פגות וגיל היילוד Flashcards
APGAR score
time of mesurement
A- apperance
0- blue
1- pink body + blue extremiteis
2- pink
P-pulse
0-absent
1- < 100
2- >100
G- grimace (reflexs)
0- abscent
1- grimaces
2- grimces + coughs, cries, pulls away
A- activity (tone)
0- weak
1- some movments
2- active
R- respiration
0- abscent
1- slow, irregular + weak cry
2- normal breathing + vigorous cry
Apgar score:
whats its means to have the following scores:
0-3
4-7
8-10
0-3 - immidiate resuscitation
4-7 possible resuscitation, continue suppory and observe
8-10 no further untervention
Meconium aspiration syndrome
risk factor?
presentation?
mgmt?
Risk factors- Postterm infants (GA > 41)
Presenation- peinatal asphyxia or respiratory distress
Mgmt- induction of delivery prior 41 wks, respiratory support as needed. NO inhaled in severe cases
Persistent pulmonaey HTN of the newborn
definition?
presentation
Dgx?
Mgmt?
Pulmonary vascular resistance remain abnormally eleveted after birth (R –> L shunting
presenation- cyanosis + respiratory distrees in first 24h
Dgx- definite by ECHO- eleveted RV pressure + ecidance of pulmonary HTN
Mgmt- repiratory support and tx underline ceause
Transient tachypnea of the newborn (TTN)
what is the most common finding on X-ray?
and when it usally resolved?
Perihilar streaking
resolve within 24 - 72hours
infant born via rapid vaginal delivery and had rapid breathing and oxygenation issues shortly after birth.
which condition is most likley?
TTN
Transient tacypnea of the newborn
*also after C-section
What is the name of the sunstance that cover the newborn after delivery?
Vernix caseosa- importent to immunity
what is that in the newborn in reaction to cold?
Cutis mamorata- עור שיש
can be normal or secondary to infection/ neonates/ hypothyroidisim/ down
What is the main reason for central cyanosis in newborn
Cyanotic heart disease
what we see in this 2 photos
(unrelated to each other)
above- harlequin dyschromia- שינוי צבע זמני בילודים בחצי גוף / גפה אחת נובע מאי יציבותצ ווסקולרית זמנית
below- Mangiolian spots - dermal melanocytosis- שכיח בילדים כהי עור, לרוב חולף עד גיל שנתיים
Which disease a/w this finding
Cafe au leit
NF if > 6 spots
which disease is a/w this finding?
what we also need to check
port wine
Struge weber syndrome
eye testing- gluocoma
Brain MRI- leptomeningial angioma
What this finding in newborn, what can we see histologicllay
when disapear
Erythema toxicum
shows in 2-3 days of life
diseapper- after a week from newborn.
What is the name of this finding?
to whice type of infection its resembele?
Pustular melanosis
more in black babies.
could last months
resemble HSV or S.aureus
What is the findings?
Salamon patch
normal and mostly resolve withing the 1st year
more porminant in cry or Tm change
What is the name of this finding?
Milia
נובע מאצירת שומן בבלוטות שומן בפנים. נעלם תוך מספר שבועות מהלידה
Which newborn reflex disapear first and which one last for life?
dissapear first- rooting reflex
last for life- parachute reflex
When is the ant. and the post fortanelle closes?
ant. frontanella- 4-24 months
post- until 2 month of age (large fronatelle - suspect for hypothyroidism/ down)
Which type of hematoma crossing the suture line?
Subgleal hematoma
יכול להיות דימום מסיבי צריך לנטר
Which type of hematoma does not cross suture line?
Cephalohematoma- local hematoma sub periosteal, 1-2% of deliveries. no need to inteven
What is Craniosynostosis?
early closure of suture, causes abnormal skull stracture
Erb’s palsy
which nerves are demege and how can we tell in physical exmination?
C5-C6
non-symmetrical moro
Grasps normal unilateral
most of the time- fully recover
Tx- follow-up and exresice to prevent stroctures
איזו תסמונת גמילה מתבטאת באי יכולת להירדם, עיטושים, פיהוקים חוסר עלייה במשקל ופרכוסים
symptoms 1-5d after delivery SGA child
and which syndrome with the same clinical presentation but after 1-4 wks
1-5 days =Heroin
1-4 wks = metadhone
איזו תסמונת גמילה ביילוד מתבטאת לאחר כשבוע עם שיהוקים, תנועות פה חריגות אי שקט וחוסר שינה ולאחר מכן עם תאבון מוגבר, הזעות ומחזורי שינ מופרעים
Phenobarbital withdrwal
Which substance use is a/w
היפרדות שליה, אספיקציה, IUGR, Low IQ, מיקרוצפלוס
Cocaine
Which heart condition is a/w fetal alcohol syndrome?
mainly malformations in septum
what are the long term complications of fetal alcoghol syndrome?
בעיות קשב וריכוז, הפרעות התנהגות ובמקרים חמורים פיגור שכלי
When jaundice is consider pathological?
- delivery < 24h
- Bilirubin elevation rate > 5 mg/dl/day
- Direct Bili > 2mg/dl
Causes of jaundice in the following time frame
* 24h
* 2-3days
* after 7 days
* > 1 month
24h- pathological
2-3days- Breastfeeding, sepsis, UTI
after 7 days- Breast-milk, sepsis, biliary atresia, hepatitis, galactosemia, hypothyroidism, CF
> 1 month- shypilis, Toxo, biliary atresia, galactosemia, hepatitis, pyloric stenosis, hypothyroidisim
Breastfeeding vs breastmilk jaundice
reasons for each one
breasfeeding- not enoughe milk = dhydration = concentrate of bili
tx- more feeding, using formula if needed
Breastmilk- substance inhibit the conjugtae enzyme
tx phototherapy
Which disease is a/w bronze baby syndrome
phototherapy to biliary atresia = high levels of direct bilirubin
most common cause of direct bilirubin in newborn
Biliary atresia
Which syndrome is a/w defect of the liver to excrete direct bilirubin and the liver has grossly black apperance with normal liver enzymes
Dubin Jhonson syndrome
rare to present in neonates
Which TORCHES inf. is most common cause of neonatal cholestasis?
CMV
but all of them can cause
Most common cause of ABO incompatibility ?
how many will actually develop hemolysis?
mom O
newborn A/B
only 10% with mismatch will develop hemolysis
which syndrome is a/w jaundice after stress?
isolated
Gilbert syndrome
Tx for Crigler najar syndrome?
Phenobarbital
severe damage in the enzyme that conjugate
only type II
type I- complete absence of the enzyme
what is the DDx for prolong jaundice?
Down
hypothyroidism
breastfeeding
Gilbert / Crigler najar
Biliary atresia
1. when jaundice show after birth?
2. colour of stool
3. Dgx- findings?
4. Tx?
- progressive jaundice around 1 wk after delivery
- a-cholic stool
- US- Triangular cod sign / small Gallbladder
- Tx- Kasai procedure- חיבור בן הכבד לדאודונום ליציאת המרה. עדיף לפני גיל 30 יום לפרוגנוזה טובה יותר
Which syndrome is AD, self resolving and a/w low bile ducts and destruction of the arcitecture?
Alagille syndrome
alpha1 anti-trypsin def will lead to destruction of intra or extra hepatic bile ducts?
intra hepatic
כולסטזיס כרוני עד אי ספיקת כבד
לעיתים מעורבות ראתית- COPD בלא מעשנים
when we will give IVIG in neonate jaundice?
jaundice due ABO or RH
Defintion of cholestasis in newborn
eleveted of direct bilirubin > 2 wks of age
direct hyperbilirubinemia is always pathological
cholestasis in newborn is diveded to intra and extra hepatic.
what are the causes of each one
extra hepatic- biliary atresia
Intra hepatic- Viral hepatitis, Alagille syndrome, idiopathic hepatitis, metabolic disase (like congenital hemochromatosis)
most common menefistation of algille syndrome in heart
peiphareal pulmonary atrial stenosis
common CHD- TOF
Butterfly vertebra and posterio embryotoxon is a/w?
Alagille syndrome
Mutation in JAG1 or NOTCH2 is a/w which syndrome?
Alagille syndrome
AD
DDx for low production of RBC in the newborn?
4
- Blackfan diamond anemia
- fanconi anemia
- infection- parvo B19, CMV, measels
- congenital leukemia
Which are the main 2 types of coombs + hemolysis anemia in the newborn?
ABO inco.
Rh inco
How can we asses the severity of the anemia in the fetus ?
Spectophotometric analysis- asses the levels of bilirubin במי השפיר
When we wil use Kleihauer betke test
identify FHb in the mother blood - Fetal-maternal hemmorage
What is the test shown here?
what is the dark spots?
Kleihauer betke test
in dark- the fetal RBC
When the newborn get to the nadir value of Hb?
around 8-12wks after delivery ~ around Hb10-11
Chest X-ray of Meconium aspiration syndrome?
הצללות דיפוזיות, היפראינפלציה , עלייה בסיכון לפניאומוטורקס ופניאומומדיאסטינום
What is a complication of Meconium aspiration syndrome?
Persistent PHN
Tx for MAS (meconium aspiration syndrome)
- respiratory support
- Surfactant / NO
- ventilation
3-5% mortality
Dgx of TTN (transient tachypnea of the newborn)
אבחנה שבשלילה
רק אחרי ששללנו - RDS or pneumonia
CXR of TTN?
ציור ריאתי מוגבר, נוזל בסדק הבין אונתי, היפראינפלציה ולעיתים גם נוזל פלאורלי
Risk factor of TTN
fist delivery
maternal asthma or DM
ceaser section
twins
post -term prenancy
Prognosis of TTN?
Self resolving after 24-72hrs
DDx for meconium plug?
- CF- 40% of cases
- hirshpung - 40% of cases
- Barium enema
Tx options for meconium plug?
self resolving - 30%
glycerine candels
Rectum wash with isotonic water
Gastrophin חוקן- helps 95% must given IV fluid with the procedure
Meconium iliues.
what is the main etiology?
CF
Tx for meconium ileus?
חוקן גסטרופין
אם אין תגובה / חשד לפרפורציה:
לפרוטומיה
Meconium ileus on XCR
מעי דק מרוחב באופן בלתי שווה + מיקרוקולון
RDS definition
חוסר בסורפקטנט המאפיין תינוקות שנולדים טרם המועד
most common cause of respiratory distress in preterm infants?
RDS due to surfactant def.
CXR of RDS
Ground glass or Great white out appearance
Air bronchogram
Definiton of apnea of prematurity?
Respiratory pause > 20s or respiratory pause + O2 desatration and or bradycarda
Dgx pf exclusion
Tx for apnea of prematurity?
- stable thermal enviroment- incubator / radient warmer
- O2 supplement 90-95%
- Caffeine
when panea of prematrity typically resolves?
around 42 weeks of postmenstural age
first line tx of RDS?
Surfactant
Which ppx tx is recommended to reduce risk of RDS in preterm delivery at 34 WGA?
true also for babies for week < 37
Antenatal steroids
which abdominal X-ray finding is the hallmark of NEC?
Pneumatosis intestinalis = gas within wall of intestines
Which labratory finding in NEC is a/w poor prognosis ?
Neutropenia
Which lab findings is correlate with NEC?
Hyponathremia
eleveted lactate»_space; acidosis / metabolic or respiratory
pancytopenia
What is the relations in NEC between onset of NEC and neonate age
as delivery was earlier»_space; the onset of NEC will be later
פג מתייצג עם בטן תפוחה וקשה, דם בצואה , לתרגיה ונראה טוקסי
בצילום חזה התמונה הבאה
מה האבחנה?
Pneumatosis intestinalis = pathognemonic for NEC
immidiate mgmt for NEC
Bowl rest, de-compression
broad spectrum Abx- after culture
a pre-term baby present with erythema and distention around the abdomen.
CXR showing the following picture.
what is the finding and what is the dgx?
pneumoperitoneum = air above the liver on lateral decubitus films = bowl perforaiton
What are the indications for laprotomy in NEC?
- perforation / positive culture from peritoneumמוחלט
יחסי - clinical worsening on optimal therapy
- fixed loop
- erythema on abdomen surface
complication- Short bowl syndrome, strictures, infection and necrosis of wound
prognosis of NEC + pneumatosis inestinalis?
20-50% fail under Tx
mortality rate 20-50%
What is the most effective way to prevent NEC
Breastfeeding
Risk factors for RDS
Maternal DM
low apgar score
previous kid with RDS
c-section
Which clinical findings is a/w shock and RDS
בצקות פריפריות
איליוס
אוליגוריה
When we will intubate RDS ?
Saturation O2% < 90% under CPAP
or
PH < 7.2
or
PCO2 ~60
or severe apnea
always add surfactant
Tx for Hypotension in RDS
and For resistant Hypotension
Hypotension- IV fluids + Dopamine
Resistant Hypotension- Hydrocortisone (susp. adrenal insuff.)
Empiric Abx for RDS
Ampiciliin + Gentamycin
Intracranial ventricular hemmorhage
when it mainly occur? (after delivery)
3 days after delivery in neonates
A neonate present in his 3rd day of life with hypotension, apnia and sezuries.
במישוש, המרפס פתוח והמטוקריט נמוך, שאינו מגיב למתן דם
מה האבחנה האפשרית?
IVH
What are the complications of IVH
- PVL (perivantricular leukomalacia)- נגעים נקרוטיים / ציסטות בחמור הלבן,סממן לפגיעה דיפוזית מוחית הפוגיה במיאלנציה
- PPH (post hemorragic hydrocephalus)- follow-up on US and consider הכנסת נקז
- CP, seziures
Prevention of IVH?
Celestone (steroids)- בסיכון ללידה מוקדמת
להיזהר בלידה מכשירנית
What are the 4 grade of IVH
I- sub epyndymal. 15% risk for permenent neurologic deficit
II- in ventricles w/o enlargment
III- ventricals + enlargment of ventricles
IV- Ventricles + brain parencyma- 75% risk for permenent neurologic deficit
Tx for PPH (post hemmoragic hydrocephalus)
VP shunt (when its progressive and symptomatic)
When and to whom we will do US screeing of the brain?
all neonates < 32 wks, in day 3 and day 7 of life
and when reach to 36-40wks »_space; evaluate PVL
most sensetive way to asses PVL?
MRI
Which cardian anomalies are a/w DM in pregnancy?
TGA, VSD
Which disease is a/w all of the following presenation in the newborn
RDS- preterm
TTN- term
Jaundice
polyhydramnius
Kideny damage
sacral agenesis
Meconium pluglimbs deformations
hypoglycemia and hypocalcemia
DM
what is Bronchopulmonary displasia (BPD)
Chronic lung disease a/w disruption of normal pulmonary development and injury to premature lungs
usally present infants with RDS who continue to depends on respiratory support beyond 28d of life / 36wks of postmenstrual age
risk factors for Bronchopulmonary dysplasia
Fetal growth restriction
maternal smoking
Dgx of BPD
neonate < 31 weeks - need O2 supplementation when 36 wks of age or discharge (the longest)
or
neonate >32 - needed O2 after 28-55 days
CXR of BPD
היפראינפלציה ועכירות אינטרסציאלית
במצב חמור- שינויים ציסטים
Common complication of BPD?
PHT ~15% of kids up to cor pulmonale and right heart failure
how many kids with congenital CMV will be symp. at delivery?
~10%
What cerachtristic uniqe for congenital CMV
Peri-ventricular calcifications
(in toxo its diffuse)
+
microchephalus (in toxo is macro)
hearing loss.
What we see in lab of congenital CMV?
PLT count
Liver enzyme
Bilirubin
Hb?
Throbocytopenia
eleveted liver enzyme
direct bilirubin elevation
anemia
Definite dgx of congenital CMV?
PCR in 3wks. from blood, urine or saliva
Tx for Congenital CMV?
and what its side effect
Ganacyclovir - reduce hearing loss and improve development prognosis
Side effect- neutropenia and myelosuppression. can give GCSF or stop tx.
Which congenital TORCES infection is a/w this picutre
Syphilis
Hutchinsons teeth
Dgx of congenital rubella?
Rubella IgM
culture
must isolate the infected babies from pregnant womens- can secrete the virus fora whole year
A newborn present with bulberry muffin rash + PDA + hearing loss and cataracts.
what is the most likely congenital inf.
Rubella
Which congenital inf. is a-symtomatic at birth but shows up a few days later?
HSV
A baby present with Chorioretinitis + macrochepalus + Diffuse brain lesions (enahance ring lesions)
what is the most likley congenital inf?
TOXO
Tx for toxoplasma and who we treat?
Treat everyone- symp. or non symp
1 year tx of- Leucovorin, pyrimethamine, sulfadiazine
for hydrocephalus- shunt
C/I for breastfeeding
maternal causes
5
- HIV, HTLV
- active TB- only after 2w of tx
- VZV- baby should recive IVIG
- HSV- if theres active lesion around breast area
- Chemotherapy
C/I for beastfeeding on the newborn
baby side
3 metabolic diseases
- Galactosemia
- Maple syrup
- PKU
Dgx of lactose intolerance?
and which formula should they get
Diarrhea , gases,
-
אבחנהחומרים מחזרים בצואה- מעיד על אי ספיגת פחמימות
LactoFree Formula
