Problems in the neonate

Question 1

Meconium aspiration - X ray feature

Answer 1

Patchy lung fields

Question 2

PPHN - definition

Answer 2

Persistent foetal circulation after birth

• the baby continues to shunt blood from RA -> LA
• blood crosses from the pulmonary artery -> descending part of the aortic arch via persistent patent ductus arteriosus

Question 3

PPHN - the majority of the blood in the systemic circulation is OXYGENATED. True or false?

Answer 3

False

- de-oxygenated

Question 4

PPHN - clinical features

Answer 4

Decreased O2 sats

- O2 sats of foot will be lower than O2 sats in baby hand

Question 5

PPHN - management

Answer 5

Ventilation
Oxygen 
Nitric oxide - vasodilator 
Sedation
Inotropes - force more blood to circulate to the lungs

Question 6

Patent ductus arteriosus - definition

Answer 6

When the ductus arteriosus persists. It should close within 2 hours post delivery due to the drop in pulmonary arterial pressure after birth (meaning its easier for blood to move into the pulmonary circulation).

Question 7

What happens to the circulation if there is a patent ductus arteriosus after birth?

Answer 7

`the pulmonary pressure will stay high ad blood will bypass the pulmonary circulation

Question 8

Hypothermia - who is at highest risk

Answer 8

Pre term babies

- low brown fat and subcutaneous fat stores

Question 9

Hypothermia - management

Answer 9

Put a hat on baby
Skin to skin contact 
Blanket/clothes 
Transwarmer mattress
Prewarmed incubator 
Put baby in a bag

Question 10

Early onset sepsis - causative organisms

Answer 10

Group B strep

Gram -ves

Question 11

Late onset sepsis - causative organisms

Answer 11

Coagulase -ve staph
Gram -ves
Staph aureus

Question 12

Physiological jaundice - definition

Answer 12

Breakdown of foetal haemoglobin

Normal from day 2-14

Question 13

Pathological jaundice

Answer 13

Jaundice that occurs before day 2 or after day 14

Question 14

Management of pathological jaundice ?

Answer 14

Blue light therapy

Question 15

Respiratory distress syndrome - clinical features

Answer 15

Tachypnoea 
Grunting 
Intercostal recession
Nasal flaring 
Cyanosis

Question 16

Respiratory distress syndrome - investigations

Answer 16

CXR - ground glass appearance

Question 17

Respiratory distress syndrome - management

Answer 17

Maternal steroids - increases surfactant production

Question 18

Foetal alcohol syndrome - clinical features

Answer 18

Small eye openings 
Flat mid face 
Upturned nose 
Smooth philtrum
Thin upper lip

Question 19

Which babies tend to get a retinopathy?

Answer 19

Premature babies

Question 20

Most common antenatal infection

Answer 20

CMV

Question 21

Most common perinatal infection

Answer 21

Group B strep

Question 22

Post natal infection causes

Answer 22

Could be anything in the external environment

Question 23

How long does the neonatal phase last?

Answer 23

First 4 weeks of life

Question 24

Necrotising enterocolitis (NEC) - definition

Answer 24

Sick gut
Where tissues in the intestine become inflamed and start to die. This can lead to a hole developing which allows the contents of the intestine to leak out to the abdomen, causing dangerous infection

Question 25

NEC - who gets it

Answer 25

Premature baby

Question 26

NEC - clinical features

Answer 26

Swollen/tender abdomen General signs of illness Problems with feeding/vomiting

Question 27

NEC - investigations

Answer 27

Abdo XR - bowel wall gets leaky and gas starts to move out to the bowel wall - wrigglers sign

Question 28

NEC - management

Answer 28

NG tube insertion to drain contents from stomach Must have surgery if perforation occurs

Question 29

What are the 3 ways of an obstruction occurring?

Answer 29

Something gets stuck in the lumen Something on the outside of the lumen pushing in Something in the bowel wall

Question 30

What type of obstruction is meconium ileus?

Answer 30

Intraluminal obstruction

Question 31

2 day old baby who is feeding ok but vomiting. The baby has not yet pooed. On examination there is a distended abdomen which feels doughy. What is the likely diagnosis?

Answer 31

Meconium ileus

Question 32

Which condition is meconium ileus associated with?

Answer 32

Cystic fibrosis

Question 33

Malrotation - definition

Answer 33

The gut is sitting in the wrong orientation

Question 34

Volvulus - definition

Answer 34

The gut twists around on itself and this cuts off the blood supply

Question 35

Malroatation - clinical features

Answer 35

Baby vomiting green bile

Question 36

Malrotation - investigations

Answer 36

Upper GI water soluble x-ray

Question 37

Malrotation - management

Answer 37

Emergency surgery

Question 38

If there is a high obstruction there will be lots/little laddering?

Answer 38

little

Question 39

If there is a low obstruction, there will be lots/little laddering?

Answer 39

Lots

Question 40

Tetralogy of fallot commonly presents within the first few days of life. True or false?

Answer 40

False | - usually infant hood or even adulthood

Question 41

Tetralogy of fallot - which murmur is it associated with?

Answer 41

Pulmonary stenosis

Question 42

Transposition of the great arteries - where does the aorta and pulmonary artery come off?

Answer 42

Aorta - comes off right ventricle | Pulmonary artery - comes off left ventricle

Question 43

When does transposition of the great arteries present?

Answer 43

Around 48 hours after birth | - when the ductus arteriosus closes