Neonatology

Question 1

What are the features of congenital rubella syndrome?

Answer 1

Absent red reflex
Widespread pupiric rash (ITP)
Sensoryneural hearing loss
PDA.

Question 2

What is the treatment for hypoxic ischaemic encephalopathy?

Answer 2

Therapeutic hypothermia

Question 3

Describe the process of therapeutic hypothermia for treatement of HIE

Answer 3

Reduction of core body temperature to 33.5°C for 72 hours followed by a slow rewarming phase (0.5°C/hour increase) over 6 hours.
Start within 6 hours of birth!

Question 4

What does RDS and a scaphoid abdomen suggest?

Answer 4

congenital diaphragmatic hernia

Question 5

What is the first line anti-convulsant medication in neonates?

Answer 5

Phenobarbitol

Question 6

What is pathagnomic x-ray finding for necrotising enteroclitiis and what does it look like?

Answer 6

Pneumatosis intestinalis.
Gas within bowel wall, dark lines around bowel loops
(also may have air under diaphragm)

Question 7

What are the potential causes of sudden new O2 requirment in intubated and ventialted neonate?

Answer 7

Displaced ET tube
Obstructed ET tube
Pneumothorax
Equipment failure

Question 8

What does bruising and oedema on neonates head, above the periosteum and over the suture lines, but well demarcated suggest?

Answer 8

Caput Succedaneum
A/W Ventouse delivery

Question 9

What does swelling of neonates head confined to suture lines suggest?

Answer 9

Cephalohaematoma

Question 10

When should premature babies recieve vaccinations?

Answer 10

Same as all babies.
If born <28 weeks gestation requires in hosptial vaccination and 48-72 hour monitoring as increased risk of apnoea

Question 11

What population of babies are at greater risk of RDS secondary to surfactant deficiency disease?

Answer 11

Babies of mothers with poorly controlled diabetes.

Question 12

Define Potters Syndrome

Answer 12

Caused by Oligohydraminos + subsequent compression of foetus
P-Pulmonary hypoplasia
O -Oligohydramnios
T -Twisted skin (wrinkly skin)
T -Twisted face (Potter facies: flattened ‘parrot-beaked’ nose, low-set cartilage-deficient ears, retrognathia, hypertelorism)
E -Extremity deformities (limb deformities: club hands and feet, joint contractures)
R -Renal abnormalities (bilateral renal agenesis, obstructive uropathy, autosomal-recessive polycystic kidney disease or dysplastic kidneys)

Question 13

When is hypospadias corrected?
What do parents need to know?

Answer 13

6-12 months
do NOT circumcise

Question 14

How would you investigate Brachial nerve palsy?

Answer 14

chest x-ray to r/o a clavicle or humeral fracture or diaphragmatic palsy

Question 15

What are the 3 types of brachial nerve palsy? What berve roots are effected?

Answer 15

Erb’s palsy = C5, C6, +/- T1
Klumpke’s palsy = C8, T1
Total palsy C5-T1

Question 16

What is the difference in clinical presentation of Erb’s and Kumpke’s palsy?

Answer 16

Erbs: arm is adducted and internally rotated with elbow extended, forearm is in pronation and wrist is flexed
Klumpke: Claw hand. a/w horners

Question 17

What is first line treatment of Erb’s Palsy?

Answer 17

Rest and careful hadnling for 1-2 weeks, then physiotherapy.
70-80% resolution in 6 weeks.

Question 18

Which pregnant ladies are offered antenatal steroids?

Answer 18

All women between 24+0 and 33+6 weeks of pregnancy who are at risk of preterm delivery within 7 days. Deliver 1-7 days after administration

Question 19

What are the features of a haemodynamically significant PDA?

Answer 19

pansystolic and pandiastolic murmur -machinery type mumur
acitve pericordium with a wide pulse pressure
Cardiac failure symptoms

Question 20

What are the characteristic clinical findings of NEC?

Answer 20

Abdominal distension, bilious aspirates and blood with mucus in the stool are all characteristic findings

Question 21

Define Grade 1 IVH

Answer 21

germinal matrix haemorrhage with or without IVH (less than 10% of ventricle filled with blood)

Question 22

Define Grade 2 IVH

Answer 22

IVH (10%–50% of ventricle filled with blood), typically without ventricular dilation.

Question 23

Define Grade 3 IVH

Answer 23

IVH (greater than 50% of ventricle filled with blood) typically with ventricular dilation

Question 24

Define Grade 4 IVH

Answer 24

periventricular haemorrhagic infarction.

Question 25

Which babies get screened for ROP?

Answer 25

<32 weeks gestational age or < 1501 g birth weight

Question 26

What is treatment for ROP?

Answer 26

Laser ablation
Intraocular injections of anti-VEGF agents such as bevacizumab for central ROP

Question 27

How is the clinical severity of PPHN calculated?

Answer 27

Using the oxygenation index
Fi O2 x Mean arterial pressure / post-ductal PaO2

Question 28

How do you manage hypoglycaemic neonate with blood glucose < 1?

Answer 28

IV bolus 10 % dextrose
Also: blood glucose, insulin, cortisol, growth hormone, fatty acids, ketone bodies, carnitine, acylcarnitine profile, amino acids, ammonia, lactate.
urine ketones and organic acids

Question 29

How do you mange hypoglycaemic yet asymptomatic baby with Blood glucose of 2.5?

Answer 29

Help to establish feeding

Question 30

How do you manage hypoglycaemic yet asymptomatic baby with blood glucose 1- 1.9?

Answer 30

Buccal dextrose gel.
Help to establish feeding.

Question 31

How do you manage hypoglycaemic neonate with BM > 1 yet is symptomatic?

Answer 31

IV bolus 10 % dextrose
Also: blood glucose, insulin, cortisol, growth hormone, fatty acids, ketone bodies, carnitine, acylcarnitine profile, amino acids, ammonia, lactate.
urine ketones and organic acids

Question 32

What is second line treatment for neonatal seizures?

Answer 32

Phenytoin

Question 33

At what level of thrombocytopenia would you consider platelet transfusion in neonate?

Answer 33

25x 10^(9)/l

Question 34

In neonate with absent thymic shadow, what do you need to consider?

Answer 34

Di George Syndrome!

Question 35

Where do you measure pre-ductal sats?

Answer 35

Right hand

Question 36

What can cause persistent pulmonary hypertension of the neonate?

Answer 36

meconium aspiration syndrome
severe sepsis
congenital pneumonia
respiratory distress syndrome
congenital diaphragmatic hernia

Question 37

What suggests PPHN?

Answer 37

Evidence of somethign that can cause PPHN
Big pre and post ductal saturation difference
Low O2 sat and normal CO2
Cardiac echo

Question 38

How do you treat PPHN?

Answer 38

Inhaled nitric oxide 20 ppm
ECMO

Question 39

What is investigation of choice for malrotation + volvulous?

Answer 39

Upper Gi contrast study

Question 40

What artery is most likely occluded in maltoration?

Answer 40

Superior messenteric artery