07: 2-hour old male with respiratory distress

Question 1

Does maternal insulin cross the placenta?

Answer 1

No, but high maternal blood glucose can stimulate fetal insulin production

Question 2

What is the primary anabolic hormone for fetal growth?

Answer 2

Insulin

Question 3

High levels of insulin in the 3rd trimester can cause what?

Answer 3

Organomegaly and a macrosomic infant

Question 4

Infants born to women with HbAc levels >12% have a ____-fold increase in major birth defects?

Answer 4

12-fold

Question 5

What are the 3 main findings of infant respiratory distress?

Answer 5

1. Tachypnea
2. Retractions
3. Grunting

Question 6

Retractions are due to increased or decreased lung compliance?

Answer 6

Decreased

Question 7

At what respiratory rate do infants often need NG tubes for feeding?

Answer 7

> 80 breaths/min

Question 8

When is an infant considered “late preterm?”

Answer 8

Between 34 weeks and 36 weeks, 6 days

Question 9

What’s the target glucose screen value prior to routine feeds?

Answer 9

> 45 mg/dL

Question 10

At 3-4 hours after birth, what should glucose levels fall between?

Answer 10

65-71 mg/dL

Question 11

Any infant discharged before ___ hours must be seen by a PCP within ___ hours?

Answer 11

48, 48

Question 12

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?

Answer 12

TTN

Question 13

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?

Answer 13

RDS

Question 14

How do you differentiate between neonatal pneumonia vs TTN/RDS?

Answer 14

X-ray findings will be similar, but clinical findings would be more concerning for sepsis

Question 15

How do you differentiate between TTN and RDS?

Answer 15

TTN is transient, beginning shortly after birth and resolving by day 2. RDS is more severe, and causes cyanosis

Question 16

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?

Answer 16

Pneumothorax

Question 17

What’s a metabolic cause of tachypnea in a newborn?

Answer 17

Hypoglycemia

Question 18

What’s a temperature cause of tachypnea in a newborn?

Answer 18

Hypothermia

Question 19

Is maternal diabetes a risk factor for the development of structural congenital heart disease?

Answer 19

Yes

Question 20

When does tachypnea due to cardiac anomalies normally occur?

Answer 20

6-8 weeks after birth

Question 21

What’s the reason that VSD, PDA, and AVC cause tachypnea?

Answer 21

Due to pulmonary overcirculation

Question 22

Why does coarctation of the aorta lead to tachypnea?

Answer 22

Pulmonary venous congestion and L heart obstruction

Question 23

When does tachypnea due to coarctation of the aorta usually occur?

Answer 23

3-7 days of age

Question 24

What’s a cyanotic defect that can cause tachypnea and cyanosis?

Answer 24

Total anomalous pulmonary venous return

Question 25

Can prolonged rupture of the membranes (>18 hours) increase risk for neonatal sepsis?

Answer 25

Yes

Question 26

What are the 4 risk factors for neonatal sepsis?

Answer 26

1. Maternal GBS colonization
2. > 18 hour rupture of membranes
3. Delivery <37 weeks
4. Maternal fever or chorioamnionitis

Question 27

What cause of newborn tachypnea might present with absent breach sounds or presence of bowel sounds on one side of the chest?

Answer 27

Congenital diaphragmatic hernia

Question 28

Where is the most common type of congenital diaphragmatic hernia located?

Answer 28

Posterolateral (Bochdalek hernia)