Common Neonatal Issues

Question 1

List the risk factors for neonatal hypoglycaemia in first 24hrs of life

Answer 1

1. IUGR
2. Preterm
3. Maternal DM
4. Large-for-dates
5. Hypothermic
6. Polycythemic
7. Ill

Question 2

How does prematurity and IUGR cause hypoglycaemia?

Answer 2

These infants have poor glycogen stores which leads to hypoglycaemia

Question 3

What is the mechanism of hypoglycaemia in infants of diabetic mothers?

Answer 3

These infants have sufficient glycogen stores but have hyperplasia of the islet cells due to exposure to high levels of blood glucose in utero, which leads to high insulin levels and hypoglycaemia

Question 4

What are the symptoms of neonatal hypoglycaemia?

Answer 4

1. Jitteriness
2. Irritability
3. Apnoea
4. Lethargy
5. Drowsiness
6. Seizures

Question 5

What are the consequences of prolonged symptomatic hypoglycaemia?

Answer 5

Permanent neurological disability

Question 6

How can we prevent neonatal hypoglycaemia?

Answer 6

Early and frequent feeding with regular monitoring of blood glucose in at risk infants

Question 7

At what point do we need to consider management of neonatal hypoglycaemia?

Answer 7

1. Asymptomatic infants:
   - 2 low glucose values (<2.6mmol/L) despite adequate feeding
   - One very low value (<1.6mmol/L)
2. Symptomatic infants

Question 8

How is neonatal hypoglycaemia managed?

Answer 8

1. IV glucose infusion with aim to keep above 2.6mmol/L
   (in form of dextrose)
2. High concentration of glucose given via CVC - avoid extravasation into tissues
3. Give glucagon if unsatisfactory response

Question 9

How do neonatal seizures present?

Answer 9

1. Repetitive, rhythmic (clonic) movements of limbs that persist despite restraint
2. Eye movements
3. Changes in respiration

Question 10

List the investigations you would perform if you suspected neonatal seizures

Answer 10

1. Continuous single-channel encephalogram (aEEG)
2. Cerebral ultrasound (can identify haemorrhage or cerebral malformation)
3. MRI (identifies some abnormalities)

Question 11

What are the causes of neonatal seizures?

Answer 11

1. Hypoxic-ischaemic encephalopathy
2. Cerebral infarction
3. Septicaemia/meningitis
4. Metabolic causes
5. Intracranial haemorrhage
6. Cerebral malformations
7. Drug withdrawal
8. Congenital infection
9. Kernicterus

Question 12

How are neonatal seizures managed?

Answer 12

Management depends on cause

Ongoing and repeated seizures are managed with anticonvulsants (efficacy poor in infants)

Question 13

What are the causes of perinatal stroke?

Answer 13

1. Ischaemia of middle cerebral artery (most common)

2. Haemorrhage or venous thrombosis in dural venous sinuses

Question 14

What are the presenting features of perinatal stroke?

Answer 14

1. Seizures at 12-48hrs in term infant

No other abnormal clinical features

Question 15

What is the diagnostic test for perinatal stroke?

Answer 15

MRI

Question 16

What is the mechanism of perinatal stroke?

Answer 16

Thrombotic

Question 17

What consequences can occur as a result of perinatal stroke?

Answer 17

1. Motor disability - hemiplegia on the contralateral side presenting in infancy or childhood
2. Cognitive dysfunction
3. Epilepsy