Addiction

Question 1

Birth defects due to nicotine use during pregnancy

Answer 1

Premature birth, cleft lip, bleeding of placenta, risk factor for SUIDS

Question 2

SUIDS

Answer 2

Sudden death in infant less than 1 year occurs during sleep.
Types: SIDS, and accidental suffocation.

Sleep on back, firm surface, near parents. No smoking.

Question 3

Two studies involving vaping

Answer 3

EVALI, PARDS

Question 4

Marijuana use while pregnant

Answer 4

Low birth weight, developmental and cognitive delays. Anxiety, asocial behavior.

Question 5

Neonatal opioid withdrawal syndrome and long term symptoms

Answer 5

Hyperactivity of CNS
At birth, drug supply is immediately cut off. Cry is higher, irritable, tremors, swearing
Treat with morphine taper.

Long term: Lower IQ, poor social skills.

Question 6

Methamphetamine use during pregnancy

Answer 6

Increased risk of miscarriage or premature
Feeding difficulties
ADHD symptoms.
Anxiety, depression.

Question 7

Alcohol use during pregnancy symptoms

Answer 7

Growth def
Neuro developmental delays
Facial dysmophism.

Question 8

Prematurity is less than how many weeks
Very preterm
Extremely preterm

Answer 8

premature: 37 weeks.
Very: Less than or equal to 32
Extreme: Less than or equal to 28

Question 9

Low birth weight
Very LBW
Extremely LBW

Answer 9

Low: Less than 2,500g (5.5)
Very low: Less than 1,500g (3.4)
Extremely low: Less than 1,000g (2.2)

Question 10

Premature risk factors

Answer 10

Maternal age less than 16
Multiples 
Medical conditions 
Infections during pregnancy 
Cigarette smoking
ETOH 1x per day 
Drug use 
Poor nutrition 
Stress

Question 11

Systemic complications of preterm birth

1. Respiratory
2. GI
3. Infection risks
4. Hearing
5. Cardiovascular
6. Neuro
7. Ophthalmic

Answer 11

1. Respiratory: Respiratory distress syndrome. 80% born before 27 weeks. Up to 5% mortality. Tx with respiratory support.
2. GI
3. Infection risks bc immature immune system
4. Hearing impairment. 1-5% at less than 26 weeks.
5. Cardiovascular. Patent Ductus Arteriosus. 5% less than 1,500g. May cause HF.
6. Neuro.
   - Interventricular hemorrhage. Up to 11% less than 1,500g.
   - Periventricular leukomalacia. (PVL) Lesions may lead to neuro delay or vision impairment.
7. Ophthalmic. Myopia or retinopathy or prematurity.

Question 12

Myopia of prematurity

Answer 12

Negative correlation with birth weight/gestational age.

Non axial- steeper cornea, shallow AC, increased lens thickness.

Question 13

Retina is avascular until __ month

Answer 13

4th

Question 14

Development of central retinal artery (along with photoreceptors)
Time it takes artery to reach equator and nasal periphery.

Answer 14

equator: 5 months.

Nasal periphery: 8 months.

Question 15

ROP (retinopathy of prematurity) risk factors

Answer 15

Birth weight, gestational age, oxygen. Retinal blood vessels regulate based on oxygen- changing amount can cause blood vessels to freak out.

Question 16

ROP screening criteria

Answer 16

If gestational age is less than/equal to 30 weeks.
Birth weight less than/equal to 1,500g.
Infants at risk determined by neonatology.

Question 17

ROP screening schedule. When to do it?

Answer 17

31 weeks of 4 weeks post-natal age if delivered at 28 or 29 weeks.

Question 18

ROP zones

Answer 18

Zone 1: Posterior pole. Radius 2x the ON to fovea.
Zone 2: Temporal equator to nasal ora.
Zone 3: Residual temporal and medial part of the retina.

Question 19

ROP stages

Answer 19

1. Demarcation line.
2. Demarcation ridge
3. Neovascularlization along the ridge.
   4a: Partial retinal detachment without fovea.
   4b: Partial retinal detachment with fovea.
4. Total RD. Will see funnel shape.

Question 20

Plus disease

Answer 20

Dilation and tortuosity of vasculature in the posterior pole. High vascular activity and shunting due to highly active vessels. Need tx because it could progress to RD.

Question 21

Treatments for ROP

Answer 21

Cryotherapy, laser tx (standard of care), and anti VEGF.

Question 22

CRYO-ROP 88 study.

• What zones did they treat?
• Results

Answer 22

Treated zones 1 or II or zone 3 with plus.

50% decrease in RD but poor VA and structural outcomes.

Question 23

ET-ROP 99 Study (laser)
Treatment groups
Results

Answer 23

Zone 1 any stage with plus.
Zone 1, stage 3 with or without plus.
Zone 3, stage 2 or 3 with plus.

Increase in myopia in zone treated.

Question 24

BEAT-ROP 11 study (VEGF)

Answer 24

Bevacizumab (avastin)
Treated Zone 1 and 2 stage 3 with plus.
Tx did not destroy retina and did not result in high myopia.
May have long term safety problems associated with developmental delays.
PEDIG is looking for lowest conc to treat.

Question 25

Why is the laser treatment causing an increase in myopia?

Answer 25

Not associated with increased axial length. Must be something retinal or vitreal.

Question 26

How to treat ROP

Answer 26

Monitor for repression.

Most common treatment is laser photocoagulation.

Question 27

Thalidomine

Answer 27

Helped with nausea in pregnant women, but children were born missing limbs/having extra.

Question 28

Isotretinoin accutane

Answer 28

25% neonatal defects. Can occur whether the mother or father is taking accurate.

Cleft palate, heart defects, hydrocephaly, eye/ear abnormalities, CNS problems.

Monthly checks by doctor, requires 2 different contraception methods.