Neonatology

Question 1

What score is used for newborns?

Answer 1

Apgar

Question 2

What does the apgar score look at?

Answer 2

Appearance
Pulse
Grimace
Activity
Respiration

Question 3

What is the maximum score for Apgar?

Answer 3

10

2 for each category

Question 4

What is a low, moderate low and normal apgar?

Answer 4

0-3 very low
4-6= moderate low
7-10= normal

Question 5

What are some common birth injuries?

Answer 5

Caput succedaneum
Cephalohaematoma
Facial paralysis
Erb's palsy
Fractured clavicle

Question 6

What is caput succedaneum?

Answer 6

Oedema collection on scalp

Crosses sutures lines and normally no discolouration

Question 7

What is caput succedaneum associated with?

Answer 7

Traumatic, prolonged or instrumental delivery

Question 8

What is cephalohaematoma?

Answer 8

Traumatic subperiosteal haematoma

Does not cross suture lines and commonly causes skin discolouration

Question 9

What are the complications of cephalohaematoma?

Answer 9

Anaemia

Jaundice as it breaks down

Question 10

What is facial paralysis associated with?

Answer 10

Forceps delivery

Question 11

What is Erbs palsy?

Answer 11

Injury to C5/6 nerve repps

Question 12

What is Erbs palsy associated with?

Answer 12

Shoulder dystocia
Traumatic or instrumental delivery
Large birth weight

Question 13

What is the presentation of Erbs palsy?

Answer 13

Weakness of shoulder abduction and external rotation, arm flexion and finger extension

Question 14

What is a fractured clavicle associated with?

Answer 14

Shoulder dystocia
Traumatic or instrumental delivery
Large birth weight

Question 15

What investigations are done for a fractured clavicle?

Answer 15

US

XR

Question 16

What can cause neonatal hypoglycaemia?

Answer 16

Maternal DM 
IUGR
Prematurity
Hypothermia
Sepsis
Inborn errors or metabolism

Question 17

What is the management of neonatal hypoglycaemia?

Answer 17

Monitoring

IV 10% glucose

Question 18

What is hypoxic ischaemic encephalopathy?

Answer 18

Hypoxia during birth casing encephalopathy

Question 19

What is the presentation of hypoxic-ischaemic encephalopathy?

Answer 19

Mild= poor feeding, general irritability
Moderate= poor feeding, lethargy, hypotonia
Severe= reduced consciousness, apnoea, flaccid, reduced reflexes

Question 20

What are the risks with hypoxic ischaemic encephalopathy?

Answer 20

Death- up to 50%

Cerebra palsy up to 90%

Question 21

What is the management of hypoxic ischaemic encephalopathy?

Answer 21

Supportive

Theraputic hypothermia

Question 22

What is the mechanism of action of therapeutic hypothermia?

Answer 22

Reduce inflammation and neurone loss after acute hypoxic injury

Question 23

What is neonatal abstinence syndrome?

Answer 23

Withdrawal symptoms in neonates of mothers with substance abuse

Question 24

What substances cause NAS?

Answer 24

3-72 hours= opiates, alcohol, SSRIs
24 hours-21 days= methadone, BZDs
Cocaine
Alcohol
Nicotine

Question 25

What is the presentation of NAS?

Answer 25

``` Irritability, not settling Tremors, seizures Sweating, unstable temperature Tachypnoea Poor feeding Hypoglycaemia ```

Question 26

What is the management of NAS?

Answer 26

``` Monitoring and support SSRI= doesn't require medical mx Mod to severe -opiate= oral morphine sulphase -non opiate= oral phenbarbitone ```

Question 27

What causes jaundice <24 hours?

Answer 27

Always pathological Sepsis HAemolysis

Question 28

What causes jaundice 24 hours-2 weeks?

Answer 28

``` Physiological Breast milk Polycythaemia Sepsis HAemolysis Caphalohaematoma ```

Question 29

What causes jaundice >2 weeks?

Answer 29

``` Breast milk Hypothyroid Pyloric stenosis Cholestasis HAemolysis Infection Hepatitis ```

Question 30

What causes physiological jaundice?

Answer 30

Short RBC lifespan Relative polycythaemia Relative immaturity of liver function

Question 31

What investigations are done for jaundice?

Answer 31

FBC, blood film Split bilirubin Direct Coombs test Suspect nfection= blood and urine cultures

Question 32

How and when is jaundice treatment?

Answer 32

Treatment threshold charts Unconjugated= phototherapy Severe= exchange transfusions

Question 33

What is a complication of jaundice?

Answer 33

Kernicterus

Question 34

What is kernicterus?

Answer 34

Brain damage due to excessive unconjugated bilirubin | Floppy, drowsy abby with poor feeding

Question 35

What are the complications of kernicterus?

Answer 35

Cerebral palsy Learning difficulties Deafness

Question 36

What causes transient tachypnoea of the newborn?

Answer 36

Delay in clearance of foetal lung fluids

Question 37

What is a risk factor for transient tachypnoea of the newborn?

Answer 37

C section

Question 38

What is the presentation of transient ytcahypnoea of the newborn?

Answer 38

Within first few hours Tachypnea, grunting Normal gases

Question 39

What is the investigation and management of transient tachypnoea of the newborn?

Answer 39

CXR= hyperinflation, fluid in horizontal fissue | Supplementary oxygen

Question 40

Who is meconium aspiration seen in?

Answer 40

Post term babies more commonly

Question 41

What is the presentation of meconium aspiration?

Answer 41

Cyanosis, apnoea Increased work of breathing Grunting

Question 42

What is the management of meconium aspiration?

Answer 42

Suction Airway support Surfactant

Question 43

What is sepsis?

Answer 43

Life threatening organ dysfunction caused by dysregulated host response to infection

Question 44

What are the causative bacteria of sepsis in neonates?

Answer 44

Group B strep= most common E. coli Listeria

Question 45

What is the presentation of sepsis?

Answer 45

``` Fever or hypothermia Non speficic Jaundice Mottled skin, cyanosis Reduced conciousness Reduced tone Poor feeding, change in behaviour, inconsolable ```

Question 46

What is the management of sepsis?

Answer 46

Sepsis 6

Question 47

What antibiotics are given in neonatal sepsis?

Answer 47

IV ben pen and gentamicin