Premature infant and neonates

Question 1

RDS.

a) Cause and clinical features
b) Appearance on CXR
c) Management

Answer 1

a) Inadequate surfactant (usually premature infants):
b) Ground glass appearance

c) SOS CpAp:
o Surfactant via ETT
o Oxygen (target: 91 – 95%)
o Supportive (nutrition, hydration, temperature, glucose, electrolytes)
o CPAP (non-invasive) or IPPV (invasive)
o Antibiotics (if culture negative, can discontinue)

Question 2

Neonatal jaundice.

a) Early (< 24h) - causes
b) When is jaundice normal?
c) Late (> 2 weeks) - causes
d) Investigations

Answer 2

a) Haemolysis (unconjugated): ABO incompatibility, Rhesus disease, G6PD deficiency
b) 2 days - 2 weeks: usually physiological (in breastfed infants)

c) - Unconjugated:
- Conjugated: biliary atresia (urgent surgical intervention)

d) BLITH:
o Bilirubin level (transcutaneous or serum if < 24h/preterm)
o LFTs
o Infection screen (TORCH, septic screen)
o TFTs
o Haemolytic causes (Maternal and foetal ABO/Rh, peripheral blood film, Coombs test, red cell enzyme assays, reticulocyte count)

Question 3

Problems of prematurity.

Answer 3

• Chronic lung disease,
• retinopathy
• NEC - stop feeds, ABx, inotropes, surgery if required
• ## Intraventricular haemorrhage (grading; risk of spastic cerebral palsy), periventricular leukomalacia

Question 4

Meconium aspiration.

Answer 4

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Question 5

Transient tachypnoea of the newborn.

a) Who gets it?
b) Sign on CXR
c) Management

Answer 5

a) Term CS babies
b) Fluid in horizontal fissure
c) Ambient O2

Question 6

Congenital diaphragmatic hernia.

Answer 6

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Question 7

NEC

Answer 7

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