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 Published: 29/11/2011

Review Questions on the Abnormal Newborn

This is intended as a selection of the kind of question you should be able to answer at the end of your clinical attachment, and particularly as a basis for discussion in your case presentation seminars.

1

Define the following terms:

  1. Low birth weight
  2. Preterm, term, post-term
  3. Small/large for gestational age
2

On centile charts for newborn weight, length and head circumference, what typical pattern of measurements might be expected in each of the following:

  1. normal term infant
  2. fetal malnutrition syndrome
  3. infant of a diabetic mother
  4. hydrocephalus
  5. microcephalus
  6. mistaken dates
3

While on holiday in a remote district where there is no doctor of nurse at hand, you are called to a mother who delivers unexpectedly. The full-term baby is pale and does not breathe, although the heart is beating slowly.

  1. How would you manage the baby?
  2. The baby could be described variously as in a state of
    1. neonatal apnoea
    2. asphyxia
    3. depression at birth
      These terms are not synonymous. Distinguish between them.
  3. Outline the more important possible causes of baby's state.
  4. What are possible effects, short-term and long-term, of severe birth asphyxia?
4 As a general practitioner in a local maternity hospital, you have just delivered a baby who shows signs of respiratory distress.
How would you assess and manage the baby?
5 What is a "neutral thermal environment" and why is it important to nurse an ill newborn infant in such an environment?
6 You are a house surgeon on an obstetric run in a base obstetric hospital in one of the five main centres. A nurse reports to you that a term baby under your care, 12 hours after birth look cyanosed.
How would you assess and manage the baby?
7

Regarding jaundice in the newborn:

  1. How is it defined?
  2. At about what plasma bilirubin concentration is jaundice usually just visible?
  3. How is jaundice best detected clinically in the newborn?
  4. What are the possible hazards of severe jaundice?
  5. What are the more important causes?
  6. When should jaundice be further investigated (beyond total serum bilirubin concentration?
  7. What investigations should be done?
  8. What forms of treatment are commonly used for neonatal jaundice and what are the indications for each?
8

Regarding preterm delivery:

  1. What are the main causes (or associations)?
  2. What are the principles hazards to the baby?
  3. What are the principles of management of the pre-term infant?
  4. What is the long-term outlook of these infants, as a group?
9

Regarding small size for gestational age:

  1. What are the main types and causes?
  2. What special hazards to the fetus and newborn are associated?
  3. Outline the principles of the clinical assessment of gestational age of a newborn baby.
10

Regarding neonatal hypoglycaemia

  1. How is it defined?
  2. What groups of babies have an especial risk of developing this disorder?
  3. What are the signs?
  4. How may it be detected?
  5. What is the treatment?
11 What are possible cause of convulsions in the newborn, what investigations should be carried out, and what are the principles of treatment?
12 What are the more important infections that may be acquired during fetal life, what are the commoner signs of each, and what investigations might be carried out in a baby with suspected congenital infection?
13

Regarding infection acquired perinatally or in the newborn period

  1. What are the commoner sites?
  2. Which are the more common causative organisms?
  3. What are possible signs?
  4. What investigations may be carried out as part of an "infection screen"?
  5. What are currently accepted principles of treatment?
14 What is the significance of bile-stained vomiting in the newborn, what are the possible causes, and what investigations may be needed to make a diagnosis
15 What are the (a) signs, and (b) emergency treatment, of congestive heart failure in the newborn?
16 A baby just born has the clinical features of Down's Syndrome.
Discuss the management of the baby and parents in the newborn period.
17 A baby girl delivers at 32 weeks weighing 1800g. She has moderately severe, but otherwise uncomplicated, respiratory distress syndrome, and requires ventilation from the first day. The parents are naturally apprehensive.
Outline your approach to them.
18 A baby boy of 3550g was born at term at home. Pregnancy, labour and delivery had been normal except that membranes had been ruptured for 35 hours before delivery. Two hours after birth he was noted to have respiratory distress requiring oxygen to maintain a reasonable colour, and was admitted to a base hospital with a provisional diagnosis of pneumonia
The parents are advocates of natural childbirth and initially refused permission for a chest x-ray or any invasive investigations or treatment. How would you manage such a situation?
19 Obstetric and newborn services in many countries are organised at three levels of care, commonly designated levels I, II, and III.
What is the purpose of this differentiation, what services (in outline) do each of the 3 levels provide, and what should be the relationship between them
20 Outline principles of nutrition of the newborn infant.
21 A baby was born normally at term and had an apparently uncomplicated course in the maternity hospital. The mother returns with him to you for the routine 6-week check.
Outline your approach to the baby.
What do you regard as the most important parts of the physical examination at this age?