1 - Neonatology 2025

Anti-convulsant

(Carbamazepine, Phenytoin, Valproate)

Spina bifida is caused by which drugs taken perinatally?

Antimicrobials

(Chloroquine, Quinine, Streptomycin)

Congenital hearing loss can result from which drug taken perinatally?

Fetal Alcohol syndrome

Microcephaly, small eyes, thin upper lips, growth deficiency, MCA, CNS abnormalities

Tetracycline

Skeletal growth abnormality, cataract, limb malformation, hypoplasia of enamel can result from which drug taken perinatally?

CNS depressants

(barbiturates, narcotics, benzodiazepines)

Neonatal hypotonia and CNS depression can result from which drug taken perinatally?

Magnesium sulfate

Neonatal respiratory depression, meconium plug, hypotonia can result from which drug taken perinatally?

Beta blockers

IUGR, hypotension, bradycardia can result from which drug taken perinatally?

5 minutes

An extended APGAR score is done every how many minutes until ≥ 7 is reached?

36.5-37.5 C

Thermal protection in neonates means maintaining body temperature at

• Oxytocin (Oozing of milk)

• Prolactin (Production of milk)

“OPPA”

(Oxytocin – Posterior pituitary; Prolactin – Anterior pituitary)

Key hormones in the maintenance of breastfeeding success

• Immediate DRYING

• Uninterrupted SKIN-TO-SKIN contact

• Properly timed CORD CLAMPING

• NON-SEPARATION of mother-baby dyad

Correct sequence of Unang Yakap protocol

60 seconds

The golden period within which the resuscitative steps including PPV should be done for a limp/apneic neonate?

"Mr. SOPA"

Mask adjustment

Suction nose and mouth

Open mouth

Pressure increase

Alternative airway

Ventilatory corrective steps in newborn resuscitation

24 hours

All newborns should undergo a complete and detailed physical exam within how many hours after birth?

Low birth weight (LBW)

Very LBW

Extremely LBW

Newborns with weight:

<2500g

<1500g

<1000g

Late preterm

Very preterm

Extremely preterm

Neonates born at:

≥ 34 and < 37 weeks

<32 weeks

<28 weeks

Post-term infants

Infants born beyond 42 weeks gestation

1st stage of post-maturity

Post-maturity stage characterized by dry, cracked, peeling, and wrinkled skin on an infant that is too big but malnourished appearing

2nd stage of post-maturity

Post-maturity stage characterized by features of stage 1 with added meconium staining of the amniotic fluid and perinatal depression

3rd stage of post-maturity

Post-maturity stage with features of 1st and 2nd stages but with meconium staining of the nails and umbilical cord

Small for Gestational Age

Birth weight that falls below the 10th percentile or 2 standard deviations below the mean weight for gestational age

Appropriate for Gestational Age

Birth weight between 10th - 90th percentile

Large for Gestational Age

Birth weight that falls above the 90th percentile

3000 g (6.5 lbs)

Average weight of a newborn

Respiration

Most important component of APGAR

Subcutaneous fat necrosis

Multiple well-circumscribed indurated plaque or nodule common over the cheeks, buttocks, and back. Key word: Forceps/vacuum assisted delivery

Hypercalcemia

Common electrolyte imbalance occurring in infants with subcutaneous fat necrosis

Mongolian spots

Bluish grey pigmentation in the buttocks, back, and occasionally in extremities - common in Asian newborns

Milia

White pin-head retention cysts on the face of newborns

Pearls

Large, single milia that occur in the genitalia and areola and disappears a few weeks after birth

Neonatal acne

Neonatal comedones and papules caused by maternal hormones

Erythema toxicum neonatorum

Eosinophil-containing vesiculopustular papules on an erythematous base over the face, trunk, and extremities

Pustular melanoses

Neutrophil-filled vesiculopustular eruptions over the chin, neck, back, extremities, palms, and soles; common in black infants

Cutis marmorata

Cobble-stoning of the skin after exposure to low temperature?

Vernix caseosa

Thick, cheese-like material that covers neonates and helps in thermoregulation?

RA 9288

Newborn Screening Act of 2004 in the Philippines

False negative for GAL and PKU

Inadequate feeding prior to taking sample for NBS results in?

5-7 days old

Ideal time to do NBS in preterm infants

24-72 hrs after birth

Ideal time to do NBS in a normal newborn

2 weeks of age

If NBS done < 24 hrs of life, repeat when?

1 month old

For sick, admitted newborns, NBS can be done until when?

Congenital Hypothyroidism

A newborn with sluggishness, hypotonia, feeding difficulties, edema of genitalia, prolonged jaundice, and developmental delay.

Thyroid dysgenesis

Most common cause of congenital hypothyroidism

21-hydroxylase (90%)

Most common form of CAH is deficiency in what enzyme?

Autosomal recessive

Pattern of inheritance of CAH

21-hydroxylase

Salt-wasting form of CAH is a result of what enzyme deficiency?

17 a-hydroxylase

Decreased levels of androstenedione is characteristic of what CAH type?

17-hydroxyprogesterone

A deficiency in 21-hydroxylase type of CAH results in increase in what intermediate?

Mineralocorticoid replacement (Fludrocortisone)

Treatment of choice for salt-wasting type of CAH

GALT (Galactose-1-phosphate uridyltransferase)

Classic Galactosemia is defined as deficiency in what enzyme

GALK (Galactokinase deficiency)

Type of Galactosemia that presents with cataract

E. coli

Newborns with Galactosemia have increased risk for developing sepsis from which organism

PAH

(Phenylalanine hydroxylase)

Enzyme deficient in PKU (Phenylketonuria)?

Phenylketonuria

CNS S/Sx + musty odor?

MSUD

CNS S/Sx + sweet/maple syrup odor

BCAA dehydrogenase

(Branched chain alpha-keto acid dehydrogenase)

Enzyme defective in MSUD?

G6PD Deficiency

Hemolytic anemia after exposure to Sulfa-containing drugs?

RA 9709

An act providing for early detection, diagnosis, and intervention of congenital hearing loss in the country.

3 months

All infants not born in hospitals should be screened within how many months after birth?

Caput succedaneum

Cephalic deformity that is vaguely demarcated and crosses suture lines. Resolves in 2-3 days

Cephalhematoma

Cephalic deformity that has distinct margins, firm, and does not cross suture lines. Resolves in 2-3 weeks.

Immobilization

Management from clavicular fracture resulting from birth trauma

Close monitoring

Management for Brachial plexopathy from birth trauma

Erb-Duchene (upper arm) paralysis

Brachial plexopathy characterized by injury to the 5th and 6th cervical nerve (Waiter's tip sign)

Klumpke (lower arm) paralysis

Brachial plexopathy resulting from cervical 8th nerve and thoracic 1st nerve injury (Absent grasp reflex)

Horner syndrome (ipsilateral)

A condition that occurs with Klumpke paralysis characterized by ptosis, miosis, and facial anhidrosis

• Instrumental delivery

• Coagulopathy

• Prematurity

• Macrosomia

• Fetal dystocia

• Precipitous labor

Risk factors for fetal subgaleal hematoma

Congenital HSV

SGA + vesicular lesions over the face and mouth

Congenital Rubella

SGA + Encephalopathy + cataract + hearing loss + congenital heart disease + blueberry muffin rash

Congenital syphilis

SGA + maculopapular rash + periostitis

Congenital CMV

SGA + Chorioretinitis + Periventricular calcification on cranial imaging

Congenital Toxoplasmosis

SGA + Microcephaly + Hepatosplenomegaly + Intracerebral calcifications

Congenital varicella

SGA + cutaneous scars + limb and ocular defect + cortical atrophy on cranial imaging

EA + TEF

Neonate with feeding intolerance, respiratory distress, and inability to insert an orogastric tube

Type C (EA with distal TEF)

Most common type of EA

TEF ligation + primary end-to-end anastomosis of esophagus

Management of TEF + EA

Congenital Diaphragmatic Hernia

Neonate with respiratory distress, scaphoid abdomen, and absent breath sounds but (+) bowel sounds on lung auscultation.

Bochdalek

(Back and left)

Most common type of CDH

Gastroschisis

Neonate with abdominal visceral extrusion but without a sac

Omphalocele

Neonate with abdominal visceral extrusion with a sac usually BELOW the umbilicus

• Profound acidemia (pH <7.0)

• APGAR 0-3 for > 5 min

• Neurologic manifestations (seizure, coma, hypotonia)

• Multiple organ involvement

Criteria for perinatal asphyxia

• Fetal HR pattern

• Meconium staining

• APGAR score

• Need for resuscitation

• Pulmonary hypertension

• Seizures

Most common features that can predict asphyxia

Necrotizing enterocolitis (NEC)

Preterm neonate becoming morbid in the ICU+ feeding intolerance + history of broad-spectrum antibiotic + history of aggressive formula feeding

Prematurity

Greatest risk factor associated with NEC

• 1. Intestinal ischemia

• 2. Enteral nutrition

• 3. Pathologic organisms

Triad of pathophysiology of NEC

Terminal ileum and proximal colon

Most common segment of the gut affected in NEC

Pneumatosis intestinalis

Complication of NEC characterized with gas in the submucosa of the bowel

IIA

Stage of NEC characterized by presence of pneumatosis intestinalis

IIB

Stage of NEC where ascites occurs

IIIB

Stage of NEC characterized by presence of pneumoperitoneum

Duodenal atresia

Newborn with bilious vomiting, acholic stools, and double bubble sign on abdominal radiograph

Hydrocoele

Scrotal enlargement + positive transillumination test

Non-communicating hydrocoele

Hydrocoele caused by trapped peritoneal fluid in the tunica vaginalis as processus closes

Communicating hydrocoele

Hydrocoele caused by patency of processus

Inguinoscrotal hernia

Scrotal enlargement + palpable reducible scrotal mass + negative transillumination test

Incarcerated hernia

Scrotal enlargement (tender) + palpable nonreducible scrotal mass + negative transillumination test

Observation up to 3-4 months

Management of undescended testes among neonates

FRC

(Functional residual capacity)

Surfactant maintains adequate volume of which lung capacity?

Between 28-32 weeks

What week of gestation can surfactant be detected din the amniotic fluid?

35 weeks

Mature levels of surfactants are present after which AOG