Sick term infant

Question 1

What is the neonatal period?

Answer 1

Up to 28 days of life

Question 2

What are the most common causes of neonatal death?

Answer 2

Prematurity 
Birth asphyxia and birth trauma
Neonatal sepsis
Pneumonia 
Congenital anomalies
Neonatal tetanus
Diarrhoea

Question 3

What is incorporated into the apgar score?

Answer 3

HR
Resp effort
Tone
Colour
Response

Question 4

What is the acronym for apgar?

Answer 4

Appearance (skin colour) 
Pulse
Grimace (reflex irritability) 
Activity (miscue tone) 
Respiration

Question 5

What are the normal parameters for a neonatal clinical assessment?

Answer 5

RR; 40-60/min
HR; 120-140 bpm 
Cap refill; 2-3 seconds
Colour; pink 
SaO2; >95%

Question 6

What should be assessed in a newborn clinical assessment?

Answer 6

RR
Work of breathing; resp effort
HR 
CRT
BP
Colour
Sats
Jaundice
Tone
Seizures
Feeding 
Bilious vomit

Question 7

What is the inital management of a sick term baby?

Answer 7

Temp; 36.5-37.5 
Airway and breathing; oxygen? 
Circulation; fluids, inotropes? 
Metabolic homeostasis; glucose management, acid base balance
Antibiotics

Question 8

What are the 4 reasons for a sick baby?

Answer 8

Pregnancy or birth related
Congenital anomaly
Infection
Metabolic

Question 9

When can babies catch infections?

Answer 9

Antenatal
Perinatal
Postnatal

Question 10

What are the sites of infections in neonates?

Answer 10

Blood stream; bacteraemia 
CNS; meningitis 
Resp; pneumonia
GU; UTI (more common in boys) 
Skin
bone
GI; NEC (preterms)

Question 11

What are the common bacteria that affect neonates?

Answer 11

GBS
E.coli
Listeria monocytogenes
Staphylococcus aureus
Staph epi

Question 12

What viral infections affect neonates?

Answer 12

CMV
Parvovirus
Herpes 
Enterovirus 
Toxoplasmosis gondii
GIV

Question 13

What is hypoxic ischaemia encephalopathy?

Answer 13

Multi organ damage due to tissue hypoxia
Poor apgar’s; resus required
Neurodevelopmental sequelae; variable prognosis

Question 14

What are the pregnancy/ birth related resp problems in neonates?

Answer 14

TTN

Pneumothorax; spontaneous vs secondary to active resus

Question 15

What can be seen on CXR of TTN?

Answer 15

White, streaky lungs with fluid in the horizontal fissure

Question 16

What are the pregnancy/ birth related cardiac problems in neonates?

Answer 16

Heart failure; hydrops (rhesus or chromosomal)

Failure to adapt; PPHN

Question 17

What is the mainstay of tx for PPHN?

Answer 17

Nitric oxide

ECMO

Question 18

What are common congenital cardiac diseases?

Answer 18

ToF 
Transposition of the great arteries
Coarctation of aorta
TAPVD
Hypoplastic left heart

Question 19

When will congenital cardiac anomalies present?

Answer 19

2 to 3 days after birth; as the heart adapts to extrauterine life

Question 20

What are common respiratory congenital diseases?

Answer 20

Tracheoesophageal fistula; blue when feeding

diaphragmatic hernia

Question 21

What are common neurological congenital anomalies?

Answer 21

Microcephaly

Spina bifida resulting in hydrocephalus

Question 22

What are common renal congenital anomalies?

Answer 22

Potters syndrome; renal agenesis with pulmonary hypoplasia

Question 23

What are common muscular congenital anomalies?

Answer 23

Myotonic dystrophy

Question 24

Why can babies present with hypoglycemia?

Answer 24

Reduced reserves; LBM/ SGA
Maternal diabetes
More complex metabolic disorder

Question 25

Why can babies present with acidosis?

Answer 25

Birth asphyxia

Inborn error of metabolism

Question 26

What are the 5 primitive reflexes?

Answer 26

Rooting and sucking (to do with breastfeeding)
Moro (startle)
Tonic neck (when head at one side; arm will stretch out)
Grasp
Stepping