Neonatology

Question 1

When is the neonatal period?

Answer 1

First 28 days of life

Question 2

What is measured in the Apgar score?

Answer 2

Appearance - Pale, blue, pink
Pulse - Absent, 100
Grimace - No response, grimace, sneeze/cough/pulls away
Activity (tone) - Absent i.e. floppy, arms and legs flexed, arms and legs actively moving
Respiration - Absent, slow/irregular, good and crying

Question 3

What is the process of resuscitation for a newborn?

Answer 3

• Dry baby, remove wet clothes, start the clock
• Initial assessment, call for help
• Maintain airway by keeping head neutral
• Breathing - Inflation breaths if no effort, may need face mask or even intubation
• Circulation - Compressions are done 3:1 in neonates

Question 4

What is therapeutic hypothermia and when is it used?

Answer 4

Used in babies with hypoxic-ischaemic encephalopathy to reduce the risk of secondary brain damage after ischaemic insult. Baby is cooled to 35.5 degrees within 6 hours of birth and maintained at this temperature for 72 hours before slow rewarming happens (0.5 degrees every 2 hours)

Question 5

List 5 important problems which are commonly faced by premature infants

Answer 5

Respiratory Distress Syndrome
Intraventricular Haemorrhage
Patent Ductus Arteriosus
Necrotising Enterocolitis
Retinopathy of Prematurity

Question 6

What are the appearances on a chest x-ray of respiratory distress syndrome in a preterm infant?

Answer 6

Ground glass appearance
Bronchograms
Increased lung opacity
May be reduced lung volume

Question 7

Why does respiratory distress syndrome happen?

Answer 7

Affects preterm infants due to lack of surfactant production.

Question 8

What is the treatment for respiratory distress syndrome in a preterm infant?

Answer 8

Surfactant administration via nasotracheal tube

Oxygen via CPAP or mechanical ventilation

Question 9

Which site of the brain is usually affected by intraventricular haemorrhage?

Answer 9

The germinal matrix above the caudate nucleus

Question 10

What is the management of intraventricular haemorrhage?

Answer 10

Therapeutic lumbar puncture to relieve pressure

Shunt if LP fails

Question 11

What diagnostic tool is used to investigate and intraventricular haemorrhage in neonates?

Answer 11

Cranial ultrasound

Question 12

What is the grading system for intraventricular haemorrhage?

Answer 12

I = Isolated germinal matrix haemorrhage
II = Intraventricular haemorrhage without ventricular dilatation
III = Intraventricular haemorrhage with ventricular dilatation
IV = Intraventricular haemorrhage with associated parenchymal haemorrhage

Question 13

When should jaundice in a neonate be investigated?

Answer 13

• If occurs within first 24 hours of life
• If lasts for more than 2 weeks in term babies or more than 21 days in preterms
• If levels are rapidly rising (>100Umol/L/24hrs)
• > 250umol/L by 48hrs or >200umol/L by 96hrs
• Conjugated hyperbilirubinaemia

Question 14

What are the causes of physiological jaundice?

Answer 14

Breast feeding
Haemolysis
Increased enterohepatic circulation
Immature hepatic enzymes
Increased RBC turnover

Question 15

What are the causes of non-physiological jaundice?

Answer 15

Haemolysis: Rhesus disease, ABO incompatibility, G6PD deficiency, hereditory spherocytosis, pyruvate kinase deficiency, alpha-thalassemia
Polycythemia
Extravasated blood
Liver enzyme deficiencies

Question 16

What is the most likely cause of jaundice occurring in the first 24 hours of life?

Answer 16

Haemolysis

Question 17

What are the treatment options for managing neonatal jaundice?

Answer 17

• Optimise hydration
• Phototherapy
• Exchange transfusion

Question 18

Why is it important to keep neonatal bilirubin levels at acceptable levels?

Answer 18

Risk of kernicterus if bilirubin levels are too high

Question 19

Which conditions are tested for in the neonatal screening ‘Guthri’ test?

Answer 19

Congenital hypothyroidism
Cystic fibrosis
Haemoglobinopathies (Sickle cell, thalassaemia)
Phenylketonuria (PKU)
MCADD (Medium-chain acyl-coA dehydrogenase deficiency)

Question 20

What is the probably cause of necrotising enterocolitis?

Answer 20

Ischaemia of the bowel wall and infection from organisms colonising the bowel

Question 21

What is the presentation of necrotising enterocolitis?

Answer 21

Stops feeding
Distended abdomen
Milk aspiration
Vomiting - may be bile stained
Blood stained stool
Shock
Apnoea

Question 22

What is the characteristic appearance of necrotising enterocolitis on abdominal x-ray?

Answer 22

Distended bowel loops
Intramural thickening due to gas in the bowel wall
Air in portal tract
Bowel perforation

Question 23

What is the treatment for necrotising enterocolitis?

Answer 23

Stop oral feeds and start enteral feeding
Cardiopulmonary support
Broad spectrum antibiotics to cover a range of organisms e.g. penicillin, gentamicin, metronidazole
Surgery to repair perforation

Question 24

True / False: It is standard practice to resuscitate a baby at 22+3 weeks gestation

Answer 24

False - It is standard practise NOT to resuscitate a baby under 23 weeks gestation

Question 25

What is measured in a neonatal ‘septic screen’?

Answer 25

Full blood count
Blood cultures
CRP

Question 26

What is the most common congenital infection?

Answer 26

Cytomegalovirus

Question 27

List some causes of conjugated hyberbilirubinaemia in the neonate

Answer 27

Bile duct obstruction
Neonatal hepatitis
Biliary atresia
Bacterial sepsis
Cystic fibrosis

Question 28

Prolonged neonatal jaundice can be divided into what two categories?

Answer 28

Unconjugated

Conjugated

Question 29

List some causes of UNconjugated prolonged neonatal jaundice

Answer 29

Infection, particularly UTIs
Hypothyroidism
Haemolysis e.g. G6PD deficiency
Galactosaemia
High GI obstruction e.g. pyloric stenosis
Liver enzyme deficiency e.g. Crigler-Najjar syndrome

Question 30

What is a Kasai procedure?

Answer 30

Performed in the management of biliary atresia in the neonate to allow bile to drain