Neonatology

Question 1

What cell produces surfactant?

Answer 1

Type II pneumocytes

Question 2

How does surfactant affect lung compliance?

Answer 2

reduces force needed to expand alveoli and therefore the lungs - increases compliance

Question 3

How do all alveoli expand equally during inspiration?

Answer 3

as alveoli expand, surfactant is spread more thinly, increasing effort needed to open them further and preventing uneven expansion

Question 4

When do type II pneumocytes start producing surfactant?

Answer 4

between 24-34 weeks gestation

Question 5

What stimulates the neonate to take their first breath?

Answer 5

~Adrenaline and cortisol
~Birth
~Temp change
~Sound
~Physical touch

Question 6

What is the consequence of the first breath on pulmonary vascular resistance?

Answer 6

Expansion of alveoli decrease pulmonary vascular resistance

Question 7

Pulmonary vascular resistance decreased after birth, what are the consequences of this?

Answer 7

~Pressure in right atrium falls
~Left atrial pressure exceeds right atrial pressure
~Blood flowing from the left tp right atrium causes functional closure of the foramen ovale

Question 8

What chemicals are required to keep the ductus arteriosus open?

Answer 8

Prostaglandins

Question 9

What causes a drop in prostaglandins after birth?

Answer 9

Increased blood oxygenation

Question 10

What does the ductus arteriosus become after closure?

Answer 10

Ligamentum arteriosum

Question 11

What can be given to keep the ductus arteriosus open in a duct-dependant congenital heart defect?

Answer 11

Prostaglandins

Question 12

List the consequences of neonatal hypoxia in order of severity.

Answer 12

~anaerobic respiration and bradycardia
~reduced consciousness
~drop in respiratory effort
~hypoxia induced encephalopathy - may lead to cerebral palsy

Question 13

Aside from hypoxia, list three issues in neonatal resuscitation.

Answer 13

~large SA to weight ratio - cool quickly
~born wet - cool quickly
~being born through meconium can cause aspiration

Question 14

What are the principles of neonatal resuscitation?

Answer 14

~Warm the baby
~Calculate APGAR score
~Stimulate breathing
~Inflation breaths
~Chest compressions
—–start if HR below 60 despite resuscitation
—–3:1 ratio of compressions to breath

Question 15

What are the 5 factors of an APGAR score?

Answer 15

~Appearance
~Pulse
~Grimace
~Activity
~Respiration

Question 16

When is the APGAR measured?

Answer 16

1,5 and 10 minutes

Question 17

What is done to babies immediately after birth?

Answer 17

~Skin to skin
~Clamp the umbilical cord
~Dry the baby
~Keep the baby warm with a hat and blankets
~Vitamin K
~Label the baby
~Measure the weight and length

Question 18

What injection do all babies get in the thigh immediately after birth?

Answer 18

Vitamin K

Question 19

Why are all babies given vitamin K?

Answer 19

They are born deficient and it helps prevent haemorrhagic disease of the newborn, particularly intracranial, umbilical stump and gastrointestinal.

Question 20

What are the benefits of skin-to-skin contact?

Answer 20

~helps warm baby
~improves bonding
~calms the baby
~improves breast feeding

Question 21

When is the newborn blood spot done?

Answer 21

Day 5

Question 22

How many drops of blood are needed for newborn blood spot screening?

Answer 22

4

Question 23

What conditions does the newborn blood spot test for?

Answer 23

~Cystic fibrosis
~Sickle cell disease
~Congenital hypothyroidism
~Phenylketonuria
~Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
~Maple syrup urine disease (MSUD)
~Isovaleric acidaemia (IVA)
~Glutaric aciduria type 1 (GA1)
~Homocystinuria

Question 24

How long do results of the newborn blood spot screening take?

Answer 24

6-8 weeks

Question 25

What is caput?

Answer 25

fluid collecting on the scalp, outside the periosteum

Question 26

What causes caput?

Answer 26

pressure to a specific are of the scalp during birth, often instrumental

Question 27

What is the treatment for caput?

Answer 27

No treatment needed, resolves within days

Question 28

What is a cephalohaematoma?

Answer 28

blood collecting between the skull and periosteum

Question 29

How can you distinguish between caput and cephalohaematoma?

Answer 29

~Caput can cross suture line sas it is outside the periosteum, ceph cannot
~Ceph can cause discolouration of skin in affected area, caput does not

Question 30

Treatment for cephalohaematoma?

Answer 30

intervention not usually required, resolves within a few months

Question 31

Monitoring for cephalohaematoma?

Answer 31

anaemia and jaundice due to increased risk

Question 32

What nerve damage leads to Erb’s palsy?

Answer 32

C5/C6

Question 33

What is the classical appearance of an arm with Erb’s palsy?

Answer 33

Waiter’s tip

Question 34

What is fractured clavicle associated with?

Answer 34

shoulder dystocia, traumatic or instrumental delivery, large birth weight

Question 35

Signs of a fractured clavicle on newborn examination?

Answer 35

~lack of movement or asymmetry of movement of affected arm
~asymmetry of shoulders, affected shoulder is lower
~pain and distress on arm movement

Question 36

Confirmation of a fractured clavicle?

Answer 36

US or x-ray

Question 37

Treatment and main complication of a fractured clavicle?

Answer 37

~Management is conservative, may have to immobilise affected arm
~Main complication is brachial plexus injury