Term Admissions to NNU

Question 1

What is meant by term?

Answer 1

Babies born >37 weeks gestation

Question 2

Why is sepsis difficult to diagnose?

Answer 2

Very generic symptoms, only half have a fever

Always consider sepsis to be a diagnosis.

Question 3

Risk factors for sepsis in neonates?

Answer 3

PROM- premature rupture of membranes
Maternal pyrexia
Maternal group B strep infection

Question 4

First line antibiotics in neonatal sepsis?

Answer 4

IV penicillin and gentamycin

->2nd line is IV vancomycin and gentamycin

Question 5

Commonest causes of neonatal sepsis?

Answer 5

Group B streptococcus
E.Coli

Question 6

What are the congenital infections to consider using the acronym TORCH?

Answer 6

Toxoplasmosis
Other- syphilis, Varicella-Zoster
Rubella
Cytomegalovirus
Herpes simplex virus

Question 7

What is transient tachypnoea of the newborn (TTN)?

Answer 7

Commonest cause of respiratory distress syndrome in neonates

Common and self-limiting

Question 8

Features of TTN?

Answer 8

Grunting
Tachypnoea, oxygen requirement

Question 9

What is the pathophysiology behind TTN?

Answer 9

Delay in clearance of foetal lung fluids

Question 10

Management of TTN?

Answer 10

Supportive care until fluid clears

Question 11

What is meconium aspiration?

Answer 11

Aspiration of meconium (first stool, tar-like) into the lung if it is passed during labour

Question 12

Risk factors for meconium aspiration?

Answer 12

Post due dates
Maternal diabetes
Maternal hypertension
Difficult labour

Question 13

Symptoms of meconium aspiration?

Answer 13

Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness

Question 14

Investigations is suspecting meconium aspiration?

Answer 14

Blood gas
Septic screen
CXR

Question 15

There are five main causes of cyanotic heart disease and they can be remembered as the 5 T’s.

Summary below :)

Answer 15

1- truncus arteriosus (number one, one vessel)

2. Transposition of the great arteries (number two, two vessels)
3. Tricuspid atresia (number three, tricuspid)
4. Tetralogy of Fallot (number four, tetra)
5. TAPVD- five words

Question 16

What can happen if there is prolonged hypoglycaemia in neonates?

Answer 16

Brain damage

Question 17

How can neonatal hypoglycaemia be managed?

Answer 17

Can be managed with additional feeding alone.

Some may need IV 10% glucose and increased fluids

->if still low, glucagon and hydrocortisone may be used

Question 18

If a child has hypothermia, what must you screen for?

Answer 18

Sepsis

->sepsis doesn’t have a set symptom pattern in young children so need to always have it in the back of our mind

Question 19

If a baby has a persistently low temperature, what should be considered as a diagnosis?

Answer 19

Congenital hypothyroidism

Question 20

Birth asphyxia?

Answer 20

Lack of oxygen at or around birth

Question 21

What can birth asphyxia lead to?

Answer 21

Multiorgan dysfunction

Question 22

List some of the causes of birth asphyxia.

Answer 22

Placental problem
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia

Question 23

Describe the two stages of birth asphyxia.

Answer 23

1st stage- occurs within minutes, cell damage occurs with lack of blood flow and oxygen

2nd stage- reperfusion injury, can last days to weeks, toxins are released from the damaged cells

Question 24

Which type of brain damage can follow birth asphyxia?

Answer 24

Hypoxic ischaemic encephalopathy

Question 25

Management of hypoxic ischaemic encephalopathy?

Answer 25

Therapeutic hypothermia (cooling) Treat seizures Supportive care Fluid restriction (to avoid cerebral oedema) Resp and cardio support ->therapeutic hypothermia improves outcomes, especially in moderate group

Question 26

Babies expected to pass stool (meconium) within first day of life. If baby has not passed stool within 2 days, what are some of the potential causes?

Answer 26

Large bowel atresia Imperforate anus Hirschsprung's disease Meconium plug Meconium ileus ->anus should always be checked in newborn exam. Cannot assume that because there is stool in nappies, that there is not an imperforate anus as in girls, it can pass out vaginally if not able to go through anus

Question 27

What is Hirschsprung's disease?

Answer 27

A birth defect in which nerves are missing from parts of the intestines and poo can get stuck in it

Question 28

If a baby has a meconium plug, there is usually an underlying disease such as?

Answer 28

Hirschsprung's disease Cystic fibrosis

Question 29

Meconium ileus in particular is indicative of which condition?

Answer 29

Cystic fibrosis ->due to defect in CFTR transport which thickens mucus in cystic fibrosis, thickens meconium too

Question 30

What are the two common types of abdominal wall defects seen in neonates?

Answer 30

Exomphalos Gastroschisis ->gut is slowly squeezed back in over time essentially, look up pictures to see difference, exomphalos has protective sac

Question 31

What happens in a diaphragmatic hernia?

Answer 31

Defect in the formation of the diaphragm meaning bowel contents herniate into chest. This causes issues with lung development.

Question 32

Management of diaphragmatic hernia?

Answer 32

Intubation and respiratory support NOT with a mask as gas can distend the bowel and cause further issues Surgery ->mortality is associated with diaphragmatic hernia, and survivors have long-term impacted lung function

Question 33

What is neonatal abstinence syndrome?

Answer 33

Withdrawal from physically addictive substances taken by the mother in pregnancy

Question 34

List some of the things neonates can be in withdrawal from in neonatal abstinence syndrome.

Answer 34

Opioids- methadone, heroin Benzodiazepines Cocaine Amphetamines

Question 35

How is a diagnosis of neonatal abstinence syndrome made?

Answer 35

Finnegan score Urine toxicology ->maybe remember the score as being a funny Irish name so maybe it's a funny Irish person who has addiction issues...idk anything to help

Question 36

Treatment of neonatal abstinence syndrome?

Answer 36

Comfort e.g. swaddling Morphine Phenobarbitone ->phenobarbitone is also first line for neonatal seizures

Question 37

If suspecting a baby has sepsis, what needs to be commenced within an hour?

Answer 37

Antibiotics