Neonatology 2 Flashcards

1
Q

A 3 day old neonate is brought into the paediatric assessment unit due to purulent discharge from his eyes + swollen eyelids.

How would you assess + manage this patient?

A
  1. Urgent swab of discharge to microbiology.
  2. Give single dose IM/IV CEFOTAXIME for possible gonococcal infection whilst awaiting swab results
  3. If results suggest chlamydia give:
    - PO/IV ERYTHROMYCIN 14 days
    - PO AZITHROMYCIN 3 days (2nd line)
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2
Q

You review a neonate who was born 12hrs previously and notice a swelling on his head. What is your differential for neonatal head lumps and how would you distinguish?

A
  1. CAPUT SUCCEDANEUM
    - oedema of presenting part
    - skin swelling not limited by suture lines (crosses midline)
    - presents right after delivery and resolves over days
  2. CEPHALOHAEMATOMA
    - bleeding between bone + periosteum
    - fluctuant swelling limited by suture lines
    - presents right after delivery and resolves over weeks
  3. SUBAPONEUROTIC HAEMATOMA
    - bleeding between aponeurosis + periosteum
    - fluctuant swelling not limited by suture lines that may shift with movement
    - develops 12-72hrs after delivery
    - can cause rapid loss of intravascular volume (tachycardia, pallor) and may require fluid resuscitation and surgical evacuation
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3
Q

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. What is your differential diagnosis?

A
  1. Transient tachypnoea of the newborn
  2. Respiratory distress syndrome
  3. Congenital heart defects e.g. TOF, TGA
  4. Congenital resp. defects e.g. diaphragmatic hernia, choanal atresia
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4
Q

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. TTN is diagnosed. How would you manage him?

A

Assess requirement for respiratory support and consider:

  • supplement O2 or CPAP
  • witholding feeds during episodes of tachypnoea
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5
Q

A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. You suspect RDS. How would you diagnose and manage him?

A

Diagnosis:

  • CXR: bilateral ground glass appearance + air bronchograms
  • SpO2 + blood gas monitoring

Management:

  • delivery room resuscitation as required
  • respiratory support e.g. high-flow nasal cannulae, CPAP, intubation + ventilation
  • surfactant therapy via catheter or ETT
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