Neonatology

Question 1

Birth weight
- Low categories

Answer 1

Birthweights

2500g - very low

1500 - extremely low

1000 - extremely extremely low

Question 2

IRDS
- Tx

Answer 2

IRDS
- Infant RDS

1. Surfactant
2. Ventilation
3. Steroids

Question 3

Newborn nutrition

• Three options

Answer 3

Newborn feeds

1. Colostrum
   - First milk
2. Breast milk
3. TPN

Question 4

Macrosomia

1. Aetiology
2. Problems

Answer 4

Macrosomia

• DM mother
• Problems
  1. Shoulder dystocia
  2. Ischaemic brain injury
• Cerebral palsy risk
• Total body cooling (33.5º)

Question 5

Craniosynostosis
- Pathology
- Types

Answer 5

Synostosis of the cranium

• Pathology
  1. Early closure of a suture
  2. Pulling of the bones towards the closure

Types
1. Sagittal
- Scaphocephaly
- Long and narrow growth

2. Coronal
   - Anterior plagiocephaly
   - Forehead flattening on closed side

• Bicoronal synostosis
• Flattening on both sides (broad)
• Brachycephaly

3. Lambdoid synostosis
   - Flattened on the back l/r
   - Posterior plagiocephaly
4. Metopic synostosis
   - Narrow at front near frontal/metopic suture
   - Trigonocephaly (narrow front, broad back)

Question 6

Cranial US

1. View
2. Pathologies

Answer 6

Cranial US

• View
• Pathologies
  1. Periventricular haemorrhage (PVH/IVH)
  2. Periventricular leukomalacia
  3. Ventricular dilatation
  4. Hydrocephalus

Question 7

Intraventricular haemorrhage

1. Epidemiology
2. Grading

Answer 7

IVH/PVH

• Epidemiology
  1. 15-30% <1500g
  2. First week of life
  3. Rare beyond 34 weeks
• Grading
  1. Caudothalamic notch
  2. In ventricle
  3. Ventricular dilation
  4. In parenchyma

Question 8

Intraventricular haemorrhage

1. Pathophysiology
2. Mx

Answer 8

IVH

• Pathophysiology
  1. <34 week baby
  2. HIE reperfusion
  3. Hemorrhagic infarct
• Mx
  1. Antenatal CSTs
  2. Antimicrobials in PRoM

Question 9

NIPE Hydrocele

1. Pathology
2. Mx

Answer 9

NIPE Hydrocele

• Pathology
  1. Patent processus vaginalis
  2. Fluid in tunica vaginalis
• Mx
  1. Observe for 1 year

Question 10

Gentamicin

1. ADRs
2. Monitoring

Answer 10

Gentamicin

• ADRs
  1. Dysphonia
  2. Tinnitus
  3. Vomiting
  4. Nephrotoxicity (in renal impairment)
• Monitoring

1. Neonates
   - after 3-4 doses
   - taken before next dose ‘trough’
   - 1 hr after IM/IV ‘peak’ conc
2. Renal function assessed before
3. Auditory and vestibular monitored

Question 11

NIPE
- Four main checks

Answer 11

NIPE

1. Eyes
2. Hips
3. Heart
   (4. Testicles)

Question 12

NIPE
- CHAMPION

Answer 12

NIPE

C - ranium
H - ead circumference
A - rteries (femoral)
M - oro reflex
P - osture/spine
I - nspect genetalia
O - rganomegaly
N - eurology

Question 13

NIPE
- Hip Checks

Answer 13

NIPE Hip

1. Barlow
   - Adduction and flexion
   - Pressure
   - Dislocation
2. Ortolani
   - Abduction
   - Click of reduction

Question 14

Gestation

1. Extremely preterm
2. Very preterm
3. Moderately preterm
4. Late preterm

Answer 14

Gestation

1. <28 weeks
   - Extremely preterm
2. 28-32 weeks
   - Very preterm
3. 32-34 weeks
   - Moderate
4. 35-37 weeks
   - Late preterm

Question 15

Prematurity

• 7 complications

Answer 15

Prematurity complications

1. Head
   - IVH
2. Eyes
   - RoP (retinopathy)
3. Heart
   - PDA
4. Lungs
   - RDS
   - CLD
5. Gut
   - NEC
6. Skin
   - Thermoregulation
7. Glucose
   - Hypo and hyperglycaemia

Question 16

Prematurity
- Head complications

Answer 16

Prematurity - Head

1. IVH
   - Grade 1-4
2. Intraparenchymal cystic lesions
3. PVL
   - Peri-ventricular leukomalacia
   - Softening of white matter

Question 17

Prematurity - RoP

1. Pathology
2. Ix
3. Mx

Answer 17

Retinopathy of Prematurity

-Pathology
1. <32wk/<2kg
2. Dependant on location

• Ix
  1. 2-weekly review
• Mx
  1. Sats 88-92%
  2. ?Prevent reperfusion injury
  3. Laser treatment

Question 18

Prematurity
- 4 causes of premature delivery

Answer 18

Prematurity causes

1. No identifiable cause
2. PROM
   - 30-40%
3. Life-threatening
   - 25%
   - Pre-eclampsia
   - Renal
   - Growth restriction
4. Emergency event
   - 25%
   - Placental abruption
   - Eclampsia
   - Severe infection

Question 19

IRDS

• Mx

Answer 19

IRDS

1. Surfactant to 32 weeks
   - ET
   - Catheter
2. Ventilation
   - CPAP
   - PEEP

Question 20

CLD
1. Definition
2. Mx

Answer 20

Chronic lung disease

1. Oxygen requirement at 36 weeks
   - Evolving CLD at 34-35
2. Nasal cannula/home oxygen therapy

Question 21

NEC
- Timing
- Mx

Answer 21

NEC

• Timing
  1. 3rd week of life
  2. 21 days
• Management
  1. Triple ABx
• Cefotaxime
• Gentamicin
• Metronidazole

2. Complications
   - eg. Strictures

Question 22

Prematurity glucose

1. Hypos and Hypers
2. Management

Answer 22

Prematurity glucose regulation

• Challenge

1. High energy demand
   - No brown fat reserves
2. High stress level
   - High cortisol

• Management
  1. Fluids
  2. NG feeding
• Breast milk fortifier
• Nutri-prem

Question 23

Prematurity
- Discharge requirements

Answer 23

Preterm discharge

1. Temperature self-regulation
2. Gaining weight
   - 50-80g/week
   - Feeding 2 hourly
3. Only one of:
   - Tube fed
   - On oxygen

Question 24

Neonatal weight change
1. Parameters
2. Recovery

Answer 24

Neonatal weight change

1. 10% loss by day 5 is a concern
2. Regain by 2-3 weeks

Question 25

Pregnancy
- Two effects of smoking

Answer 25

Smoking during Pregnancy

1. Placental insufficiency
2. Low birth weight

Question 26

PDA
1. Prevalence
2. Mx

Answer 26

PDA
- Prevalence
1. 1/2000 term
2. 20-60% preterm

• Mx
  1. NSAIDs
• Ibuprofen
• Indomethacin

2. CHD maintenance of PDA
   - Alprostadil (PGE1)
   - Dinoprostone (PGE2)

Question 27

Neonatal infection
- Two concerning pathogen groups

Answer 27

Neonatal infection

1. ESBL
   - Extended-spectrum-beta-lactamases
   - Treated by meropenem/tazocin/amikacin
2. Ureaplasma
   - Hydrolyse urea to make ATP
   - 40-80% of healthy vaginal flora
   - Macrolide 10 days (erythromycin)

Question 28

Neonatal Caffeine
- Indication
- Regimen

Answer 28

Neonatal caffeine

• Indications
  1. Apnoea/desaturation
  2. Need for IPPV
  3. Extubation
• Regimen
  1. 20mg/kg LD
  2. 5-20mg/kg maintenance

Question 29

MBD
- Pathology
- Mx

Answer 29

Metabolic bone disease/Osteopenia of P

• Pathology
  1. <1500g/<32 weeks
• Placenta converts VitD to Calcitriol (1,25DHChoCal)
  2. Fractures from routine handling
• Mx
  1. Monitor
• Ca, P, ALP
• Vit D, PTH
  2. Fortified EBM
  3. Vit D

Question 30

NIPE
- Penis abnormalities

Answer 30

NIPE Penises

• Chordae (1/200)
  1. Penile torsion
  2. Skin tethering
  3. Penoscrotal web
  4. Dorsal preputial hood
• Hypospadias
• Associated with chordae
  1st degree
• Glanular
• Coronal
  2nd degree
• Subcoronal
• Penile (prox/mid/dist)
  3rd degree
• Penoscrotal
• Scrotal
• Perineal

Question 31

HIE
- Causes

Answer 31

HIE

• Causes (asphyxia)
  1. Maternal shock
  2. Intrapartum haemorrhage
  3. Prolapsed cord
  4. Nuchal cord (wrapping)

Question 32

HIE
- Grading

Answer 32

HIE Grading

1. Mild
   - Poor feeding
   - Resolves within 24 hours
2. Moderate
   - Lethargic, hypotonic
   - 40% CP
3. Severe
   - Reduced AVPU, apnoeas, flaccid
   - 50% mortality
   - 90% CP

Question 33

HIE
- Mx

Answer 33

HIE Mx.

1. Supportive
   - Resus
   - Ventilation
   - Nutrition
2. Therapeutic hypothermia
   - 33.5º
   - 72 hours
   - Reduced inflammation and neuron loss
3. MDT

Question 34

Neonatal hypoglycaemia

• RFs
• S&S
• Mx

Answer 34

Neonatal hypoglycaemia

• RFs
  1. IUGR/SGA
• Decreased glycogen/adipose stores
• Increased requirements
  2. Maternal DM/Macrosomia
• Hyper insulinism
• 3. Late-preterm
  4. Distressed
• Eclampsia
• Sepsis
• Hypothermia
• CHD
• S&S
  1. Apnoea
  2. Iritability
  3. Lethargy
  4. Seizures
• Mx
  1.Early feeding (1st hour)
• High frequency
  2. Early monitoring
  3. Buccal dextrose

4. NICU
5. 10% IV dextrose
6. CSTs/IM Glucagon