Neonatology pt 2

Question 1

Pathophysiology of respiratory distress syndrome?

Answer 1

Inaqequate surfactant leading to high surface tension within alveoli. This causes atelectasis leading to hypoxia, hypercapnia and distress.
CXR shows ground glass appearance.

Question 2

What is the management of respiratory distress dyndrome?

Answer 2

Antepartum maternal steroids if preterm labour is suspected/confirmed.
Neonates may need intubation and ventilation, endotracheal surfactant, CPAP and supplimentary O2.

Question 3

What are the complications of respiratory distress syndrome?

Answer 3

Short term - pneumothorax, infection, apnoea, intraventricular haemorrhage, pulmonary haemorrhage, necrotising entercolitis.

Long term - Chronic lung disease of prematurity, retinopathy of prematurity, neurological, hearing and visual impairment.

Question 4

what are the causes of hypoxic-ischaemic encephalopathy?

Answer 4

Anything that leads to asphyxia to the brain, eg,
Maternal shock, intrapartum haemorrhage, prolapsed cord, nuchal cord.

Question 5

Management of HIE?

Answer 5

Supportive care
Theraputic hypothermia - cooling blankets/hat. Aim for temp of 33-34. Continued for 72 hours. This reduced inflammation and neuronal loss after a hypoxic injury. reduces risk of cerebral palsy, developmental delat, learning disibilities and death

Question 6

What is necrotising enterocolitis and its risk factors?

Answer 6

Disorder in neonates where part of bowel becomes necrotic - can lead to perforation.
Risk factors - very low birth weight or prematurity, formula feeds, respiratory distress, sepsis, congenital heart disease

Question 7

Presentation of necrotising enterocolitis?

Answer 7

Intolerance to feeds,
Vomiting - green bile,
Distended, tender abdomen,
Absent bowel sounds.
Blood in stool

Question 8

Investigations for necrotising enterocolitis?

Answer 8

Bloods: FBC, CRP, capillary blood gas, blood cultures.
Abdominal x-ray (ix of choice) - dilated bowel loops, bowel wall oedema, pneumatosis intestinalis (intramural gas), pneumoperitoneam, football sign

Question 9

Management of necrotising enterocolitis?

Answer 9

NBM
IV fluids
TPN
Abx,
NG tube to drain fluid/gas.
Immediate referral to surgical team.

Question 10

Complications of necrotising enterocolitis?

Answer 10

Perforation and peritonitis,
Sepsis,
Death,
Strictures,
Abscess formation,
Recurrance,
long term stoma
Short bowel syndrome

Question 11

Describe features of meconium aspiration syndrome?

Answer 11

Respiratory distress due to meconium in trachea.
More common in postnatal deliveries.
Ix: Assess amniotic fluid for presence of meconium and CXT for assessment of lungs.
Rx: Immediate suctioning after birth, O2 therapy and antibiotics

Question 12

Describe features of meconium ileus

Answer 12

Thickening of meconium causing obstruction in neonatal bowel. Early indicator of CF.
Symptoms: bilious vomiting, distended abdomen and failure to pass meconium.
Ix: Abdo X ray/US for diagnosis and sweat test for CF.
Rx: Surgery to remove obstruction

Question 13

Risk factors for neonatal sepsis?

Answer 13

Vaginal GBS colonisation.
GBS in previous baby.
Maternal sepsis, chorioamnionitis or fever > 38 degrees.
Prematurity.
PPROM.

Question 14

Clinical features of neonatal sepsis

Answer 14

Fever - not a reliable sign as can vary from elevated, normal or low.
Reduced tone and activity,
Poor feeding,
Resp distress or apnoea,
Vomiting,
Tachycardia or bradycardia,
Hypoxia,
Jaundice within 24hr,
Seizures,
Hypoglycaemia.

Question 15

Causes of early/late onset sepsis in the neonate?

Answer 15

Early - GBS.
Late - commonly coagulase negative staph (S. epidermidis) or gram negative bacteria eg, pseudomonas aeruginosa, klebsiella or enterobacter.

Question 16

Investigations for neonatal sepsis?

Answer 16

Blood cultures
FBC
CRP
Blood gases
Urine M,C&S
LP

Question 17

Management of neonatal sepsis?

Answer 17

IV benzylpenicillin with gentamicin.
CRP should be remeasured at 24h
Blood cultures remeasured at 36hr.
Consider stopping abx if baby is clinically well, blood cultures negative and CRP < 10.

Question 18

Types of spina bifida?

Answer 18

Spina bifida occulta - incomplete fusion of vertebrae but no herniation of spinal cord.
Meningocele - incomplete fusion of vertebra with herniation of meningeal sac containing CSF
Myelomeningocele - incomplete fusion of vertebrae with herniation of meningeal sac containing CSF and spinal cord
Managed with surgery

Question 19

Clinical manifestations of spina bifida

Answer 19

Neurological - motor deficits, sensory deficits, neurological bladder/bowel, hydrocephalus, seizures.
MSK - Increased risk of hip subluxattion, scoliosis and contractures.

Question 20

What is Talipes and the two types?

Answer 20

‘Clubfoot’ - fixed, abnormal ankle position present at birth.
Talipes equinovarus - plantar flexion and supination.
Talipes calcaneovalgus - dorsiflextion and pronation

Question 21

Talipes assocations?

Answer 21

Spina bifida,
Cerebral palsy,
Edward syndrome,
oligohydramnios,
Arthrogryposis

Question 22

Management of talipes?

Answer 22

Conservative methods eg, Ponseti method - manipulation and progressive casting starting soon after birth.
Achilles tenotomy performed at some point.
Brace used to hold feet in place until child is age 4 years old.