Sick Infants

Question 1

What is the time period for classifying a new baby as a neonate?

Answer 1

Up to 28 days

Question 2

What are the components of the APGAR score?

Answer 2

Appearance
Pulse
Grimace
Activity
Respirations

Question 3

What is a normal APGAR score?

Answer 3

8 or 10

Question 4

How is appearance scored on APGAR?

Answer 4

Blue or pale = 0
Blue in extremities = 1
No cyanosis = 2

Question 5

How is pulse scored on APGAR?

Answer 5

Absent = 0
Less than 100 = 1
More than 100 = 2

Question 6

How is grimace scored on APGAR?

Answer 6

No response = 0
Feeble cry when stimulated = 1
Cry or pull away when stimulated = 2

Question 7

How is activity scored on APGAR?

Answer 7

No activity = 0
Some flexion = 1
Flexed arms and legs that resist extension = 2

Question 8

How is respiration scored on APGAR?

Answer 8

No respiration = 0
Weak, irregular, gasping = 1
Strong cry = 2

Question 9

What is a normal respiratory rate for a neonate?

Answer 9

40-60 breaths/min

Question 10

What are the 4 main causes/groups of causes of a sick term infant?

Answer 10

Congenital abnormality
Metabolic disorder
Birth-related
Infection

Question 11

List the main bacterial infections that affect neonates

Answer 11

Group B Strep.
E. coli
Listeria
Staph. aureus
Staph. epidermidis

Question 12

List the main viral infections that affect neonates

Answer 12

Cytomegalovirus
Parovirus
Herpes virus
Enterovirus

Question 13

What is hydrops foetalis?

Answer 13

Accumulation of fluid in at least 2 compartments (ascites, pleural effusion etc.)

Question 14

When is a baby classed as preterm?

Answer 14

Born before 37 weeks gestation

Question 15

When is a baby classed as post-term?

Answer 15

Born after 42 weeks gestation

Question 16

List some risk factors for preterm birth

Answer 16

Smoking, alcohol, drugs
Poor socioeconomic status/poverty
Complications, maternal disease
Twin pregnancy
Teenage mother
IVF conception

Question 17

What are the physiological differences between a preterm and term infant?

Answer 17

Get colder quicker
Fragile lungs
Less effective breathing
Little reserve

Question 18

The cord should be clamped immediately in a preterm baby. True/False?

Answer 18

False

Can wait a minute to allow placental transfusion if baby is OK and can be kept warm

Question 19

How can a neonate be kept warm?

Answer 19

Wrap clothes
Plastic bag under a radiant heater
Skin-skin care
Prewarmed incubator

Question 20

List the main medical concerns in a preterm infant

Answer 20

Hypothermia
Sepsis
Undernutrition
Respiratory distress
Patent ductus arteriosus
Interventricular haemorrhage
Necrotising enterocolitis

Question 21

How does hypothermia lead to hypoxia?

Answer 21

Increased metabolism decreases O2 supply

Question 22

How does hypothermia lead to hypoglycaemia?

Answer 22

Increased metabolism increases glucose uptake and usage of glycogen stores

Question 23

How does hypothermia lead to respiratory distress?

Answer 23

Brown fat metabolism causes release of fatty acids which decreases surfactant production, requiring more work for breathing

Question 24

For preterm infants, gestational correction is done for plotting growth charts. How is gestation corrected?

Answer 24

Number of weeks early = 40 weeks minus gestational age

Question 25

What is the pathophysiology behind respiratory distress syndrome?

Answer 25

Surfactant deficiency causes alveolar collapse and decreased residual capacity, requiring more effort to breathe

Question 26

List clinical features of respiratory distress syndrome in neonates

Answer 26

Tachypnoea
Grunting
Intercostal recession
Nasal flaring
Cyanosis

Question 27

How is neonatal respiratory distress managed?

Answer 27

Steroid
Surfactant
Ventilation (invasive/non-invasive)

Question 28

When does intraventricular haemorrhage occur typically in neonates?

Answer 28

First day of life

Insult is present by 72 hours

Question 29

What is the most common neonatal surgical emergency?

Answer 29

Necrotising enterocolitis

Question 30

List clinical features of necrotising enterocolitis

Answer 30

Lethargy
Gastric residue
Bloody stool
Sepsis

Question 31

List long-term complications of premature birth

Answer 31

Neurodevelopmental dysfunction
Growth issues
Chronic medical conditions