Neonatal Tutorial

Question 1

list 5 common neonatal problems?

Answer 1

hypoglycaemia
jaundice
respiratory distress
infection
NAS

Question 2

criteria for neonatal hypoglycaemia?

Answer 2

BM <2.6

Question 3

signs of neonatal hypoglycaemia?

Answer 3

hypothermia
feeding
infection/sepsis
lethargy
jitteriness
seizure activity

Question 4

how is neonatal hypoglycaemia managed?

Answer 4

keep baby warm (36.5 - 37.5)
early feeding
minimise handling (do minimise energy expenditure)
consider change in environment to avoid stressors

Question 5

risk factors for neonatal hypoglycaemia?

Answer 5

preterm
small for dates
low birth weight
diabetic mother
maternal use of beta blockers
infant who suffered asphyxia at delivery or needed resuscitation

Question 6

feeding in neonatal hypoglycaemia?

Answer 6

bottle feeds
cup/syringe feeds
NG feeds

Question 7

when is jaundice considered physiological and hence not a concern?

Answer 7

between 24 hrs and 2 weeks

- if jaundiced under 24 hrs potentially pathological

Question 8

investigations in neonatal jaundice?

Answer 8

uncongugated vs conjugated
FBC
serum bilirubin (SBR)
coombs test (DCT) to check rhesus status etc

Question 9

how is neonatal jaundice managed?

Answer 9

phototherapy (blue light)
adequate hydration
identify and treat underlying cause

Question 10

risk factors for neonatal jaundice?

Answer 10

bruising during birth (forceps delivery etc)
twin to twin transfusion
FH of jaundice, blood disorders etc

Question 11

features of neonatal jaundice?

Answer 11

yellow tinged skin and eyes
sleepiness
not waking for feeds > seizures
hepatomegaly
splenomegaly 
dark urine and pale stools

Question 12

how is light used to treat neonatal jaundice?

Answer 12

blue light used for photo-isomerization of bilirubin
converts trans-bilirubin to the more water soluble cis form which is excreted in the bile without conjugation

can be done via biliblanket or phototherapy light unit

Question 13

side effects of phototherapy for neonatal jaundice?

Answer 13

dehydration
skin rash
eye damage

Question 14

when in jaundice considered prolonged?

Answer 14

lasting >14 days in term baby

lasting >21 days in preterm baby

Question 15

important features to check for in prolonged jaundice?

Answer 15

feeding
weight loss
family history
stool/urine colours
behaviour
organomegaly

Question 16

initial investigations in prolonged jaundice?

Answer 16

FBC
LFTs
serum bilirubn (SBR)
thyroid function tests (TFTs)
further investigations for specifics

Question 17

causes of unconjugated jaundice in newborn?

Answer 17

physiological
breast milk
haemolysis
infection
inherited causes
intestinal obstruction

Question 18

causes of conjugated jaundice in newborn?

Answer 18

biliary atresia
total parenteral nutrition (TPN)
hypothyroidism
alpha 1 antitrypisn 
galactosaemia 
CF
down's syndrome
dubin johnson
alagile syndrome

Question 19

unonjugated vs conjugated jaundice?

Answer 19

conjugated always patholoical

uncongugated can by physiological or pathological

Question 20

when does physiological jaundice peak?

Answer 20

day 3

Question 21

what is breastmilk jaundice?

Answer 21

develops after day 4 -7
peaks around end of 2nd week
may last longer time but still not pathological

Question 22

what can cause haemolysis in a newborn?

Answer 22

ABO (haemolytic disease of the newborn)
rhesus
specific antibody incompatibility
haemoglobinopathies (e.g sickle cell)

Question 23

causes of respiratory distress in newborn?

Answer 23

TTN
Respiratory distress syndrome (RDS)
infection/sepsis
pneumonia
pneumothorax
metabolic
haematological  
cardiac 
neurological
congenital lung malformations
anatomical abnormalities

Question 24

investigations in respiratory distress?

Answer 24

check airway (position, patency, abnormal anatomy, blockage)
check breathing )work of breathing, chest wall movement, efficiency/efficacy, SpO2)
could also do CBG, CXR and cold light examination

Question 25

management of respiratory distress?

Answer 25

respiratory support
surfactant 
stop feeds
antibiotics if needed
suction to remove blockage (yankeur or fine bore suction tube)

Question 26

maternal risk factors for neonatal infection?

Answer 26

mother has received IV antibiotics for confirmed or suspected invasive bacterial infection at any time during labour or in 24 hrs before and after birth
any pyrexia during labour
multiple birth if other baby has infection
group B strep in this pregnancy
mother has had previous baby with group B strep disease

Question 27

in which circumstaces are blood cultures taken and antibiotics started regardless of risk factors and clinical suspician?

Answer 27

if mother has previous baby with group B strep disease

Question 28

neonatal risk factors for infection?

Answer 28

prolonged rupture of membranes
preterm birth
chorioamnionitis

Question 29

what drugs are common causes of neonatal withdrawal/abstinence?

Answer 29

opiate based drugs (heroin, methadone, cannabis, benzodiazepines, alcohol etc)

Question 30

how is opiate withdrawal in neonate managed?

Answer 30

oramorph

can also use phenobarbital if there are worries about the use of CNS depressants

Question 31

what dangerous condition can occur as a result of consistently high/increasing bilirubin?

Answer 31

kernicterus (encephalopathy) which can lead to cerebral palsy