Neonates

Question 1

1. what is the duration of the post natal period?

2. what us the focus of care during this period?

Answer 1

1. end of labour to 6-8 weeks after birth

2. mother and baby, monitoring progress and recognising warning signs of abnormality

Question 2

1. when does the first post natal visit usually occur?
2. when is the neonatal blood spot test carried out?
3. When does discharge to health visitor occur?

Answer 2

1. day after discharge from hospital
2. day 5
3. day 10

Question 3

Name symptoms of:

1. postpartum haemorrhage
2. post partum infection
3. pre-eclampsia/eclampsia
4. thromboembolism

Answer 3

1. sudden and profuse blood loss or persistent increased blood loss
   faintness, dizziness or tachycardia
2. fever, shiverring, abdo pain and/or offensive vaginal loss
3. headache, accompanied by visual disturbances or nausea/vomiting in first 72 hours post birth
4. unilateral calf pain, redness/swelling of calves, SOB

Question 4

1. name 5 indicators of successful feeding in babies

2. name 3 indicators of successful indicators in mother

Answer 4

1. audible and visible swallowing
sustained rhythmic suck
relaxed arms and hands
moist mouth
regular soaked/heavy nappies

2. breast softening
   no compression of the nipple at the end of the feed
   woman feels relaxed and sleepy

Question 5

1. What is assessed in the APGAR Score?
2. a score of less than 7 indicates what?
3. A score of less than 5 indicates what?

Answer 5

1. Activity (muscle tone), pulse, grimace, appearance (skin colour), respiration
2. possibility for some form of resusctation
3. possible transfer to SCBU

Question 6

1. What is examined at the newborn examination?
2. when is the hearing screen carried out?
3. What is screened for in the blood spot test?

Answer 6

1. eyes, heart, hips, testicles
2. before discharge or within 4 weeks
3. sickle cell, CF, congenital hypothyroidism, inherited metabolic diseases

Question 7

1. Why is the neonatal airway vulnerable? (2)
2. at what gestational age is surfactant produced?
3. at what gestational age is gas exchange possible from?

Answer 7

1. can be obstructed by blood meconium; small - 2.5-3.5mm in diameter
2. 32 weeks
3. 26 weeks

Question 8

1. what is pulmonary hypoplasia?

2. What is congenital diaphragmatic hernia?

Answer 8

1. congenital anomaly whereby the lungs develop incompletely, resulting in an abnormally low number/size of alveoli
   most often occurs secondary to other foetal abnormalities such as oligohydroaminos
2. congenital defect of the diaphragm, which allows the abdominal organs to push into the chest cavity, which hinders proper lung formation

Question 9

Name 6 causes of surfactant insufficiency

Answer 9

1. congenital absence
2. prematurity
3. infection (neutralises surfactant)
4. acidosis
5. hypothermia
6. meconium aspiration (blocks airways and neutralises surfactant)

Question 10

1. What is the appearance of respiratory distress syndrome on a CXR?
2. How is respiratory distress syndrome managed?
3. what is a side effect of continued management?

Answer 10

1. ground glass
2. ventilation
3. bronchopulmonary displasia - fluid build up on the lungs with increased likelihood of lung damage

Question 11

name 4 adaptations of the foetal circulation to bypass the lungs

Answer 11

1. foramen ovale
2. ductus arteriosus (pulmonary artery to aorta)
3. increased vascular resistance in the lung
4. ductus venosus (umbilical vein to IVC)

Question 12

what happens to the foetal circulation when:

1. the placenta is cut
2. the baby breathes
3. What are the consequences of this?
4. When does the ductus arteriosus close and why?

Answer 12

1. loss of placental return > decreased vascular flow in the IVC > decreased flow in the RA.
   Increased systemic resistance > increased LV workload
2. ventilation > decrease in pulmonary vessel resistance
   more blood flow to lungs > increased flow to LA
3. Increased LA flow and decreased RA flow closes foramen ovale.
4. 24-48 hours after birth due to reduced placental prostaglandins

Question 13

1. What is duct dependent circulation?
2. Give an example of a condition causing duct dependent circulation
3. what is persistent pulmonary hypertension?
4. What is a consequence of persistent pulmonary hypertension

Answer 13

1. circulation that is dependent on the foetal ducts. When these close, the baby will die
2. transposition of the great arteries - switching of the aorta and pulmonary artery
3. pulmonary arterioles stat constricted as lungs are stiff (therefore poorly ventilated)
   High pulmonary resistance means it is easier for blood to go through ductus arteriosus. Foetal circulation persists.

Question 14

1. When does foetal Hb change to adult Hb?
2. why do babies loose heat easily? (2)
3. from which gestational weeks does the foetus develop:
   a) subcutaneous stores of glucose?
   b) liver glycogen?
4. What do newborns switch to as an energy source following birth and why?

Answer 14

1. 10 weeks
2. large SA:vol ratio; skeletal muscle unable to shiver

3a) 28-30 weeks
3b) 36 weeks
4. switch to using ketones as main energy source, as glucose falls rapidly and glycogen stores are used up rapidly

Question 15

name 7 factors that influence the weight of a newborn

Answer 15

1. gestational age
2. foetal gender (girls are usually smaller than boys)
3. parity - nulparity is associated with smaller babies
4. maternal weight
5. maternal/paternal height
6. ethnic group
7. altitude

Question 16

what is the difference between size and growth?

Answer 16

babies of small size are referred to as small for gestational age but likely to be healthy.
can be estimated on one measurement

intrauterine growth restriction refers to a baby who has not reached its growth potential. Must be diagnosed on two measurements spaced by at least 2 weeks

Question 17

when is a baby classed as:

1. preterm
2. term
3. post-term

Answer 17

1. before 37 weeks
2. between 37 and 42 weeks
3. after 42 weeks

Question 18

1. define hyperplasia

2. define hypertrophy

Answer 18

1. increase in cell number

2. increase in cell size

Question 19

describe the sequence of foetal growth

Answer 19

1. cellular hyperplasia - 0-14 weeks
2. continued hyperplasia, and hypertrophy - 15-32 weeks
3. cellular hypeetrophy - 32 weeks onwards

Question 20

what is the commonly adopted definition of IUGR?

Answer 20

estimated foetal weight or abdominal circumference <10th centile

Question 21

1. what is symmetrical IUGR?
2. what does it indicate?
3. What is asymmetrical IUGR?
4. What does it indicate?

Answer 21

1. decrease in abdominal and head circumference
2. that the foetus has developed slowly throughout the duration of pregnancy
3. decreased abdo circumference more than head size
4. the foetus has grown normally for the first two trimesters, but encounters difficulties in the third

Question 22

1. name maternal factors causing IUGR
2. name foetal factors causing IUGR
3. name placental factors causing IUGR
4. name uterine factors causing IUGR

Answer 22

1. smoking, alcohol, anaemia, medical condition (CV, renal, hypertension)
2. structural abnormalities, chromosomal abnormalities, in utero infection
3. abruptio placenta, placenta praevia, thrombosis/infarction, cord abnormalities
4. decreased uterine blood flow, pre-eclampsia, atherosclerosis of uterine spiral arteries

Question 23

1. Name biochemical tests for IUGR
2. what 4 things can be measured using ultrasound to test for IUGR
3. what is a doppler analysis used for?

Answer 23

1. HPL, oestriol, foetal protein, HCG. All indicators of placental function
2. abdo circumference, head circumference, femur length, liquor volume
3. analysis of umbilical artery blood flow

Question 24

1. When is caesarian indicated for IUGR?

2. when is induction for vaginal delivery indicated for IUGR?

Answer 24

1. if doppler is poor - blood flow through placenta decreases more during uterine contractions and we want to avoid this
2. doppler normal