Neonatology Made Simple For NLE NRE Step 1

1. Apgar Score

A rapid scoring system used to evaluate a newborn’s cardiopulmonary adaptation after birth.

• Assessed at 1 minute and again at 5 minutes.
• Higher score = better adaptation and stability.

Apgar Parameters and Scoring

Sign	0 Points	1 Point	2 Points
Activity (Muscle tone)	No movement	Arms flexed, legs extended	Active movement
Pulse (Heart rate)	Absent	<100 beats/min	>100 beats/min
Grimace (Reflex irritability)	No response	Some flexion of extremities	Coughs / sneezes / pulls away
Appearance (Color)	Cyanosis or pale	Pink body, blue extremities (acrocyanosis)	Completely pink
Respiration	Absent	Weak/slow cry	Vigorous cry

Interpretation of Apgar Score

• 0–3 → Severe depression requires immediate resuscitation.
• 4–7 → May require assistance; keep under observation.
• 8–10 → No resuscitation needed, good cardiopulmonary adaptation.

2. Neonatal Jaundice

Yellowish discoloration of skin and sclera in newborns due to elevated serum bilirubin (>5 mg/dL).

Feature	Physiological Jaundice	Pathological Jaundice
Time of appearance	Not present in 1st 24 hrs	Present within 24 hrs
Bilirubin rise	↑ 5 mg/dL	<5 mg/dL/day
Peak bilirubin	<15 mg/dL	>15 mg/dL
Duration	Resolves within 1–2 weeks	Persists >2 weeks

Kernicterus

• Occurs when the bilirubin level is >25 mg/dL.
• A complication of conjugated hyperbilirubinemia.

Conjugated Jaundice = Always pathological.

Bilirubin Metabolism Disorders

Step in Pathway	Defect	Syndrome
Unconjugated → Conjugated (via UDP-glucuronyl transferase)	Enzyme absent	Crigler–Najjar Syndrome
	Enzyme partially works / stress-induced defect	Gilbert Syndrome
Conjugated → Hepatic Canaliculi (excretion)	Transport absent	Dubin–Johnson Syndrome
	Transport partially defective	Rotor Syndrome

3. Neonatal Respiratory Distress Syndrome (NRDS)

The most common cause of respiratory failure in preterm babies is due to a lack of surfactant (mainly dipalmitoylphosphatidylcholine – DPPC) produced by Type II pneumocytes.

Surfactant Production in Pregnancy

• Insufficient levels in preterm → ↑ risk of NRDS
• Appears: 26–34 weeks

Clinical Features (onset 48–72 hours after birth)

• Expiratory grunting
• Tachypnea (>60/min)
• Nasal flaring
• Subcostal retractions
• Cyanosis

Investigations

• Chest X-ray: Ground-glass appearance
• Lecithin/Sphingomyelin (L/S) ratio:
  • <1.5–2 → ↑ risk of NRDS

Treatment

• Surfactant infusion
• CPAP (Continuous Positive Airway Pressure)

5. Febrile Seizures

A seizure occurring in children due to a sudden rise in temperature or infection.
Common risk factor: Genetic predisposition.

Epidemiology

• Peak age: 6 months – 5 years
• After 5 years, → risk decreases

Types

Feature	Simple Seizure	Complex Seizure
Number of attacks (24 hr)	Single attack	Multiple attacks
Recovery	Quick return to normal	Delayed recovery
Duration	< 15 minutes	> 15 minutes
Fever	Occurs with fever (before seizure)	Low-grade fever for few days

Investigations

Main aim: Exclude sepsis / CNS infection

• Clinical diagnosis
• Lumbar puncture → rule out meningitis
• Urine R/E
• Sepsis workup if suspected

Treatment

• Antipyretics: Paracetamol (Panadol)
• Antiepileptics: Only if recurrent/complex (e.g., Carbamazepine)
• Reassure parents (most febrile seizures are benign & self-limiting)

6. Cerebral Palsy

A group of disorders causing abnormal development or function of movement and posture due to damage/dysfunction of the cerebrum, basal ganglia, or cerebellum.

Causes / Risk Factors

• Exact mechanism: unknown
• Possible causes:
  • IUGR
  • Hypoxia/birth asphyxia
  • Chromosomal/genetic disorders

Types

1. Spastic type (≈75%)
   • Quadriplegia → all 4 limbs weak
   • Diplegia → both lower limbs are weak
   • Monoplegia → one limb weak
   • Hemiplegia → one side of the body is weak
2. Ataxic type (5–10%)
   • Poor balance & coordination
3. Dyskinetic type
   • Athetoid palsy → involuntary jerky movements

Investigations

• CT Scan
• MRI (preferred for detailed assessment)

Treatment

• Supportive care (multidisciplinary approach):
  • Physiotherapy
  • Occupational therapy
  • Speech therapy
  • Medications if needed (e.g., antispastic agents)

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7. Childhood Bone Tumors

Feature	Osteosarcoma	Ewing Sarcoma
Peak Age	10–20 years & 50–60 years (bimodal)	12–22 years
Clinical Features	Intense bony pain at night, usually no systemic symptoms	Bony pain + systemic symptoms (fever, weight loss)
Origin	Metaphysis of long bones (e.g., distal femur, proximal tibia)	Diaphysis of long bones
X-ray Findings	Codman’s triangle (periosteal reaction)	Onion-skin appearance

8. Vesicoureteral Reflux (VUR)

Definition

A condition in which urine refluxes from the bladder back into the ureter.

Clinical Features

• Asymptomatic (mild cases)
• Flank pain
• Weak urinary stream, dribbling
• Recurrent UTIs

Notes

• Mild reflux → often asymptomatic
• Severe reflux → can lead to renal scarring, raised creatinine, and CKD

Investigations

• Urine R/E (routine)
• Urine C/S (culture & sensitivity)
• USG KUB
• CT Scan (if needed)
• Serum creatinine (may be raised)

Treatment

• Fluids
• Antibiotics (for UTI prophylaxis/acute infection)
• Surgery (for severe reflux or failed medical management)