Neonatology

Question 1

Define neonate.

Answer 1

Baby up to 4 weeks old

Question 2

When is a baby ‘full term’?

Answer 2

38-42 weeks

Question 3

When is a baby ‘pre-term’?

Answer 3

Born before 37 weeks

Question 4

At what age would you attempt to resuscitate a baby born pre-term? (weeks)

Answer 4

24 weeks definitely try

23-24 weeks depends on how viable they look

Before 23 not obligated to resuscitate

Question 5

What is Hypoxic-ischaemic encephalopathy?

Answer 5

Brain injury caused by lack of oxygen to the brain in the peri-natal period

Question 6

What are some causes of Hypoxic-ischaemic encephalopathy?

Answer 6

Failure of gas exchange across placenta

Interruption of umbilical blood flow

Inadequate maternal placental perfusion

Failure of cardio + resp system to adapt after birth

Question 7

Clinical features of Hypoxic-ischaemic encephalopathy?

Answer 7

Low HR
Depressed breathing
Seizures
Low muscle tone
Pale, cyanosed
Reduced reflexes
Neurological signs

Question 8

What’s the prognosis of Hypoxic-ischaemic encephalopathy?

Answer 8

If mild, most recover fully

If more severe then left with long term disability or multi-organ failure

Question 9

Management of neonate with Hypoxic-ischaemic encephalopathy?

Answer 9

Respiratory support
EEG monitoring
Treat electrolyte imbalance
Anti-convulsants

Question 10

What is respiratory distress syndrome?

Answer 10

Deficiency of surfactant in the lungs, which lowers surface tension.

Low surface tension means the alveoli are stuck together, they don’t open and fill with air.

Question 11

Management of respiratory distress?

Can anything be done ante-nataly?

Answer 11

Give pig or cow surfactant directly into the lungs.
Give respiratory support if required (oxygen, CPAP)

Yes, give the mother steroids(betamethasone)

Question 12

What are the symptoms of respiratory distress syndrome?

Answer 12

Tachypnoea
Chest wall recession
Nasal flaring
Grunting
Cyanosis

Question 13

Babies at all gestational ages get respiratory distress syndrome. True or false?

Answer 13

False

It’s only in pre-term infants, usually those born before 28 weeks

Question 14

What are two complications of respiratory distress syndrome? How is it treated?

Answer 14

Pneumothorax: chest drain

Chronic lung disease

Question 15

You have a neonate with suspected sepsis.

What’s the likely causative organism?
What’s the treatment?

Answer 15

Group B strep

Need to cover for gram -ve and +ve bacteria

Benzyl penicillin and Gentamicin

Question 16

What is necrotising enterocolitis (NEC)?

Answer 16

Where portions of the bowel mucosa become inflamed and undergo ischaemic necrosis because of bacterial invasion

This leads to patches of the bowel wall dying and potentially perforating

Question 17

Which babies are likely to get NEC? When do they get it?

What’s a big risk factor for NEC?

Answer 17

Preterm babies, in the first few weeks of life

Feeding cow’s milk formula

Question 18

Presentation of NEC?

XR signs?

Answer 18

Vomiting, which can be bilious

Distended abdomen

Blood in stool

Shock

Dilated bowel loops, pneumoperitoneum: air under diaphragm, Rigler’s sign, bowel wall oedema

Question 19

Management of NEC?

Answer 19

Broad spectrum antibiotics: metronidazole + cef or ampicillin

Stop oral feeds (rest the bowel)

Surgery is sometimes needed

Question 20

A baby born at term has breathing difficulties, what are some possible causes?

Answer 20

Meconium aspiration

Transient Tachypnoea of newborn (too much fluid on lungs, commonly C section babies)

Question 21

At what age are pre-term babies able to:

• suck
• feed from a cup?

Answer 21

Suck and swallow after 35 weeks

Cup feeding from 29 weeks

Question 22

List some long term problems that preterm babies have?

Answer 22

Retinopathy of prematurity

Sensorineural or conductive hearing loss

Chronic lung disease

Cerebral palsy

Question 23

Some preterm babies get haemorrhages in the brain.

When do they occur?

What are some risk factors?

Answer 23

Usually within 72hrs of life

Being very low birth weight
Perinatal asphyxia
Respiratory distress syndrome

Question 24

A pre-term baby presents with acute onset of hydrocephalus, his fontanelle is tense.

What could be the cause?
Management?
Long-term consequences?

Answer 24

Intra-ventricular haemorrhage

IVH can impair drainage and resorption of CSF, causing raised ICP which either resolves or leads to hydrocephalus.

May need a shunt

Cerebral palsy (hemiplegic)

Question 25

What is a ‘shunt’?

Answer 25

Used to treat hydrocephalus (excess CSF on the brain due to problem with draining and resorption)

Commonly ventriculoperitoneal (drains into peritoneal cavity)

Question 26

Why are preterm babies more susceptible to infections?

Answer 26

IgG only crosses placenta in last trimester, so might not have crossed over yet