Neonatology

Question 1

Grade 1-4 IVh

Answer 1

I: germinal matrix 35%
II: extension into lat ventricles <50% space
III: haemorrhage occupying at least 50%
IV: parenchyma involvement

(50% withinin 24h most by 3 days)

Question 2

Indomethacin action

Answer 2

Cyclooxygenase 1 and 2 inhibitor - decreases prostaglandin synthesis from arachidonic acid

Question 3

Ibuprofen action

Answer 3

Cyclooxygenase 2 inhibitor

Less profound s/e

Question 4

Spontaneous closure what percent PDA

Answer 4

30-65%

Question 5

Which zero type GBS more common in meningitis/late onset

Answer 5

Type 3

Question 6

Colonisation rate GBS

Answer 6

5-40%

Question 7

RBC lifespan prem and term

Answer 7

35-50 days

60-70

Question 8

Bw under 1500g or <28w behaviour outcome

Answer 8

> 11x increase depression, 2.6x increase ADHD

Same quality of life

Question 9

Do preterm babies have increased insulin resistance later in life

Answer 9

Yes

Question 10

Late preterm risk CP

Answer 10

> 3x more cf term

Question 11

Anomalies percent in gastroschisis and omphalocoele

Answer 11

10% gastroschisis and 60% omohalocoele

Question 12

Survival in 23/40, 24, 25, 27, >30

Answer 12

23: 15%
24: 66%
25: 80%
27: 90-95%
30: 97-99%

Question 13

Severe neurological disability ELBW

Answer 13

10-20%

Question 14

Infant of diabetics mother at risk for

Answer 14

An infant of a diabetic mother is at risk for hypoglycemia, hypocalcemia,
polycythemia, and neonatal small left colon syndrome.

Question 15

Soy formula term and preterm

Indications (2)

Answer 15

Term is as good as cows milk formula for growth
Not for preterm

The most appropriate indications for soy formula are in infants with
galactosemia and congenital lactase deficiency (extremely rare)

Question 16

Me onion aspiration cxr finding

Answer 16

Coarse opacities and hyperexpansion

Question 17

Corkscrew on axr diagnostic for

Answer 17

Midgut volvulus

Question 18

Infantile spasms treatment

Answer 18

Vigabatrin

Question 19

HIE in term cooling temperature

Answer 19

33 degrees

Question 20

Sats target <28w

Answer 20

90-95%

After 32w need higher sats for better eyes

Question 21

What percent of CP from birth asphyxia

Answer 21

10%

Question 22

Severe disability and dev delay in 22-27w what percent

Answer 22

3.7%

Question 23

Normal volume ventilation baby per breath

Answer 23

4-5ml/kg/breath

Question 24

HFOV under ventilated and under oxygenated change what settings

Answer 24

To improve ventilation (increase amplitude and then decrease Hz) AF
To improve oxygenation (increase MAP)

Question 25

IVH 3 and 4 outcome severe impairment

Answer 25

3: 40-50% 4: 60-90%

Question 26

CAP trial showed

Answer 26

Decreased disability and CP and death | Improved PDA and CLD

Question 27

NEC likely to present when

Answer 27

Week 2-3 Triad of bloody stool, distension, bile aspirate

Question 28

Stages of ROP

Answer 28

1-5 4: some retinal detachment 5: complete retinal detachment

Question 29

Post natal steroids given and why

Answer 29

> 7 days because improves CLD but increased risk ROP (but not blindness) Very high risks if given sooner

Question 30

Delayed cord clamping other effects (apart from less blood transfusions)

Answer 30

Less IVH and NEC

Question 31

Difference in QOL prem vs term

Answer 31

Very little difference in quality of life preterm/VLBW vs term control

Question 32

IVF IUGR baby with high glucose and low insulin presenting in first 6 months

Answer 32

``` Neonatal diabetes Genetic links Transient 50% (comes back in adolescence) Permanent (Insulin and oral sulphonuria) ```

Question 33

Bifid uvula genetic cause

Answer 33

Loews-Dietz syndrome

Question 34

Congenital scoliosis also assoc with two other organ abnormalities

Answer 34

Heart and GU

Question 35

Prem calories required

Answer 35

120kCal/kg/day

Question 36

Apt Test for maternal blood pink test goes what colour if adult Hb denatured?

Answer 36

Yellow indicating presence of maternal blood not fetal

Question 37

Kleihauer test is looking for

Answer 37

Quantitating fetal-maternal haemorrhage (differential resistance of fetal hb to acid)

Question 38

Fergus with flat nasal bridge, wide spaces eyes, digital hypoplasia and CV abnormalities associated with

Answer 38

Phenytoin exposure | Fetal hydatoin syndrome

Question 39

Most common type oesophageal atresia

Answer 39

Blind pouch with distal TOF

Question 40

What immunoglobulin in breast milk most protective

Answer 40

IgA

Question 41

Phenobarbitone is commonly used as the first line anticonvulsant in the treatment of neonatal seizures. In what percentage of cases would you expect to achieve clinical control of seizures after a loading dose of 20 mg/kg phenobarbitone?

Answer 41

40%

Question 42

``` A six-month-old infant drinks 1000 ml of a standard cow milk formula daily. Approximately how much energy does the child get per day from his milk intake? A. 200 kcal (840 kJ) B. 500 kcal (2100 kJ) C. 670 kcal (2820 kJ) D. 810 kcal (3400 kJ) E. 1000 kcal (4200 kJ) ```

Answer 42

C

Question 43

``` An infant is born at 26 weeks gestational with a birth weight of 750g. What are the expected insensible water losses (mls/kg/hour) on day one of life? A. 0.5 – 1.0. B. 2.0 – 3.0. C. 4.0 – 5.0. D. 8.0 –10.0. E. 12.0 – 15.0. ```

Answer 43

B

Question 44

Mother first episode herpes risk to child if vaginal birth?

Answer 44

35-50%

Question 45

If mother recurrent herpes then risk percent and plan?

Answer 45

3-5% | Cultures at 24-48h and then treat if symptoms or positive swab

Question 46

Weight gain per week 1-3m 3-6m 61-12m

Answer 46

0 to 3 months 150 -200g/week 3 to 6 months 100 - 150g/week 6 to 12 months

Question 47

Newborn serum creatinine reflects maternal in first ? Hours

Answer 47

48

Question 48

What is essential for growth

Answer 48

Sodium

Question 49

Hearing screen NZ and Aus uses

Answer 49

Automated auditory brainstem response (aABR) | Used to use automated otoacoustic emission (AOAE)

Question 50

Difference between bochdalek and morgagni hernias

Answer 50

Morgagni on right side cf bochdalek left

Question 51

Form of SCID with no hair and skin rash like eczema

Answer 51

Omenn syndrome

Question 52

Risk factor for group b strep

Answer 52

Prematurity (young mum)

Question 53

Antigen in neonatal alloimmune thrombocytopenia

Answer 53

Human platelet antigens (HPA-1a)

Question 54

Guthrie TSH cf plasma is

Answer 54

Half

Question 55

30% pier-robin sequence associated with what syndrome

Answer 55

Stickler

Question 56

CF males percent infertility

Answer 56

99% azoospermia

Question 57

Fetal Hb drops below 2% when

Answer 57

12m | Only trace 6-12m (10% at 6m)

Question 58

What happens to SVR at birth

Answer 58

Due to loss of tremendous blood flow through the placenta, the systemic vascular resistance at birth doubles.

Question 59

Which one of the following is the major cause of physiologic neonatal jaundice? A. Decreased bilirubin uptake by the hepatocyte. B. Decreased hepatic bilirubin conjugation. C. Decreased hepatic excretion of bilirubin. D. Increased de novo bilirubin synthesis. E. Increased enterohepatic circulation

Answer 59

D

Question 60

Kleihaur and apt test described

Answer 60

HbF is resistant to alkali (Apt) and acids (Kleihauer) and so the HbA containing RBCs (maternal) will be hemolyzed but not the fetal RBCs as they contain the HbF.

Question 61

Calories in 100ml breast milk?

Answer 61

70

Question 62

Fetal haematopoeisis

Answer 62

Yolk sac from 2weeks – 2 months; liver 2-7 months; bone marrow starts at 3 months and predominates from 7th month

Question 63

Indomethicin mode of action

Answer 63

Inhibits PG synthase

Question 64

Exposure to what causes broad low nasal bridge epicanthal folds, wide spaced eyes and CVD with digital hypoplasia

Answer 64

Fetal hydantoin syndrome from phenytoin

Question 65

ALPACA related to what brain abnormality

Answer 65

Holoprosencephaly

Question 66

Porencephalic cyst vs arachnoid cyst

Answer 66

Arachnoid on outside and surrounded by grey matter | Porencephalic is by ventricle inside

Question 67

Balanced Robertsonian translocation (carrier with normal phenotype) number of chromosomes total

Answer 67

45

Question 68

Kidney size per gestational week

Answer 68

Mm per week and complete by about 32-24 weeks

Question 69

Ear tags associated with?

Answer 69

Nager syndrome Oculoauriculovertebral Townes Brockw 4- and 5- deletion and 11q duplication

Question 70

Ear pits with?

Answer 70

Brachotorenal | BWS