paeds819
A term baby is born through thick meconium. The baby has not yet cried and is making no respiratory effort. The baby appears to be covered in thick particulate meconium.What is the next most appropriate step?
Archives: MRCPCH FOP/TAS
paeds820
A term baby weighing 3.3kg is admitted to NICU at 3 hours old with increased respiratory effort. The baby was delivered by spontaneous vaginal delivery following an uncomplicated pregnancy. Membranes ruptured 30 hours before delivery and there are no other risk factors for infection. On examination the baby is visibly tachypnoeic with intercostal recession and nasal flaring. Heart sounds are normal with no murmurs. Femoral pulses are present bilaterally. Capillary refill time is 3 seconds centrally and baby has cool hands and feet. Respiratory rate is 90/min, heart rate 170/min and oxygen saturations measured on the right hand are 85% in room air. IV access has been obtained and antibiotics are being given. Enough blood was obtained for culture, blood sugar and venous blood gas. Blood sugar is 2.6 mmol/l. Blood gas shows: pH 7.25, CO2 8.5 kPa, BE -8. Despite low flow nasal cannula oxygen baby’s saturations remain around 88%. What should be the next step in this baby’s management?
paeds821
A term baby with a birth weight of 3.6 kg with hypoxic ischaemic encephalopathy is intubated and ventilated. Cooling treatment has started. The baby is sedated and paralysed and is being ventilated on the mode continuous mandatory ventilation (CMV). Settings are: targeted tidal volume 14 ml, maximum PIP 25, PEEP 5, rate 60/min, FiO2 0.21. Baby’s oxygen saturations are 100%. Blood gas shows pH 7.47, CO2 2.8 kPa, BE -6.What is the first change that should be made to the ventilation?
paeds822
A term baby with a birth weight of 4.2 kg with meconium aspiration syndrome is intubated and ventilated. Conventional ventilation was unsuccessful and so a trial of high-frequency oscillatory ventilation has commenced. Chest X-ray shows good lung inflation. There is minimal chest wobbleť on the baby. Settings are mean airway pressure 16, delta P 25, rate 10 Hz, FiO2 0.5. Baby’s oxygen saturations are 94%. Blood gas shows pH 7.19, CO2 9.3 kPa, BE -5. What is the first change that should be made to the ventilation?
paeds823
A term baby with a birth weight of 4.5 kg with meconium aspiration syndrome is intubated and ventilated. Conventional ventilation was unsuccessful and so a trial of high-frequency oscillatory ventilation has commenced. Settings are mean airway pressure 14 cmH2O, delta P 25, rate 10 Hz, FiO2 1.0. Baby’s oxygen saturations are 84%. Blood gas shows pH 7.32, CO2 6.5 kPa, BE -4. Chest X-ray shows poorly inflated lungs.What is the first change that should be made to the ventilation?
paeds824
A well 2-week-old baby born at term is referred to hospital with a discharging umbilicus. The cord separated at 10 days and there is no peri-umbilical swelling or erythema. There is a small red mass at the site of cord separation, which is discharging a small amount of yellow fluid. The GP had taken a swab of this which grew Staphylococcus epidermidis.The MOST appropriate course of action is which of the following?
paeds825
A well, breastfed term infant presented with jaundice at 36 hours of age. The serum bilirubin was 286 µmol/L, direct Coombs test negative, blood film showed spherocytes and reticulocytes. The baby’s blood group was A rhesus negative and mother’s blood group O Rhesus negative.Which of the following is the MOST likely diagnosis?
paeds826
Which of the following is a risk factor for neonatal death and stillbirth?
paeds827
A nuchal translucency measurement is taken from the nape of the foetus’ neck to screen for Down’s syndrome.Which of these is the embryological origin of this tissue?
paeds828
According to NICE guidelines, which of the following factors pose an increased risk of severe hyperbilirubinemia?