neonatology

Question 1

categories of term admission

Answer 1

sepsis
resp
cardio
hypoglycaemia
hypothermia
jaundice
birth asphyxia
surgical problems
neonatal abstinence syndrome

Question 2

symptoms of sepsis in the neonate

Answer 2

• pyrexia or hypothermia
• poor feeding
• lethargy or irritable
• early jaundice
• tachypnoea
• hypo/hyperglycaemia
• floppy
• asymptomatic

Question 3

risk factors for sepsis in the neonate

Answer 3

premature rupture of membranes

maternal pyrexia

maternal GBS carriage

Question 4

management of presumed neonatal sepsis

Answer 4

• admit NNU
• partial septic screen - FBC, CRP, blood cultures and blood gas
• consider CXR, LP
• IV penicillin and gentamicin 1st line
• add medronidazole if surgical/abdo concerns
• fluid management and treat acidosis
• monitor vital signs and support resp and CVS system as required

Question 5

commonest causes of neonatal sepsis

Answer 5

1. group B strep
2. e coli
3. listeria
4. coag -ve staphylococci (if lines in situ)
5. haemophilus influenzae

Question 6

onset of GBS sepsis

Answer 6

early onset: birth - 1wk

late onset/recurrence - up to 3mths

Question 7

difficulties w/ GBS sepsis

Answer 7

may be non-specific sepsis

may have no risk factors

Question 8

complications of GBS sepsis

Answer 8

meningitis

DIC

pneumonia and resp collape

hypotension and shock

Question 9

causes of congenital infection - TORCH

Answer 9

toxoplasmosis

other - syphilis, VZV

rubella

CMV

HSV

Question 10

what is a congenital infection

Answer 10

infections acquired transplacentally or in utero

typically occurs when a woman contracts an infection w/ one of the responsible organisms for the 1st time during pregnancy and the foetus then becomes affected

Question 11

what can congenital infections result in

Answer 11

IUGR

brain calcifications

neurodevelopmental delay

visual impairment

recurrent infections

Question 12

signs and symptoms associated w/ congenital infection

Answer 12

Question 13

how common is resp distress in neonates

Answer 13

one of the most common reasons for admission to NNU

Question 14

causes of resp problems in neonates

Answer 14

sepsis

TTN - transient tachypnoea of the newborn

meconium aspiration

Question 15

how common is TTN

Answer 15

self limiting and commonest cause of resp distress in term neonate

Question 16

presentation of TTN

Answer 16

presents within 1st few hrs of life

grunting, tachypnoea, oxygen requirement, normal gases

Question 17

pathophysiology of TTN

Answer 17

delay in clearance of foetal lung fluids

• normally at birth a small amount of fluids are expelled from the mouth, majority is absorbed by lung epithelium (influenced by catecholamines)

Question 18

management of TTN

Answer 18

supportive

abx - make sure to exclude other serious causes

fluids

O2

airway support

Question 19

what is associated w/ TTN

Answer 19

C section

lower concentration of catecholamines to help clear lung fluids

absence of physical pressure squeezing on the chest

Question 20

what is seen here

Answer 20

TTN

• wet lungs
• prominent vascular markings
• horizontal fissure (separating right upper lobe from middle lobw)

Question 21

what is meconium

Answer 21

first stool passed by a newborn

10% of neonates pass it during labour

Question 22

risk factors for meconium aspiration

Answer 22

post dates

maternal HT

maternal DM

difficult labour

Question 23

symptoms of meconium aspiration

Answer 23

cyanosis

increased work of breathing

grunting

apnoea

floppiness

Question 24

investigations for meconium aspiration

Answer 24

blood gas

septic screen

CXR

Question 25

why is meconium aspiration important

Answer 25

thick meconium inhaled can cause obstruction and air trapping increased risk of pneumothorax or air leaks irritant properties - chemical pneumonitis reduces effectiveness of surfactant and predisposes to chest infections

Question 25

why is meconium aspiration important

Answer 25

thick meconium inhaled can cause obstruction and air trapping increased risk of pneumothorax or air leaks irritant properties - chemical pneumonitis reduces effectiveness of surfactant and predisposes to chest infections

Question 26

what can be seen here

Answer 26

meconium aspiration * flattened diaphragm * hyperinflation of the chest * coarse opacities w/ patchy areas of collapse and areas of overinflation

Question 27

treatment for meconium aspiration

Answer 27

suction below cords airway support - intubation and ventilation fluids and IV abx surfactant NO or ECMO

Question 28

prognosis for meconium aspiration

Answer 28

most do well some develop PPHN - persistent pulmonary hypertension of the newborn associated mortality

Question 29

what happens to the circulation in PPHN

Answer 29

R → L shunt across PFO/PDA (persistence of foetal circulation) failure to oxygenate and pulmonary HT

Question 30

things to remember about cardiac conditions in neonates

Answer 30

* most murmurs aren't significant and don't need NNU admission * blue baby = urgent treatment * sepsis and resp causes are more common than cardiac

Question 31

investigation of the blue baby

Answer 31

hx and exam sepsis screen blood gas and blood glucose CXR pulse oximetry ECG echo hyperoxia test

Question 32

what is a hyperoxia test

Answer 32

try to differentiate cardiac from resp disease * administer 100% O2 for short time period lung disease - improved pp O2 on blood gas cyanotic heart disease - healthy lungs already oxygenating as much as possible, no difference on blood gas

Question 33

DDx - cardiac diagnoses for the blue baby

Answer 33

TGA TOF TAPVD hypoplastic L heart syndrome tricuspid atresia truncus arteriosus pulmonary atresia

Question 34

5 Ts of cyanotic congenital cardiac disease

Answer 34

1. Truncus arteriosus (one vessel) 2. TGA (2 major vessels are switched) 3. TRIcuspid atresia 4. TOF (4 defects) 5. TAPVD (total anomalous pulmonary venous drainage)

Question 35

defects in TOF

Answer 35

pulmonary stenosis VSD overriding aorta RVH