QuestionSBA
QuestionChoice
This is an extremely important differential which would need to be excluded, but the timeframe, yawning, lack of fever and prematurity are more in keeping with maternal drug use.
10034938
b
Neonatal sepsis
QuestionChoice
This may explain the low birth weight as it can cause both macrosomia and intrauterine growth restriction but does not explain the current presentation.
10034940
d
Maternal gestational diabetes mellitus
QuestionChoice
This is correct. The likely diagnosis is maternal opiate use and subsequent neonatal withdrawal. Yawning is a specific sign for opioid withdrawal and being well for the first few days suggests withdrawal over other differentials such as infection. The low birth weight and prematurity also suggest maternal drug use.
10034937
a
Maternal drug use
QuestionChoice
This is less likely to affect babies born at 34 weeks when most babies would have produced surfactant. It would also have been present since birth and does not explain the yawning.
10034939
c
Neonatal respiratory distress syndrome
QuestionChoice
This presents later in life with cyanosis and cardiac signs that are not described in this scenario.
10034941
e
Tetralogy of Fallot
QuestionComment
why cant this be neonatal hypoglycaemia?

43349
QuestionComment
that would most likely present soon after birth
43891
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Phaeochromoexamoma
QuestionComment
also would expect them to have a higher birth weight due to hyperglycaemic exposure 
46285
User
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Relapse Tachycardia
User
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Neoplasia Nightshift
QuestionComment
never expected to use my opiate withdrawal knowledge in a paeds question
45026
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Serpiginous Defibrillator
Concept
Chapter
2693
6106
Neonatal mortality and stillbirth
Topic
153
Paediatrics
19391
Neonatal withdrawal symptoms, such as irritability and yawning, often indicate maternal opiate use during pregnancy.
A 3-day-old baby is recovering in the labour ward. On the last day, he has become irritable and has been constantly crying and frequently yawning. He was born via vaginal delivery at 34 weeks and was 1.6kg at birth. He is afebrile. He was well in his first 2 days of life.

Which of the following is the most likely aetiology of the underlying condition?
a