Neonates

Question 1

Three categories of neonatal jaundice

Answer 1

Physiological (1-14 days) Pathological (<24 hours) Prolonged (>14 days)

Question 2

Cause of physiological jaundice

Answer 2

ABSENCE OF ANAEMIA, MODERATE BILIRUBIN AND shortened RBC lifespan Increased breakdown Low EPO

Question 3

Pathological jaundice causes (<24 hours)

Answer 3

• METABOLIC + Crigler Najar + Gilbert’s disease - IMMUNE + Haemolytic disease of Newborn - INFECTION + TORCH organisms + Hepatitis B - TRAUMA + Cephalhaematoma

Question 4

Prolonged jaundice (1-14 days)

Answer 4

• METABOLIC + Galactosaemia + Breast milk jaundice - ENDOCRINE + Hypo/hyperthyroidism

Question 5

4 causes of conjugated hyperbilirubinaemia

Answer 5

• Neonatal hepatitis - Sepsis - CF - Biliary atresia

Question 6

Complication of jaundice

Answer 6

Kernicterus - EPSEs, visual problems, cognitive impairment

Question 7

Risk factors for neonatal jaundice

Answer 7

1) Sibling with phototherapy 2) Breast fed babies 3) Mothers with diabetes

Question 8

Other signs to look for in jaundice

Answer 8

1) Hepatosplenomegaly 2) Petechiae 3) Microcephaly

Question 9

Investigations jaundice

Answer 9

1) Bilirubin 2) LFTs 3) Infection screen: TORCH, Swabs, Blood culture, Urine Culture 4) Direct Coombs Test in the infant

Question 10

Management of jaundice (3)

Answer 10

Phototherapy Exchange transfusion Monitor bilirubin

Question 11

Risk factors for IVH (2)

Answer 11

Prematurity Low birthweight

Question 12

Signs of IVH

Answer 12

Bulging fontanelle Eye signs Diminished primitive reflexes

Question 13

Neonatal sepsis presenting

Answer 13

Symptoms Seizures Sleeping Reduced movements Diarrhoea Poor feeding Signs Abnormal HR Bulging/depressed fontanelle Decreased/increased temp Hypoxia

Question 14

Neonatal sepsis investigations

Answer 14

UNLESS OBVIOUS BRONCHIOLITIS in Neonate <30 days 1) FBC 2) Blood culture 3) Urinalysis 4) Lumbar puncture 5) Urine culture ALSO CXR

Question 15

Neonatal sepsis management

Answer 15

1) IV penicillin + gentamicin

Question 16

Neonatal sepsis causative organisms

Answer 16

1) GBS, e.coli, Haemophilus influenza 2) If late onset (4-90 days) then Staph aureus, e.coli, candida

Question 17

What is PPROM?

Answer 17

Preterm prelabour rupture of membranes (P-PROM) is the rupture of membranes prior to the onset of labour, in a patient who is at less than 37 weeks of gestation

Question 18

What are three risks to neonate of PPROM?

Answer 18

Prematurity Sepsis (ascending infection) Pulmonary hypoplasia

Question 19

How should PPROM be manageD?

Answer 19

1) Steroids 2) Prophylactic antibiotics - Erythromycin or penicillin if GBS identified

Question 20

Short-term complications of IUGR

Answer 20

1) Jaundice 2) Meconium aspiration 3) Necrotising enterocolitis

Question 21

Late complications of IUGR

Answer 21

1) Cerebral palsy 2) Poorer scores on cognitive testing 3) Obesity

Question 22

Definition of prematurity

Answer 22

Born <37 weeks

Question 23

Problems of prematurity (short-term)

Answer 23

BRAIN - IVH EYES - ROP LUNGS - RDS (O2 leads to ROP) GUT - NEC LIVER - Jaundice & Kernicterus METABOLIC - Hypothermia - Hypoglycaemia

Question 24

Problems of prematurity (long-term)

Answer 24

• Cognitive difficulties - Obesity

Question 25

Causes of prematurity

Answer 25

Pre(eclampsia)-M-atU(terine abnormalities)RI(UGR)TY 1) multiple pregnancy 2) Pre-eclampsia 3) IUGR 4) Uterine anomalies

Question 26

Identify

Answer 26

Stork bite Not serious Lesions on eyelids fade in the first year; over 95% will fade by 12 months. Back of the neck may never fade.

Question 27

Identify

Answer 27

Milia Sebaceous cysts, very small raised pearly white or yellowish bumps on the skin. Seen on the nose, cheeks, eyelids, forhead and chest, but can occur anywhere Affects about half of babies Retentions of keratin and sebaceous material in sweat glands that are not fully formed Will clear spontaneously in weeks

Question 28

Identify

Answer 28

Erythema Toxicum Small firm yellow or raised bumps filled with pus on top of a red area of skin, contains eosinophils. Occur on any part of the body except the palms and soles. Often begins on face and spreads. Appears on day 2-3 and disappears by day 10. HALF of all newborn infants.

Question 29

Identify

Answer 29

Cradle Cap Usually occurs on the scalp but can affect face, ears, neck, nappy area or skin folds Does not cause itch or discomfort – if scratching consider atopic eczema Recognised by large, greasy yellow or brown scale on cap Seborrhoeic dermatitis Large greasy yellow or brown scales on the scalp Massaging scalp with baby oil will help loosen flakes

Question 30

Identify

Answer 30

Cavernous Haemangioma May be present at birth but more commonly develop in the first month. Grow for 3-4 years when they start to regress. Commonest tumour in infancy affecting 5-10% of Caucasian babies. More common with low birthweight, prematurity and multiple gestations Increases in size until 3-15 months and then regresses No treatment unless interferes with vision or the airway Can be external, internal (liver, heart, brain) or both

Question 31

Identify

Answer 31

A vascular malformation of developmental origin with ectasia of superficial dermal capillaries Face, nape of neck and upper trunk Pink to deep red or purple patches; often unilateral with distinct cut-off Lesions tend to persist, darken and thicken with age Disfiguring lesions can be improved with laser therapy Occasionally associated with congenital glaucoma, sturge weber syndrome (Portwine + hemiparesis + epilepsy + vascular headache) and klippel-trenauny-weber syndrome (portwine + giant limb)

Question 32

Identify

Answer 32

Blue/black discolouration at the base of the spine or on the buttocks Occasionally occurs on the legs or any other part of the body Usually, although not invariably, on afro-carribean or Asian babies Fade slowly over the years

Question 33

Identify

Answer 33

Satellite lesions are common Fungal infection manifest by widespread vivid sharply bordered erythema with satellite pauples or vesicles. Frequently found in anterior perineum, perianal and folds Systemic antibiotic treatment is a common trigger Antifungal agents like nystatin or miconazole can be used in association with gentle cleansing of the perineum. May need oral nystatin.

Question 34

Identify

Answer 34

‘W’ shape of lesion – affecting convex areas and sparing folds Worsening of lesions with baby wipes and cloth diapers also suggest diagnosis, because that kind of diaper has diminished power of absorption. Baby wipes make worse so advise against. Other causative are increasing skin h, local humidity, coverage and friction Treated with zinc oxide

Question 35

Meconium aspiration syndrome definition

Answer 35

AS is defined as a respiratory distress that develops shortly after birth, with radiographic evidence of aspiration pneumonitis and presence of meconium-stained amniotic fluid.

Question 36

Risk factors for Meconium Aspiration Syndrome

Answer 36

Pre-eclampsia Oligohydramnios Smoking

Question 37

Meconium Aspiration Syndrome Investigations

Answer 37

FBC CXR Brain imaging ECG

Question 38

Meconium Aspiration Syndrome Management

Answer 38

Suction Oxygen Ventilatory support Surfactant replacemetn

Question 39

Respiratory Distress Risk Factors

Answer 39

Prematurity C-section Maternal diabetes

Question 40

Respiratory distress presentation

Answer 40

Tachypnoea Grunting Flaring of nostrils Subcostal recession

Question 41

Respiratory Distress Management

Answer 41

Surfactant Replacement Therapy Oxygen therapy Gentle management

Question 42

Respiratory Distress Chronic Complications

Answer 42

Bronchopulmonary dysplasia Retionpathy of prematurity Neurological impairment

Question 43

Determining level of gestation

Answer 43

Dubowitz/Ballard Examination

Question 44

Investigation for IVH

Answer 44

Cranial Ultrasound Scan

Question 45

Investigations for premature infants

Answer 45

Blood gas FBC U&E Blood culture CRP Blood group & direct coombs test

Question 46

What should obstetricians offer women likely to give birth to premature babies? (2)

Answer 46

Antenatal steroids Magnesium sulphate

Question 47

NEC Symptoms

Answer 47

Bloating Off feeds Altered stool pattern Bloody mucoid stool Billious vomiting

Question 48

NEC investigations

Answer 48

Abdominal x-ray FBC, U&E, Blood gas

Question 49

NEC Management

Answer 49

Nil by mouth IV fluids, TPN, IV antibiotics (Ampicillin & Gentamicin)

Question 50

NEC Prevention

Answer 50

Feed with human milk Slow-feeds

Question 51

What is this?

Answer 51

Ground glass shadowing indicated respiratory distress

Question 52

What is this?

Answer 52

NEC

Question 53

What does condition does a meconium ileus indicate?

Answer 53

Cystic Fibrosis

Question 54

When should meconium be passed by?

Answer 54

24 hours

Question 55

Bilious vomiting: five causes

Answer 55

1) Meconium ileus 2) hirschprung's disease 3) Duodenal atresia 4) Imperforate anus 5) Necrotizing entercolitis

Question 56

Cephalhaematoma vs Caput Succenadeum

Answer 56

Cephalhaematoma - between periosteum and skull, limited by suture lines Caput Succenadeum - Between scalp and periosteum , spreads over suture lines Subgaleal - scalp galea aponeurosis and periosteum. Lots of associated head trauma.

Question 57

Name three overarching newborn screening tests

Answer 57

1) Newborn and 6-8 week physical examination 2) Newborn hearing screen 3) Newborn blood spot test

Question 58

Give five conditions tested for by newborn bloodspot test

Answer 58

1) PKU 2) Congenital hypothyroidism 3) Sickle cell disease 4) Cystic fibrosis 5) Maple syrup urine disease 6) MCAD 7) Homocysteinuria

Question 59

Give four conditions picked up by newborn physical examinations

Answer 59

1) Cataracts 2) Congenital heart disease 3) Undescended testes 4) Developmental dysplasia of the hip

Question 60

Two bits of newborn hearing test

Answer 60

1) Automated otoacoustic emission 2) Autmated auditory brainstem response

Question 61

Neonatal sepsis red flags (5)

Answer 61

1) Seizures 2) Shock 3) Resp distress \>4 hours after birth 4) Suspected or confirmed infection in twin 5) Systemic abx given to mother intrapartum

Question 62

When to stop ABx in babies with neonatal sepsis?

Answer 62

the blood culture is negative, and the initial clinical suspicion of infection was not strong, and the baby’s clinical condition is reassuring with no clinical indicators of possible infection, and the levels and trends of C-reactive protein concentration are reassuring.