07: 2-hour old male with respiratory distress Flashcards
Does maternal insulin cross the placenta?
No, but high maternal blood glucose can stimulate fetal insulin production
What is the primary anabolic hormone for fetal growth?
Insulin
High levels of insulin in the 3rd trimester can cause what?
Organomegaly and a macrosomic infant
Infants born to women with HbAc levels >12% have a ____-fold increase in major birth defects?
12-fold
What are the 3 main findings of infant respiratory distress?
- Tachypnea
- Retractions
- Grunting
Retractions are due to increased or decreased lung compliance?
Decreased
At what respiratory rate do infants often need NG tubes for feeding?
> 80 breaths/min
When is an infant considered “late preterm?”
Between 34 weeks and 36 weeks, 6 days
What’s the target glucose screen value prior to routine feeds?
> 45 mg/dL
At 3-4 hours after birth, what should glucose levels fall between?
65-71 mg/dL
Any infant discharged before ___ hours must be seen by a PCP within ___ hours?
48, 48
Which respiratory disorder of the newborn causes wet looking lungs on x-ray, is the result of delayed clearance of fluid from the lungs following birth, and is much more common to infants born to diabetic mothers or born by c-section?
TTN
Which respiratory disorder of the newborn causes diffuse ground glass and air bronchograms on x-ray, is caused by a deficiency of lung surfactant and delayed lung maturation, can occur as late as 37 weeks gestation, is the most common cause of respiratory distress in premature infants, and is more common in infants of diabetic mothers due to a delay of sufficient surfactant production?
RDS
How do you differentiate between neonatal pneumonia vs TTN/RDS?
X-ray findings will be similar, but clinical findings would be more concerning for sepsis
How do you differentiate between TTN and RDS?
TTN is transient, beginning shortly after birth and resolving by day 2. RDS is more severe, and causes cyanosis
Which cause of newborn tachypnea is caused by a collection of gas in the pleural space, with resultant collapse of lung tissue, is relatively uncommon, but can be caused by mechanical ventilation in a preemie or by meconium aspiration or severe RDS?
Pneumothorax
What’s a metabolic cause of tachypnea in a newborn?
Hypoglycemia
What’s a temperature cause of tachypnea in a newborn?
Hypothermia
Is maternal diabetes a risk factor for the development of structural congenital heart disease?
Yes
When does tachypnea due to cardiac anomalies normally occur?
6-8 weeks after birth
What’s the reason that VSD, PDA, and AVC cause tachypnea?
Due to pulmonary overcirculation
Why does coarctation of the aorta lead to tachypnea?
Pulmonary venous congestion and L heart obstruction
When does tachypnea due to coarctation of the aorta usually occur?
3-7 days of age
What’s a cyanotic defect that can cause tachypnea and cyanosis?
Total anomalous pulmonary venous return
Can prolonged rupture of the membranes (>18 hours) increase risk for neonatal sepsis?
Yes
What are the 4 risk factors for neonatal sepsis?
- Maternal GBS colonization
- > 18 hour rupture of membranes
- Delivery <37 weeks
- Maternal fever or chorioamnionitis
What cause of newborn tachypnea might present with absent breach sounds or presence of bowel sounds on one side of the chest?
Congenital diaphragmatic hernia
Where is the most common type of congenital diaphragmatic hernia located?
Posterolateral (Bochdalek hernia)
