Neonatology

Question 1

how to manage an infant with Congential diaphragmatic hernia at birth

Answer 1

all neonates with CDH should be intubated and ventilated at birth
immediate intubation prevents entrapment of air in the intestines and further compression of lungs and heart

Question 2

Physiological Jaundice - why and management

Answer 2

occurs due to increased haeme metabolism, decreased secretory capacity in the liver and low UGT activity
management phototherapy
adequate hydration

Question 3

RF for physiological jaundice

Answer 3

premature
exclusively BF
FH

Question 4

Where in the lung is surfactant sythensised

Answer 4

type 2 pneumocytes

Question 5

how does congenital toxoplasmosis present

Answer 5

triad: cerebral calcification, hydrocephalus, chorioretinitis (posterior uveitis)
IUGR

other complications:
strabismus, blindness, developmental delay, epilepsy and sensorineural deafness

Ocular toxplasmosis most commonly presents as macular chorioretinitis
may present at birth with leukocoria (abnormal white reflection from retina) or later with chorioretinal scars which have a circumscribed hyperpigmented border with a pale centre

Question 6

features of IUGR

Answer 6

hypothermia, thermal instability
polycythaemia - secondary to chronic hypoxia
hypoglycaemia - secondary to reduced glycogen stores and impaired gluconeogenesis
neutropenia
thrombocytopenia
necrotising entercolitis

Question 7

IUGR associated with:

Answer 7

smoking in pregnancy
lower socioeconomic class
malnutrition in pregnancy
alcohol abuse
chromosomal abnormalities
congenital infections
drugs

Question 8

Newborn blood spot which diseases are screened for:

Answer 8

sickle cell
CF
congenital hypothyroidism
phenylketonuria PKU
MCADD
MSUD
isovaleric acidaemia - IVA
glutaric aciduria type 1
homocystinuria

Question 9

most common disease picked up on Newborn blood spot screening

Answer 9

congenital hypothyroidism

Question 10

Risk factors for transient tachypnoea of the newborn

Answer 10

CS without onset of labour
maternal DM
maternal asthma
maternal obesity
SGA
LGA
delivery before 39/40

Question 11

CXR findings in transient tachypnoea of the newborn

Answer 11

hyperinflation
prominent perivascular markings

Question 12

treatment for transient tachypnoea of the newborn

Answer 12

positive pressure respiratory support

Question 13

pathophysiology of transient tachypnoea of the newborn

Answer 13

edogenous catecholamines increase rapidly during vaginal delivery which increases sentivity of Na channels and stimulates fetal lung resabsorption

doesnt happen in transient tachypnoea of the newborn

Question 14

Retina of prematurity screening

Answer 14

recommended <31/40 or <1501g

Question 15

Congenital Cytomegalovirus (CMV) presentation in baby

Answer 15

periventricular calcifications
IUGR
sensorienural deafness
thrombocytopenia
hepatitis
chorioretinitis
microcephaly
Premature delivery or still birth

Question 16

congenital herpes simplex presentation in newborn

Answer 16

cerebral oedema and hepatosplenomegaly
petechial rash
jaundice
vesicular lesions

Question 17

congenital varicella presentation in newborn

Answer 17

low birth weight
cicatricical skin lesions - pale yellow dermatomal scars
limb hydroplasia (deformed limbs)
microcephaly
chorioretinitis
corneal clouding and optic atrophy

Question 18

Aetiology behind testicular torsion in neonatal period

Answer 18

extravaginal torsion
twisting of entire cord along processus vaginalis due to lack of fixation of tunia vaginalis to gubernaculum

Question 19

Choanal Atresia

Answer 19

blocked choanae by abnormal bone or soft tissue, unilateral or BL
baby unable to breath and cyanotic when feeding
symptoms improve when baby cries as oral airway opens
unable to pass NG through nostrils

Question 20

Hydrops Fetalis

Answer 20

fluid builds up in babies tissue and organs
anaemia, oedema (pleural oedema) and respiratory distress

cause: rhesus disease (rhesus neg mum sensitised after prev exposure to rhesus pos baby, haemolytic disease of newborn

Question 21

what antibodies can cross placenta

Answer 21

IgG only
rhesus antibodies are IgG
IgG can cause haemolytic disease of the newborn
antibodies for ABO = IgM

Question 22

NEC

Answer 22

bloody stools and distended abdomen
gas within intestinal wall
XRAY: distended bowel loops, pneumonatosis intestinalis (Gas within wall) portal vein gas, ascities, pneumoperitoneum

Question 23

which artery is compromised in volvulus

Answer 23

superior mesenteric artery

Question 24

GBS what type of organism

Answer 24

Gram pos cocci
anaerobic

Question 25

surfactant is produced at

Answer 25

24 weeks gestation

Question 26

hemorrhagic disease of the newborn

Answer 26

GI bleeding, bleeding from umbilical stump, bruising after 2-7 days

if active bleeding give IV vit K and FFP

Question 27

football sign on abdo xray

Answer 27

intestinal perforation
free gas

Question 28

what is the canicular stage (embryological lung development)

Answer 28

airway epithelium thins out
17-24 weeks

Question 29

on which day is it appropriate to change neonates co2 parameters

Answer 29

4

Question 30

primary apnoea vs terminal apnoea

Answer 30

once fetus becomes hypoxic it will breath. if not born yet breaths are ineffective and = hypoxic, hypercapnic and acidotic, HR falls to 60. Baby then enters primary apnoea, infant will gasp in a couple of minutes allowing them to breath for themselves

terminal = hypoxic for 20 mins prior to birth baby attempting breaths leads to primary apnoea and gasping before delivery