Neonatology

Question 1

Define low birth weight, very low birthweight and extremely low birth weight

Answer 1

LBW <2500g
VLBW <1500g
ELBW <1000g

Question 2

Define preterm and extremely preterm

Answer 2

Preterm <37 weeks

Extremely preterm <28 weeks

Question 3

Define the perameters for heart rate and resp rate in neonates

Answer 3

Normal HR: 120 – 160 bpm
Tachycardia >160 bpm
Bradycardia <100 bpm
Normal RR 30-60 /min

Question 4

Why might a baby be small for dates?

Answer 4

Maternal pre-eclamptic toxaemia
Chromosomal syndromes
Infection e.g. CMV
Placental abruption
Twin pregnancy

Question 5

What short-term problems can arise in small babies?

Answer 5

Perinatal hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopenia
Gastrointestinal problems (feeds, NEC)
Respiratory distress syndrome
Infection

Question 6

What long-term problems can arise in small babies?

Answer 6

Hypertension
Reduced growth
Obesity
Ischaemic heart disease

Question 7

Give two examples of skin marks/rashes which fade in time

Answer 7

Erythema toxicum (maculo-papular rash)
Capillary haemangioma (strawberry naevi - cluster of dilated capillaries)

Question 8

Give two examples of skin marks which are permenant but benign

Answer 8

Mongolian blue spot (accumulation of melanocytes)

Port wine stains (naevus flammus)

Question 9

What is cephalohaematoma?

Answer 9

Haemorrhage beneath pericranium causing a bulge on the side of the head
Not associated with intracranial haemorrhage Resolves spontaneously in 3 – 4 weeks

Question 10

What is caput succedaneum?

Answer 10

Head swelling caused by pressure of the presenting part of the scalp against the dilating cervix during delivery Resolves over the first few days

Question 11

Give three causes of respiratory distress syndrome in term babies

Answer 11

Meconium aspiration
Birth asphyxia
Transient tachypnoea of the new-born

Question 12

List the acute conditions which require neonatal intensive care (term babies)

Answer 12

RDS
Cyanotic heart disease
Sepsis
Severe jaundice
Surgical problems

Question 13

Describe the approach to a baby with jaundice

Answer 13

Pathological if within first 24 hours
Measure serum bilirubin and conjugated fraction
- worry if conjugated fraction is greater than 20 and 20%
HIDA scan to exclude biliary atresia
Also do FBC, blood film, blood type and Coombs

Question 14

Describe the management of a baby with jaundice

Answer 14

Treat underlying cause
Hydrate
Phototherapy
Exchange transfusion
Immunoglobulin

Question 15

What is the main complication of severe jaundice?

Answer 15

Kernicterus (bilirubin encephalopathy)

Question 16

Describe the main components of routine management of the preterm baby

Answer 16

Respiratory function/oxygen sats
Fluid balance
Thermoregulation (especially hypothermia)
Hypoglycaemia
Patent ductus arteriosus

Question 17

What are the potential outcomes of extreme premature birth?

Answer 17

• 1/3 die
• 1/3 have normal life or mild disability
• 1/3 have moderate or severe disability for lifetime
• 1 in 6 is entirely normal at 6 years of age

Question 18

List the major short-term problems associted with prematurity

Answer 18

Respiratory Distress Syndrome
Ventilation management and complications (e.g. pneumothorax),
Biochemical disorders e.g. acidosis,
Temperature control,
Nutrition and fluid management,
Infection including sepsis and necrotising enteric colitis (NEC),
Brain haemorrhage (Intraventricular Haemorrhage - IVH),
Circulatory issues (e.g. PDA)
Jaundice

Question 19

List the major long-term problems associated with prematurity

Answer 19

Retinopathy of Prematurity (ROP), 
Periventricular leukomalacia (PVL), 
Post haemorrhagic hydrocephalus (PHH), 
Chronic lung disease/ Broncho Pulmonary Dysplasia (BPD), 
Developmental delay and cerebral palsy 
Poor growth.

Question 20

Give three causes of failure to pass meconium

Answer 20

Hirschsprung’s disease
Cystic fibrosis (meconium ileus)
Bowel/rectal atresia or imperforate anus

Question 21

Why might there be meconium in the amniotic fluid?

Answer 21

Foetus has passed meconium while still in utero:

• Post-date pregnancy
• Signs of foetal distress

Question 22

What is the main risk of meconium in the amniotic fluid?

Answer 22

Meconium aspiration syndrome

- baby aspirates meconium which triggers reaction in the lung tissue, causing respiratory distress