OSCE in NeonatologyA Guide Book

OSCE in Neonatology A Guide Book

Editors-in-Chief

Srinivas MurkiMD DNB DM(Neo)

Senior ConsultantFernandez Hospital

Hyderabad, Telangana, India

Rhishikesh ThakreMD DNB DM(Neo) DCH FCPS FIAP

Consultant NeonatologistDirector

Neo Clinic and HospitalAurangabad, Maharashtra, India

New Delhi | London | PanamaThe Health Sciences Publisher

An Official Publication of Indian Academy of PediatricsNeONAtOLOgy ChAPter

ForewordPraveen Kumar

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OSCE in Neonatology: A Guide Book

First edition: 2018ISBN 978-93-5270-105-6

Printed at

Jaypee Brothers Medical Publishers (P) Ltd

Editorial Board

Chief Academic Editors

Associate Editors

Sandeep Kadam MD DM(Neo)

Senior Neonatal Consultant KEM Hospital and Ratna HospitalPune, Maharashtra, India

Naveen Jain DM (Neo) MD DNB

Associate ProfessorDepartment of Neonatology Kerala Institute of Medical SciencesTrivandrum, Kerala, India

Sanjay Wazir DM(Neo) MD

Director, Department of Neonatology Cloudnine HospitalGurugram, Haryana, India

Naveen Bajaj DM(Neo) MD Consultant Neonatologist Department of NeonatologyDeep HospitalLudhiana, Punjab, India

Suman Rao PN DM(Neo) MD

Professor and Head Department of Neonatology St Johns Medical College HospitalBengaluru, Karnataka, India

OSCE in Neonatology

vi

J Kumutha MD DCH Professor and Head Department of Neonatology Saveetha Medical CollegeChennai, Tamil Nadu, India

Swarna Rekha MD FNNF

Former Professor and HeadDepartment of NeonatologySt Johns Medical College HospitalBengaluru, Karnataka, India

Ranjan Kumar PejaverFRCP FRCPCH (UK) FIAP FNNF

Chief of NeonatologyMeenakshi HospitalsHon Professor, Department of NeonatologyKempegowda Institute of Medical SciencesBengaluru, Karnataka, India

Jayashree Mondkar MD DCH

Professor and Head Department of Neonatology I/C Human Milk Bank Lokmanya Tilak Municipal Medical CollegeMumbai, Maharashtra, India

Ruchi Nanavati MD IBCLC

Professor and Head Department of Neonatology Seth GS Medical College and KEM HospitalMumbai, Maharashtra, India

Editorial Advisory Board

Neonatology Chapter of Academy of Pediatrics

Office Bearers 2017–18

Chairperson : Dr Sanjay WazirHon. Secretary : Dr Naveen BajajTreasurer : Dr Nandkishor KabraJoint Secretary : Dr Rajesh KumarImm. Past Chairperson : Dr Rhishikesh Thakre

Executive MembersEast Zone : Dr Arjit Mohapatra, Dr Vinod KumarWest Zone : Dr Ashish Mehta, Dr Sanjay GhorpadeNorth Zone : Dr Deepak Chawla, Dr Kamal AroraCentral Zone : Dr Basawaraj T, Dr Ravi Shankar KSouth Zone : Dr Suman Rao, Dr VC Manoj

Indian Academy of Pediatrics

Office Bearers 2017

President : Dr Anupam SachdevaPresident Elect, 2017 : Dr Santosh T SoansVice President : Dr Mahaveer Prasad Jain Imm. Past President : Dr Pramod JogSecretary General : Dr Bakul J ParekhTreasurer : D Sandeep Bapu KadamEditor-in-Chief, IP : Dr Dheeraj Shah Editor-in-Chief, IJPP : Dr NC GowrishankarJoint Secretary : Dr Ajay Gambhir

Office Bearers

Contributors

Adhisivam B DCH DNB

Associate ProfessorDepartment of NeonatologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry, IndiaE-mail: adhisivam1975@yahoo.co.uk

AK Rawat MD

Professor and HeadDepartment of PediatricsBundelkhand Medical CollegeSagar, Madhya Pradesh, IndiaE-mail: drakrawat01@rediffmail.com

Amrit Jeevan DCH MD

Surya Mother and Child Super Speciality HospitalMumbai, Maharashtra, IndiaE-mail: dramritjeevan@gmail.com

Anil Kumar MD

Consultant NeonatologistCloud Nine HospitalGurugram, Haryana, IndiaE-mail: dranil_kr@rediffmail.com

Anjali Kulkarni MD

Former HeadDepartment of Pediatrics and NeonatologySir HN Reliance Foundation HospitalMumbai, Maharashtra, IndiaE-mail: dr.kulkarnianjali@gmail.com

Anu Sachdeva MD DNB (Pediatrics)

MNAMS DM (Neonatology)

Assistant ProfessorDepartment of PediatricsAll India Institute of Medical SciencesNew Delhi, IndiaE-mail: dranuthukral@gmail.com

Anuradha Murki MS

Assistant ProfessorDepartment of Obstetrics and GynecologyKamineni Academic Institute and Research CenterHyderabad, Telangana, IndiaE-mail: dogiparthi_anu@yahoo.com

Archana Kadam MD DNB

Developmental PediatricianKEM Hospital and Jehangir HospitalPune, Maharashtra, IndiaE-mail: dr.archana.ped@gmail.com

Ashish Jain DM (Neo) MD

Assistant ProfessorDepartment of NeonatologyMaulana Azad Medical CollegeNew Delhi, IndiaE-mail: neoashish2008@gmail.com

Asim Kumar Mallick MD

Professor and In-Charge, Neonatal UnitDepartment of PediatricsNRS Medical College and HospitalKolkata, West Bengal, IndiaE-mail: asim_mallick2004@yahoo.com

Atul Kulkarni MD

Assistant ProfessorAshwini Rural Medical College and HospitalSolapur, Maharashtra, IndiaE-mail: dratulkulkarni@rediffmail.com

Bhavani Kalavalapalli MRCPCH

CCT FRCPCH

Consultant Pediatrician and NeonatologistDirectorInstitute of Diabetes, Endocrinology and Adiposity Centres

OSCE in Neonatology

x Hyderabad, Telangana, IndiaE-mail: bhavani_kalavalapalli@yahoo.co.uk

Brajesh Jha DM

Senior Resident (Neo)Department of NeonatologyMaulana Azad Medical CollegeNew Delhi, IndiaE-mail: docbkjha@gmail.com

Chandrasekharam

MCH(Paediatric Surgery)

Pediatric SurgeonAnkura HospitalHyderabad, Telangana, IndiaE-mail: vvsssekharam@yahoo.co.in

Deepak Niraj DM (Neo) MD

Senior ConsultantBJ Wadia Children HospitalMumbai, Maharashtra, IndiaE-mail: drndipak@gmail.com

Deepak Sharma DNB (Neo) MD

Consultant NeonatologistNeo ClinicJaipur, Rajasthan, IndiaE-mail: dr.deepak.rohtak@gmail.com

Dhanya Dharmapalan MD

Consultant PediatricianApollo HospitalNavi Mumbai, Maharashtra, IndiaE-mail: drdhanyaroshan@gmail.com

Dinesh Chirla MD DM MRCPCH

DirectorRainbow Children HospitalHyderabad, Telangana, IndiaE-mail: dchirla@gmail.com

Femitha P DM (Neo) MD

Associate ConsultantDepartment of NeonatologyKerala Institute of Medical SciencesThiruvananthapuram, Kerala, IndiaE-mail: femi_shifas@yahoo.com

Haribalakrishna Balasubramanian DM (Neo) MD

Surya Children HospitalMumbai, Maharashtra, IndiaE-mail: doctorhbk@gmail.com

Hemasree Kandraju MD DNB(Neo)

Consultant NeonatologistFernandez HospitalHyderabad, Telangana, IndiaE-mail: drhema4@gmail.com

J Kumutha MD DCH

Professor and HeadDepartment of NeonatologySaveetha Medical CollegeChennai Tamil Nadu, IndiaE-mail: dr_kumutha@yahoo.com

Kanishka Das MS MCH

ProfessorDepartment of Pediatric SurgerySt John’s HospitalBengaluru, Karnataka, IndiaE-mail: kanishkadas@hotmail.com

Kanithi Ravishankar DM (Neo) MD

DirectorSowmya Children’s HospitalHyderabad, Telangana, IndiaE-mail: ravineonatologist@gmail.com

LS Deshmukh DM (Neo) MD

Professor and HeadDepartment of NeonatologyGovernment Medical College and HospitalAurangabad, Maharashtra, IndiaE-mail: deshmukhls@yahoo.com

Madhavi Shelke MD

Fellowship in Pediatric NeurologyConsultant Pediatric NeurologistICON Centre for Child NeurodevelopmentAurangabad, Maharashtra, IndiaE-mail: madhavishelke@yahoo.com

Contributors

xiMadhavi V MD

Clinical GeniticistFernandez HospitalHyderabad, Telangana, IndiaE-mail: damamadhavai@gmail.com

Mangala Bharathi S MD DM(Neo) DNB

Associate ProfessorDepartment of NeonatologyInstitute of Child Health and Hospital for ChildrenMadras Medical CollegeChennai, Tamil Nadu, IndiaE-mail: drmangalabharathi@gmail.com

Manigandan Chandrasekaran MD

Department of NeonatologySaveetha Medical CollegeChennai, Tamil Nadu, India

Mehul Shah MD (Ped) DCH (Bom) MD

(USA) DABPN (USA)

Consultant Pediatric NephrologistApollo Health City and Little Stars Childrens HospitalHyderabad, Telangana, IndiaE-mail: mehulashah@hotmail.com

Mohit Sahni MBBS DCH DNB(Ped)

Fellowship Neonatology and Neonatal Cardiology Sydney (Australia) and Toronto (Canada) Director NICU and AccedemicsConsultant Neonatologist and Neonatal CardiologistNirmal Hospital Pvt Ltd.Surat, Gujarat, IndiaE-mail: mohitsahni2505@gmail.com

Monika Kaushal DM (Neo) MD

Visiting Fellowship RCPCH

HeadDepartment of Pediatrics and NeonatologyZulekha HospitalDubai, UAEE-mail: mkaushal@zulekhahospitals.com

Murlidhar D Mahajan MD DCH

DNB MNAMS

Consulting Metabolic SpecialistJupiter Hospital Mumbai, Maharashtra, IndiaE-mail: drmurlidhar@rediffmail.com

N Chandra Kumar MD DNB

MNAMS DM (Neonatology) DNB (Neo)

DirectorCloud NineChennai, Tamil nadu, IndiaE-mail: drchandrakumar@gmail.com

Nageshwar Rao DM MD

ChiefDivision of Pediatric CardiologyCare HospitalHyderabad, Telangana, IndiaE-mail: drkoneti@yahoo.com

Nandkishor S Kabra DM (Neo)

MD (Ped) DNB (Ped) MSc (Clinical

Epidemiology)

Director, Neonatal Intensive Care UnitSurya Children’s Medicare Pvt LtdMumbai, Maharashtra, IndiaE-mail: nskabra@gmail.com

Naveen Bajaj DM (Neo) MD

Consultant NeonatologistDepartment of NeonatologyDeep HospitalLudhiana, Punjab, IndiaE-mail: bajajneo@gmail.com

Naveen Jain DM (Neo) MD DNB

Associate ProfessorDepartment of NeonatologyKerala Institute of Medical SciencesThuruvananthapuram, Kerala, IndiaE-mail: naveen_19572@hotmail.com

Nitasha Bagga MD

ConsultantRainbow Children HospitalHyderabad, Telangana, IndiaE-mail: nitashabagga@gmail.com

OSCE in Neonatology

xii Pankaj Bhansali MD

Consultant NephrologistNiramay Children HospitalAurangabad, Maharashtra, IndiaE-mail: drpbhansali@gmail.com

Pradeep Suryawanshi MD DCH

(Sydney)

Fellowship in Neontal Perinatal Medicine (Australia)Professor and HeadDepartment of NeonatologyBVU Medical CollegePune, Maharashtra, IndiaE-mail: drpradeepsuryawanshi@gmail.com

Pradnya Deshmukh MS (Ophth)

Associate ProfessorDepartment of OphthalmologyMGM College and HospitalAurangabad, Maharashtra, IndiaE-mail: pradnya_kerkar@yahoo.co.in

Prashant P Patil MD (Peds) PDCC ESPE

Consultant Pediatric and Adolescent Endocrinologist and DiabetologistRainbow Pediatric Multispeciality ClinicMumbai, Maharashtra, IndiaE-mail: dr_prash4u@yahoo.com

Prashantha YN MD DM

Senior ResidentDepartment of NeonatologySt John’s Medical College HospitalBengaluru, Karnataka, India

Preetha Joshi MD

Fellowship in NICU, University of Sydney and HamiltonFellowship in PICU, Critical Care TransportCardiac ICU, University of Sydney and TorontoPediatric and Neonatal IntensivistKokilaben Dhirubhai Ambani HospitalMumbai, Maharashtra, IndiaE-mail: preetha.joshi@relianceada.com

Premal Naik MS DNB (Ortho)

Department of OrthopedicsSmt SCL HospitalSmt NHL Municipal Medical CollegeAhmedabad, Gujarat, IndiaE-mail: premalnaik@gmail.com

Rahul Bhamkar MD

Associate ConsultantSir HN Reliance Foundation HospitalMumbai, Maharashtra, IndiaE-mail: Rahul.Bhamkar@rfhospital.org

Rajesh Kumar DM (Neo) MD

Director and Chief NeonatologistRani HospitalRanchi, Jharkhand, IndiaE-mail: drrajeshranihospital@gmail.com

Rajiv Sharan DNB MNAMS

Consultant PediatricianTata Motors HospitalJamshedpur, Jharkhand, IndiaE-mail: drrajeev_sharan@yahoo.com

Raktima Chakrabarti MD

Fellowship in Neonatology (Germany)

Consultant Pediatrician and NeonatologistEscape, Nirvana CountryGurugram, Haryana, IndiaE-mail: dr_raktima@yahoo.com

Ramani Ranjan DCH MD

Fellowship in NeonatalogySpecialist in Pediatrics and NeonatologyTata Main HospitalJamshedpur, Jharkhand, IndiaE-mail: dr.rranjan@tatasteel.com

Rhishikesh Thakre MD DNB

DM(Neo) DCH FCPS FIAP

Consultant NeonatologistDirectorNeo Clinic and HospitalAurangabad, Maharashtra, IndiaE-mail: rptdoc@gmail.com

Contributors

xiiiRoopa Bellad MD DCH

ProfessorDepartment of PediatricsJawaharlal Nehru Medical CollegeBelgaum, Karnataka, IndiaE-mail: roopabellad@hotmail.com

Sandeep Kadam MD DM (Neo)

Senior Neonatal ConsultantKEM Hospital and Ratna HospitalPune, Maharashtra, IndiaE-mail: drsandeepkadam@gmail.com

Sandeep Patil MD DM(Neo)

Consultant Neonatologist“Care” Advanced Neonatal CenterNanded, Maharashtra, IndiaE-mail: drsandeepsudpatil@gmail.com

Sanjay Wazir DM (Neo) MD

DirectorDepartment of NeonatologyCloudnine HospitalGurugram, Haryana, IndiaE-mail: swazir21@gmail.com

Smruti Patel MD

Fellowship in Pediatric CardiologyPediatric CardiologistFortis Hospital, Deep HospitalLudhiana, Punjab, IndiaE-mail: smrutivp@rediffmail.com

Snehal Kulkarni MD DNB (Card) FACC

ChiefDivision of Pediatric CardiologyKokilaben Dhirubhai Ambani HospitalMumbai, Maharashtra, IndiaE-mail: kulkarnisnehal15@yahoo.com

Snehal Thakre MS (Ophthal) DNB

ProfessorDepartment of OphthalmologyMGM Medical College and HospitalAurangabad, Maharashtra, IndiaE-mail: tsnehal73@gmail.com

Srinivas Murki MD DNB DM(Neo)

Senior ConsultantFernandez HospitalHyderabad, Telangana, IndiaE-mail: srinivas_murki2001@yahoo.com

Suman Rao PN DM (Neo) MD

Professor and HeadDepartment of NeonatologySt John’s Medical College HospitalBengaluru, Karnataka, IndiaE-mail: raosumanv@rediffmail.com

Surg Cmde Sheila S Mathai, VSM DM (Neo) MD DNB

Professor and HeadDepartment of PediatricsArmed Forces Medical CollegePune, Maharashtra, IndiaE-mail: sheilamathai@yahoo.com

Tanushri Mukherjee DCH DNB

IAP Neonatology FellowshipClinical AssociateDepartment of NeonatologyKokilaben Dhirubhai Ambani HospitalMumbai, Maharashtra, IndiaE-mail: gettanushri@gmail.com

Tejopratap Oleti DM (Neo) MD

Consultant NeonatologistFernandez HospitalHyderabad, Telangana, IndiaE-mail: tejopratap@gmail.com

Umesh Vaidya MD

HeadDepartment of NeonatologyKEM HospitalPune, Maharashtra, IndiaE-mail: kemnicu@gmail.com

Vaman V Khadilkar MD DNB MRCP

(UK) DCH (London)

Consultant Pediatrician, Adolescent Endocrinologist and DiabetologistJehangir Hospital, Pune Bombay Hospital, Mumbai HeadDivision of Pediatric Endocrinology

OSCE in Neonatology

xiv Bharati Vidyapeeth Medical CollegePune, Maharashtra, IndiaE-mail: vamankhadilkar@gmail.com

VC Manoj MD

Associate Professor and HeadDepartment of NeonatologyJubilee Mission Medical CollegeThrissur, Kerala, IndiaE-mail: jubileenicu@gmail.com

Vijay Yewale MD

Consultant PediatricianApollo HospitalNavi Mumbai, Maharashtra, IndiaE-mail: vnyewale@gmail.com

Vikram Hirekerur MD DCH DNB

Associate ProfessorAshwini Rural Medical College and HospitalSolapur, Maharashtra, IndiaE-mail: vikram.hirekerur@yahoo.com

Vinay Joshi DM (Neo) MD

Fellowship in PICU and PCICU, University of Toronto, CanadaFellowship in Neonatal and Perinatal Medicine, University of New South Wales, Sydney, AustraliaPediatric Intensivist and NeonatologistKokilaben Dhirubahai Ambani HospitalMumbai, Maharashtra, IndiaE-mail: Vinay.Hk.Joshi@relianceada.com

Yogesh Waikar MD DNB MNAMS

PGCC

Fellow in Pediatric Gastroenterology and Liver TransplantConsultant Pediatric Gastroenterologist and HepatologistPedgihep ClinicsNagpur, Mahrashtra, IndiaE-mail: pedgihep@yahoo.com

Foreword

Neonatal intensive care has always been a highly technology-dependent specialty. With exponential advancements in medical equipment and laboratory in recent years, the clinical skills of eliciting history, doing a systematic but meaningful examination and synthesizing the data to reach at a pathophysiological diagnosis have further dwindled. The goal behind publication of this book is to facilitate a structured and systematic approach to clinical evaluation, examination and skills essential for care of the sick newborn. In addition, the book also offers very useful and practical information about imaging, medications and vital statistics related to India’s newborn. Divided into theme-based sections, several topics of practical and clinical relevance have been covered with focus on essential clinical skills.

Over the last decade, the Neonatology Chapter of Indian Academy of Pediatrics has taken great strides and done phenomenal work towards training and education of postgraduates, fellows and nurses in the field of neonatology. The dynamic, committed and highly motivated leadership of this chapter has mastered the art of organizing high quality workshops and conferences with pure academic focus in a short span of time. They have excelled in producing and publishing a number of hugely popular resources for everyone working for the care of newborns. OSCE in Neonatology: A Guide Book is another unique effort to help the postgraduates and fellows in honing their skills in neonatal medicine. OSCEs are an essential and very effective method of teaching, learning and evaluating neonatology. The book should serve as a useful resource for examiners.

I am confident this book will become an essential resource for all students, house officers, postgraduates, fellows and clinicians working in SNCUs and NICUs. The contributions of more than 60 trained neonatologists, should be able to guide readers towards optimal and rational utilization of available resources translating into better and cost-effective clinical care.

My best wishes for the success of OSCE in Neonatology: A Guide Book.

Praveen KumarProfessor, Neonatal Unit

Department of PediatricsPost Graduate Institute of Medical Education and Research

Chandigarh, India

We take great pleasure and pride in offering the OSCE in Neonatology: A guide book. Clinical medicine is the core of patient care. History, physical examination, ordering tests and their interpretation form the foundation of this clinical medicine. Knowing the family and establishing rapport with the parents would also add value to the clinical care. In the present technology- driven neonatal care, there is tendency to ignore the core concepts and order of tests and investigations even before a detailed evaluation of the newborn. In this book, we have provided a structured approach to the newborn care with special emphasis on history, examination, interpretation of laboratory tests and tried to bridge the gap between bench and bedside.

The book has chapters on focused history, focused examination, emergency room assessment and stabilization, case scenarios, drugs, equipment, interpreting tests/results and counseling, which provide insights into clinical approach. We sincerely hope the book adds to the armamentarium of postgraduates, fellows, and students of neonatology to sharpen the skills and provide a rational clinical approach.

We are grateful to all our authors for their valuable contributions without which this book would not have seen the light of the day. We would appreciate and look forward to your feedback and comments.

We thank the office bearers of IAP Neonatology Chapter for having the faith in us. We appreciate all the support of Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Ritu Sharma (Director–Content Strategy), Ms Sunita Katla (PA to Group Chairman and Publishing Manager), Mr Manish Pahuja (General Manager–Production) for all their support to work in this project and make it a success. Without their cooperation, we could not have completed this project.

Preface

Srinivas MurkiMD DNB DM(Neo)

Rhishikesh ThakreMD DNB DM(Neo) DCH FCPS FIAP

ContentsChapter 1. Focused History Taking ...................................................1

Instructions to Facilitator ...........................................................................1Preterm Admission at Birth .......................................................................1Feeding History Taking ...............................................................................2Inadequate Breast Milk ...............................................................................4Respiratory Distress .....................................................................................4Shock .................................................................................................................5Hypoglycemia ................................................................................................5Jaundice ...........................................................................................................6

Chapter 2. Focused Clinical Examination ..........................................8Well Baby Examination ...............................................................................8Breastfeeding .............................................................................................. 10Weight, length and Occipitofrontal Circumference (OFC) Measurement .............................................................................................. 11Capillary Refill Time ................................................................................... 13Blood Pressure Measurement by Oscillometry ............................... 14Developmental Dysplasia of Hip .......................................................... 14Jaundice ........................................................................................................ 16Moro Examination ..................................................................................... 17Popliteal Angle ............................................................................................ 18Heel to Ear Examination .......................................................................... 19Scarf Sign ...................................................................................................... 19Assessment of Shoulder Tone ............................................................... 20Palmar Grasp Reflex .................................................................................. 22Plantar Grasp Reflex .................................................................................. 23Asymmetric Tonic Neck Reflex .............................................................. 24Denver Developmental Screening Test (DDST)-II .......................... 25Respiratory Distress Scoring .................................................................. 26Evaluate for Systemic Causes of Poor Weight Gain ....................... 29Check for Adequacy of Ventilator Settings ....................................... 29Check for Adequacy of Bubble CPAP Settings ................................ 30Assessing Fontanel ................................................................................... 30Hammersmith Neonatal Neurological Examination ..................... 31New Ballard Score ...................................................................................... 33

Chapter 3. Emergency Assessment/Stabilization ............................40Identifying a Sick Newborn .................................................................... 35Assess for Jaundice Severity .................................................................. 36Respiratory Distress .................................................................................. 37Shock .............................................................................................................. 39Hypoglycemia ............................................................................................. 40Seizures ......................................................................................................... 41Abnormal Movements (not Seizures) ................................................. 42

OSCE in Neonatology

xx Assessing Hydration ................................................................................. 43Excessive Crying ......................................................................................... 45Vomiting ........................................................................................................ 46Previous Sibling Unexpected Death ................................................... 47Cough in a Neonate .................................................................................. 48Case Studies: Jaundice ............................................................................. 49Case Studies: Respiratory Distress ....................................................... 53Case Studies: Sick Newborn ................................................................... 56

Chapter 4. Case Studies .................................................................67Cardiology ................................................................................................... 64Electrolyte Disturbances ......................................................................... 68Infections in the Newborn ...................................................................... 73Musculoskeletal .......................................................................................... 78Jaundice ........................................................................................................ 82Inborn Errors of Metabolism .................................................................. 89Nutrition and Growth ............................................................................... 94Nephrology .................................................................................................. 97Emergency and Critical Care ................................................................101Necrotizing Enterocolitis .......................................................................104Adopted Baby ...........................................................................................106Gastroesophageal Reflux ......................................................................107Thyroid Disorders in the Newborn ....................................................110Retinopathy of Prematurity Screening ............................................113Statistics ......................................................................................................120

Chapter 5. Drugs ......................................................................... 127Adenosine...................................................................................................124Adrenaline ..................................................................................................125Magnesium Sulfate .................................................................................125Erythromycin .............................................................................................125lyophilized Amphotericin ....................................................................126Amphotericin ............................................................................................127Calcium Gluconate ..................................................................................128Thiamine .....................................................................................................128Pyridoxine ...................................................................................................128Anti-D ...........................................................................................................128Dextrose ......................................................................................................129Diazoxide ....................................................................................................129Milrinone .....................................................................................................130Fluconazole ................................................................................................132Fosphenytoin ............................................................................................132Intravenous Immunoglobulin (IVIG) .................................................133linezolid .....................................................................................................133low Molecular Weight Heparin ..........................................................134Nitric Oxide ................................................................................................135Normal Saline ............................................................................................136Dexamethasone .......................................................................................136Betamethasone ........................................................................................137

Contents

xxiPropranolol ................................................................................................138Phenobarbitone .......................................................................................139Probiotics ....................................................................................................139Sildenafil ......................................................................................................140Vancomycin................................................................................................141Alpostin .......................................................................................................142

Chapter 6. Instruments ............................................................... 147Bilirubinometer .........................................................................................143FiO2 monitor ..............................................................................................144Fluxmeter ....................................................................................................144Neonatal Incubator .................................................................................145Infusion Pump ...........................................................................................146Multichannel (Multi-parameter) Monitor ........................................147Phototherapy Unit ...................................................................................148Pulse Oximeter ..........................................................................................148Radiant Warmer ........................................................................................149Self-inflating Bag and Mask..................................................................150Syringe Pump ............................................................................................151Weighing Machine ..................................................................................152

Chapter 7. Imaging ..................................................................... 158Interpretation of Chest X-ray/Abdomen .........................................153Neonatal Cranial Ultrasound ...............................................................171Echocardiogram .......................................................................................176Magnetic Resonance Imaging ............................................................179

Chapter 8. Interpretation ............................................................ 186Arterial Blood Gas ....................................................................................186Capnography .............................................................................................191C-reactive Protein ....................................................................................192Cardiotocography ....................................................................................193Denver Developental Screening Test-II Interpretation of Reports ......................................................................197Neonatal Electroencephalogram .......................................................200Genetics .......................................................................................................210Intrauterine Growth Chart ....................................................................219Hepatobiliary Case Studies ..................................................................220Jaundice Evaluation ................................................................................224Microerythrocyte Sedimentation Rate ............................................227Neurology Case Studies.........................................................................227Partograph ................................................................................................232Peripheral Smear .....................................................................................234Pulse Oximeter Predischarge ...............................................................239Shake Test ...................................................................................................240Neonatal Surgery .....................................................................................241

Chapter 9. Observed Station ........................................................ 249Neonatal Resuscitation ..........................................................................249Phenobarbital Administration ...........................................................251

OSCE in Neonatology

xxii Unexplained Birth Asphyxia ................................................................252Counseling .................................................................................................253Sudden Neonatal Death in Unit .........................................................254Sudden Death of a Newborn in the Unit .........................................255Previous Sibling Unexpected Death .................................................255Consent for a New Drug or Trial .........................................................256Consent for Therapeutic Hypothermia ............................................257Death of ElBW Baby ...............................................................................258Death of a Baby after a Prolonged Hospital Stay .........................259Death of Baby Operated for Diaphragmatic Hernia ....................260

Chapter 10. miscellaneous ............................................................ 262India Demographics Spots ...................................................................262Spots .............................................................................................................269

Index .................................................................................................... 281