Neonatology

Question 1

What is prematurity defined as?

Answer 1

Birth earlier than 37 weeks gestation

Most problems happen at < 32wks gestation
Survival is currently not possible <22wks gestation

Question 2

What are some common complications of prematurity?

Answer 2

• Resuscitation at birth
• Poor temperature control
• Immaturity of organ systems
• Low Energy reserves
• Early hypoglycaemia
• Difficulty in providing adequate nutrition

Long-term complications: chronic lung disease, poor neurodevelopment & behaviour problems sensorineural (uncommonly get hearing loss, blindness)

Question 3

Which gender has more complications of prematurity?

Answer 3

Females survive 2:1

Question 4

How do antenatal steroids help survival?

Answer 4

Speed up development of babies lungs

Steroid treatment usually consists of two injections given 24 hours apart
Used between 25 and 33 weeks of pregnancy

Question 5

Why does prematurity cause poor temperature control?

Answer 5

• High surface area to volume ratio
• Thin immature skin & little subcutaneous fat
• Water evaporation through skin
  causing heat loss
• Limited capacity to produce heat

Hypothermia reduces survival

Question 6

What is respiratory distress syndrome?

Answer 6

Caused by underdeveloped lungs because the lungs don’t have enough surfactant

Question 7

Why are babies more susceptible to infection?

Answer 7

• Immature barriers (skin)
• Breaking the barriers by invasive IV lines –needed to give IV nutrition
• Very little antibody (IgG) from mother before 32wks gestation
• Reduced cell-mediated immunity
• Exposure to resistant microorganisms

Question 8

What is IUGR?

Answer 8

Intrauterine growth restriction

Symmetric: Usually early IUGR. Fetal growth is affected primarily by cell division, think of congenital infection, chromosomal abnormalities or dysmorphic syndromes

Asymmetric: later IUGR. More common and is when faetal growth occurs 2º to increases in cell size (eg: maternal hypertension, PET) Most severe reduction is in weight , next in length with relative head sparing – have better long term growth and development outcome

Question 9

What are some acute clinical complications of IUGR?

Answer 9

• Perinatal asphyxia
• Hypothermia
• Hypoglycaemia
• Hyperviscocity thrombocytopaenia
• Altered immunity

Question 10

What are the neurodevelopmental outcomes to IUGR?

Answer 10

• Proportional IUGR has a negative effect on brain growth
• Attention and performance deficits can occur
• Cognitive development in the end is strongly associated with parental factors but only marginally associated with IUGR

Question 11

What is TANDEM mass spectrometry in paeds?

Answer 11

Used to diagnose metabolic errors in newborn

Question 12

What is a Guthrie screening card?

Answer 12

Used to collect capillary blood from an infant’s heel

Question 13

What is phototherapy used to treat?

Answer 13

Used to treat jaundice

Converts unconjugated bilirubin into non-toxic isomers in the skin

Question 14

What are the complications of rhesus incompatibility?

Answer 14

• Blood exchange transfusion
• Kernicterus
• Encephalopathy with apnoea, seizures, opisthotonos, severe handicap