1) Regarding ultrasound scans of the neonatal head: A Periventricular haemorrhages occur in 25% of very low birth weight infants. B Bleeds into the germinal matrix are unlikely to be associated with long term sequelae. C Most haemorrhages occur in the first 72 hours of life. D Grade 4 haemorrhages are unlikely to be symptomatic. E Ischaemic lesions are easily detected in the paraventricular area. (True) (True) (True) (False) (False)

Comments: Bleeds occur in about 25% of very low birth weight infants and are relatively easy to see. Ischaemic lesions are much more difficult to detect, but may be marked by a flare in the periventricular area. Lesions are graded I-IV. 1. Grade I means a bleed into the germinal matrix. 2. Grade II is unilateral blood in the lateral ventricle. 3. Grade III means the changes are bilateral and associated with dilatation of the lateral ventricles. 4. Grade IV means that there are intracerebral abnormalities associated. Grade IV lesions are the most serious, and are associated with significant risk of neurodevelopmental problems. The worst outcomes are associated with bilateral periventricular leucomalacia. Dilatation of the ventricles is readily detected on ultrasound scan, and the commonest cause is intraventricular bleed. This may spontaneously regress, arrest or progress causing significant hydrocephalus with tense fontanelle, suture separation and enlarging head circumference. Fits or other neurological symptoms may occur at this stage, which is usually treated with a VP shunt. 2) Which of the following is/are true of Hirschsprung's disease? A Often presents with neonatal large bowel obstruction. B Is due to absence of ganglion cells in Auberbach's plexus. C A contrast-study will show dilatation of the aganglionic segment. D Increased acetylcholinesterase activity is a histological feature. E Early treatment may involve rectal irrigation or an emergency colostomy. (True) (True) (False) (True) (True)



Comments: Hirschsprung's disease is a common cause of neonatal large bowel obstruction. It results from failure of migration of ganglion cells to the affected segment of bowel. This always involves the distal colon but the proximal extent of the involvement is variable and in rare cases may involve the whole of the large bowel. Histologically, the affected segment has absent ganglion cells in the Meissner's and Auerbach's plexus but immunohistochemical evidence of increased ACE activity. 80% of cases present in the neonatal period. Contrast studies show the affected segment to be tonically contracted. Rectal irrigation or an emergency colostomy may be required before a definitive 'pull-through' procedure. 3) The following may present as haemolytic disease of the newborn: A Hereditary spherocytosis B Glucose 6 phosphate dehydrogenase deficiency C Sickle cell trait D ABO incompatibility E Vitamin K1 deficiency Comments:
• • • • •

(True) (True) (False) (True) (False)

Immune: (Rh, ABO, other) Membrane defects: Spherocytosis, elliptocytosis Enzyme defects: G6PD, PK, hexokinase Sepsis Polycythaemia: IDM, fetal transfusion.

Sickle cell and thalassaemia do not present in the neonatal period (HbF present).

4) The following features are characteristic of William's Syndrome:

A Supravalvular aortic stenosis B Short stature C Transient neonatal hypocalcaemia D Normal facies E Mild to moderate learning difficulties

(True) (True) (False) (False) (True)



Comments: Recognized clinical features of William's Syndrome include: 1. Short stature 2. Characteristic facies "elfin" (full face with high rounded cheeks, broad forehead, flattened bridge of the nose and long upper lip), 3. Idiopathic hypercalcaemia 4. Supravalvular aortic stenosis 5. Mild to moderate learning difficulties.

5) Concerning blood flow in the fetus: A Blood flows from right to left through the foramen ovale. B Blood in the ascending aorta has a higher oxygen content than in the descending aorta. C The ductus arteriosus is closed. D Pulmonary pressure equals systemic pressure. E The haemoglobin may be 20g/dl. (True) (True) (False) (False) (True)

Comments: Persistence of the fetal circulatory pattern of right-to-left shunting through the patent ductus arteriosus and foramen ovale after birth is due to an excessively high pulmonary vascular resistance. Fetal pulmonary vascular resistance is usually elevated relative to fetal systemic or postnatal pulmonary pressure. This fetal state permits shunting of oxygenated umbilical venous blood to the left atrium (and brain) through the foramen ovale and bypasses the lungs through the ductus arteriosus to the descending aorta. After birth, pulmonary vascular resistance normally declines rapidly as a consequence of vasodilatation due to gas filling the lungs, a rise in postnatal PaO2, a reduction in PCO2, increased pH, and release of vasoactive substances. Normal haemoglobin range in the first 1-3 days of life is between 14.5-22.5 g/dl.

6) The following are normal in the newborn infant: A A systolic blood pressure of 70mm in mercury. B Penile erections. C A Persistently palpable bladder. (True) (True) (False)



ACTH. 7) The following are associated with neonatal hypoglycaemia: A Septicaemia B Respiratory distress syndrome C Rhesus incompatibility D Maternal beta blockers E Intravenous hydrocortisone (True) (True) (True) (True) (False) Comments: • Neonatal Transient: Inadequate substrate (SGA. nesidioblastosis) Hormone deficiency (panhypopit. (False) (True) Comments: Murmurs if innocent would be systolic and of short duration. Persistently palpable bladder indicates the presence of urethral obstruction. permaturity) Hyperinsulinism (IDM. erythroblastosis fetalis) Septicaemia • Neonatal Persistent: Hyperinsulinism (Beckwith. long medium and short. E Increased incidence of congenital abnormalities.chain fatty acid oxidation defects. cortisol. GH. MSUD) Glycogen storage diseases Disorders of gluconeogenesis (alcohol. (False) (False) (True) (True) (True) Neonatology 4 .D A soft diastolic heart murmur. hyperglycaemia) • Other: GIPUT • Disorders of fat (alternative fuel): 1st and 2nd carnitine deficiency. 8) The major problems associated with multiple births include: A Impossibility of breast feeding B Increased incidence of APH C Increased incidence of preterm labour D Increased incidence of growth retardation. E An inherent prepuce. aspirin. adrenaline) Substrate limited (ketotic hypoglycaemia.

with triplets approximately 1:10. putting strain on intensive care cot facilities. B Cuboidal cells are capable of gas transfer in utero. Fertility treatment has vastly increased this rate. before that time.000.000. 9) Concerning fetal lung development: A Type II pneumocytes are present at 24 weeks gestation. pneumothorax. preterm labour (-2 weeks from term for each extra child) with all the extra morbidity and mortality that goes with it. (True) (False) (True) (True) (False) Comments: Lung development proceeds with the budding of bronchi. appear to be necessary for the development of the acinus. D The large airways are formed at 16 weeks gestation. Alveoli continue to develop up to the age of 8 or so: this is why patients with chronic lung disease tend to survive if they get through the first two winters. Alveolarisation is also influenced by physical stimuli. E The adult complement of alveoli are present at birth. and quadruplets 1:500. Neonatology 5 . and successively smaller divisions. and an increased incidence of congenital abnormalities. primitive alveoli have formed and surfactant production has begun (type II pneumocytes). the absence of alveoli renders the lung useless as an organ of gas exchange. growth retardation and twin/twin blood transfusions. for instance. and necrotizing enterocolitis. such as intraventricular haemorrhage. development. Prenatal glucocorticoids may act synergistically with postnatal exogenous surfactant therapy. complicated deliveries including malpresentation. C There is virtually no smooth muscle in the terminal and respiratory bronchioles at 6 months of age. for example) results in pulmonary hypoplasia with reduced numbers of alveoli. lung mechanics or growth. Both the stretch by the liquid contained in the fetal lung and the periodic distension provided by the action of the respiratory muscles during fetal breathing. bronchioles. By 20-24 wk. or the incidence of infection. The major problems associated with multiple births are: Preeclampsia.Comments: Twins occur from natural causes about 1% of the time. particularly a problems with monochorionic twins. without affecting neonatal growth. Prenatal glucocorticoid therapy decreases the severity of RDS and reduces the incidence of other complications of prematurity. Their absence when the lungs or chest are compressed (as in the case of a diaphragmatic hernia or oligohydramnios) or when fetal breathing is abolished (by spinal cord lesions. patent ductus arteriosus.

genital herpes. B Anaemia. renal transplant • Immune: Rh/ ABO. obesity • Other: pre-eclampsia. Diabetes. (False) (False) (False) (True) (False) Neonatology 6 . Graves.10) The following maternal conditions can cause disease in the fetus/newborn: A Hyperparathyroidism B Immune thrombocytopaenic purpura C Myasthenia gravis D Diabetes mellitus E Thyrotoxicosis (True) (True) (True) (True) (True) Comments: • Organ failure: Cholestasis. C Hyponatraemia. isoimmune neutropaenia or thrombocytopaenia • Hormonal: endemic goitre. cyanotic heart disease. sickle. E Hypomagnesaemia. Drug addiction. melanoma. PKU. 11) The fetus with intrauterine growth retardation is at risk from: A Developing diabetes in the neonatal period. hyperparathyroidism. D Necrotizing enterocolitis. myesthenia gravis. ITP.

The latter infants tend to remain small permanently. and ready to eat poultry unless it has been thoroughly reheated. and birth asphyxia. due to fetal response to hypoxia). D Toxoplasma infection can be acquired from cattle. though they are not terrible sensitive or specific. chronic medical condition or malnutrition. (True) (False) (True) (False) (False) C Peri-conceptual folic acid supplements reduce the risk of neural tube defects. Low dose folic acid supplementation is recommended for all women planning a pregnancy with a higher does for women with a previously affected fetus or on anti-epileptic medication. • Hypocalcaemia. • Hypothermia (relatively large surface area). congenital infection. Listeria infection can be acquired from eating unpasteurised dairy products such as soft ripened cheeses. with an increased risk of diabetes in adulthood. B Eating kidneys can lead to vitamin A toxicity in the fetus. • Polycythaemia (venous amount >0. Eating liver during pregnancy is best avoided because of potential vitamin A toxicity. E An amniocentesis is mandatory when the mother is over 32 years old. Antenatal CTG and Doppler ultrasound of the uterine artery are attempts to measure the well-being of these fetuses. • Hypoglycaemia (poor fat and glycogen stores). with relative preservation of head circumference. Symmetrical growth retardation suggests prolonged poor intrauterine growth. pates. 12) Regarding ingested substances during pregnancy: A Eating unpasteurised dairy products increases the risk of listeria infection. drug or alcohol abuse. Most commonly growth retardation is asymmetrical.65. and this is usually due to placental insufficiency. Comments: Exposure to toxoplasmosis should be minimised by not handling cat litter or eating undercooked poultry. while the former often show good catch-up growth. or maternal smoking. and there is an increased risk of fetal chromosomal disorder or syndrome.Comments: Particular risks are: • Intrauterine hypoxia and death. Neonatology 7 .

Frontal plagiocephaly A coronal/sphenofrontal suture. Neonatology 8 . Apert. and Pfeiffer Syndromes. Single suture involvement rarely is associated with neurological problems. (False) (True) (False) (True) (False) Comments: Craniosynostosis is defined as premature closure of the sutures. The skull bones develop from mesenchyme. Chotzen. Trigonocephaly Ametopic suture. with genetic syndromes accounting for 10%. B The skull vault develops from mesenchyme. confirmed by skull x-rays. and a prominent bony ridge from the affected suture (S) may be found. The majority are idiopathic. Specific forms include: • • • • • Scaphocephaly A sagittal suture. D Occipital plagiocephaly is usually due to infant positioning. and craniosynostosis may be due to abnormal skull base development disrupting suture development. Osteoblasts and osteoclasts are not thought to be abnormal. C Scaphocephaly develops from premature fusion of the coronal suture. Most cases are evident from birth. Carpenter. Turricephaly A coronal/sphenofrontal sutures. Surgery is only needed for cosmetic appearance. Genetic disorders involving multiple sutures include: Crouzon.13) Regarding the development of the skull sutures: A Craniosynostosis is due to dysfunctioning osteoblasts. Occipital plagiocephaly A infant positioning. and may be primary or secondary to failure of brain growth. E Scaphocephaly develops from premature fusion of the lamdoid suture.

Multi-organ failure may be present. D Alternating hypotonia and hypertonia suggests severe hypoxic ischaemic encephalopathy. hyperventilation. E NMR imaging is mandatory in all children with possible birth asphyxia. B There may be prolapse of a ring of vaginal mucosa in a female infant. no response to pain. with 20% suffering neurodevelopmental disabilities including CP. D Swollen eyelids suggest gonococcal infection. CTG and fetal blood sampling are both poor predictors of long term outcome. 15) With regard to the normal examination of the newborn: A Cysts can occur normally on the gums (epulis). C Low apgar scores at 5 minutes are a good predictor of long term neurological outcome. Severe HIE has a 12% mortality. poor feeding.14) Regarding birth asphyxia in the newborn: A The fetal cardiotachograph is a sensitive and specific assessment (False) of potential asphyxia. but a low apgar at 10-20 minutes is a much better predictor of poor outcome. and it is an important cause of brain damage. Severe . E An umbilical hernia often requires surgical repair in the first few (True) (True) (True) (False) (False) Neonatology 9 . The incidence of these problems is increased if cystic lesions or ventricular dilatation from cerebral atrophy are seen on scans. Moderate . seizures are prolonged and resistant to treatment. A low apgar score in the first 5 minutes is also a poor predictor. (False) (False) (True) (False) Comments: The incidence of birth asphyxia is around 5 per 1000 live births. C Petechiae may be found over the head and neck following a traumatic delivery. spontaneous movements. HIE is graded as: • • • Mild . B Fetal blood sampling is a good predictor of long term neonatal outcome. Mild HIE usually recovers completely.irritability.lethargy reduced spontaneous movements.

E Dilated cardiomyopathy is a potential complication. Indications include chromosomal analysis. and to obtain samples for PCR diagnosis of congenital infection. Breast enlargement may also occur in either sex and a small amount of milk may be discharged. but does have the advantage of being possible in the first trimester before fetal movements have started. with low-set ears Neonatology 10 . C The neck is webbed with a trident hairline. and this may be accompanied by a prolapse of a ring of vaginal mucosa. A white vaginal discharge or small withdrawal bleed occurs in female infants as transferred maternal oestrogen levels fall. D Pectus excavatum is a recognized feature. 17) The following are recognized features of Noonan's Syndrome: A The palprebal fissures are mongoloid in slant. 16) Indications for chorionic villus sampling include: A Suspected Rhesus Disease B Chromosomal analysis C Enzyme analysis for inborn error of metabolism D DNA analysis for Duchenne muscular dystrophy E Suspected congenital infection (False) (True) (True) (True) (True) Comments: Chorionic villus sampling has slightly greater rate of fetal wastage than amniocentesis. Traumatic cyanosis is common. Umbilical hernias are common particularly in Afro-Caribbean infants and no treatment is usually required with it resolving by the first 3 years of life. B It is occasionally associated with mild learning difficulties. as are ventouse marks and forceps marks. (False) (True) (True) (True) (False) Comments: Clinical features of Noonan's Syndrome include: Characteristic facies with Anti-mongoloid slant of the eyes which are relatively wide-spaced. Comments: Cysts of the gums (epulis) or the floor of the mouth (ranular) are normal. Swollen eyelids and distortion of the shape of the head from delivery are common. enzyme analysis.years of life. DNA analysis. and may take the form of petechial bleeding into the skin of the head and neck area and subconjunctival haemorrhages.

can treat heart failure of the surviving twin. 18) In monochorionic twins with uncompensated placental arteriovenous shunts: A The donor twin may have olighydramnios. E The surviving twin is at risk of disseminated intravascular coagulation. The latter becomes plethoric and large while the former is anaemic and small. B The donor twin may have microcardia. Congenital heart disease is common. C The recipient twin may have large glomeruli. The vascular anastomoses in monochorionic placentas may be artery-to-artery. In such cases the twin attached to the secondary cord is usually malnourished or dies in utero. Vein-to-vein communications are similarly recognised and are less common. (True) (True) (True) (True) (True) Comments: Placental vascular anastomoses occur with high frequency only in monochorionic twins. Artery-to-artery communications cross over placental veins. Neodymium: YAG laser ablation of the anastomoses. They are usually well enough balanced so that neither twin suffers. Many children experience great difficulty with feeding in the first year of life. or artery-to-vein. blood can readily be stroked from one fetal vascular bed to the other. there is a 5 g/dl haemoglobin and 20% body weight difference in this syndrome. D By definition the twins vary in Hb by > 5g/dl. one umbilical cord may arise from the other after leaving the placenta. The stature is short and there may occasionally be mild learning difficulties. This rare lethal anomaly (1:35. Anticipating this possibility by preparing to transfuse the donor twin or to bleed the recipient twin may be lifesaving. By definition. The chest is commonly deformed with pectus excavatum or asymmetry and a short sternum. an artery from one twin delivers blood that is drained into the vein of the other. the fetal vasculature is usually joined. particularly dysplastic pulmonary valve and ASD in addition to a hypertrophic cardiomyopathy. In monochorionic placentas. possibly as the result of transfusion of thromboplastin-rich blood from the Neonatology 11 . Twins of widely discrepant size are usually monochorionic. sometimes in a very complex manner. vein-to-vein. and when anastomoses are present. Maternal hydramnios in a twin pregnancy suggests the fetal transfusion syndrome. short webbed neck with trident hairline. A combination of artery-to-artery and vein-to-vein anastomoses is associated with acardiac fetus. In rare cases.and Turners-like.000) is secondary to the TRAP sequence-Twin Reversed Arterial Profusion. in utero. Death of the donor twin in utero may result in generalised fibrin thrombin in the smaller arterioles of the recipient twin. In the fetal transfusion syndrome.

D An abortion is a premature expulsion from the uterus of the products of conception before 26 completed week’s gestation. Miscarriage is the loss of the products of conception before the fetus is viable. cardiac failure. polycythaemic. B The perinatal mortality rate is the total of still births plus deaths within the first month per 1000 live and still births. hypervolaemic. 19) The following definitions are true: A Still birth rate is the rate of fetal deaths after 28 completed weeks of pregnancy per 1000 total pregnancies. Treatment of this highly lethal problem includes maternal digoxin. well-nourished Plethoric. Donor twin (arterial side): Oligohydramnios Small premature.macerating donor fetus. Perinatal mortality rate is the still births plus deaths within the first 6 days per 1000 live and still births. hypoglycaemic Pale. and an Abortion is the premature expulsion from the uterus of the products of conception either embryo or non-viable fetus. 20) The following diagnoses can be reliably made on antenatal ultrasound performed before 20 weeks: A Spina bifida occulta B Gastroschisis (False) (True) Neonatology 12 . (False) (False) (True) (False) (False) Comments: Still birth is defined as a fetal death after 24 completed weeks of pregnancy. anaemic. C The neonatal mortality rate is the deaths of live born infants less than 28 days of age per 1000 live births. Neonatal mortality rate is the deaths of live born infants less than 28 days of age per 1000 live births. Large glomeruli. or Nd:YAG laser ablation of the anastomosis. E A miscarriage is the loss of the products of conception from the uterus before 16 completed weeks. malnourished. Thick-walled arterioles. selective twin termination. The surviving twin may develop disseminated intravascular coagulation. hypovolaemic Small glomeruli Thin-walled arterioles Recipient twin (venous side): Polyhydramnios Large preterm.

Oligohydraminos and polyhydraminos can also be diagnosed. The phenotype may be manifest as a congenital malformation or in adult life. talipes. Neonatology 13 . but after this the margin for error increases. Mutual fold thickness is being investigated as a possible means of making a diagnosis of Down's Syndrome. cleft lip and palate. Up to 70% of major structural abnormalities can be identified. The disease may also be more severe in relatives. VSD can be very difficult to detect. and more detailed scans and specialist centres arranged. Multiple pregnancies can be identified. and these parameters show a normal distribution in the population. • Congenital malformations: Neural tube defects. Fetal growth can now be reliable measured from serial abdominal circumference by parietal diameter and femur length. congenital heart disease. a sex difference in prevalence results in an increased risk to relatives. They are thought to result from the additive effect of several genes with or without the influence of environmental or other unknown factors. 21) The following are examples of multifactorial inheritance manifest in the neonatal period: A Anencephaly B Pyloric stenosis C Myotonic dystrophy D Ankylosing spondylitis E Leber's optic neuropathy (True) (True) (False) (False) (False) Comments: Polygenical multifactorial inheritance refers to a spectrum of disorders which are neither purely environmental in origin nor purely hereditary. Height and IQ are inherited in this way. In addition. Relatives of an affected person show an increased liability to the disorder so that a greater proportion of them than in the general population will fall beyond the threshold and will manifest the disorder. pyloric stenosis. CDH.C Ventricular septal defect D Gestational age E Down's Syndrome (False) (True) (False) Comments: Gestational age can be reliably estimated if performed before 20 weeks. but this is not generally available or accepted. Although specialist centres can reliably diagnose major cardiac malformations. particularly where there is a close relationship to the affected person and there are multiple affected family members.

This is usually only grade 1 or 2 (reversible) rather than grade 3 or 4 (requiring treatment). E It may progress extremely rapidly. D It is first detected at the equivalent of 32-38 weeks gestational age. fibrosis and blindness. Severe visual impairment occurs in only 1% of low birth weight infants. It was previously the commonest cause of blindness in children. It is first detected between 32 and 38 weeks of age. asthma. but may progress rapidly. B It occurs in 50% of very low birth weight infants. HLA associated diseases. Vascular proliferation may progress to retinal detachment. the infant with retarded Neonatology 14 . but careful monitoring has reduced its incidence to only 30% of very low birth weight infants (more in extremely preterm infants). Leber's hereditary optic neuropathy is a mitrochondrial abnormality. Follow-up only needs to take place until the retina is fully vascularised. Adult life: Atherosclerosis and coronary heart disease.• hypospadias. C Cryosurgery or laser therapy may be indicated for grade 3 or 4 disease. (False) (False) (True) (True) (True) Comments: Retinopathy of prematurity (ROP. epilepsy. retinalentral fibroplasia) affects vessels at the junction of the vascular and non-vascularised retina. 22) Regarding retinopathy of prematurity: A All babies who have received oxygen should have their eyes examined until a corrected age of 44 weeks gestation. diabetes mellitus. 23) The following are useful in assessing the gestational age of an infant: A Posture B Elbow angle C Square window test D Nipple formation E Palmar creases (True) (False) (True) (True) (False) Comments: Compared with the premature infant of appropriate weight. hypertension.

popliteal angle. nerve conduction velocity) correlates with gestational age despite reduced fetal weight. Dubowitz scoring consists of: • NEUROLOGICAL: Posture. colour. In general. ear formation and firmness. and fetal ultrasonic evaluation. and opacity. neurologic maturity (e. but the reduction in birth weight is related to the number of cigarettes smoked per day. C Maternal smoking may adversely affect testicular function in male children. lanugo. scarf sign. the babies of smokers weigh 170g less than non-smokers.intrauterine growth has a reduced birth weight and may appear to have a disproportionately larger head relative to body size. square window. arm and leg recoil. 25) following are characteristic of Cri-du-Chat Syndrome: A Hypotonia (True) Neonatology 15 . head lag. nipple. D Dysmorphic facies is a recognised complication. ankle dorsiflexion.. breast. infants in both groups lack subcutaneous fat. and genitalia formation. Physical signs may be useful in estimating gestational age at birth. the mother's estimated date of last menstrual period. The infant has a greater risk of Sudden Infant Death Syndrome. E The newborn baby may require adjustments in drug dosages because of it. 24) The following statements are true regarding smoking in pregnancy: A Smoking assists in maturation of the fetal lung. • CUTANEOUS: Oedema. Commonly used. (False) (True) (False) (False) (False) Comments: Smoking reduces birth weight which may be of critical importance if the baby is born pre-term. An infant should be presumed to be at high risk of mortality or morbidity if a discrepancy exists between the estimation of gestational age by physical examination. plantar creases. No dysmorphic syndrome has yet been described. On average. heel-to-ear. B The reduction in birth weight is related to the number of cigarettes smoked per day. skin texture. Smoking is also associated with an increased risk of miscarriage and still birth.g. the Dubowitz scoring system is accurate to ±2 wk. ventral suspension. There is some evidence that maternal smoking may adversely affect ovarian function in female children.

compared with 9% in the abstinent and 14% in the moderate group. the greater the intake. the more severe the signs.B Laryngeal abnormalities C Hypotelorism D Encephalocele E Deletion of 5pComments: (True) (False) (False) (True) Cri-du-Chat Syndrome is due to a 5p. Infants born to heavy drinkers have twice the risk of abnormality compared with those born to moderate drinkers. The main features are: • • • • • • • • • • Hypotonia Short stature Characteristic cry because of laryngeal abnormalities Microcephaly with protruding metopic suture Moon-like face Hypertelorism Bilateral epicanthic folds High-arched palate Wide and flat nasal bridge Mental retardation. A specific pattern of malformation identified as the fetal alcohol syndrome has been documented and major and minor components of the syndrome are expressed in 1-2 infants/1. The characteristics of the fetal alcohol syndrome include: Neonatology 16 . 26) Fetal alcohol syndrome is characterized by: A Fetal anomalies in 10% of severe alcohol exposure B Intra-uterine growth retardation C Altered dermatoglyphics D Atrial septal defect E Joint hyperextensibility (False) (True) (True) (True) (False) Comments: High levels of alcohol ingestion during pregnancy can be damaging to embryonic and fetal development.deletion. 32% of infants born to heavy drinkers demonstrated congenital anomalies. Both moderate and high levels of alcohol intake during early pregnancy may result in alterations in growth and morphogenesis of the fetus.000 live births.

The infants may remain hypotonic and tremulous despite sedation. intracranial haemorrhage. rarely. Cardiac defects. including short palpebral fissures.1. since no specific therapy exists. and the prognosis is poor. The detrimental effects may be due to the alcohol itself or to one of its breakdown products. 2. Neonatology 17 . primarily septal defects. hypocalcaemia. hypoglycaemia. Fetal alcohol syndrome is a common cause of mental retardation. and thin upper lip. 4. and. Delayed development and mental deficiency varying from borderline to severe. micrognathia. pyridoxine dependency. hyponatraemia. Facial abnormalities. drug withdrawal. including some restriction of movement and altered palmar crease patterns. maxillary hypoplasia. 27) Neonatal convulsions can be caused by: A Maternal hyperparathyroidism B Subdural haematoma C Birth asphyxia D Hyponatraemia E Wilson's disease (True) (True) (True) (True) (False) Comments: Convulsions usually point to a disorder of the central nervous system and suggest hypoxic-ischemic encephalopathy resulting from asphyxia. which accounts for the intrauterine growth retardation. and head circumference. Counselling with regard to recurrence is important. meningitis. epicanthal folds. weight. Prenatal onset and persistence of growth deficiency for length. both necessary for protein synthesis. or familial seizures. The management of these infants may be difficult. Minor joint and limb abnormalities. Some evidence suggests that alcohol may impair placental transfer of essential amino acids and zinc. infarction. subdural effusion. cerebral anomaly. 5. Prevention is achieved by eliminating alcohol intake after conception. hypernatraemia. The severity of dysmorphogenesis may range from severely affected infants with full manifestations of the fetal alcohol syndrome to those mildly affected with only a few manifestations. 3. inborn errors of metabolism.

and in polycythaemic neonates. in those who experienced birth asphyxia or drug withdrawal. Seizures in premature infants are often subtle and associated with abnormal eye or facial movements. leading to subsequent hyponatraemia and water intoxication in the infant. 28) Regarding hyaline membrane disease: A It is caused by deficiency of surfactant production by type 2 respiratory cells. in infants of diabetic mothers. particularly in a premature infant. (True) (True) (True) Neonatology 18 . Term infants may have focal or multifocal. acidosis or hypothermia.Seizures beginning in the delivery room or shortly thereafter may be due to unintentional injection of maternal local anaesthetic into the fetus. C It may be exacerbated by hypoxia. B The hyaline membrane seen histologically is caused by a protenacious exudate. neck. Convulsions may also result from administration of large amounts of hypotonic fluids to the mother shortly before and during delivery. Apnoea may be the first manifestation of seizure activity. Convulsions (epileptic seizures) should be distinguished from the jitteriness that may be present in normal newborns. the motor component is often that of tonic extension of the limbs. clonic or myoclonic movements but may also manifest more subtle seizure activity. and trunk. it often depends on sensory stimuli and is not associated with abnormal eye movements. as maternal calcium crosses to the fetus and suppresses the fetal parathyroid glands. Jitteriness resembling simple tremors may be stopped by holding the infant's extremity. Maternal hyperparathyroidism can result in neonatal hypocalcaemia.

Neonatology 19 . Pleural effusions have been successfully drained. The hyaline membrane on histology is formed by a protenacious exudate. (False) (True) Comments: Surfactant is a mixture of lipoproteins produced by type 2 respiratory cells. not an option. E Steroids given antenatally to the mother stimulate surfactant production. Attempts to repair diaphragmatic hernia have resulted in preterm delivery. and it is also commoner in the infant of a diabetic mother. therefore. and the treatment of stenotic heart valves have only been successful in case reports. Currently. but shunting of urinary obstructions has been disappointing. though the condition can still occur rarely in the term infant. acidosis or hypothermia increase the likelihood of it. Antenatal steroids and exogenous surfactant therapy have been major advances in its management. It is excreted by the alveolar epithelium. with no definite benefit on lung development.D It occurs in 45% of children born before 28 weeks of completed gestation. with the majority of those below 28 weeks gestation being affected. routine surgery is. Treatment of hydrocephalus has largely been abandoned because the survivors are severely disabled. 29) The following conditions can be successfully treated by surgery on the fetus: A Diaphragmatic hernia B Hydrocephalus C Hydronephrosis D Pleural effusion E Hypoplastic left heart syndrome (False) (False) (False) (True) (False) Comments: Fetal surgery is being attempted in specialised centres. but the results have been generally disappointing. and results in a lowering of surface tension so that alveoli can remain patent. The more preterm the infant the higher the incidence of RDS. Hypoxia.

Patau's Syndrome: Structural defects of the brain. but this is often not possible. (True) (True) (False) (False) (False) Comments: Glucocorticoid therapy given before pre-term delivery accelerates lung maturation and surfactant production reducing the incidence in severity of RDS and IVH. rocker-bottom feet. and Rhesus immunisation is best treated with fetal blood transfusions into the umbilical vein. For optimal effect it needs to be given at least 48 hours before delivery. 31) The following conditions can be treated by giving medication to the mother: A Fetal supraventricular tachycardia. This may be required regularly from about 20 weeks of gestation.30) The following suggest Patau's Syndrome rather than Edward's Syndrome: A Overlapping digits B Holoprose encephaly C Midline cleft palate D Rocker-bottom feet E Low-set ears (False) (True) (True) (False) (False) Comments: Edward's Syndrome: Small chin. Neonatology 20 . microphthalmia and other eye defects. E Frusemide to treat fetal hydrops. cardiac and renal malformations. B Accelerating surfactant production using antenatal steroids. Complete heart block is unresponsive to therapy. polydactyly.scalp lesions. low-set ears. Digoxin or flucanide can be given to the mother to treat fetal supraventricular tachycardia. cardiac and renal malformations. overlapping digits. D Atropine to treat fetal congenital heart block. C Reducing the risk of kernicterous in Rhesus Disease by giving mother Phenobarbitone. Midline cleft palate .

D A extremely low birth weight infant weighs less than 750g.32) The following definitions are correct: A A preterm infant is one born before 37 completed weeks of gestation. A preterm infant is born before 37 completed weeks of gestation.delayed initiation of respiration (False) (True) (True) (True) (True) Comments: Opiates of anaesthetic agents may suppress respiration at birth and result in a delay in establishing normal breathing. a very low birth weight infant less than 1500g. E Small for gestational age means that the birth weight is less than the 10th centile for gestational age. (True) (True) (False) (False) (True) Comments: A neonate is an infant less than or equal to 28 days of age. Epidural anaesthesia can cause maternal pyrexia which Neonatology 21 .hypotension C Oxytocin . A low birth weight infant is less than 2500g. 33) The following drugs given in labour can cause the adverse affects indicated in the fetus: A Opiates .constipation B Diazepam .fetal hypoxia D IV fluids . Small for gestational age means that the birth weight is less than the 10th centile for gestational age. while large for gestational age means the birth weight is above the 90th centile for gestational age. and a post-term infant greater than or equal to 42 completed weeks. B A low birth weight infant weighs less than 2500g.neonatal hyponatraemia E Opiates . and an extremely low birth weight infant less than 1000g. C A very low birth weight infant weighs less than 1000g.

RC enzyme or membrane defect) Sepsis. B A grade 3/6 murmur is likely to be pathological. septicaemia). It may also delay feeding in the infant. rubella o Metabolic: galactosaemia. Excessive IV fluids may cause neonatal hyponatraemia unless they contain an adequate concentration of sodium. (False) (True) Neonatology 22 . neonatal hepatitis difficult to distinguish from infection. CONJUGATED: o Infection: bacterial (UTI. 34) Prolonged jaundice in a neonate can be caused by: A Hypothyroidism B Galactosaemia C Von Gierke's disease D Gaucher's disease E Maple syrup urine disease Comments: Prolonged jaundice may be: • (True) (True) (False) (False) (False) • UNCONJUGATED: Hypothyroidism. fructosaemia. CMV. Crigler-Najjar Prolonged haemolysis (immune-mediated. hepatitis. CF. choledochal cyst. toxoplasma. alpha0-AT o Obstructive: biliary atresia. 35) Regarding the neonatal cardiac examination: A A chest x-ray and ECG are routinely indicated. and is also associated with neonatal jaundice. Sedatives such as Diazepam may cause sedation and hypotension in the newborn. Oxytocin may hyperstimulate the uterus causing fetal hypoxia.

No particular race or sex is unduly susceptible to the disease. as neonates can deteriorate rapidly if they have significant heart disease. Cyanosis may occur in the neonatal period when crying due to shunting through a patent foramen ovale. 36) Necrosing enterocolitis is associated with: A Intrauterine growth retardation B Cow's milk formula feeding C Birth asphyxia D Prematurity E Oxygen therapy (True) (True) (True) (True) (False) Comments: This serious disease of the newborn is of unknown aetiology and is characterised by varying degrees of mucosal or transmural necrosis of the intestine. Since the very small.C Cyanosis on crying is normal. Only occasionally are these caused by congenital heart disease. and death. a rising incidence in recent years may reflect improved survival of this high-risk group of patients. E A loud second heart sound may be normal. cyanosis nor abnormal pulses. Innocent murmurs are usually soft and either blowing or buzzing in character. The disease does rarely occur in term infants. the gas accumulation in the submucosa of the bowel wall (pneumatosis. D Babies with weak femoral pulses should be re-examined a few hours later. A loud second heart sound or weak femoral pulses should always be taken as significant until proven otherwise. and progression of the necrosis leading to perforation. The heart sounds are normal and there are no accompanying thrills. Incidence ranges from 1 to 5% of admissions to neonatal intensive care units. sepsis. Neonatology 23 . (True) (False) (False) Comments: Heart murmurs are often audible in the neonatal period. but resolve shortly afterwards. intestinalis). Many factors may contribute to the development of a necrotic segment of intestine. ill preterm infant is particularly susceptible to NEC. The distal ileum and proximal colon are involved most frequently. They are usually localized to the left sternal edge with no diastolic component and no radiation.

particularly during epidemics. This refers to the Neonatology 24 . Escherichia coli. Nonetheless. The clustering of cases suggests a primary role for an infectious agent. hypertonic milk or medicines. in most situations no identifiable pathogen is recovered. but not with oxygen itself. It is associated with sick infants (who may require oxygen). Clostridium perfringens. or too rapid feeding protocols may contribute to mucosal injury and subsequent infection leading to bowel necrosis. and rotavirus have commonly been recovered from cultures.A variety of factors such as polycythaemia. Staphylococcus epidermidis. 37) The following are characteristic features of Prader-Willi Syndrome: A Uniparental disomy with deletion of the paternal chromosome 15 B Large testes C Hypotonia D Initial growth retardation E Large hands and feet Comments: (True) (False) (True) (True) (False) Prader-Willi Syndrome is a classic example of imprinting. NEC also occurs in premature infants without stress.

results in Angelman's Syndrome. Other: Cohen Syndrome. and mental retardation. a defect at a similar location on chromosome 15 of the mother. or head retraction (opisthotonus). Carpenter Syndrome.observation that phenotypic expression depends on the parent of origin for certain genes and chromosomal segments. genetic or other: 1. jaundice. poor feeding. small hands and feet. hypogonadism. Meningitis is suggested by a tense or bulging fontanelle. 38) The following are recognised clinical features of neonatal sepsis: A Hypothermia B Vomiting C Hyperglycaemia D Jitteriness E Hypocalcaemia (True) (True) (True) (True) (False) Comments: Clinical features of neonatal sepsis include Fever or temperature instability. In the case of Prader-Willi Syndrome. Interestingly. seizures. hypo or hyperglycaemia. hypothyroidism. causes may be endocrine. Prader-Willi. 2. Laurence-Moon-Biedl Syndrome. 3. hyperinsulinaemia. and growth hormone deficiency. Endocrine: Cushing's. In the differential diagnosis of childhood OBESITY. fits. irritability. apnoea and bradycardia or respiratory distress. or shock. lethargy or drowsiness. short stature. this comes from the paternal chromosome 15. obesity after initial failure to thrive. Genetic: Turner's syndrome. 39) Hydrops fetalis is caused by intrauterine infection with: A Syphilis (True) Neonatology 25 . vomiting. Prader-Willi is characterised by severe hypotonia at birth. and Pseudohypoparathyroidism type 1. Stein-Leventhal. abdominal distension.

syphilis CVS: SVT. trisomies Idiopathic. CMV. cirrhosis. Noonan Chromosomal: XO.B Listeria C Parvovirus D Group B streptococcus E Toxoplasma Comments: Causes of hydrops include: • • (False) (True) (False) (True) IMMUNE : Haematologic: Rh and ABO incompatibility NON-IMMUNE: • • • • • • • • • • • Infectious: parvovirus. 40) The following methods can be used for prenatal diagnosis: A Amniocentesis at 16-20 weeks of gestation B Chorionic villus sampling at 12-14 wks gestation C Fetal blood sampling D Foetoscopy E Ultrasonogram (True) (False) (True) (True) (True) Comments: Amniocentesis is done at 16-20 weeks gestation. Fetal blood sampling is sometimes performed. lymphangiectasia Tumour: neuroblastoma. storage diseases Malformations: Arthrogryphosis. volvulus. teratoma Hepatic: hepatitis. haemangioma. prune belly GI: atresia. for measurement of metabolites and karyotype estimation. Foetoscopy involves endoscopic examination or surgery of the foetus through Neonatology 26 . fibrosis Renal: nephrosis. toxo. AV malformation. heart block Pulmonary: diaphragmatic hernia. CVS from placental tissue has to be performed 10th -12th week. CF Metabolic: IDM.

Intellectual impairment occurs in all patients. A Trendelenburg gait. An early Gowers' sign is often evident by 3 years of age and is fully expressed by 5 or 6 years of age. but clinically follows a milder and more protracted course. B One third have an IQ less than 75. Becker muscular dystrophy is the same fundamental disease as Duchenne dystrophy. 41) Duchenne muscular dystrophy: A Occurs more commonly in children of elderly mothers. This disease is inherited as an X-linked recessive trait. foci of mononuclear inflammatory cell infiltrates as a reaction to muscle fibre necrosis. Contractures most often involve the ankles. Scoliosis is common. Ultrasonography is the most non invasive of all. E In a muscle biopsy immune labelled dystrophin will be visible. hips. affecting all races and ethnic groups. and many dense fibres. Neonatology 27 . appears at this time. mild architectural changes in still functional muscle fibres. Myopathic changes include endomysial connective tissue proliferation. scattered degenerating and regenerating myofibres. Death occurs usually at about 18 years of age. Its incidence is 1:3. although only 20-30% have an intelligence quotient (IQ) less than 70. knees.the abdominal/uterine portal of entry. A specific molecular genetic diagnosis is now possible by demonstrating deficient or defective dystrophin by immunohistochemical staining of sections of muscle biopsy tissue or by DNA analysis from peripheral blood. or hip waddle. Enlargement of the calves (pseudohypertrophy) and wasting of thigh muscles is a classic feature. and elbows. Walking is often accomplished at the normal age of about 12 months. but hip girdle weakness may be seen in subtle form as early as the 2nd year. D The diagnosis is commonly confirmed by detecting the gene mutation. Cardiomyopathy is a constant feature of this disease. (False) (True) (True) (True) (True) Comments: Duchenne muscular dystrophy is the most common hereditary neuromuscular disease. Toddlers may assume a lordotic posture when standing to compensate for gluteal weakness.600 liveborn male infants. The muscle biopsy is diagnostic and shows characteristic changes. C A translocation of an autosome to the Xp21 site explains why occasionally females are affected. The causes of death are respiratory failure in sleep. with a genetic defect at the same locus. Confirmation of the diagnosis by one of these methods should be done in every case. The abnormal gene is on the X-chromosome at the Xp21 locus and is one of the largest genes yet identified.

incidence is inversely proportional to the gestational age and birth weight. E Is more common in infants of mothers addicted to narcotics. premature rupture of the fetal membranes. Copyright © 2002 Dr Colin Melville 42) Respiratory distress syndrome: A Occurs in 30% of premature babies of 34 weeks gestation. delivery before 37 wk gestation. C The lungs have low compliance. or occasionally aspiration and airway obstruction. in about 5% beyond 37 wk. cold stress. pneumonia. in 10-30% of those between 32 and 36 wk. (True) (True) (True) (False) (False) Comments: HMD occurs primarily in premature infants. asphyxia. D Is commoner in girls. and rarely at term. narcotic addiction. caesarean section delivery. and interstitial oedema make the lungs less compliant. and a history of prior affected infants. It occurs in 60-80% of infants less than 28 wk of gestational age. Earlier lung maturation may occur when there is severe premature separation of the placenta. hyaline membrane formation. multifetal pregnancies. precipitous delivery. The incidence is highest among preterm male or white infants.intractable congestive heart failure. B Occurs more frequently in infants of diabetic mothers. An increased frequency is associated with infants of diabetic mothers. requiring greater pressure to expand the small alveoli and airways. or maternal hypertensive and renal vascular disease. Alveolar atelectasis. 42) The conditions in which Genetic Anticipation occur include: A Cystic fibrosis (False) Neonatology 28 .

Interestingly. In this case a CTG (cytosinethymine-guanine) repeat in the 3´ {prime} untranslated region of the relevant gene is greatly expanded in affected individuals. macro-orchidism. late-onset neurodegenerative diseases. The first class is characterised by large expansions of a CGG trinucleotide (cytosine-guanine-guanine). all of the known disorders exhibiting this type of expansion are dominantly inherited. If the number of repeats exceeds a certain threshold. and rearrangements of DNA sequences occurring as a normal mechanism (evolved perhaps to increase the diversity of gene expression or as divergence from and expansion of a gene family) are susceptible to mutation. Anticipation results from the successive increases in repeat expansion and is observed to a lesser degree in the other classes of disorders. The genetic defect in autosomal dominant FSH muscular dystrophy is at the 4q35 locus. a clinical phenomenon known as anticipation. and other somatic changes in affected males. Such a site is so designated because it is associated with chromosome breakage under certain in vitro growth conditions. A commonly observed characteristic of this dominantly inherited disease is an increase in disease severity in successive generations. A recently recognised type of mutation involves the expansion of tandemly repeated nucleotide triplets. in which an expanded CGG repeat in the 5' untranslated region of the FMR1 gene leads to underexpression and a clinical phenotype of mental retardation. with corresponding classes of phenotypes. This type of unstable (or dynamic) mutation can result in disease in individuals carrying the expanded repeats. The third class of disorder involving triplet repeat expansion is represented by the disorder myotonic dystrophy. leading to a fragile site in the chromosome. The prototype for this class is the fragile X syndrome (FRAXA). These Tri-nucleotide repeat arrays are found in normal individuals in certain genes and are capable of occasionally being expanded in size through an increase in trinucleotide repeat number. the repeat array becomes unstable. leading to a polyglutamine stretch in the resulting protein. and additional size increases are likely to occur in succeeding generations. the best known example being Huntington disease. and these tracts of DNA are often referred to as unstable. At present these Tri-nucleotide repeat expansions fall into three classes. Facioscapulohumeral (FSH) muscular dystrophy (Landouzy-Déjerine disease) also shows the phenomenon of anticipation. Neonatology 29 .B Huntington's chorea C Fragile X syndrome D Myotonic dystrophy E Marfan's syndrome (True) (True) (True) (False) Comments: The human genome is a dynamic apparatus. The second class of disorder involves the relatively small expansion of an in-frame CAG (cytosine-adenine-guanine) repeat in the coding region of the respective genes.

Neonatology 30 . are postnatal in origin. Because they are not truly congenital in origin. the term development dysplasia of the hip is now recommended. The hips at birth are rarely dislocated but rather "dislocatable. Maintaining the hips in the position of adduction and extension may lead to dislocation. There is also a 9:1 female predominance. thus. Postnatal factors are also important determinants. or a syndrome complex. There is also an association of congenital muscular torticollis (14 -20%) and metatarsus adductus (1 00%) with DDH. in which there is an underlying neuromuscular disorder such as myelodysplasia. The frank breech position with the hips flexed and the knees extended is the position of highest risk. having both physiologic and mechanical factors. arthrogryposis multiplex congenita. Decreased hip motion leads to a lack of normal development of the cartilaginous acetabulum. The positive family history (20%) and the generalised ligamentous laxity are related etiologic factors. and 30 -50% developed in the breech position.43) Factors contributing to the occurrence of congenital dislocation of the hip include: A Breech presentation B Male sex C Achondroplasia D Laxity of the joints E Spina bifida occulta (True) (False) (False) (True) (False) Comments: Developmental dysplasia of the hip (DDH) usually occurs in the neonatal period. and teratologic. The cause of DDH is multifactorial. Approximately 60% of children with typical DDH are first-born. An unstable femoral head. Maternal estrogens and other hormones associated with pelvic relaxation result in further. can be displaced from the acetabulum over several days or weeks. The breech position results in extreme hip flexion and limitation of hip motion. and this can predispose to hip instability." Dislocations tend to occur after delivery and. The majority of children with DDH have generalised ligamentous laxity. DDH is classified into two major groups: typical. This puts the unstable hip under pressure because of the normal hip flexion and abduction contractures. Increased hip flexion results in stretching of the already lax capsule and ligament teres. The presence of either condition requires a careful examination of the hips. although the exact time when dislocations occur is controversial. Teratologic dislocations occur in utero and are therefore truly congenital. It also produces posterior uncoverage of the femoral head. in a neurologically normal infant. although temporary. relaxation of the newborn hip joint. as a consequence.

18-Trisomy is one of the more frequent abnormalities. it is important that at every delivery the cut cord and the maternal and fetal surfaces of the placenta be inspected. Since many abnormalities are not apparent on gross physical examination. and many such infants are stillborn or die shortly after birth. 3 and 4 months of age. 1 month and 6 months of age. Comments: Premature babies should be immunised at chronological rather than corrected age. The number of arteries present should be recorded as an aid to the early suspicion and identification of abnormalities in such infants. and 4 months of age. Primary immunisations should be given as follows: A DPT at a corrected age of 2. B Congenital anomalies are found in about 1/3 of cases. B BCG at 6 weeks of age. (False) (True) (True) (True) (False) Comments: A single umbilical artery is present in about 500/1. C There is an association with trisomy 18. D Associated defects may be subtle.000 twin births. usually more than one. D MMR at 9 months of age. 3.2kg. Neonatology 31 . Approximately one third of infants with a single umbilical artery have congenital abnormalities. E Hib at 2. C Hepatitis B vaccination at birth. Hib and Polio at 2. 3 and 4 months. They should receive the normal immunisation schedule which consists of: • (False) (False) (False) (False) (True) DPT. E There is an association with Beckwith's syndrome. the frequency is about 35-70/1.44) The following are true of infants with a single umbilical artery: A The incidence is 1:100.000 births. 45) A baby girl was born at 32 weeks gestation weighing 1.

a weakly to moderately positive direct Coomb's test. Jaundice usually appears during the first 24 hr. it may become severe. The Coomb's test is not always positive. Booster DT and Polio at 13 . and usually the infants are of type A1. pallor is not present and hydrops fetalis is extremely rare. and symptoms and signs of kernicterus develop rapidly. 47) Regarding apnoea of prematurity: A The incidence of the idiopathic form varies inversely with gestational age. and spherocytes in the blood smear.• • • • MMR at 10 . along with second dose of MMR. Although ABO incompatibility occurs in 20{endash}-25% of pregnancies. Maternal antibody may be formed against B cells if the mother is type A or against A cells if the mother is type B. BCG in infancy or between 10 and 14 years of age. and the second and third doses being given at monthly intervals thereafter. For children who are on the neonatal intensive care unit. with the first dose being given on discharge from hospital. Rarely. with jaundice as the only clinical manifestation. which may at times suggest the presence of hereditary spherocytosis. C It increases in frequency during non-REM sleep. oral polio vaccine should be deferred.12 months of age. (True) (True) (False) Neonatology 32 . 46) Recognised consequences of ABO incompatibility include: A Coomb's negative haemolysis B Jaundice on the first day of life C Increased severity in further pregnancies D Normal haemoglobin on the first day of life E Spherocytes in the blood (True) (True) (True) (True) (True) Comments: Major blood group incompatibility between mother and fetus usually results in milder disease than does Rh incompatibility. A presumptive diagnosis is based on the presence of ABO incompatibility. Liver and spleen are not greatly enlarged.18 years. The infant is not generally affected at birth. Most cases are mild. which is more antigenic than A2.5 years of age. Booster DT and Polio at 3 . usually the mother is type O and the infant is type A or B. if at all. haemolytic disease develops in only 10% of such offspring. B It may be caused by neonatal sepsis. However.

Apnoea is defined as cessation of breathing for longer than 20 seconds or cessation of breathing is associated with cyanosis and bradycardia.D Bag and mask ventilation is often required. Unless severe. It is described as idiopathic when identifiable causes are absent. recurrent. since the latter may be associated with serious illness. muscle weakness). The idiopathic form varies inversely in frequency with gestational age. meningitis. 3. Apnoea of prematurity usually disappears by 36 weeks post-conceptual age. ROP etc.). or refractory to therapy. and does not predict future episodes of SIDS. (False) (True) Comments: Periodic breathing must be distinguished from prolonged apnoeic pauses. Ventilatory defects (pneumonia. HMD. Oxygen and Theophylline or caffeine should be prescribed if they recur. drugs. Neonatology 33 . E May be treated with blood transfusion. BPD. It is rare on day 1. CNS depression (hypoglycaemia. Occasionally nasal CPAP is required for mixed or obstructive apnoeas (assists in splinting the upper airway). The aetiology includes: 1. sepsis. Sudden onset of severe apnoeas and bradycardia deserve investigation. with bag and mask ventilation for recurrent or prolonged apnoea. anaemia). the prognosis is related to underlying conditions (IVH. 2. Abnormal oxygen delivery (shock. haemorrhage). PFC. but tends to start between day 2 and 7 of life. Treatment includes cutaneous stimulation. The haemoglobin should be maintained with transfusion or erythropoietin.

the following suggests a diaphragmatic hernia: A Delivery by caesarean section B Heart sounds on the right side of the chest C A CTG showing type 2 dips D Scaphoid abdomen E Prolonged rupture of the membrane (False) (True) (False) (True) (False) Comments: Diaphragmatic hernia has an incidence of 1:4000. It is often diagnosed antenatally.48) In respiratory distress in the newborn. Neonatology 34 . or may present with failure to respond to resuscitation or increase in tachypnoea in the neonatal period. A nasogastric tube should be passed and ventilation commenced at high rate. Antenatal evidence of birth asphyxia makes meconium aspiration more likely. low peaks and low pressures. Over vigorous resuscitation may cause air leaks. nitric oxide or echmo may be required. and delivery by caesarean section is associated with an increased incidence of transient tachypnoea of the newborn. Oscillatory ventilation. It is often accompanied by pulmonary hypoplasia and persistent fetal circulation. Prolonged rupture of membranes is associated with an increased risk of congenital pneumonia or septicaemia. The majority are left-sided causing displacement of the heart into the opposite hemithorax.

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