Neonatology

Question 1

What is surfactant produced by

Answer 1

Type 2 alveolar cells

Question 2

How does surfactant effect lung surface tension

Answer 2

Reduces it

Question 3

Why is high surface tension an issue in lungs

Answer 3

Water in lungs
Water attracts each other
On either side of sacs
Closes alveoli sacs

Question 4

How does surfactant effect compliance

Answer 4

Increases compliance

Less force needed to expand alveoli

Question 5

When is surfactant produces and fully equipped

Answer 5

24 - 34 weeks gestation

Question 6

What does hypoxia in birth lead to

Answer 6

Hypoxic-ischaemia encephalopathy

THEN CP

Question 7

Why do babies get cold when born

Answer 7

Large surface to weight ratio when born

And wet

Question 8

1st thing to do when a baby is born and not breathing

Answer 8

vigerious rubbing/ drying

BEFORE A-E/ 5 RESCUE BREATHS

Question 9

When should a Apgar score be calculated

Answer 9

1, 5 and 10 minutes

Question 10

What should be done after drying if baby is not breathing

Answer 10

5 breaths
Reassess
5 breaths

3:1 CPR

Then chest compressions

Question 11

Acceptable pre ductal sats at 2 mins and when should they be 100%

Answer 11

65%

10 mins (or sooner!!)

Question 12

In a newborn what bpm would indicate need for CPR

Answer 12

Less than 60

Question 13

5 components of APGAR

Answer 13

Appearance (colour)
Pulse
Grimmace
Activity
Respiration

Question 14

One possible negative of delayed cord clamping

Answer 14

May be associated with higher rates of neonatal jaundice

Question 15

How soon should the newborn exam be after birth

Answer 15

72 hours

Question 16

When is the newborn heel prick test taken

Answer 16

Day 5

Can be upto 8

Question 17

How long does it take for newborn heel screening test to come back

Answer 17

6-8 weeks

Question 18

What should babies o2 sats be on newborn exam

Answer 18

Pre and post ductal

Above 96% with no less than 2 % difference

Question 19

What is affected in Erbs palsy

Answer 19

Injury to the upper trunk - C5 and C6

Paralysis or loss of sensation

Question 20

How do port wine stains change with time

Answer 20

Get darker

Question 21

What is Sturge Weber syndrome

Answer 21

Associated with port wine stains

Visual impairment, learning difficulties, headaches, epilepsy, glaucoma

Question 22

How long does a cephalohaematoma take to resolve

Answer 22

Months

Question 23

Does a cephalohaematoma cross suture lines

Answer 23

No

Blood and fluid below the periosteum

Question 24

Does a caput succedaneum cross suture lines

Answer 24

Yes

CAP = CAPUT (crosses lines just like a cap)

Question 25

What is more dangerous caput or cephalohaematoma

Answer 25

cephalohaematoma as blood collection can cause anaemia and jaundice 5% associated with scull fracture

Question 26

What nerves are injured in Erbs palsy

Answer 26

C5 C6 in the brachial plexus

Question 27

How does Erbs palsy present

Answer 27

Waiters tip Internal rotation of shoulder, extended elbow and pronated wrists

Question 28

Does Erbs palsy ever resolve?

Answer 28

Normally resolves within a few months

Question 29

Other than the scull, what bone is most commonly fractured in birth

Answer 29

Clavicle

Question 30

Most common organism in neonatal sepsis (and 4 other less common)

Answer 30

GBS E coli, listeria, klebsiella, staph aureus

Question 31

Which babies may receive therapeutic hypothermia

Answer 31

HIE at term or near term

Question 32

When is neonatal jaundice always pathological

Answer 32

First 24 hours!

Question 33

Main complication of neonatal jaundice

Answer 33

Kernicterus

Question 34

Prolonged jaundice cut off periods

Answer 34

2 weeks for term | 3 weeks for pre term

Question 35

Grades of prematurity

Answer 35

Under 28 - extreme 28-32 - very preterm 32-37 - moderate to late pre term

Question 36

Definition and management of apnoea of prematurity

Answer 36

Breathing stops for 20 seconds or more with bradycardia/ low sats Apnoea monitors and IV caffeine

Question 37

4 key interventions to improve outcomes in preterm labour

Answer 37

Tocolysis (nifidipine) Maternal steroids IV MGSO4 Delayed cord clamping/ milking Cervical suture/ vaginal progesterone before labour

Question 38

What condition can affect retina of pre term newborns

Answer 38

Retinopathy of prematurity Retinal blood vessel development finishes at 37-40 weeks

Question 39

Retinopathy of prematurity key risk

Answer 39

Scar causes retinal detachement

Question 40

Retinopathy of prematurity pathophysiology

Answer 40

Hypoxia drives new vessel growth If vessels not already developed, giving baby O2 reduces hypoxia so less hypoxic vessel growth

Question 41

What babies are screened for Retinopathy of prematurity

Answer 41

Under 32 weeks or under 1.5kg Every 2 weeks screening test until vessels grow to outskirts of eye

Question 42

Treatment for Retinopathy of prematurity

Answer 42

Transpupilary laser photocoagulation to stop new blood vessels forming

Question 43

Xray appearance of RDS

Answer 43

Ground glass

Question 44

Key risk factors for NEC

Answer 44

Low birth weight/ premature Formula fed Sepsis PDA or congenital heart defect

Question 45

Imaging of choice for NEC

Answer 45

Abdominal X ray

Question 46

NEC abdo xray key findings

Answer 46

GAS IN BOWEL WALL (pneumatosis intestinalis) Dilated loops of bowel Bowel wall oedema Pneumoperiternium (if perforated)

Question 47

NEC management

Answer 47

Nil by mouth IV fluid, TPN Antibiotics Surgical removal