Neonatology 3

Question 1

List the common problems associated with prematurity

Answer 1

Respiratory distress
Necrotising enterocolitis
Infection
Hypoglycaemia
Temperature control
Apnoea of prematurity
Retinopathy of prematurity
Intraventricular haemorrhage

Question 2

Presentation of NEC

Answer 2

Stops tolerating feeds
Bile-stained vomiting
Milk aspirated from stomach
Abdomen distended
Stool sometimes contains fresh blood

Rapid shock
May require artificial ventilation from abdo pain/distension

Disease may progress to bowel perforation

Question 3

X ray features of NEC

Answer 3

Distended loops of bowel

Thickening of bowel wall with intramural gas

Question 4

Treatment of NEC

Answer 4

Stop oral feeding
Broad-spectrum antibiotics (aerobic + anaerobic organisms)

Parenteral nutrition (ALWAYS)
Artificial ventilation
Circulatory support

Surgery if there is bowel perforation

Question 5

Risk factors for hypoglycaemia in the first 24 hours

Answer 5

IUGR
Preterm
Diabetic mother
Large for gestational stage
Hypthermic
Polycythaemic
Ill for any reason

Question 6

Symptoms of Hypoglycaemia in a neonate

Answer 6

Jitteriness
Irritability
Apnoea
Lethargy
Drowsiness
Seizures

Question 7

Prevention of hypoglycaemia

Answer 7

Early and frequent feeding with breast milk and regular monitoring if at risk

If asymptomatic but 2 measurements <2.6mmol/L or 1 <1.6 then give IV INFUSION

Question 8

Management of hypothermia in neonates (can lead to hypoxia and hypoglycaemia)

Answer 8

Incubators to maintain temp in small babies

Can also provide humidity which reduces transepidermal loss

Question 9

What are episodes of apnoea of prematurity

Answer 9

Episodes of apnoea, bradycardia and desaturation common in very low birthweight infants until they reach 32 weeks gestation

Bradycardia may occur when infant stops breathing for >20secs or when it continues against a closed glottis

Question 10

Commonest causes of apnoea of prematurity

Answer 10

Commonest - immature respiratory centre

Hypoxia
Infection
Anaemia
Hypoglycaemia
Seizure
Heart failure

Question 11

Management of apnoea of prematurity

Answer 11

Gentle physical stimulation is usually enough to start breathing

Respiratory stimulate CAFFEINE (yeahh boiii) often helps

CPAP may be necessary if apnoeic episodes frequent

Question 12

Consequences of retinopathy of prematurity

Answer 12

Affects developing blood vessels at the junction of the vascular and non-vascularised retina

Vascular proliferation may progress to retinal detachment, fibrosis and blindness

Question 13

Screening for retinopathy in susceptible infants

Answer 13

In susceptible preterm infants (<1500g or <32 weeks)
Every week by an ophthalmologist

Because laser therapy reduces visual impairment

Question 14

How does intraventricular haemorrhage present in very low birth weight infants?

Answer 14

Very common if 500-750g
Presents in first days of life:
Apnoea
Lethargy
Poor muscle tone
Sleepiness
Coma..
Bulging fontanelle!

Question 15

Management of intraventricular haemorrhage in preterm infants

Answer 15

Supportive:
Correct 
acidosis
anaemia
hypotension

Probably fluid treatment along with medication to prevent high ICP

Ventriculoperitoneal shunt is the definitive treatment

Question 16

At which gestation are infants mature enough to suck and swallow milk. How are less mature babies fed?

Answer 16

35-36 weeks

less mature are fed via oro- or nasogastric tube

Even in very preterm infants, enteral feeds (probably breast milk) are introduced as early as possible

Sometimes donor breast milk if maternal is not available

Question 17

Supplementation needed in premature infants

Answer 17

Breast milk supplemented with:
phosphate
protein
calcium
calories (rapid growth)

Iron supplements are started at several weeks

Question 18

What are the advantages of breast milk to the premature infant?

Answer 18

Provides ideal nutrition for infants in first 4-6 months of life
Life-saving in developing countries
Reduces risk of GI infection/ NEC
Enhances mother child relationship
Reduces risk of diabetes, HTN and obesity in later life

Question 19

What is bronchopulmonary dysplasia (chronic lung disease)

Answer 19

Infants who still require oxygen at post-gestation stage of 36 weeks.
Usually due to damage from pressure and volume trauma from artificial ventilation, oxygen toxicity and infection

Question 20

What is done to try to prevent chronic lung disease

Answer 20

Most infants are weaned off artificial ventilation onto CPAP and then additional ambient oxygen (sometimes over several months)

Corticosteroid therapy can help facilitate earlier weaning from ventilator.. however concern about increased risk of CP (neurodevelopmental) so only short courses

Question 21

What can cause deterioration in premature infants with lung disease

Answer 21

Intercurrent infection
-eg. subsequent pertussis and RSV may cause respiratory failure

Pulmonary HTN

Pneumothorax (10% of infants ventilated for RDS)

Question 22

How is the risk of pneumothorax minimized in infants with RDS

Answer 22

Ventilate at the lowest pressure to achieve good oxygenation

CXR and chest drain to treat pneumothorax

Question 23

What are the neurodevelopmental complications and difficulties resulting from prematurity

Answer 23

5-10% with very low birthweight develop CP

Most commonly learning difficulties

Highest risk if born <26 weeks

Additional difficulties:
Fine motor skills
Concentration (short attention span)
Behavior problems (attention deficit)
Abstract reasoning eg. maths
Multitasking