Pre-term infant

Question 1

Risk factors for pre-term delivery (6)

Answer 1

Previous pre-term delivery
Multiple pregnancy
Uterine abnormality
IVF conception
Smoking/drugs/drinking
Chronic medical conditions

Question 2

What happens after failure to breath for around 2-3 mins?

Answer 2

Primary apnoea induces reflexive gasping breaths using accessory muscles

Question 3

How long should cord clamping be delayed for?

Answer 3

At least a minute

Question 4

What causes bronchopulmonary dysplasia?

Answer 4

Over-inflation of fragile pre-term lungs, causing inflammation and subsequent permanent damage

Question 5

Solutions for hypothermia in the pre-term infant (3)

Answer 5

Wraps/plastic bags
Pre-warmed incubator
Skin to skin care

Question 6

How are growth charts corrected for pre-term labour?

Answer 6

Subtract the number of weeks pre-term from the age of neonate; for babies born 32-36 weeks, continue this for a year, before 32 weeks- continue this for two years

Question 7

Two different types of neonatal sepsis?

Answer 7

Early onset- acquired before/during delivery

Late onset- community/nosocomial

Question 8

Pathophysiology of respiratory distress syndrome (RDS)

Answer 8

Insufficient surfactant production; lungs unable to stay expanded meaning re-inflation is required with each breath, leading to exhaustion and respiratory failure

Question 9

Clinical features of RDS (5)

Answer 9

Tachypnoea
Grunting
intercostal recessions 
nasal flaring
Cyanosis

Question 10

Prevention of RDS

Answer 10

Betamethasone 12mg IM, two injections 12hours apart. Tocolytics e.g. nifedipine can be given to allow time for corticosteroids to be given

Question 11

Treatment of RDS

Answer 11

Intubate at birth if

Question 12

Complications of RDS (4)

Answer 12

Bronchopulmonary dysplasia
Persistent pulmonary hypertension
Patent ductus arteriosus
Intracranial haemorrhage

Question 13

The role of the ductus arteriosus

Answer 13

In the foetus it is a right-left shunt allowing blood to escape the pulmonary artery into the descending aorta

Question 14

Why is PDA an acyanotic heart disease?

Answer 14

It’s a left to right shunt, causing overload of the pulmonary circulation

Question 15

Examination/investigations findings in PDA (3)

Answer 15

“Machinery” murmur in the pulmonary area
Systolic thrill in the pulmonary area
LVH on ECG

Question 16

Treatment of PDA (2)

Answer 16

Dexamethasone helps close PDAs; NSAIDs (ibuprofen, indomethacin) reduce prostaglandin synthesis and thereby help close the duct

Question 17

A form of intracranial haemorrhage which begins with bleeding into the germinal matrix

Answer 17

Intraventricular haemorrhage

Question 18

Two main risk factors for IVH

Answer 18

Prematurity, RDS

Question 19

Symptoms and signs of IVH (3)

Answer 19

Diminished moro reflex
Poor muscle tone
Sleepiness and floppiness
Bulging fontanelles
Apnoea

Question 20

Prevention of IVH (3)

Answer 20

Antenatal steroids
Indomethacin
Vit K

Question 21

What is the most common surgical emergency in neonates?

Answer 21

Necrotizing enterocolitis

Question 22

What causes necrotizing enterocolitis?

Answer 22

Bowel ischamia, overgrowth of gas-forming bacteria causing inflammation, necrosis and perforation

Question 23

Signs of NE? (3)

Answer 23

Bloody stool
Bile stained vomiting
Abd. distension

Question 24

Management of NE (3)

Answer 24

NBM
Naso/orogastric tube to decompress bowel with suction
IV fluids, total parenteral nutrition, IV antibiotics for 10-14 days

Question 25

Mortality rate for NE

Answer 25

Between 20-40%