Preterm Baby

PRETERM BABY

Q. 1

Incidence of undescended testis in preterm infants is:

 A

<5%

 B

10%

 C

20%

 D

30%

Q. 1

Incidence of undescended testis in preterm infants is:

 A

<5%

 B

10%

 C

20%

 D

30%

Ans. D

Explanation:

The incidence of undescended testes is approximately 30% in preterm infants.

Remember that undescended testis is more common in preterm when compared with term babies.
Ref: Schwartz’s principle of surgery 9th edition, chapter 39.

Q. 2

Which of the following is NOT used in a preterm infant to assess need for resuscitation?

 A

Color

 B

Heart rate

 C

Rate of respiration

 D

Muscle tone

Q. 2

Which of the following is NOT used in a preterm infant to assess need for resuscitation?

 A

Color

 B

Heart rate

 C

Rate of respiration

 D

Muscle tone

Ans. C

Explanation:

Respiratory effort is used instead respiratory rate in APGAR scoring system for resuscitation in neonates.
 
Apgar scoring system:
 
Apgar scores are a numerical expression of a newborn infant’s physical condition. Usually determined 1 min after birth and again at 5 min, the score is the sum of points gained on assessment of color, heart rate, reflex irritability, muscle tone, and respirations. The total score, based on the sum of the five components.

 

Signs

0

1

2

Heartbeats per minute

Absent

Slow (<100)

>100

Respiratory effort

Absent

Slow, irregular

Good, crying

Muscle tone

Limp

Some flexion of extremities

Active motion

Reflex irritability

No response

Grimace

Cry or cough

Color

Blue or pale

Body pink, extremities blue

Completely pink

 

If the score is

 

Ref: Raab E.L., Kelly L.K. (2013). Chapter 9. Normal Newborn Assessment & Care. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.


Q. 3

A preterm infant showed apnoea at birth associated with bradycardia. Apnoea is defined as cessation of respiration for at least:

 A

2 sec

 B

5 sec

 C

10 sec

 D

20 sec

Q. 3

A preterm infant showed apnoea at birth associated with bradycardia. Apnoea is defined as cessation of respiration for at least:

 A

2 sec

 B

5 sec

 C

10 sec

 D

20 sec

Ans. D

Explanation:

Apnea is defined as a respiratory pause lasting more than 20 seconds—or any pause accompanied by cyanosis and bradycardia.

 

 

 

Shorter respiratory pauses associated with cyanosis or bradycardia also qualify as significant apnea, whereas periodic breathing, which is common in full-term and preterm infants, is defined as regularly recurring ventilatory cycles interrupted by short pauses not associated with bradycardia or color change.

 

 

 

Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

 


Q. 4

True about apnoea in a Preterm baby are all, EXFEPT:

 A

Cessation of breathing for < 20sec

 B

Associated with bradycardia

 C

Leads to hypoxia

 D

May cause cyanosis

Q. 4

True about apnoea in a Preterm baby are all, EXFEPT:

 A

Cessation of breathing for < 20sec

 B

Associated with bradycardia

 C

Leads to hypoxia

 D

May cause cyanosis

Ans. A

Explanation:

Apnea is defined as the cessation of breathing for more than 20 seconds or apnea or the cessation of breathing for less than 20 seconds if it is accompanied by bradycardia or oxygen (O2) desaturation.

 

Bradycardia in a premature neonate is considered clinically significant when the heart rate slows by least 30 bpm from the resting heart rate.

 

The presence and duration of central cyanosis should also be noted which is significant.

 


Q. 5

True about breast feeding –

 A

Best for both preterm & term

 B

50% energy from protein

 C

Promote lactobacillus growth in bowel

 D

a and c

Q. 5

True about breast feeding –

 A

Best for both preterm & term

 B

50% energy from protein

 C

Promote lactobacillus growth in bowel

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Best for both preterm & term ‘c’ i.e., Promote lactobacillus growth in bowel

o Breast milk is beneficial for both preterm and term infants because the composition of breast milk varies according to

the needs and age of the infants. For example, preterm milk contains more protein `S’, sodium, iron, immunoglobulins

and calories as they are needed by the preterm baby.

o Breast milk and energy by different constituents

Carbohydrate                                 30-40%

Protein                                         7-10%

Fat                                             45-60%

o Breast milk contains N-acetyl-D glucose and lactose which promotes lactobacillus. On the other hand, high content of glucose and casein in formula feeds inhibits the growth of lactobacillus.

o Breast milk appears to be protective for necrotizing enterocolitis. Almost all patients of neonatal necrotizing enterocolitis are artificially fed.

o Low protein contents of breast milk along with a higher concentration of secretory IgA decreases the absorption of protein macromolecules -4 Less chances of allergy and asthma.


Q. 6

A non ventilated preterm baby in incubator is under observation. Which is the best way to monitor the baby’s breathing and detect apnaea ?

 A

Infrared throraric movement study

 B

Capnography

 C

Nasal digital temperature monitoring

 D

Impedence technique

Q. 6

A non ventilated preterm baby in incubator is under observation. Which is the best way to monitor the baby’s breathing and detect apnaea ?

 A

Infrared throraric movement study

 B

Capnography

 C

Nasal digital temperature monitoring

 D

Impedence technique

Ans. D

Explanation:

 Ans. is ‘d’ i.e., Impedence technique

o The respiratory monitor based on impednace technique measures changes in the electrical resistance during breathing.

The electrode is fixed on the chest wall to pick up signals which are displayed as respiratory rate.

o Capnography – It is a simple non invasive method to assess arterial CO2.

o It is used to assess the placement of ET tube in esophagus or trachea.


Q. 7

The following factors contribute to hypothermia in preterm babies except –

 A

Decreased subcutaneous fat and brown fat

 B

Large surface area in relation to body weight

 C

Less oxygen consumption

 D

Increased muscular activity

Q. 7

The following factors contribute to hypothermia in preterm babies except –

 A

Decreased subcutaneous fat and brown fat

 B

Large surface area in relation to body weight

 C

Less oxygen consumption

 D

Increased muscular activity

Ans. D

Explanation:

Ans. is ‘d’ i.e., Increased muscular activity


Q. 8

Blood volume in preterm neonate is –

 A

90 ml/kg

 B

80 ml/kg

 C

70 ml/kg

 D

60 ml/kg

Q. 8

Blood volume in preterm neonate is –

 A

90 ml/kg

 B

80 ml/kg

 C

70 ml/kg

 D

60 ml/kg

Ans. A

Explanation:

Ans. is ‘a’ i.e., 90 ml/kg

Age                                      Blood volume

Preterm                                90-110 ml/kg (average 100 ml/kg)

Term                                    80-90 ml/kg (average 85 ml/kg)

1-3 months                          75 ml/kg

3 months – adults                 70 ml/kg


Q. 9

Late metabolic acidosis is seen in-

 A

Term infant given formula feed

 B

Preterm baby getting cow milk

 C

Long term breast feeding

 D

None of the above

Q. 9

Late metabolic acidosis is seen in-

 A

Term infant given formula feed

 B

Preterm baby getting cow milk

 C

Long term breast feeding

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., Preterm baby getting cow milk

Late metabolic acidosis (LMA)

o Late metabolic acidosis is a special type of acidosis in apparently healthy premature infant.

o This hyperchloremic acidosis appeares during second and third week of life, and resolves spontaneously within a couple of weeks.

Definition

“An acidosis occuring after second day of life, in which base excess values are lower than -5meq/L on two consecutive estimations done at least 24 hours apart”.

Etiology

o Prematurity is the most important single predisposing factor in the development of LMA.

o The incidence varies considerably depending upon the gestational maturity and protein content of feeding formula.

o In preterm neonates fed on a modified cow’s milk the risk of developing LMA is very high.


Q. 10

Preterm infant is defined as –

 A

Born between 37-42 weeks

 B

Born > 42 weeks

 C

Born < 37 weeks

 D

Born < 25 weeks

Q. 10

Preterm infant is defined as –

 A

Born between 37-42 weeks

 B

Born > 42 weeks

 C

Born < 37 weeks

 D

Born < 25 weeks

Ans. C

Explanation:

Ans. is ‘c’ i.e., Born < 37 weeks 

Term neonate (term baby)

o Any neonate born between 37 and < 42 weeks (259 - 293 days) of pregnancy irrespective of the birth weight. Preterm baby

o Any neonate born before 37 weeks (<259 days) of pregnancy irrespective of the birth weight. Post-term baby

o Any neonate born at or after 42 weeks (294 days or more) of pregnancy irrespective of the birth weight.


Q. 11

Physiological jaundice in preterm infant lasts upto:

September 2011

 A

5 days

 B

7 days

 C

10 days

 D

14 days

Q. 11

Physiological jaundice in preterm infant lasts upto:

September 2011

 A

5 days

 B

7 days

 C

10 days

 D

14 days

Ans. D

Explanation:

Ans. D: 14 days

Physiological jaundice usually appears on 2nd and 3rd day and disappears by 7-10th day, a little later in premature neonates Jaundice in paediatrics:

Unconjugated bilirubinemia:

– Criggler Najar syndrome (I and II)

– Physiological jaundice

– Breast milk jaundice

Conjugated bilirubinemia:

– MC cause: Idiopathic infantile hepatitis

– Biliary atresia (intra-hepatic and extra-hepatic)

In kernicterus, unconjugated bilirubin is increased

  • In kernicterus, staining of brain is more in basal ganglia
  • MC cause of jaundice of newborn within 24 hours is: Erythroblastosis fetalis
  • Breast milk jaundice is due to pregnandiole
  • In physiological jaundice, total bilirubin level rises less than 5 mg/ dl/ day


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