Neonatology

Question 1

list some functions of the placenta

Answer 1

gas exchange
waste product and nutrient transport
acid base balance
transport of IgG

Question 2

list the three shunts in the foetus and what they are called when closed or patent

Answer 2

foramen ovale - becomes persistent foramen ovale
ductus arteriosus becomes ligamentus arteriosus
ductus venosus beceoms ligamentus teres

Question 3

describe persistent pulmonary hypertension of the newborn and presentation

Answer 3

failure to move from foetal to neonatal circulation after birth
pulmonary hypertension causing hypoxia secondary to left-to-right shunting of blood at ductus arteriosus

Question 4

what are the 3 most important regulatory mechanisms a newborn must do

Answer 4

thermoregulation
glucose homeostasis
nutrition

Question 5

why is thermoregulation so difficult in newborns

Answer 5

high surface area to volume ratio, a lot of heat is lost through their head

Question 6

what are the methods of keeping a newborn warm

Answer 6

hats, skin to skin, heated blankets, incubators

Question 7

why is glucose homeostasis difficult for newborns to manage

Answer 7

switch from basal enteral nutrients from the placenta to bolus oral milk every couple of hours

Question 8

what is colostrum

Answer 8

the first round of breast milk a mother produces, thick and very antibody rich compared to foremilk and hindmilk

Question 9

list some causes of physiological jaundice

Answer 9

breakdown of foetal Hb
conjugating pathways not matured yet
increase in circulating unconjugated bilirubin

Question 10

a premature baby is born before how many weeks

Answer 10

37

Question 11

a post term baby is born after how many weeks

Answer 11

41

Question 12

post term babies are at risk of what conditions

Answer 12

still birth and cerebral palsy

Question 13

what is the normal birth weight for a baby

Answer 13

2.5-4kg

Question 14

which trimester has the largest weight gain for baby

Answer 14

3rd trimester

Question 15

list some perinatal adaptions a newborn baby must do

Answer 15

alveolar expansion - first cry
decrease in pulmonary arterial pressure
increase in PaO2

Question 16

what is apgar score used for

Answer 16

measure effectiveness of perinatal adaption

Question 17

describe the components and scoring of APGAR scoring

Answer 17

measures heart rate, respiratory rate, responsiveness, tone and colour
each component gets a max of 2 points - normal scoring >8

Question 18

describe haemorrhagic disease of the newborn

Answer 18

rare clotting disorder causing spontaneous bleeding which untreated can lead to intracranial haemorrhage

Question 19

what is given to prevent haemorrhagic disease of the newborn

Answer 19

IM vitamin K - especially important in breast fed babies as breast milk lacks it

Question 20

what screening tests are carried out as part of newborn baby checks

Answer 20

universal hearing screening 
hip screening - clinical and USS
CF
haemoglobinopathies 
thyroid function tests 
metabolic disorders

Question 21

list common causes of death in neonate

Answer 21

prematurity 
pneumonia 
birth trauma 
neonatal sepsis 
congenital abnormalities

Question 22

what is the normal heart rate for newborn

Answer 22

120-140 bpm

Question 23

what is the normal respiratory rate for newborn

Answer 23

40-60/min

Question 24

where are common sites of infection in neonates

Answer 24

CNS - meningitis
resp - pneumonia
GI
all can lead to sepsis

Question 25

list common bacterial pathogens in neonatal infections

Answer 25

group B strep E. coli listeria staph aureus and epidermidis

Question 26

what is transient tachypnoea of the newborn

Answer 26

self-limiting condition where there is delay in clearance of the fluid from lungs - can cause ineffective gas exchange and tachypnoea

Question 27

what is the presentation of transient tachypnoea of the newborn

Answer 27

``` tachypnoea nasal flaring grunting intercostal retractions crackles on auscultation ```

Question 28

what are some of the causes of hypoglycaemia in neonates

Answer 28

reduced reserves eg low birth weight | related to maternal disease eg diabetes mellitus

Question 29

what are the reasons for more preterm babies

Answer 29

increased maternal age increase rate of complications during pregnancy increased rate of fertility treatments more C-sections before term date

Question 30

causes of preterm births

Answer 30

spontaneous preterm labour multiple pregnancy preterm prelabour eg rupture of membranes pregnancy associated hypertension

Question 31

list risk factors for preterm births

Answer 31

``` >2 more previous preterm deliveries abnormally shaped uterus multiple pregnancies <6months between pregnancies smoking, alcohol and drugs during pregnancy poor nutrition ```

Question 32

list complications for the baby of preterm birth

Answer 32

``` poor temperature control sepsis respiratory distress syndrome patent ductus arteriosus intraventricular haemorrhage necrotising enterocolitis ```

Question 33

which organisms are most likely to cause neonatal sepsis

Answer 33

group B strep | gram negatives

Question 34

what is respiratory distress syndrome

Answer 34

deficiency of surfactant causing re-inflation of the lungs on each breath leading to respiratory failure most common in premature babies

Question 35

what is the treatment for respiratory distress syndrome

Answer 35

maternal betamethasone if high risk give surfactant non-invasive ventilation