Question 9

Any complications of meconium aspiration?

Answer 9

Persistant Pulm HTN of Newborn (PPHN)

Question 10

How can you treat neonatal hypoglycaemia?

Answer 10

Enteral Feeds
IV 10% glc
Fluids
Glucagon
Hydrocortisone

Question 11

Birth Asphyxia is a serious problem in which low O2 at birth –> Multiorgan failure. What could cause it?

Answer 11

• Placental problems
• Cord Prolapse
• Infection
• Neonatal Airway abnormality
• Long, difficult delivery

Question 12

What are the phases of birth asphyxia?

Answer 12

Stage 1 = cell damage occurring within minutes

Stage 2 = reperfusion injury due to toxins from damaged cells (Days or weeks)

Question 13

How do you classify birth asphyxia?

Answer 13

Mild
Mod
Severe

Question 14

How do you manage a baby with birth asphyxia?

Answer 14

Fluid restriction (prevent cerebral oedema)
Monitor U&Es + C & LFTs for organ failure

Resp support (O2, intubate, ventilate etc)

Cardiac support

Treat any seizures

Therapeutic Hypothermia!

Question 15

Which babies get diaphragmatic hernias?

Answer 15

Male > Female
Ass with some syndromes

Mostly left

Also associated with pulm hypoplasia

Question 16

How do you manage a diaphragmatic hernia?

Answer 16

Intubate at birth
Resp support (O2, intubation, ventilation etc)
Surgery

Question 17

How do you manage a blue baby?

Answer 17

• Examination/ history
• Sepsis screen
• Blood gas and blood glucose
• CXR
• Oximetry
• ECG
• Echo
• Hyperoxia test

Question 18

What are you possible differentials for a blue baby?

Answer 18

• Transposition of great vessels
• Teratology of fallot
• TAPVD
• Hypoplastic left heart syndrome
• Tricuspid atresia (absence/ abnormal opening)
• Truncus arteriorosus
• Pulmonary atresia

Question 19

What can cause neonatal abstinence syndrome?

Answer 19

• Opiods
• Benzodiazepenes
• Cocaine
• Amphetamines
• Maternal co-morbidity
• Social and discharge planning

Question 20

what is neonatal abstinence syndrome? and how would you monitor it?

Answer 20

Abstinence from physically addictive substance taken by mother in pregnancy

Monitor

• urine toxicology
• Finnegran screen

Question 21

How do you treat neonatal abstinence syndrome?

Answer 21

• comfort
• morphine
• Phenobarbitone

Question 22

hypothermia in the NNU

Answer 22

• place on ventilator
• sepsis screen and antbx
• consider checking thyroid function
• monitor blood glucose

Question 23

Complications from TORCH infections

Answer 23

• IUGR
• Brain calcification
• Neurodevelopmental delay
• Visual impairment
• Recurrent infections

Question 24

Management of sepsis

Answer 24

´Admit NNU
´Partial septic screen (FBC, CRP, blood cultures) and blood gas
´Consider CXR, LP
´IV penicillin and gentamicin 1st line
´2nd line iv vancomycin and gentamicin
´Add metronidazole if surgical/abdominal concerns
´Fluid management and treat acidosis
´Monitor vital signs and support respiratory and cardiovascular systems as required