{"id":36994,"date":"2026-06-07T07:18:09","date_gmt":"2026-06-07T01:48:09","guid":{"rendered":"https:\/\/atsixty.com\/?p=36994"},"modified":"2026-06-07T07:18:48","modified_gmt":"2026-06-07T01:48:48","slug":"neonatology-summative-revision","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/neonatology-summative-revision\/","title":{"rendered":"Neonatology: Summative Revision"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* Namespaced to #nrev01 *\/\n#nrev01 *,#nrev01 *::before,#nrev01 *::after{box-sizing:border-box;margin:0;padding:0}\n#nrev01{\n  --rose:#8B3A3A;--rose-dark:#5C1E1E;--rose-pale:#F9EDED;--rose-mid:#C97A7A;\n  --ter:#5C1E1E;--ter-pale:#FDF0F0;\n  --ink:#2A1010;--ink-mid:#5A3030;--ink-soft:#9A7070;\n  --line:#EDD8D8;--cream:#FDF4F4;--warm:#FFFAFA;\n  --correct:#2D6B47;--correct-bg:#EAF6EF;\n  font-family:'Source Serif 4',Georgia,serif;\n  font-size:16px;color:var(--ink);background:var(--cream);\n  line-height:1.78;padding:0 0 72px;\n}\n#nrev01 .rv-header{background:var(--rose);color:#FFFAFA;padding:36px 24px 30px;text-align:center}\n#nrev01 .rv-eyebrow{font-size:0.68rem;letter-spacing:0.18em;text-transform:uppercase;font-weight:600;opacity:0.65;margin-bottom:10px}\n#nrev01 .rv-title{font-family:'Playfair Display',serif;font-size:1.9rem;font-weight:700;line-height:1.2;margin-bottom:4px}\n#nrev01 .rv-title em{font-style:italic;font-weight:400;opacity:0.88}\n#nrev01 .rv-subtitle{font-size:0.84rem;opacity:0.72;font-style:italic;margin-top:8px}\n#nrev01 .rv-chips{display:flex;justify-content:center;gap:10px;margin-top:16px;flex-wrap:wrap}\n#nrev01 .rv-chip{background:rgba(255,255,255,0.13);border:1px solid rgba(255,255,255,0.22);border-radius:20px;padding:4px 13px;font-size:0.72rem}\n#nrev01 .rv-body{max-width:740px;margin:0 auto;padding:0 18px}\n#nrev01 .rv-section{background:var(--warm);border:1px solid var(--line);border-left:4px solid var(--rose);border-radius:10px;margin:28px 0;overflow:hidden;box-shadow:0 1px 6px rgba(42,16,16,0.05)}\n#nrev01 .rv-sec-head{background:var(--rose-pale);padding:14px 20px 12px;border-bottom:1px solid #E8C8C8}\n#nrev01 .rv-sec-num{font-size:0.61rem;font-weight:700;letter-spacing:0.14em;text-transform:uppercase;color:var(--rose);margin-bottom:3px}\n#nrev01 .rv-sec-title{font-family:'Playfair Display',serif;font-size:1.15rem;font-weight:700;color:var(--rose-dark)}\n#nrev01 .rv-sec-body{padding:16px 20px 18px}\n#nrev01 .rv-sec-body p{font-size:0.92rem;color:var(--ink-mid);line-height:1.75;margin-bottom:0.9em}\n#nrev01 .rv-sec-body p:last-child{margin-bottom:0}\n#nrev01 .rv-sec-body strong{font-weight:600;color:var(--ink)}\n#nrev01 .rv-sec-body em{font-style:italic}\n#nrev01 .rv-sub{font-family:'Playfair Display',serif;font-size:0.92rem;font-weight:700;color:var(--rose);margin:16px 0 6px;letter-spacing:0.02em}\n#nrev01 .rv-pill{display:inline-block;background:var(--ter-pale);border:1px solid #E8C8C8;border-radius:16px;padding:3px 11px;font-size:0.78rem;font-weight:600;color:var(--ter);margin:2px 3px 2px 0}\n#nrev01 .rv-pill-green{background:var(--correct-bg);border:1px solid #A8D8B8;color:var(--correct)}\n#nrev01 .rv-pill-warn{background:#FFF8E0;border:1px solid #E8D890;color:#7A6000}\n#nrev01 .rv-table-wrap{overflow-x:auto;margin:12px 0 4px}\n#nrev01 table{width:100%;border-collapse:collapse;font-size:0.83rem}\n#nrev01 th{background:var(--rose);color:#FFFAFA;padding:8px 12px;text-align:left;font-weight:600;font-family:'Source Serif 4',serif}\n#nrev01 td{padding:7px 12px;border-bottom:1px solid var(--line);color:var(--ink-mid);vertical-align:top}\n#nrev01 tr:last-child td{border-bottom:none}\n#nrev01 tr:nth-child(even) td{background:#FDF4F4}\n#nrev01 td strong{color:var(--ink)}\n#nrev01 .rv-figure{margin:18px 0 8px;background:var(--warm);border:1px solid var(--line);border-radius:8px;padding:16px;text-align:center}\n#nrev01 .rv-fig-cap{font-size:0.76rem;color:var(--ink-soft);font-style:italic;margin-top:10px;line-height:1.45}\n#nrev01 .rv-rule{height:1px;background:var(--line);margin:6px 0 12px}\n#nrev01 .rv-intro{margin:28px 0 8px;font-size:0.93rem;color:var(--ink-mid);line-height:1.8;padding:0 2px}\n#nrev01 .rv-intro p{margin-bottom:0.9em}\n@media print{\n  #nrev01 .rv-header{background:#8B3A3A !important;-webkit-print-color-adjust:exact}\n  #nrev01{padding-bottom:20px}\n  #nrev01 .rv-section{break-inside:avoid;box-shadow:none}\n}\n@media(max-width:480px){\n  #nrev01 .rv-title{font-size:1.45rem}\n  #nrev01 .rv-sec-title{font-size:1rem}\n  #nrev01 table{font-size:0.76rem}\n  #nrev01 td,#nrev01 th{padding:6px 8px}\n}\n<\/style>\n\n<div id=\"nrev01\">\n\n  <div class=\"rv-header\">\n    <div class=\"rv-eyebrow\">Morning Rounds &middot; Neonatology Series<\/div>\n    <div class=\"rv-title\">Neonatology<br><em>Summative Revision Notes<\/em><\/div>\n    <div class=\"rv-subtitle\">Seven topics &middot; NEET-PG and UPSC CMS &middot; Key facts, tables, and diagrams<\/div>\n    <div class=\"rv-chips\">\n      <span class=\"rv-chip\">Jaundice<\/span>\n      <span class=\"rv-chip\">Respiratory Distress<\/span>\n      <span class=\"rv-chip\">Sepsis<\/span>\n      <span class=\"rv-chip\">HIE<\/span>\n      <span class=\"rv-chip\">Seizures<\/span>\n      <span class=\"rv-chip\">Preterm<\/span>\n      <span class=\"rv-chip\">Omnibus<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"rv-body\">\n\n    <div class=\"rv-intro\">\n      <p>These notes summarise the seven Morning Rounds in the Neonatology series. They are written for rapid pre-exam revision, not first-time learning. Each section is self-contained. Read the debrief panels in the quizzes for the full clinical reasoning; use these notes to consolidate what you already know.<\/p>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 01 \u2014 NEONATAL JAUNDICE\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 01 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Neonatal Jaundice<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Physiological vs Pathological<\/div>\n        <p><strong>Physiological jaundice<\/strong> appears after 24 hours, peaks at days 3&ndash;4 (term) or days 5&ndash;7 (preterm), and resolves by day 10 (term) or day 14 (preterm). <strong>Pathological jaundice<\/strong>: appears within 24 hours, rises &gt;5 mg\/dL\/day, TSB exceeds phototherapy threshold, conjugated fraction &gt;20% of total, or persists beyond 14 days (term) \/ 21 days (preterm).<\/p>\n\n        <div class=\"rv-sub\">Phototherapy and Exchange Transfusion Thresholds<\/div>\n        <p>Thresholds are <strong>gestational-age and risk-stratified<\/strong> &mdash; always use the nomogram, not a fixed number. For a low-risk term neonate (&ge;38 weeks): phototherapy at approximately 15&ndash;18 mg\/dL at 72 hours; exchange transfusion approximately 5 mg\/dL higher. <strong>Risk factors lowering the threshold<\/strong>: isoimmune haemolytic disease, G6PD deficiency, asphyxia, sepsis, prematurity.<\/p>\n\n        <!-- SVG: Bilirubin action zones -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 560 200\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:560px;display:block;margin:0 auto\">\n            <rect width=\"560\" height=\"200\" rx=\"6\" fill=\"#FFFAFA\"\/>\n            <!-- zone fills: x-axis = 0-144h, y-axis 0-25 mg\/dL\n                 origin x=50, y=185; width=490px=144h; height=170px=25mg -->\n            <!-- Safe zone -->\n            <polygon points=\"50,185 125,152 510,120 510,185\" fill=\"#EAF6EF\" opacity=\"0.85\"\/>\n            <!-- Phototherapy zone -->\n            <polygon points=\"125,152 510,120 510,88 125,118\" fill=\"#FFF8E0\" opacity=\"0.9\"\/>\n            <!-- Exchange zone -->\n            <polygon points=\"50,118 125,118 510,88 510,18 50,18\" fill=\"#FDF0F0\" opacity=\"0.7\"\/>\n            <!-- axes -->\n            <line x1=\"50\" y1=\"18\" x2=\"50\" y2=\"185\" stroke=\"#5A3030\" stroke-width=\"1.2\"\/>\n            <line x1=\"50\" y1=\"185\" x2=\"510\" y2=\"185\" stroke=\"#5A3030\" stroke-width=\"1.2\"\/>\n            <!-- phototherapy line: (0h,6mg)=(50,144.7) to (144h,18mg)=(510,83.5) -->\n            <line x1=\"50\" y1=\"144.7\" x2=\"510\" y2=\"83.5\" stroke=\"#C8A820\" stroke-width=\"2\" stroke-dasharray=\"6,3\"\/>\n            <!-- exchange line: (0h,14mg)=(50,90.7) to (144h,25mg)=(510,17) -->\n            <line x1=\"50\" y1=\"90.7\" x2=\"510\" y2=\"17\" stroke=\"#C83030\" stroke-width=\"2\" stroke-dasharray=\"6,3\"\/>\n            <!-- labels -->\n            <text x=\"515\" y=\"87\"  font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#A87010\" font-weight=\"700\">Phototherapy<\/text>\n            <text x=\"515\" y=\"21\"  font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#922020\" font-weight=\"700\">Exchange<\/text>\n            <!-- zone labels -->\n            <text x=\"400\" y=\"175\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9\" fill=\"#2D6B47\" font-weight=\"700\">OBSERVE<\/text>\n            <text x=\"400\" y=\"110\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9\" fill=\"#A87010\" font-weight=\"700\">PHOTOTHERAPY<\/text>\n            <text x=\"280\" y=\"55\"  text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9\" fill=\"#922020\" font-weight=\"700\">EXCHANGE TRANSFUSION<\/text>\n            <!-- y-axis labels -->\n            <text x=\"46\" y=\"188\" text-anchor=\"end\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">0<\/text>\n            <text x=\"46\" y=\"120\" text-anchor=\"end\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">10<\/text>\n            <text x=\"46\" y=\"52\"  text-anchor=\"end\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">20<\/text>\n            <text x=\"8\"  y=\"105\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#5A3030\" transform=\"rotate(-90,8,105)\">TSB (mg\/dL)<\/text>\n            <!-- x-axis labels -->\n            <text x=\"50\"  y=\"196\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">0<\/text>\n            <text x=\"172\" y=\"196\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">36<\/text>\n            <text x=\"294\" y=\"196\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">72<\/text>\n            <text x=\"416\" y=\"196\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">108<\/text>\n            <text x=\"510\" y=\"196\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8\" fill=\"#9A7070\">144h<\/text>\n          <\/svg>\n          <div class=\"rv-fig-cap\">Bilirubin action thresholds for a low-risk term neonate (&ge;38 weeks). Thresholds are lower for preterm infants and those with haemolysis, sepsis, or other risk factors &mdash; always use the gestational-age-specific nomogram.<\/div>\n        <\/div>\n\n        <div class=\"rv-sub\">Haemolytic Jaundice<\/div>\n        <p><strong>ABO incompatibility:<\/strong> O-mother \/ A or B baby; no prior sensitisation needed; spherocytes on film; weakly positive DCT; usually mild. <strong>Rh disease (anti-D):<\/strong> requires prior sensitisation; strongly positive DCT; can cause hydrops; prevented by anti-D prophylaxis. <strong>G6PD deficiency:<\/strong> X-linked; triggers: infections, drugs (dapsone, primaquine), fava beans; bite cells and Heinz bodies on film.<\/p>\n\n        <div class=\"rv-sub\">Key Rules<\/div>\n        <p><span class=\"rv-pill\">Jaundice &lt;24 h = always pathological<\/span> <span class=\"rv-pill\">Conjugated &gt;20% = investigate<\/span> <span class=\"rv-pill-green\">IVIG: only for confirmed isoimmune haemolysis<\/span> <span class=\"rv-pill-warn\">G6PD: avoid triggers lifelong<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 02 \u2014 NEONATAL RESPIRATORY DISTRESS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 02 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Neonatal Respiratory Distress<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>RDS<\/th><th>TTN<\/th><th>MAS<\/th><th>Pneumothorax<\/th><\/tr>\n            <tr><td><strong>Gestation<\/strong><\/td><td>Preterm &lt;34 wk<\/td><td>Near\/full term<\/td><td>Post-term \/ term<\/td><td>Any<\/td><\/tr>\n            <tr><td><strong>Onset<\/strong><\/td><td>Birth &rarr; 4 h<\/td><td>Birth &rarr; 6 h<\/td><td>Immediate<\/td><td>Sudden, any time<\/td><\/tr>\n            <tr><td><strong>CXR<\/strong><\/td><td>Ground-glass + air bronchogram<\/td><td>Perihilar streaking, fissure fluid<\/td><td>Coarse patches + hyperinflation<\/td><td>Absent BS; tracheal deviation<\/td><\/tr>\n            <tr><td><strong>Mechanism<\/strong><\/td><td>&darr; Surfactant<\/td><td>Delayed fluid resorption<\/td><td>Airway obstruction<\/td><td>Air leak<\/td><\/tr>\n            <tr><td><strong>Treatment<\/strong><\/td><td>Surfactant + CPAP<\/td><td>Supportive only<\/td><td>Suction + support<\/td><td>Needle decompression<\/td><\/tr>\n            <tr><td><strong>Course<\/strong><\/td><td>Worsens 48&ndash;72 h<\/td><td>Resolves 24&ndash;48 h<\/td><td>Variable; risk PPHN<\/td><td>Emergency if tension<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">High-yield points<\/div>\n        <p><strong>RDS:<\/strong> antenatal corticosteroids (betamethasone &ge;24 h before delivery) are the most effective preventive measure. Incidence inversely proportional to gestational age. <strong>TTN:<\/strong> elective LSCS without labour bypasses the catecholamine-driven fluid clearance mechanism &mdash; classic setup. <strong>MAS + PPHN:<\/strong> right-to-left ductal shunt on echo is the hallmark; treat with iNO. <strong>IDM and RDS:<\/strong> fetal hyperinsulinaemia antagonises cortisol-driven surfactant synthesis &mdash; do not use gestational age alone to exclude RDS in an IDM.<\/p>\n        <p><span class=\"rv-pill\">Tension PTX: needle 2nd ICS MCL immediately<\/span> <span class=\"rv-pill\">Transillumination = rapid bedside test<\/span> <span class=\"rv-pill-green\">Surfactant: intratracheal, not IV<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 03 \u2014 NEONATAL SEPSIS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 03 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Neonatal Sepsis<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>Early-Onset (EOS)<\/th><th>Late-Onset (LOS)<\/th><\/tr>\n            <tr><td><strong>Onset<\/strong><\/td><td>&lt;72 hours of life<\/td><td>&gt;72 h (up to 28 days)<\/td><\/tr>\n            <tr><td><strong>Source<\/strong><\/td><td>Vertical (maternal)<\/td><td>Horizontal (nosocomial)<\/td><\/tr>\n            <tr><td><strong>Organisms<\/strong><\/td><td>GBS, <em>E. coli<\/em>, <em>Listeria<\/em><\/td><td>CoNS, <em>S. aureus<\/em>, <em>Klebsiella<\/em>, Candida<\/td><\/tr>\n            <tr><td><strong>Risk factors<\/strong><\/td><td>PROM &gt;18 h, maternal GBS, prematurity, maternal fever<\/td><td>Prematurity, central lines, TPN, intubation, steroids<\/td><\/tr>\n            <tr><td><strong>Empirical Rx<\/strong><\/td><td>Benzylpenicillin + gentamicin<\/td><td>Vancomycin + gentamicin<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Critical pharmacology points<\/div>\n        <p><strong>Listeria monocytogenes<\/strong> is intrinsically resistant to ALL cephalosporins &mdash; this is why benzylpenicillin (not cefotaxime) is used for EOS; ampicillin + gentamicin is the regimen of choice when Listeria is confirmed. <strong>CoNS LOS:<\/strong> vancomycin + remove central line; source control is non-negotiable. <strong>Invasive candidiasis:<\/strong> fluconazole first-line for susceptible <em>C. albicans<\/em>; remove central line; ophthalmology + echo to exclude end-organ disease.<\/p>\n\n        <div class=\"rv-sub\">LP in neonatal sepsis<\/div>\n        <p>Mandatory in all confirmed or probable sepsis (unless haemodynamically unstable). Meningitis occurs in up to 30% of bacteraemic neonates. Do LP <em>before<\/em> antibiotics if possible &mdash; CSF sterilises within hours. Meningitis extends treatment to 14&ndash;21 days and may require adding a third-generation cephalosporin.<\/p>\n        <p><span class=\"rv-pill\">Culture before Abx &mdash; never delay Abx for culture<\/span> <span class=\"rv-pill-warn\">Listeria: cephalosporins FAIL<\/span> <span class=\"rv-pill-green\">Candida: never a contaminant in VLBW<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 04 \u2014 BIRTH ASPHYXIA & HIE\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 04 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Birth Asphyxia &amp; HIE<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Sarnat Grading<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>Grade I (Mild)<\/th><th>Grade II (Moderate)<\/th><th>Grade III (Severe)<\/th><\/tr>\n            <tr><td><strong>Consciousness<\/strong><\/td><td>Hyperalert<\/td><td>Lethargic<\/td><td>Stupor \/ coma<\/td><\/tr>\n            <tr><td><strong>Tone<\/strong><\/td><td>Normal \/ mild &uarr;<\/td><td>Hypotonia<\/td><td>Flaccid<\/td><\/tr>\n            <tr><td><strong>Seizures<\/strong><\/td><td>None<\/td><td>Present<\/td><td>Absent or prolonged<\/td><\/tr>\n            <tr><td><strong>Outcome \/ TH<\/strong><\/td><td>Good; TH not indicated<\/td><td>Variable; TH indicated<\/td><td>Poor; TH indicated<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Therapeutic Hypothermia (TH)<\/div>\n        <p>Criteria: &ge;36 weeks gestation + perinatal asphyxia (cord pH &le;7.0 or BD &ge;16 mmol\/L, or need for resuscitation) + clinical\/aEEG evidence of encephalopathy (Grade II or III). Target: <strong>33&ndash;34&deg;C for exactly 72 hours<\/strong>; must start within <strong>6 hours<\/strong> of birth. NNT ~7 to prevent one death or major neurodisability. Seizures are <strong>not<\/strong> a contraindication.<\/p>\n\n        <div class=\"rv-sub\">NRP Algorithm Key Decision Points<\/div>\n        <p>Chest compressions when HR &lt;60\/min after 30 seconds of effective PPV. Compression:ventilation ratio <strong>3:1<\/strong> (not 15:2). Adrenaline (IV umbilical vein preferred) when HR &lt;60\/min after 60 seconds of coordinated CPR. <strong>Phenobarbitone 20 mg\/kg IV<\/strong> is first-line for neonatal seizures; clearance reduced ~20&ndash;30% during cooling &mdash; monitor levels carefully.<\/p>\n\n        <div class=\"rv-sub\">MRI Timing<\/div>\n        <p><strong>DWI<\/strong> (diffusion-weighted imaging): most sensitive in first 7 days, peaks at 3&ndash;5 days. <strong>T1\/T2<\/strong>: most informative at 7&ndash;14 days. PLIC (posterior limb of internal capsule) signal at 7&ndash;14 days predicts motor outcome. Basal ganglia + thalamic injury &rarr; dyskinetic CP; watershed cortical injury &rarr; spastic quadriplegia.<\/p>\n        <p><span class=\"rv-pill\">TH window: 6 hours<\/span> <span class=\"rv-pill\">TH duration: exactly 72 hours<\/span> <span class=\"rv-pill-green\">MRI at 5&ndash;7 days for prognosis<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 05 \u2014 NEONATAL SEIZURES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 05 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Neonatal Seizures<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Causes by Time of Onset<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Time window<\/th><th>Common causes<\/th><th>Key point<\/th><\/tr>\n            <tr><td><strong>0&ndash;24 h<\/strong><\/td><td>HIE (commonest), ICH, hypoglycaemia, hypocalcaemia, EOS (GBS)<\/td><td>HIE accounts for ~50%; exclude metabolic causes immediately<\/td><\/tr>\n            <tr><td><strong>24&ndash;72 h<\/strong><\/td><td>HIE (ongoing), cerebral infarction, hypocalcaemia, hypomagnesaemia, bacterial meningitis<\/td><td>Benign neonatal convulsions (fifth-day fits) peak at day 5<\/td><\/tr>\n            <tr><td><strong>72 h&ndash;1 week<\/strong><\/td><td>HSV encephalitis, cerebral infarction, late hypocalcaemia, inborn errors of metabolism<\/td><td>HSV: empirical aciclovir immediately; do not await PCR<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Seizure Types<\/div>\n        <p><strong>Subtle:<\/strong> lip-smacking, cycling, eye deviation, apnoea &mdash; commonest in term neonates; some have no EEG correlate. <strong>Focal clonic:<\/strong> rhythmic jerking one limb; not suppressible (distinguishes from jitteriness); EEG correlate present. <strong>Tonic:<\/strong> sustained posturing. <strong>Jitteriness:<\/strong> stimulus-sensitive, suppressible by restraint, no eye deviation, no EEG correlate &mdash; <em>not<\/em> a seizure.<\/p>\n\n        <div class=\"rv-sub\">Special Causes<\/div>\n        <p><strong>Late hypocalcaemia (day 5&ndash;14):<\/strong> cow&rsquo;s milk formula &rarr; high phosphate load &rarr; hyperphosphataemia &rarr; hypocalcaemia. Pattern: low Ca + high PO&#x2084; + normal Mg. Treat with calcium gluconate. <strong>HSV encephalitis:<\/strong> onset day 7&ndash;14; lymphocytic CSF pleocytosis; 30&ndash;40% occur without skin vesicles; aciclovir 20 mg\/kg 8-hourly for 21 days. <strong>Pyridoxine dependency (ALDH7A1 mutation):<\/strong> refractory seizures from birth; normal metabolic screen; dramatic response to IV pyridoxine 100 mg; lifelong oral pyridoxine.<\/p>\n        <p><span class=\"rv-pill\">Phenobarbitone 20 mg\/kg IV = first-line<\/span> <span class=\"rv-pill-warn\">HSV: aciclovir before PCR result<\/span> <span class=\"rv-pill-green\">Pyridoxine trial in refractory unexplained seizures<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 06 \u2014 THE PRETERM INFANT\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 06 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">The Preterm Infant<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <!-- SVG: Four complications at a glance -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 640 148\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:640px;display:block;margin:0 auto\">\n            <rect width=\"640\" height=\"148\" rx=\"6\" fill=\"#FFFAFA\"\/>\n            <!-- headers -->\n            <rect x=\"8\"   y=\"8\" width=\"118\" height=\"24\" rx=\"4\" fill=\"#E8C0C0\"\/>\n            <rect x=\"136\" y=\"8\" width=\"118\" height=\"24\" rx=\"4\" fill=\"#C97A7A\"\/>\n            <rect x=\"264\" y=\"8\" width=\"118\" height=\"24\" rx=\"4\" fill=\"#A85050\"\/>\n            <rect x=\"392\" y=\"8\" width=\"118\" height=\"24\" rx=\"4\" fill=\"#8B3A3A\"\/>\n            <rect x=\"520\" y=\"8\" width=\"112\" height=\"24\" rx=\"4\" fill=\"#5C1E1E\"\/>\n            <text x=\"67\"  y=\"24\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9.5\" font-weight=\"700\" fill=\"#5C1E1E\">Complication<\/text>\n            <text x=\"195\" y=\"24\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9.5\" font-weight=\"700\" fill=\"#FFFAFA\">Staging<\/text>\n            <text x=\"323\" y=\"24\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9.5\" font-weight=\"700\" fill=\"#FFFAFA\">Screening<\/text>\n            <text x=\"451\" y=\"24\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9.5\" font-weight=\"700\" fill=\"#FFFAFA\">Treat when<\/text>\n            <text x=\"576\" y=\"24\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"9.5\" font-weight=\"700\" fill=\"#FFFAFA\">Treatment<\/text>\n            <!-- rows -->\n            <rect x=\"0\" y=\"36\"  width=\"640\" height=\"26\" fill=\"#FDF4F4\"\/>\n            <rect x=\"0\" y=\"62\"  width=\"640\" height=\"26\" fill=\"#FFFAFA\"\/>\n            <rect x=\"0\" y=\"88\"  width=\"640\" height=\"26\" fill=\"#FDF4F4\"\/>\n            <rect x=\"0\" y=\"114\" width=\"640\" height=\"26\" fill=\"#FFFAFA\"\/>\n            <!-- row labels -->\n            <text x=\"6\" y=\"54\"  font-family=\"Georgia,serif\" font-size=\"9\" font-weight=\"700\" fill=\"#9A7070\">ROP<\/text>\n            <text x=\"6\" y=\"80\"  font-family=\"Georgia,serif\" font-size=\"9\" font-weight=\"700\" fill=\"#9A7070\">IVH<\/text>\n            <text x=\"6\" y=\"106\" font-family=\"Georgia,serif\" font-size=\"9\" font-weight=\"700\" fill=\"#9A7070\">NEC<\/text>\n            <text x=\"6\" y=\"132\" font-family=\"Georgia,serif\" font-size=\"9\" font-weight=\"700\" fill=\"#9A7070\">BPD<\/text>\n            <!-- ROP -->\n            <text x=\"195\" y=\"50\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Stage 1&ndash;5 + Zone<\/text>\n            <text x=\"195\" y=\"61\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">+ Plus disease<\/text>\n            <text x=\"323\" y=\"50\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">&lt;32 wk or &lt;1500 g<\/text>\n            <text x=\"323\" y=\"61\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Ophtho at 4 wk<\/text>\n            <text x=\"451\" y=\"50\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Type 1 ROP<\/text>\n            <text x=\"451\" y=\"61\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">(Stage 3+ \/ plus)<\/text>\n            <text x=\"576\" y=\"50\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Laser \/ anti-VEGF<\/text>\n            <text x=\"576\" y=\"61\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">(bevacizumab)<\/text>\n            <!-- IVH -->\n            <text x=\"195\" y=\"76\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Papile I&ndash;IV<\/text>\n            <text x=\"195\" y=\"87\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">IV = parenchymal<\/text>\n            <text x=\"323\" y=\"76\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Cranial USS 3&ndash;5 d<\/text>\n            <text x=\"323\" y=\"87\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Repeat 7&ndash;10 d<\/text>\n            <text x=\"451\" y=\"76\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">III\/IV: monitor<\/text>\n            <text x=\"451\" y=\"87\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">for hydrocephalus<\/text>\n            <text x=\"576\" y=\"76\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Serial USS;<\/text>\n            <text x=\"576\" y=\"87\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">VP shunt (PHH)<\/text>\n            <!-- NEC -->\n            <text x=\"195\" y=\"102\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Bell I&ndash;III<\/text>\n            <text x=\"195\" y=\"113\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">III = perforation<\/text>\n            <text x=\"323\" y=\"102\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">AXR: pneumatosis,<\/text>\n            <text x=\"323\" y=\"113\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">portal venous gas<\/text>\n            <text x=\"451\" y=\"102\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Stage II+: NBM,<\/text>\n            <text x=\"451\" y=\"113\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">IV Abx, TPN<\/text>\n            <text x=\"576\" y=\"102\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Stage III:<\/text>\n            <text x=\"576\" y=\"113\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">surgery<\/text>\n            <!-- BPD -->\n            <text x=\"195\" y=\"128\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Mild\/Mod\/Severe<\/text>\n            <text x=\"195\" y=\"139\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">O&#x2082; at 36 wk CGA<\/text>\n            <text x=\"323\" y=\"128\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">O&#x2082; &gt;28 days<\/text>\n            <text x=\"323\" y=\"139\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">+ at 36 wk CGA<\/text>\n            <text x=\"451\" y=\"128\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Vent-dependent<\/text>\n            <text x=\"451\" y=\"139\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">&gt;1&ndash;2 weeks<\/text>\n            <text x=\"576\" y=\"128\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">Caffeine, diuretics,<\/text>\n            <text x=\"576\" y=\"139\" text-anchor=\"middle\" font-family=\"Georgia,serif\" font-size=\"8.5\" fill=\"#2A1010\">O&#x2082; SpO&#x2082; 90&ndash;95%<\/text>\n            <!-- dividers -->\n            <line x1=\"126\" y1=\"8\" x2=\"126\" y2=\"148\" stroke=\"#EDD8D8\" stroke-width=\"1\"\/>\n            <line x1=\"254\" y1=\"8\" x2=\"254\" y2=\"148\" stroke=\"#EDD8D8\" stroke-width=\"1\"\/>\n            <line x1=\"382\" y1=\"8\" x2=\"382\" y2=\"148\" stroke=\"#EDD8D8\" stroke-width=\"1\"\/>\n            <line x1=\"510\" y1=\"8\" x2=\"510\" y2=\"148\" stroke=\"#EDD8D8\" stroke-width=\"1\"\/>\n            <line x1=\"0\" y1=\"36\"  x2=\"640\" y2=\"36\"  stroke=\"#EDD8D8\" stroke-width=\"0.5\"\/>\n            <line x1=\"0\" y1=\"62\"  x2=\"640\" y2=\"62\"  stroke=\"#EDD8D8\" stroke-width=\"0.5\"\/>\n            <line x1=\"0\" y1=\"88\"  x2=\"640\" y2=\"88\"  stroke=\"#EDD8D8\" stroke-width=\"0.5\"\/>\n            <line x1=\"0\" y1=\"114\" x2=\"640\" y2=\"114\" stroke=\"#EDD8D8\" stroke-width=\"0.5\"\/>\n          <\/svg>\n          <div class=\"rv-fig-cap\">Four major complications of prematurity &mdash; staging, screening schedule, treatment trigger, and treatment at a glance.<\/div>\n        <\/div>\n\n        <div class=\"rv-sub\">PDA in Prematurity<\/div>\n        <p>Ductus kept patent by PGE2; fails to close in preterm due to high circulating PGE2 and reduced smooth muscle responsiveness. Haemodynamically significant PDA: bounding pulses, wide pulse pressure, continuous murmur, left atrial dilatation on echo. Treatment: fluid restriction + diuretics &rarr; <strong>indomethacin or ibuprofen (COX inhibitor, &darr; PGE2)<\/strong>; oral paracetamol emerging alternative; surgical ligation for pharmacological failure.<\/p>\n\n        <div class=\"rv-sub\">Hypoglycaemia in Preterm \/ SGA<\/div>\n        <p>Threshold for intervention: <strong>&lt;2.6 mmol\/L<\/strong> in at-risk neonates. At &lt;1.5 mmol\/L or symptomatic: IV 10% dextrose 2 mL\/kg bolus + maintenance infusion (GIR 4&ndash;6 mg\/kg\/min). Dextrose gel for mild asymptomatic cases in term\/near-term only. SGA: limited glycogen + impaired gluconeogenesis + relative hyperinsulinism.<\/p>\n        <p><span class=\"rv-pill\">Pneumatosis = pathognomonic of NEC<\/span> <span class=\"rv-pill\">Breast milk reduces NEC risk 6-fold<\/span> <span class=\"rv-pill-green\">ROP screen: 4 wk of life or 31 wk CGA, whichever later<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPIC 07 \u2014 OMNIBUS HIGH-YIELD SUMMARY\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Topic 07 &middot; Neonatology<\/div>\n        <div class=\"rv-sec-title\">Omnibus &mdash; High-Yield Rapid Reference<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Congenital Infections<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Infection<\/th><th>Hallmark feature<\/th><th>Calcification<\/th><th>Treatment<\/th><\/tr>\n            <tr><td><strong>CMV<\/strong><\/td><td>SNHL (commonest); periventricular calcification<\/td><td>Periventricular<\/td><td>Valganciclovir 6 months<\/td><\/tr>\n            <tr><td><strong>Toxoplasma<\/strong><\/td><td>Chorioretinitis, hydrocephalus, seizures<\/td><td>Diffuse \/ scattered<\/td><td>Pyrimethamine + sulfadiazine + folinic acid<\/td><\/tr>\n            <tr><td><strong>Rubella<\/strong><\/td><td>Cataracts + cardiac defects + SNHL (classic triad)<\/td><td>Diffuse<\/td><td>Supportive; prevention by vaccination<\/td><\/tr>\n            <tr><td><strong>HSV<\/strong><\/td><td>Skin vesicles (absent in 30&ndash;40% of CNS disease); seizures day 7&ndash;14<\/td><td>None typical<\/td><td>Aciclovir IV 20 mg\/kg 8-hourly for 21 days<\/td><\/tr>\n            <tr><td><strong>Syphilis<\/strong><\/td><td>Snuffles, palms\/soles rash, periostitis, hepatosplenomegaly<\/td><td>None typical<\/td><td>Aqueous benzylpenicillin IV 10&ndash;14 days<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Haematological Conditions<\/div>\n        <p><strong>NAIT:<\/strong> HPA-1a antibodies (mother lacks HPA-1a antigen); first pregnancy affected; mother&rsquo;s platelets normal; treat with HPA-1a-negative irradiated platelets or IVIG. <strong>Polycythaemia:<\/strong> venous Hct &gt;65%; partial exchange transfusion with normal saline (not albumin) for symptomatic or Hct &gt;70%. <strong>HDN \/ ABO:<\/strong> spherocytes, weak DCT, first pregnancy possible; IVIG for confirmed isoimmune haemolysis.<\/p>\n\n        <div class=\"rv-sub\">Congenital Hypothyroidism<\/div>\n        <p>Commonest preventable cause of intellectual disability. TSH-based newborn screening. Start <strong>levothyroxine 10&ndash;15 mcg\/kg\/day within 2 weeks of life<\/strong>. Delay beyond 2 weeks causes irreversible neurodevelopmental damage even if treated adequately later. Commonest cause: thyroid dysgenesis. Do not defer for scintigraphy &mdash; treat first.<\/p>\n\n        <div class=\"rv-sub\">Neonatal Abstinence Syndrome (NAS)<\/div>\n        <p>Opioid withdrawal: onset 24&ndash;72 h (methadone), 12&ndash;24 h (heroin). Finnegan score &ge;8 on two assessments triggers treatment. First-line: <strong>oral morphine solution<\/strong> titrated to Finnegan score, then weaned 10%\/1&ndash;2 days. Clonidine\/phenobarbitone: adjuncts only. <strong>Naloxone: absolutely contraindicated<\/strong> &mdash; precipitates acute severe withdrawal and seizures.<\/p>\n\n        <div class=\"rv-sub\">Nutrition in the Preterm<\/div>\n        <p>Unfortified breast milk does not meet preterm demands for protein (3.5&ndash;4 g\/kg\/day), calcium, and phosphorus &mdash; add <strong>human milk fortifier (HMF)<\/strong>. Breast milk still preferred: reduces NEC 6-fold, provides immune protection (sIgA, lactoferrin), improves neurodevelopment. Donor pasteurised breast milk (milk bank) if maternal EBM unavailable.<\/p>\n\n        <p>\n          <span class=\"rv-pill\">CMV: periventricular calcification<\/span>\n          <span class=\"rv-pill\">Rubella: cataracts + cardiac + SNHL<\/span>\n          <span class=\"rv-pill\">Toxo: diffuse calcification + chorioretinitis<\/span>\n          <span class=\"rv-pill-warn\">Naloxone: NEVER in opioid-exposed neonate<\/span>\n          <span class=\"rv-pill-green\">CH: treat within 2 weeks, not after scintigraphy<\/span>\n          <span class=\"rv-pill\">Syphilis: aqueous penicillin IV, not IM benzathine<\/span>\n        <\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- Footer -->\n    <div style=\"margin-top:32px;text-align:center;font-size:0.80rem;color:#9A7070;font-style:italic;line-height:1.6\">\n      Neonatology Summative Revision &middot; atsixty.com &middot; Morning Rounds Series<br>\n      For clinical reasoning practice, return to the seven Morning Rounds quizzes linked in the series index.\n    <\/div>\n\n  <\/div>\n<\/div>\n\n\n<ul class=\"wp-block-latest-posts__list wp-block-latest-posts\"><li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/neonatology-summative-revision\/\">Neonatology: Summative Revision<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/neonatology-omnibus\/\">Neonatology Omnibus<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/the-preterm-infant\/\">The Preterm Infant<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/neonatal-seizures\/\">Neonatal Seizures<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/clinical\/pediatrics\/birth-asphyxia-hie\/\">Birth Asphyxia &amp; HIE<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Morning Rounds &middot; Neonatology Series NeonatologySummative Revision Notes Seven topics &middot; NEET-PG and UPSC CMS &middot; Key facts, tables, and diagrams Jaundice Respiratory Distress Sepsis HIE Seizures Preterm Omnibus These notes summarise the seven Morning Rounds in the Neonatology series. 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