neonates

Question 1

when is APGAR score used

Answer 1

1 min, 5 mins, 10 if needed

Question 2

categories for APGAR

Answer 2

(all out of 2) // pulse // resp effort // colour // tone // reflex irritability

Question 3

score interpretation APGAR

Answer 3

<3 = bad // 4-6 = moderate // 7-10 = good

Question 4

what cyanosis is common in first 24 hours of life

Answer 4

peripheral eg hands and feet

Question 5

what hb level is central cyanosis in newborn seen

Answer 5

more than 5g/L drop

Question 6

invx to determine cardiac vs non-cardiac cyanosis in neonate

Answer 6

nitrogen washout test (give 100% O2 for 10 min –> ABG –> pO2 <15 = congenital heart disease

Question 7

causes cyanotic congenital heart disease

Answer 7

tetralogy of fallot // transposition of arteries // tricuspid atresia

Question 8

mx congenital heart disease

Answer 8

PGE1 eg alprostadil // (maintain patent ductus arteriosis –> surgery)

Question 9

what is acrocyanosis

Answer 9

common finding in health newborn // peripheral cyanosis in mouth and extremeties // occurs straight after birth for 24-48 hours

Question 10

what is therapeutic cooling

Answer 10

deliberate hypothermia –> protect brain from damage

Question 11

indication therapeutic cooling

Answer 11

open heart surgery or neurosurgery // post VF arrest // head trauma // acute ischaemic stroke // NEONATES with hypoxic ischaemic encephalopathy

Question 12

consequences hypoxic ischaemic encephalopathy

Answer 12

epilepsy, low IQ, cerebral palsy

Question 13

criteria neonates therapeutic cooling

Answer 13

> 36 gestation and >1800g // acute perinatal event with hypoxia // apgar <5 at 10 mins // met acidosis // seizure

Question 14

invx to help eligibility of therapeutic cooling

Answer 14

EEF

Question 15

time of therapeutic cooling newborn

Answer 15

within 6 hours of birth –> 72 hours

Question 16

temperature target therapeutic cooling

Answer 16

33-34 (whole body) // 34-35 (head cooling)

Question 17

how is therapeutic cooling measured

Answer 17

rectal or nasopharyngeal thermometer

Question 18

how to rewarm after therapeutic cooling

Answer 18

slowly

Question 19

what is microcephaly

Answer 19

occipital frontal circumference <2nd centile

Question 20

causes microcephaly

Answer 20

normal variation // familial // infection // hypoxic encephalopathy // fetal aclohol // patau syndrome

Question 21

features Fetal alcohol syndrome

Answer 21

small eyes // thin upper lip // absent filtrum // micocephaly // cardiac issue // growth retardation // learning difficulties

Question 22

what is Caput succedaneum

Answer 22

oedema of presenting part of scalp (usually vertex)

Question 23

causes Caput succedaneum

Answer 23

prolonged labour, use of ventouse (vacuum)

Question 24

symptoms Caput succedaneum

Answer 24

soft, puffy swelling due to oedema // present at birth // crosses sutures // resolves within a few days

Question 25

symptoms cephalohaematoma

Answer 25

develops several hours after birth // does not cross suture lines // jaundice // takes 3 months to resolve

Question 26

where does cephalohaematoma occur

Answer 26

parietal region

Question 27

when does neonatal blood spot occur

Answer 27

5-9 days after birth (heel prick)

Question 28

conditions in blood spot

Answer 28

hypothyroid // CF // sickle cell // phenylketonuria // medium chain acyl-CoA dehydrogenase deficiency // maple syrup disease // isovaleric acidaemia // glutaric aciduria type // homocystinuria

Question 29

causes neonatal hypotonia (neonatal cause)

Answer 29

sepsis // werdnig hoffman (muscular atrophy) // hypothyroid // prader willi

Question 30

maternal hypotonia

Answer 30

benzos // myasthenia gravis

Question 31

when is neonatal hypoglycaemia common

Answer 31

first few hours after birth (<2.6)

Question 32

causes of persistent Neonatal hypoglycaemia

Answer 32

preterm <37 // maternal diabetes // IUGR // hypothermia // sepsis

Question 33

symptoms Neonatal hypoglycaemia

Answer 33

jittery, irritable, fast RR, pale // poor feeding, weak cry, drowsy, hypotonia, seizure // hypothermia

Question 34

mx asymptomatic Neonatal hypoglycaemia

Answer 34

encourage feeding + monitor BM

Question 35

mx symptomatic (or v low) Neonatal hypoglycaemia

Answer 35

admit + IV 10% dextrose

Question 36

what is early onset neonatal sepsis

Answer 36

within 72 hours birth

Question 37

what is late onset neonatal sepsis

Answer 37

72 hours - 28 days

Question 38

most common cause early neonatal sepsis

Answer 38

group B strep

Question 39

organism late onset neonatal sepsis

Answer 39

E. coli, staph, psuedomonas

Question 40

RF neonatal sepsis

Answer 40

mother with GBS colonisation, bacteruria, temp >38 // preterm // low birth weight <2.5kg // chorioamnionitis

Question 41

symptoms neonatal sepsis

Answer 41

resp distress (grunting, nasal flaring, fast RR) most common // may be subtle

Question 42

invx neonatal sepsis

Answer 42

culture + FBC // CRP // blood gas // urine

Question 43

mx neonatal sepsis

Answer 43

IV pen V + gentamicin

Question 44

until what age is neonatal death

Answer 44

0-28 days

Question 45

what includes perinatal mortality

Answer 45

still birth and within 7 days

Question 46

newborn resus

Answer 46

dry + warm –> tone, RR, HR –> 5 rescue breaths –> reassess chest movement –> compression
+ ventilation breaths 3:1