Neonatal problems

Question 1

What are the red flags for neonatal sepsis?

Answer 1

Suspected sepsis in mother
Signs of Shock
Seizures
Resp distress > 4hrs after birth
Suspected sepsis in other baby if multiple

Question 2

What are the risk factors for neonatal sepsis?

Answer 2

GBS colonisation/sepsis in previous pregnancy
Maternal sepsis, chorioamnionitis >38 degrees
<37 weeks
Premature rupture of membranes
Prolonged rupture of membrane

Question 3

For neonatal sepsis when do you
Observe
Start Antibiotics

Answer 3

1 risk factor/feature = observe
>=2 factors/features = start abx

Question 4

What Abx do you give in neonatal sepsis?

Answer 4

Penicillin + Aminoglycoside
eg benpen + gent

Question 5

How do you provide further management in neonatal sepsis?

Answer 5

24hr CRP
36hrs Blood cultures
Consider stopping abx if well/results normal

Question 6

What constitutes the APGAR score?

Answer 6

Appearance
Pulse
Grimace
Activity
Respiration
Get up to 2 points for each

Question 7

APGAR appearance score

Answer 7

2: Pink
1: Blue extremeties
0: Blue

Question 8

APGAR pulse score

Answer 8

2: >100
1: <100
0: Absent

Question 9

APGAR Grimace score

Answer 9

2: Cries/sneezes/coughs
1: Grimace
0: Nothing

Question 10

APGAR Activity Score

Answer 10

2: Active
1: Flexed arms and legs
0: Floppy

Question 11

APGAR Respiratory Effort

Answer 11

2: Strong/Crying
1: Slow/Irregular
0: Absent

Question 12

APGAR
Good
Moderate
Low

Answer 12

7-10
4-6
0-3

Question 13

What is the most common organism for late onset (>72hrs) neonatal sepsis?

Answer 13

Coag negative staph eg Staph Epidermidis

Question 14

Outline Neonatal resuscitation

Answer 14

Birth

Dry baby and APGAR

Gasping/no breath: Airway + 5 breaths

No chest movement: Repeat airway + breaths

Reassess chest + HR, repeat above if needed

If HR < 60 now: Compressions 3:1

Reassess + consider direct access drugs

Question 15

Male delivered via C-section displays raised RR and intercostal recession. His mother is diabetic. What is his likely condition?

Answer 15

Surfactant deficient lung disease/ARDS

Question 16

How do you manage ARDS?

Answer 16

Antenatal steroids to prevent

Oxygen

Assisted ventilation

Question 17

What is seen in transient tachypnoea of the newborn and how do you manage it?

Answer 17

Hyperinflation of the lungs + fluid in horizontal fissure

Observation + supplementary oxygen

Question 18

Which congenital infection causes:

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

Answer 18

Cytomegalovirus

Question 19

Which congenital infection causes:

Itchy rash on head/trunk that spreads

Macular –> Papular –> Vesicular

Fever

Answer 19

Chickenpox

Question 20

What congenital infection causes

Skin scarring

Eye defects

limb hypoplasia

Microcephaly

Learning disabilities

Answer 20

Fetal varciella syndrome

Question 21

Mother unsure if immune to chickenpox, what do?

Answer 21

Check maternal blood for antibodies

Question 22

If a woman is VZ antibody -ve, what is the plan if they are…

19 weeks

27 weeks

Answer 22

under 20 weeks: VZIG ASAP up to 10 days post-exposure

Over 20 weeks: VZIG/antivirals between 7-14 days post-exposure

Question 23

How do you manage a pregnant woman who has chickenpox rash after 20 weeks?

Answer 23

Oral aciclovir within 24 hours exposure

Question 24

What childhood infection causes

Fever

Rash behind ears then all over: maculopapular –> blotchy

White spots in mouth

Answer 24

Measles

Question 25

How do you confirm and treat measles?

Answer 25

IgM antibodies

Supportive unless IC/pregnant

Question 26

Which childhood infection causes

Pink rash on face that spreads to body, stops between day 3-5

Lymph nodes behind ears and back of head

Answer 26

Rubella

Question 27

What childhood infection causes

Viral symptoms

Slapped cheek 3 days later

Itchy rash on trunk and limbs

Answer 27

Parovirus B19

Question 28

Which childhood infection causes

Sudden high fever

Truncal rash that spreads to extremeties

Affects 6-36 month olds

Answer 28

Roseola infantum

Question 29

What infection causes strawberry tongue and tonsilitis? How do you treat it?

Answer 29

Scarlet fever (GAS)

Oral penicillin/aminoglycoside 10 days

Question 30

What is the school exclusion for the following?

Scarlet fever

Whooping cough

Measles

Rubella

Chickenpox

Mumps

Diarrhoea & vomiting

Impetigo

Scabies

Influenza

Answer 30

Scarlet fever: 24 hours after abx therapy

Whooping: 2 days after abx start/21 days from onset

Measles: 4 days from rash onset

Rubella: 5 days from rash

Chickenpox: All lesions crusted/5 days after rash onset

Mumps: 5 days from gland onset

Diarrhoea + Vomiting: 48 hours after settling

Scabies: Until treated

Influenza: Until recovery

Question 31

Which congential infections cause sensorineural deafness?

Answer 31

Rubella

Cytomegalovirus