Term Admissions to NNU

Question 1

Symptoms of sepsis in term neonates

Answer 1

Baby pyrexia 
Hypothermia
Poor feeding
Lethargy 
Early jaundice 
Hypoglycaemia
Hyperglycaemia
Asymptomatic

Question 2

Risk factors for sepsis in term neonates

Answer 2

PROM
maternal pyrexia
maternal GBS carriage

Question 3

Investigations of presumed sepsis

Answer 3

Admit NUU
Partial septic screen (FBC, CRP, blood cultures) and blood gasses
Consider CXR, LP

Question 4

Treatment of presumed sepsis

Answer 4

IV penicillin and gentamicin 1st line
IV vancomycin and gentamycin 2nd line 
Add metronidazole if surgical/abdominal concerns 
Fluid management
Treat acidosis 
Monitor vital signs 
treat CSV and resp systems as required

Question 5

Commonest causes of neonatal sepsis

Answer 5

1. Group B streptococcus
2. E coli
3. Listeria
4. coag-neg staphlycocci (if lines in situ)
5. haemophilus influenzae

Question 6

How long is early onset GBS sepsis?

Answer 6

birth to one week

Question 7

How long is late onset or recurrence GBS sepsis?

Answer 7

Up to 3 months

Question 8

Complications of GBS sepsis

Answer 8

Meningitis 
DIC
pneumonia
Resp collapse
hypotension 
shock

Question 9

Prognosis of GBS sepsis

Answer 9

4 - 30% mortality

Question 10

Congenital infections (ToRCH)

Answer 10

Toxoplasmosis
Rubella
CMV
Herpes

Question 11

What can congenital infections result in?

Answer 11

IUGR
Brain calcifications
Neurodevelopment delay 
Visual impairment 
Recurrent infections
Cataracts / retinitis
Pneumonitis 
Hepatomegaly 
Jaundice
Hepatitis 
Anaemia
Neutropenia 
Thrombocytopenia  
Splenomegaly 
Bone abnormalities 
Cardiomegaly / PDA
Microcephalus 
Deafness

Question 12

Causes of respiratory distress

Answer 12

Sepsis
TTN
Meconium aspiration

Question 13

What does TTN stand for?

Answer 13

Transient tachypnoea of the newborn

Question 14

When does TTN present?

Answer 14

within 1st few hours of life

Question 15

Presentation of TTN

Answer 15

Grunting
Tachypnoea
Oxygen requirement
Normal gases

Question 16

Pathology of TTN

Answer 16

delay in clearance of foetal lung fluids

Question 17

Treatment of TTN

Answer 17

supportive
Ax
fluids
O2
airway support

Question 18

What is meconium aspiration?

Answer 18

Meconium is inhaled into the lungs

Question 19

What is meconium?

Answer 19

Earliest stool of a mammalian infant

Question 20

Risk factors for meconium aspiration

Answer 20

Post dates (aged placenta)
Maternal DM
Maternal HTN
difficult labour

Question 21

Symptoms of meconium aspiration

Answer 21

Cyanosis 
Increased work of breathing
grunting 
apnoea 
floppiness

Question 22

Investigations of meconium aspiration

Answer 22

Blood gas
septic screen
CXR

Question 23

Treatment of meconium aspiration

Answer 23

Suction below cords
Airway support
- intubation and ventilation 
Fluids 
Antibiotics 
Surfactant 
NO or ECMO

Question 24

Prognosis of meconium aspiration

Answer 24

Most do well
Some develop PPHN
There is an associated mortality

Question 25

What does PPHN stand for?

Answer 25

Persistent pulmonary HTN of the newborn

Question 26

The _____ baby needs urgent treatment

Answer 26

Blue

Question 27

What level of deoxyhaemoglobin is there when cyanosis occurs?

Answer 27

> 5g/dl

Question 28

Investigations of the blue baby

Answer 28

``` Exam and history sepsis screen blood gas + blood glucose CXR pulse oximetry ECG ECHO (hyperoxia test) ```

Question 29

Differential diagnosis of the blue baby

Answer 29

``` TGA Teratology of fallots TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia ```

Question 30

Management of hypoglycaemia in NNU

Answer 30

``` Start IV 10% glucose Increase fluids Increase glucose concentration (central IV access) Glucagon Hydrocortisone ```

Question 31

What is an IUGR twin prone to?

Answer 31

Hypoglycaemia

Question 32

What do you have to monitor in hypothermia?

Answer 32

Sepsis screen Thyroid function Blood glucose

Question 33

Treatment of hypothermia

Answer 33

Incubator | Antibiotics if needed

Question 34

When would jaundice need admission to NNU?

Answer 34

Severe jaundice for intensive phototherapy and/or exchange transfusion Incubator and IV fluids may be required

Question 35

What is birth asphyxia?

Answer 35

Lack of oxygen at or around birth leading to multiorgan dysfunction

Question 36

Causes of birth asphyxia

Answer 36

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

Question 37

Stages of birth asphyxia

Answer 37

``` 1st stage - within minutes without O2 - cell damage occurs with lack of blood flow and O2 2nd stage - reperfusion injury - can last days or weeks - toxins are released from damaged cells ```

Question 38

Management of hypoxic ischaemic encephalopathy

Answer 38

``` Therapeutic hypothermia (cooling) Treat seizures Supportive Fluid restriction (to avoid cerebral oedema) Monitor for renal and liver failure Resp support Cardiac support ```

Question 39

Surgical problems in the NNU

Answer 39

``` Oesophageal atresia/fistula Duodenal atresia and other GI atresias Causes of failure to pass stool Abdominal wall defects Diaphragmatic hernia ```

Question 40

Causes of failure to pass stool

Answer 40

``` Constipation Large bowel atresia imperforate anus +/- fistula Hirschspurngs disease Meconium ileus - think CF ```

Question 41

What is meconium ileus?

Answer 41

Meconium ileus is a bowel obstruction that occurs when the meconium in your child's intestine is even thicker and stickier than normal meconium, creating a blockage in the ileum

Question 42

What gender gets diaphragmatic hernias?

Answer 42

M > F

Question 43

Treatment for diaphragmatic hernias

Answer 43

Intubation at birth resp support surgery

Question 44

What sign would indicate a diaphragmatic hernia in a cyanosed baby?

Answer 44

Evidence of bowel sounds on respiratory exam

Question 45

What occurs alongside congenital diaphragmatic hernia?

Answer 45

Pulmonary hypoplasia