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Boards > Neonates > Flashcards

Neonates Flashcards

1
Q

Ways to reduce the risk of SIDS

A 
Breastfeeding
Ensuring babies are not too hot
Use of dummies
"Back to sleep" 
"Feet to foot" - ensuring the baby's feet touch the end of the cot
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2
Q

Preterm infants require Fe supplementation T/F

A

True - iron stores are laid down in the third trimester

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3
Q

In a neonate at about what age do the blood vessels reach the peripheral retina?

A

1 month

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4
Q

What is the classic presentation of renal vein thrombosis in a neonate secondary to dehydration?

A

Triad of:
gross haematuria
thrombocytopenia
enlarged kidneys

Note: usually anticoag is not used in treatment of unilateral thrombosis but it might be used in bilateral

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5
Q

In a full term male infant with undescended testes after how long is spon descent rare?

A

Spon descent is rare after 6 months

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6
Q

In preterm infants 70% of undescended testes are on the left T/F

A

F - 70% on the right

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7
Q

Risk factors for neonatal death and still birth

A 
Low SES
African race
Male infant
Nullip or multip (3rd and subsequent)
Non singleton
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8
Q

Classic finding for Hirschprung disease on contrast enema in neonate?

A

Transition zone typically in the sigmoid colon

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9
Q

Developmental dysplasia of the hip is more common in males or females? Which hip is more commonly affected?

A

More common in females 6:1
More common in left hip
Both hips affected in 1/3 of cases

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10
Q

Treatment of haemorrhagic disease of the newborn (vit K def) with active bleeding?

A

IV vit K + FFP

Note: IV vit K works faster than IM. FFP is given as even IV vit K does not work fast enough

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11
Q

When does haemorrhagic disease of newborn usually present and how? RFs?

A

2- 7 days of life (can be later in those with malabs)
GI bleed, bleeding from umbilical stump and bruising
Those who did not receive vit K + breastfeed are most at risk

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12
Q

What is the main protein in breast milk?

A

Whey

Note: is is more digestible than cow’s milk protein, casein. Breast milk contains low levels of vitamins K but higher levels of vitamins A, C and E (compared to cow’s milk)

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13
Q

A rate of increase of bilirubin above 6.5 micro mol/L per hour is a RF for kernicterus T/F

A

F - above 8.5

Other RFs:
Bili > 340 in infant with GA > 37 wks
Clinical features of acute bilirubin encephalopathy

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14
Q

2 day old infants with rhythmic focal myoclonic jerks at a rate of 1-3/sec what pathology

A

Early onset hypocalcaemia

Note: may be followed by a generalised seizure

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15
Q

Acetylsalicylic acid is C/I in when breastfeeding T/F

A

T - AKA aspirin

Due to risk of Reye’s and may inhibit plt fxn in infant

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16
Q

How many calories are found in mature breast milk

A

70kcal/100ml

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17
Q

In which congenital infection are the eye defects unilateral?

A

Varicella zoster - can have unilateral microphthalmia, chorioretinitis, cataract - development in involved dermatome

Other features - skin scarring in a dermatomal distribution, limb hypoplasia, microcephaly, developmental delay, dysfunction of the bowel and bladder sphincters

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18
Q

Ideal weight increase of a newborn / day

A

15g/kg/day

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19
Q

What is the most common cause of hydrops fetalis?

A

Fetomaternal haemorrhage

Other causes: paroxysmal SVT, Turner syndrome, congenital infections

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20
Q

A rubella non immune mother contracts the disease at 30 weeks, what is the % risk of congenital rubella?

A

0%

Note: 8-10 weeks - 90%; 11 -16 weeks - 10 -20%; > 16 weeks- nearly nil

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21
Q

By how many weeks gestation is surfactant produced?

A

22 - 24 weeks

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22
Q

By how many weeks gestation does complete alveolisation occur?

A

28 weeks

Note: lung development is not complete until 7 yrs old

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23
Q

Indications for operative intervention in acute NEC?

A

Absolute: pneumoperitoneum; failure of medical mgmt with worsening of clinical situation 48 hours into the onset of disese
Relative: peritonism; palapable mass; discolouration of abdo; fixed abdo loops on serial radiographs

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24
Q

Typical presentation of bilateral choanal atresia

A

Infant will develop resp distress as it is an obligate nose breather, cyanosis at rest but will regain colour when they cry as they open their mouth

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25
Q

IVH without ventricular dilatation is grade 2 T/F

A

True

Grade 1: ependymal (germinal matrix)
Grade 2: IVH w/o dilatation
Grade 3: IVH w dilatation
Grade 4: parenchymal

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26
Q

Prognosis of grade 1 and 2 IVH is good T/F

A

True - likely no long term side effects

Grade 3: possible impairment on the contralateral side depending on degree of dilatation
Grade 4: likely motor impairment on contralateral side

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27
Q

What is the most common bone to fracture during labour and delivery?

A

Clavicle

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28
Q

What proportion of still births are attributable to congenital abnormalities?

A

Less than 10%

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29
Q

Initial investigation in a infant with suspected fetal alcohol syndrome?

A

CMA - want to rule out other aetiologies

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30
Q

How does protein and carb content vary in colostrum compared to mature breast milk?

A

Colostrum has high protein and lower carbs

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31
Q

Compare the timing of neonatal vs perinatal deaths?

A

Neonatal - death within first 28 days of life
Perinatal - still births plus death within 1st 7 days of life

Note: still birth = in utero death after 24 weeks gestation

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32
Q

How to differentiate neonatal alloimmune thrombocytopenia from neonatal autoimmune thrombocytopenia?

A

In allo immune the maternal plts will be normal and infants will be low

In auto immune both the maternal and infant plts will be low

Note: alloantibodies are against a certain foetal platelet antigen that the baby inherits from the father but is absent in the mother. In autoimmune it is the mother who has the autoimmune disease.

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33
Q

Up until what age can a newborn hearing screen be carried out?

A

12 weeks

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34
Q

What is the earliest age at which weaning from formula/breast milk can start?

A

17 weeks

35
Q

In an infant with congenital heart block what is the most likely antibodies that crossed the placenta from the mother?

A

Anti Ro/Anti La

36
Q

In persistent pulmonary hypertension in neonates signs of heart failure are often present T/F

A

F - signs of heart failure are often absent

37
Q

Pulmonary hypertension can be associated with birth asphyxia and sepsis T/F

A

T

38
Q

Defn of polycythemia in neonate and when it needs to be treated?

A

Venous blood haematocrit > 65% is diagnostic

Should be treated if > 70% or symptomatic

39
Q

Lab abnormalities in IUGR baby

A

Hypoglycaemia
Neutropenia
Thrombocytopenia
Polycythaemia (secondary to chronic hypoxia)

40
Q

What type of IG are rheusus antibodies?

A

IgG

Note: these are the only antibodies that can Go across the placenta

41
Q

When is amniocentesis and chorionic villus sampling typically done?

A

Amniocentesis from 15 weeks onwards

Chorionic villus sampling from 11 - 13 6/7 weeks

42
Q

What is the best way to measure blood pressure in an infant?

A

Doppler auscultation

43
Q

What is the definition of broncho pulmonary dysplasia?

A

Need for resp support > 28 days or past 36 weeks gestation

44
Q

Most infants who are born SGA will achieve catch up growth T/F

A

T - 80% will

45
Q

Facial nerve palsy is common in neonates due to birth trauma, what is the mgmt?

A

Usually requires no treatment and will resolve on it’s own in 2 months

46
Q

For how long is an infant’s creatinine indicative of the maternal creatinine?

A

First 2 days of life

47
Q

What are the two most important aims of mgmt in a baby born with gastroschisis?

A

Prevention of fluid and heat loss –> wrap the defect in cling film

48
Q

Survival rates of babies born at 21, 22 and 23, 24, 26 weeks respectively

A 
21 - 0%
22 - 10%
23 - 40%
24 - 60%
26 - 80%
49
Q

Most common cause of subgalael haematoma?

A

Ventouse extraction

50
Q

Bleed between the peri osteum and scalp aponeurosis is called

A

subgalael haematoma

General develop between 12 hours to 3 days after birth

51
Q

Subcutaneous fat necrosis of the newborn is usually present at birth T/F

A

F - usually develops in the weeks following delivery and resolves by 6 - 8 weeks of age

Presents as a firm tender subcut nodule with an overlying dusky purple discolouration

52
Q

Complication of subcut far necrosis of the newborn?

A

Hypercalcaemia

53
Q

Cephalohaematoma or caput crosses suture lines?

A

Caput crosses

54
Q

Which takes longer to resolve caput or cephalohaematoma?

A

cephalohaematoma - weeks to months

caput - days

55
Q

How long does the grasp reflex last?

A

Hands - until about 5-6 months

Feet - 9-12 months

56
Q

Advanced maternal age is a risk factor for SIDS T/F

A

F - maternal age < 20 yrs is a major maternal risk factor for SIDS. The 2nd major maternal factor is smoking

Note: other pregnancy complications that increase risk placenta previa, placental abruption, premature ROM and elevated maternal alpha feet protein

57
Q

The majority of natal teeth are due to premature eruption of the primary deciduous teeth - T/F

A

T - more than 90%

Note: they should only be removed if they are supernumerary (this needs to be confirmed by X-ray)

58
Q

Natal tooth eruption is a common finding in newborns T/F

A

F

59
Q

What type of hyperbiliruninaemia is often present in infants of diabetic mothers?

A

Un conjugated

60
Q

In the absence of any clinical findings all females born breech should under go hip ultrasound at 6 weeks T/F

A

T - risk if hip dysplasia in breech females is 12%

61
Q

Risk factors for renal vein thrombosis?

A 
Perinatal asphyxia 
Septic shock
Dehydration
Congenital hypercoag states
Maternal DM
62
Q

Caudal regression syndrome is associated with what maternal condition?

A

Maternal DM

Note: a spectrum of structural defects of the sacral region

63
Q

What commonly causes diaphragmatic paralysis? What other injury is it commonly associated with ?

A

Injury to C3-5 nerve roots

Brachial plexus injury is associated in 90%

64
Q

Infant born with murmur consistent with VSD and meningomyelocele, what antiHTN medication did the mother take?

A

ACEi

They are also associated with renal and limb anomalies and pulm hypoplasia

65
Q

In an infant born with a single umbilical artery what is the recommended initial investigation?

A

A thorough physical exam recognising an increased risk of congenital anomalies

Note: 25% of infants with single umbilical artery have anomalies : 20% of anomalies are renal however USS kidney is no longer routinely recommended

66
Q

Non blanching bluish fluctuant swelling in the mouth lateral to the midline which displaces the tongue. What pathology and what treatment?

A

Ranula

Tx: complete surgical excision in continuity with the associated glands

67
Q

Bohn nodules typically location and appearance?

A

Alveolar ridge in neonate

Whitish/clear inclusion cysts

68
Q

Where are mucoceles typically located?

A

Buccal mucosa along the occlusal plane

69
Q

Harlequin color change in common in normal healthy neonates T/F

A

T - occurs in approx 10% of healthy newborns

70
Q

What medications are associated with gastroschisis?

A

Vasoactive substances - cocaine, nicotine, pseudoephedrine

Note: pasthophys - vascular accident involving the right umbilical vein or right omphalomesenteric artery that leads to ischaemic necrosis or the abdominal wall, allowing bowel to enter into the amniotic cavity

71
Q

What differentiates Apert from Crouzon syndrome clinically?

A

Apert have limb abnormality (syndactyly) and Crouzon do not

Note: both have craniosynostosi and ocular proptosis

Saethre-Chotzen syndrome is another craniosynostosis syndrome with syndactyly

72
Q

Preterm birth is a risk factor for hip dysplasia. T/F

A

F - they have a decreased risk

73
Q

Features of neonatal behavioural syndrome due to maternal SSRI use?

A 
Hypothermia + hypoglycaemia
Emesis + frequent stools
Feeding difficulty 
Poor sleep
Agitated/jittery
Abnormal tone
Seizures
74
Q

Jaundice within the first 24 hours of life is normal T/F

A

F - jaundice before 48 hours is pathologic and requires a work up

75
Q

Which infant in twin twin transfusion is at highest risk of hyperbilirubinaemia?

A

The larger (recipient) twin - due to an increased haemoglobin load

76
Q

In twin twin transfusion fetal hydrops can occur in both infants T/F

A

T - in the donor due to anaemia and in the recipient due to polycythaemia

77
Q

Indications for surgery for an umbilical hernia?

A
  1. Symptomatic
  2. Still present at 5-6 yrs of age
  3. Increases in size between 1-2 yrs old
78
Q

When can a mother with Hep B initiate breast feeding?

A

Immediately

Do not need to wait until after vaccines

79
Q

What is often the first clinical finding in a pt with congenital hypothyroidism?

A

Prolonged physiologic jaundice

Note: due to delayed maturation of glucuronide conjugation.
Other features: umbilical hernia, poor feeding, wide open fontanelle

80
Q

Findings in child > 8 -10 weeks with developmental hip dysplasia?

A

+ Galeazzi sign ( asymmetry in the height of the knees)
Limited abduction of hip
+ Trendelenburg (in ambulatory child)

81
Q

Indications for GBS prophylaxis in a mother with unknown carrier status?

A

One of
< 37 weeks gestation
ROM > 18 hours
Intrapartum temp > 100.4 (38)

Note: if prophylaxis was indicated but not received or inadequate and infant is term with ROM > 18 hours, limited eval (bcx and CBC) with 48 hours monitoring is recommended

82
Q

What drugs are associated with early onset haemorrhage disease of newborn?

A

AEDs - phenytoin, barbiturates, carbamazepine
AntiTB - rifampin, isoniazid
Vit K antagonists - warfarin

83
Q

Infants who are IUGR are at risk for what pathology as adults?

A

Metabolic syndrome
Hypertension
Non alcoholic fatty liver (but not cirrhosis)
Reduced cognitive executive functioning

84
Q

What is the most common presentation of cerebral infarction?

A

Seizures within the first 3-4 days of life

Note: hypotonia and resp irregularities may be seen in the days to weeks

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