Neonates - Pathology

Question 1

How do we refer to a foetus with IUGR once it’s born?

Answer 1

Small for Gestational Age (SGA)

Question 2

How small is SGA?

Answer 2

<2500g (<10th centile)

Question 3

What are the types of SGA?

Answer 3

Symmetric (affecting all growth parameters, usually starts early)

Assymetric (Typically effecting weight/height but no head size)

Question 4

List 6 things that can cause a baby to be SGA?

Answer 4

• Smoking
• Pre-eclamptic Toxaemia
• Chromosomal e.g. Edward’s
• Infection e.g. CMV

Placental Abruption

Twins

Question 5

What problems can arise from being SGA?

Answer 5

• Perinatal hypoxia
• Hypoglycaemia
• Hypothermia
• Thrombocytopenia
• Polycythaemia –> Thick blood & jaundice
• Acidosis
• GI problems

Long term HTN, obesity, IHD & reduced growth

Question 6

Define the tiers of pre-term?

Answer 6

Pre-term < 37wks

Extremely <28wks

Question 7

Define the tiers of low Birth weight?

Answer 7

<2500g = low
<1500g = very low
<1000g = Extremely Low

Question 8

List 8 complications ass with being born preterm?

Answer 8

REsp Distress Syndrome (RDS)
Bronchopulmonary Dysplasia (BPD)
Minor rest problems e.g. apnoea

Intraventricular Haemorrhage (IVH)
Post-haemorrhagic Hydrocephalus (PHH)
Periventricular Leucomalacia (PVL)

Necrotising Entero-colitis (NEC)

PDA

Question 9

What can we do to prevent RDS from developing and how do we treat it post-delivery?

Answer 9

Antenatal Steroids to speed surfactant development

Treat early with surfactant, early extubation and N-CPAP

Question 10

Bronchopulmonary Dysplasia is a scarring of the lungs, what causes it?

Answer 10

Long term O2 & CPAP –> Inflammation & infection

Typically as treatment for RDS

Question 11

How do we manage BPD?

Answer 11

O2 & Ventilation
Nutrition

Steroids to kill inflammation

Question 12

What treatments are available for minor resp problems after birth?

Answer 12

Caffeine

N-CPAP

Question 13

How can we grade an IVH?

Answer 13

Grade 1-4 following US through fontanelle

Question 14

How can we prevent and treat IVH?

Answer 14

Antenatal Steroids

Symptomatic treatment and drain the blood

Question 15

What are the consequences of a PDA?`

Answer 15

• Overperfusion of lungs –> Pulm Oedema
• Systemic Underperfusion
• -> Fluid retention (renal underperfusion)
• -> GI problems e.g. NEC

Question 16

How would you spot some with NEC

Answer 16

Large shiny abdomen, vomiting and blood in the stool. Often occurs secondary to some form of ischaemia

Question 17

How do you treat NEC?

Answer 17

Abx
Parenteral Nutrition

Often need surgery

Question 18

How good are the outcomes in premature kids?

Answer 18

1in3 will have a desirable QoL i.e. normal or mild disability

1/3rd will die and 1/3rd have mod/severe disability