Neonatology…..part 2

Question 1

Scalp layers

Answer 1

S- skin 
A-aponeurosis = glea 
L-loos ct =subglea 
P-periosteum 
S-sull bone

Question 2

Caput succedaneum

Answer 2

• serosanguinus fluid
• SC tissue
• cross suture + shift with postining
• soft spongy- pitting edama **
• resolve 48-72 hrs

Question 3

Cephalohematoma

Answer 3

-blood bt bone and priosteium
- stops at sutre lines
-occipital and prital may bilateral
Firm initially: 48 more fluctuate
Resolve by 2w-3m

Question 4

Subgleal hge

Answer 4

-subgleal spase can hold up to 240 ml of blood
-rupture of emissary veins
-cross sutures
- may extend from eys to nap of neck
-firm-fluctuations boggy - dependant swiiling
Sever anemia + hypovolemic shock
2w-3w
-high morbidity

** assessment hourly+CBC
-vital , perfusion
-scalp
Chang in loc

Question 5

Noenatal Respiratory distress syndrome RDS

Answer 5

Increase risk 1. Male sex 2. Maternal diabetes 3. Perinatal asphyxia 4. Hypothermia 5. C/S delivery 6. Multiple pregnancy

Decrease risk 1. Chronic intrauterine stress 2. PROM = prolonged rupre of mm 3. IUGR/SGA = intrautrine growth retardation \ small for gesttional age 4. Antenatal glucocorticoid 5. Maternal HTN, toxemia 6. Tocolytic agent

كل ما نقص وزنه او كلما كان preterm - زاد الرسك

Question 6

RDS signs

Answer 6

Progressive signs of respiratory distress within 4 hours of birth:
Tachypnea Grunting Subcostal / Intercostal recession Nasal Flaring Cyanosis

Radio • diffuse reticular
granular • air bronchograms • ground-glass
appearances

Question 7

Prevention of RDS

— management

Answer 7

Prevention:
Tocolytics to inhibit premature labor.
Antenatal corticosteroid therapy:
►
They induce surfactant production and accelerate fetal lung maturation.
►
indicated in pregnant women 24-34 weeks’ gestation at high risk of preterm delivery within the next 7 days. ►
Optimal benefit begins 24 hrs after initiation of therapy and lasts seven days.
Dexa or betamethasone

—— Early CPAP administration in the delivery room.

Any neonates require assisted ventilation with (FiO2)
of >0.40 should receive intratracheal surfactant as
soon as possible, preferably within 2 hours after
birth.
• maintain a pH of 7.25-7.35 • PaO2 of 50-70 mm Hg • carbon dioxide pressure (PCO2) of 40-65 mm Hg.

Question 8

Transient tachypnea of newborn TTN

Answer 8

Rf • Risk factors – cesarean section, IDM,
maternal asthma
## Usually present at birth • Improves over first 12 – 24 hours • Alone should not necessitate ventilation

Question 9

MAS

Answer 9

Meconium is composed of : • Epithelial cells, fetal hair, mucus, bile.
• It is a sterile compound made up
primarily of water (75 %), with mucous
glycoproteins, lipids and proteases.

Question 10

MAS patho

Answer 10

 Airway obstruction.  chemical pneumonitis.  Surfactant dysfunction.

Question 11

MAS x-ray

Answer 11

 Hyperinflated lung  Flattened diaphragm  Coarse irregular patch infiltration  PAL
Pneumothorax
Pneumomediastinum 25%

Question 12

MAS management

Answer 12

Ventilation strategies
 Avoid air leak, check CXR with acute
deterioration  Prevent pulmonary hypertension -
generous O2
• Antibiotics (ampicillin, gentamicin) • Surfactant ????? • Inhaled Nitric Oxide

Question 13

Neonatal pneumonia

Answer 13

Common organisms:
•GBS
•gram–ve organisms (e.g. E.Coli , Klebsiella,Pseudomonas). •Staph. aureus, Staph. Epidermidis •Candida. •acquired viral infections (e.g., HSV, CMV).

Management
• I n i t i a t e ampicillin and gentamicin
IV; modify according to culture
results and continue therapy for 14
days. • I f there is a fungal infection, an
antifungal agent is used.

Question 14

Air Leak Syndromes

-RF

Answer 14

RF : • MV,MAS, surfactant therapy without
decreasing pressure support in ventilated
infants
vigorous resuscitation, • Prematurity • Pneumonia

pneumothorax Pneumomediastinum
It can occur with aggressive ETT insertion, Ryle’s feeding tube
insertion, lung disease, MV, or chest surgery (e.g., TEF). Pneumopericardium Pneumoperitoneum Subcutaneous emphysema

@@ needle aspiration btw 4th and 5th rib

Question 15

Tension pneumothorax

Answer 15

a life-threatening condition→
Decrease cardiac
output and
obstructive  shock.
 urgent  drainage
prior  to a radiograph  is mandatory.

Question 16

Needle aspiration in air leak syndrome #pneumothorax

Answer 16

@lat apporch
Bet ant axillary and mid Bet 4th and 5th ribs #saver

Ant approach #injry of vs
2nd ICS mid clavicle line

Question 17

Diaphragmatic hernia

Answer 17

Herniation of abdominal viscera into the thorax • Result from failure of the pleuroperitoneal canal to close
at ~ 8th wk of gestation or early return of midgut to the
peritoneal cavity • Most challenging and frustrating of all neonatal surgical
emergencies

• Presentation
– most commonly in left side. – Sever respiratory distress. – Cyanosis. – Sunken abdomen. – Bowel sound may be heard in the chest.

Scaphoid abdomen

Question 18

Diaphragmatic hernia management

Answer 18

Diaphragmatic hernia
IMMEDIATE Intubation
 \+ Stomach Decompression by NGT 
Avoid bag/mask ventilation. • Can fill up the bowel in the chest with air
• Impairs ventilation.
• Pushes heart over.

Question 19

IDM

Answer 19

The Infant of a Diabetic Mother Is infant born to a mother with diabetes or gestational diabetes.
severity of the problem depend on the severity of maternal diabetes.

Question 20

Perinatal and Neonatal Complications of IDM

Answer 20

• Disorders of fetal growth • Intrauterine and perinatal asphyxia • Hypoglycemia • Respiratory distress syndrome
• Hypertrophic Cardiomyopathy • Polycythemia • Hyperbilirubinemia • Hypocalcemia

Neonatal hyperinsulinemia results in neonatal
hypoglycemia

Question 21

Macrosomia

Answer 21

Macrosomia
• Birth Weight > 4000 g or > 90 th %-ile • Incidence 15 to 45% among IDM • Increased rate of C-section • Birth Trauma
 shoulder and body dystocia
 brachial plexus injury
 facial nerve injury
 clavicular or humeral fractures  asphyxia  abdominal trauma

Question 22

Signs of Hypoglycemia of IDM

Answer 22

Signs of Hypoglycemia
• Tremors • Jitteriness • Irritability • Lethargy • Apnea
• Cyanosis • Hypothermia • Weak or high
pitched cry • Poor feeding • Seizures

Question 23

Small for Gestational Age

Answer 23

weights below the 10 percentile for their gestational age

IUGR: is a term used by OB to describe a pattern of growth over a period of time.

Question 24

IUGR

Rf

Answer 24

Symmetricl  - the baby's head and body are proportionately small. may occur when the foetus experiences a problem during early development.
####

• Multiple pregnancy. • High altitude. • Drugs like anticoagulants, anticonvulsants. • cardio-vascular disease-preeclampsia,
hypertension, cyanotic heart disease, cardiac
disease , diabetic vascular lesions. • Chronic kidney disease • Nutritional.

baby’s brain is abnormally large when compared to the liver. may occur when the foetus experiences a problem during later development

Fetal Risk Factors
• Congenital infection. 
• A birth defect
– (cardiovascular, renal, anencephally, limb defect, etc). 
• A chromosome defect-
–  trisomy-18 (Edwards’ syndrome),21(Down’s syndrome), 16, 13, xo
(turner’s syndrome.
placental insufficiency.

Question 25

IUGR complications

Answer 25

IUFD. • Birth asphyxia • Meconium
aspiration • Neonatal
hypoglycemia
• Hypothermia • Abnormal
neurological
development

Question 26

CRITERIA FOR PERINATAL ASPHYXIA

Answer 26

1. Prolonged metabolic or mixed acidemia (pH < 7.00)
   on an umbilical cord arterial blood sample 2. Persistence of an Apgar score of 0-3 for > 5 minutes 3. Clinical neurological manifestations e.g. seizure,
   hypotonia, coma or hypoxic-ischaemic
   encephalopathy in the immediate neonatal period 4. Evidence of multiorgan system dysfunction in the
   immediate neonatal periods

Question 27

Asphyxia management

Answer 27

MANAGEMENT

• Oxygenation & ventilation • Adequate perfusion • Normal glucose & calcium • Normal hematocrit • Treat seizure

Question 28

Preterm labor

Answer 28

higher the number of fetuses in the pregnancy the greater the risk for prematurity.

Question 29

Multiple pregnancy

Answer 29

CONGENITAL ANOMALIES

Increase four times in monochorionic type.

Question 30

Tracheoesophageal Fistula

Answer 30

Etiology: failure in mesenchymal separation of upper foregut
Clinical Presentation
choking on 1st feed coughing cyanosis excessive salivation aspiration pneumonia

Question 31

VACTERL

Answer 31

VATER and VACTERL
V vertebral anomalies or VSD A anorectal malformation C cardiac anomalies (common) T TEF= Tracheoesophageal Fistula

E esophageal atresia R renal abnormalities L
limb/radial malformation

Question 32

• Diarrhea • Acute diarrhea • Persistent diarrhea • Dysentery • Chronic diarrhea

Answer 32

Diarrhea
• Ty p i c a l l y, p e r s i s t e n t loose or watery stools occurring at least three times a
day (consistency is more important than frequency or volume). • Infants and toddlers: > 10 g/kg/day and in older children: > 200 g/day. • Note: From birth to 4th month Breast fed: 1-7 motions I day is normal.
• Acute diarrhea
• Start acutely, less than 14 days. • Pe r s is t e n t d ia rr h e a
• Started as acute diarrhea (watery or dysentery) but persist more than 14
days. • Dysentery
• Is an acute diarrhea with visible blood in stool. • Chronic diarrhea
• Diarrhea of gradual onset, lasting for more than 14 days or recurrent due to
non infectious cause.

Question 33

PAT H O P H YS I O L O G Y

• Osmotic • Secretory • Motility disorder • Decreased surface area

Answer 33

• Osmotic:
• Due to presence of non-absorbable solutes in GIT that lead to osmotic load
then shift of water to intestinal lumen.
• Secretory:
• Damaged absorptive villi cells that lead to excessive secretions & diminished
absorption • Entero toxins release that lead to excessive intestinal secretions.
• Motility disorder
• hypermotility that cause decrease transit time.
• hypomotility that lead to stasis and bacterial overgrowth.
• Decreased surface area act like motility disorder and osmotic.