Sick Term 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 is the most common cause of neonatal death?

Answer 2

Prematurity

Question 3

What are the components of the APGAR score?

Answer 3

Appearance
Pulse
Grimace (reflex irritability)
Activity (tone)
Respirations

Question 4

What is a normal APGAR score?

Answer 4

8 or 10

Question 5

How is appearance scored on APGAR?

Answer 5

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

Question 6

How is pulse scored on APGAR?

Answer 6

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

Question 7

How is grimace scored on APGAR?

Answer 7

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

Question 8

How is activity scored on APGAR?

Answer 8

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

Question 9

How is respiration scored on APGAR?

Answer 9

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

Question 10

List important parts of the maternal history to ask about during newborn clinical assessment

Answer 10

PMHx
Pregnancy issues
Drugs
Infection risks

Question 11

List important parts of the fetal history to ask about during newborn clinical assessment

Answer 11

Fetal gorwth
Fetal anomaly
Delivery
Resuscitation

Question 12

List the important examinations involved in a newborn clinical assessment

Answer 12

Inspect: tone, arousal, colour, vomit, feeding, seizures
AB: respiratory rate, effort, colour, sats (95%)
C: heart rate, CRT, BP

Question 13

What is a normal respiratory rate for a neonate?

Answer 13

40-60 breaths/min

Question 14

What is a normal heart rate for a neonate?

Answer 14

120-160/min

Question 15

List aspects of initial management in an ABCDE assessment

Answer 15

AB: oxygen
C: fluids, inotropes, umbilical access
D: glucose management, acid-base balance
E: temperature, antibiotics

Question 16

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

Answer 16

Congenital abnormality
Metabolic disorder
Pregnancy/Birth-related
Infection

Question 17

List the main bacterial infections that affect neonates

Answer 17

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

Question 18

List the main viral infections that affect neonates

Answer 18

Cytomegalovirus
Parovirus
Herpes virus
Enterovirus
Toxoplasma gondii
HIV
Syphilus

Question 19

List the TORCH infections which are commonly associated with congenital anomalies

Answer 19

Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19)
Rubella
Cytomegalovirus (CMV)
Herpes

Question 20

List the most common sites of infection found in sick term infants

Answer 20

Blood stream (bacteraemia,septicaemia)
CNS (meningitis)
Respiratory (pneumonia)
GU (UTI)
GI (NEC)
Skin, bone

Question 21

Give a cause of neurodevelopmental problems shortly after delivery that requires immediate resuscitation in the newborn

Answer 21

Hypoxic ischaemic encephalopathy

Multi-organ damage due to tissue hypoxia

Question 22

List respiratory problems that can be seen in the newborn shortly after delivery

Answer 22

Transient tachypnoea of newborn (TTN)

Pneumothorax (spontaneous or secondary to resusc)

Question 23

What is transient tachypnoea of newborn? What is a major risk factor?

Answer 23

Inability of the newborn’s lungs to expel or absorb amniotic fluid during and following delivery
Cesarean delivery

Question 24

State a cardiac problem that is a common cause of heart failure in the newborn

Answer 24

Hydrops foetalis

Question 25

What is hydrops foetalis?

Answer 25

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

Question 26

What are the two main types of hydrops foetalis?

Answer 26

Immune (due to Rhesus disease) | Chromosomal

Question 27

State a cardiac problem that is due to a failure to adapt to postnatal life

Answer 27

Persistant pulmonary hypertension of newborn | Pressure in lungs does not drop, causing hypoxia

Question 28

List common cardiac-related congenital diseases found in the newborn

Answer 28

``` Tetralogy of fallot Transposition of great arteries Coarctation of aorta Total anomolous pulmonary venous drainage Hypoplastic heart ```

Question 29

What is a common clinic sign of coarctation of aorta?

Answer 29

Absent femoral pulses

Question 30

List the main components of tetralogy of fallot

Answer 30

``` "Don't DROP the baby" Defect (VSD) Right ventricular hypertrophy Overriding aorta Pulmonary stenosis ```

Question 31

What is total anomolous pulmonary venous drainage (TAPVD)?

Answer 31

Four pulmonary veins drain abnormally to the right atrium, instead of the left, by way of an abnormal (anomalous) connection

Question 32

What is hypoplastic heart?

Answer 32

Left ventricle is underdeveloped leading to reduced pumping action of the heart

Question 33

List common respiratory-related congenital diseases found in the newborn

Answer 33

Tracheo-oesophageal fistula | Diaphragmatic hernia

Question 34

What is a common sign on imaging of tracheo-oesophageal fistula?

Answer 34

NG tube can't pass down oesophagus as it isn't formed properly

Question 35

List common neuro-related congenital diseases found in the newborn

Answer 35

Microcephaly | Spina bifida

Question 36

State a common renal-related congenital disease found in the newborn

Answer 36

Potter's syndrome | Kidney's fail to develop in the womb leading to reduced amniotic fluid production

Question 37

State a common muscular-related congenital disease found in the newborn

Answer 37

Congenital myotonic dystrophy | Weak muscles and a lack of muscle tone

Question 38

List common metabolic congenital diseases found in the newborn

Answer 38

Hypoglycaemia | Acidosis

Question 39

List risk factors for hypoglycaemia in the neonate

Answer 39

Maternal diabetes SGA or LGA Prematurity Difficult birth

Question 40

List signs of hypoglycaemia in the newborn

Answer 40

``` Jitteriness Cyanosis Apnea Hypothermia Poor body tone Poor feeding Lethargy Seizures ```

Question 41

List some conditions tested for on the Guthrie card or heel prick test

Answer 41

PKU Sickle cell anaemia Cystic fibrosis Congenital hypothyroidism