Neonatology

Question 1

Define prematurity and extreme prematurity

Answer 1

Prematurity: birth before 37 weeks gestation

Extreme prematurity: birth before 28 weeks gestation

Question 2

What complications can arise from prematurity?

Answer 2

Respiratory distress syndrome
Sepsis
Intraventricular haemorrhage
Patent ductus arteriosus
Necrotising enterocolitis
Retinopathy of prematurity

Question 3

Define low birth weight

Answer 3

Low birth weight: < 2500g
Very low birth weight: <1500g
Extremely low birth weight: < 1000g

Question 4

What can cause a baby to be born with a low birth weight?

Answer 4

Placental insufficiency leading to intrauterine growth restriction

• PIH (pregnancy-induced hypertension)
• pre-eclampsia
• diabetes
• smoking, alcohol
• maternal systemic disease
• multiple gestation

Question 5

What are the two types of intrauterine growth restriction?

Answer 5

Asymmetrical and Symmetrical

Asymmetrical:

• head is spared
• normal growth in trimesters 1-2, restriction in trimester 3
• most common

Symmetrical:

• head is also small
• slow development throughout pregnancy
• likely to have permanent neurological sequelae

Question 6

Which pathogens are most likely to cause sepsis in neonates?

Answer 6

Group B Streptococcus
E. Coli
Staphylococcus
Haemophilus influenza
Listeria monocytogenes

Question 7

How does sepsis present in neonates?

Answer 7

Fever
Jaundice
Specific/local signs e.g. meningitis (not always present!)

Question 8

What is TORCH syndrome?

Answer 8

Vertically transmitted infections that can cause IUGR and/or fetal abnormalities

• Toxoplasmosis
• Other (HIV, Chlamydia)
• Rubella
• Cytomegalovirus
• Herpes simplex

Question 9

What abnormalities can be caused by TORCH syndrome?

Answer 9

Small for gestational age, Fever, difficulty feeding, purpura, hepatosplenomegaly,
jaundice, hearing impairment, autisim/mental delay, specific abnormalities associated with each
cause

Question 10

Concerning necrotising enterocolitis, describe:

1. risk factors
2. presentation

Answer 10

1. may be triggered by increasing feed too quickly.
   Breast milk is preventative
2. Acute abdomen, feed intolerance

Question 11

What sign on imaging is pathognomic of necrotising enterocolitis?

Answer 11

Pneumatosis intestinalis: abdominal x-ray shows gas in the bowel wall

Question 12

Give a common cause of respiratory distress in a term baby (particularly if delivered by C-section)
How is this condition managed?

Answer 12

Transient tachypnoea of the newborn (TTN)
- caused by retained fetal lung fluid due to impaired clearance mechanisms
Managed conservatively: O2, CPAP, may withhold feeds to prevent aspiration

Question 13

Give the most common cause of respiratory distress in a preterm baby

Answer 13

Respiratory distress syndrome

• surfactant deficiency due to premature lungs
• lungs are not compliant which means that great effort is required to inflate them, causing respiratory distress