Neonatal Problems

Question 1

What is necrotising enterocolitis?

Answer 1

Inflammatory bowel necrosis

Question 2

What are risk factors for necrotising enterocolitis?

Answer 2

Weight < 1500g
Enteral feeds
Bacterial colonisation
Mucosal injury

Question 3

what are signs of NEC?

Answer 3

Abdominal distension
Bloody stools
Feeding intolerance
Tendersness
Shock
DIC 

Progress to perforation, peritonitis

Question 4

What investigations in NEC?

Answer 4

AXR: penumatosis intestinal - gas in gut wall intramural gas
Dilated bowel loops
Bowel wall oedema
Portal venous gas
Pneumoperitoneum if perforated, Riglers’s sign

Question 5

What is management for NEC?

Answer 5

Stop oral feeding except oral probiotics
Barrier nurse
Culture faeces
Cross match
Antibiotics - cefotaxime + vancomycin

Progressive distension, perforation are indications for laparotomy

Question 6

What is haemorrhage disease of the newborn?

Answer 6

Newborn babies are vitamin K deficient as they lack enteric bacteria to make it.

This may result in impaired production of clotting factors which can lead to haemorrhage
Baby is usually well apart from bruising/bleeding
Bleeding may range from minor bruise to intracranial haemorrhage

Question 7

What investigations in HDN?

Answer 7

Prothrombin and partial thromboplastin times raised

Platelets normal

Question 8

What is prevention for HDN?

Answer 8

Newborns in the UK are offered vitamin K IM or oral

Phytomenadione can be given

Question 9

What are signs of DIC?

Answer 9

Septic signs
Petechiae
Venepuncture oozing
GI bleeding

Question 10

What investigations for DIC?

Answer 10

Thrombocytopenia
Schistocytes (fragmented RBCs) on film
INR raised
Fibrinogen low
Raised APTT
Raised d-dimer

Question 11

Mx for DIC?

Answer 11

Trat cause (NEC, sepsis)
Give Vitamin K slow IV + platelet transfusion

Question 12

What is immune thrombocytopenic purpua?

Answer 12

Immune mediated reduction in platelet count
Typically more acute
May follow infection or vaccination
Usually runs self limiting course

Treat severe thrombocytopenia with compatible platelets or irradiated maternal platelets

Question 13

What is strawberry naevus?

Answer 13

May not be present at birth
Increase in size over the first few months then fade again
Some may ulcerate or bleed
If large or in critical area consider early propanolol

Question 14

What are milia?

Answer 14

1-2mm pearly white, cream papules caused by retention of keratin in dermis

Question 15

What is erythema toxic?

Answer 15

Harmlesss red blotches often with central white pustule which come and go in crops
Described as flea bite appearance
Last around 24h

Question 16

What is a stork mark?

Answer 16

Areas of capillary dilatation on the eyelids, central forehead and back of the neck where baby is deemed to have been held in the storks beak

Question 17

When is the neonatal blood spot screening test carried out? What does it test for?

Answer 17

5-9 days
Congenital hypothyroidism
CF
Sickle cell disease
Phenylketonuria
Maple syrup urine disease
Homocystinuria

Question 18

What are causes of neonatal hypotonia?

Answer 18

Sepsis
Hypothyroidism
Prader willi

Question 19

What are causes of neonatal hypoglycaemia?

Answer 19

Maternal DM
Prematurity
IUGR
Hypothermia
Sepsis