Case 7 - Newborn with resp distress

Question 1

C-section predisposes to what cause of neonatal resp distress?

Answer 1

TTN (transient tachypnea of the neonate)

Question 2

What counts as prolonged PROM?

Answer 2

≥ 18 hrs

Question 3

RDS occurs as late as __ weeks’ gestation.

Answer 3

37

Question 4

DDx for neonate w/ resp distress?

Answer 4

TTN, RDS, pneumothorax, hypoglycemia, CHF, neonatal sepsis, congenital diaphragmatic hernia, severe coarc, maternal drug use, meconium aspiration

Question 5

What are the five components of APGAR?

Answer 5

Appearance/Color, Pulse (0, 100), Grimace/”Reflex Irritability”, Activity/Tone, Respirations

Question 6

Define LGA

Answer 6

Large for gestational age (LGA) is defined as weight for gest. age > 90th %ile [REMEMBER: Confirm WGA w/ Ballard exam]

Question 7

Define SGA

Answer 7

SGA = wt for gest age < 3rd (or 10th depending on who you ask) %ile

Question 8

Unique problems of the SGA baby

Answer 8

Temperature instability (hypothermia); Inadequate glycogen stores (hypoglycemia); Polycythemia and hyperviscosity

Question 9

HR and RR in first hour of life?

Answer 9

HR is often 160-180/min, and RR is often 60-80/min

Question 10

If an infant successfully transitions its circulation, what should its HR and RR be at 2 hrs of life?

Answer 10

HR is usually 120-160/min, and RR is usually 40-60/min

Question 11

DDx of blue baby?

Answer 11

Resp: TTN, RDS (Pneumothorax, Diaphragmatic hernia, Choanal atresia, Pulm hypoplasia); Cardiac: Tet, TGA (Truncus arteriosus, Tricuspid atresia, TAPVR, Pulm atresia); Neuro: HIE, Intraventric hemorr, Sepsis/meningitis; ID: Septic shock, Meningitis; Other: Resp depr 2/2 maternal meds, Hypothermia, Polycythemia/hyperviscosity syn

Question 12

(proposed) definition of hypoglycemia in the neonate?

Answer 12

Asymptomatic infants and infants at risk for hypoglycemia: < 35 mg/dL; Symptomatic infants: < 45 mg/dL

Question 13

A diaphragmatic hernia most commonly develops on the ____ side

Answer 13

left

Question 14

Perform screening for Developmental Dysplasia of the Hip (DDH) until what age?

Answer 14

Until child is 18 m/o.

Question 15

Call the doc if the newborn has fewer than ___ wet diapers per day

Answer 15

6 (though keep in mind how good new diapers are)

Question 16

Define AGA.

Answer 16

Within 10–90th percentile on the intrauterine growth curve

Question 17

Risk factors for DDH?

Answer 17

1. Breech (30–50% occur in breech infant); 2. Sex (9:1 female predom); 3. Family hx

Question 18

A - scoring [A]ppearance in APGAR?

Answer 18

2 - all pink; 1 - limbs blue; 0 - all blue or pale

Question 19

P - scoring [P]ulse in APGAR?

Answer 19

2 - HR > 100bpm; 1 - HR < 100bpm; 0 - no HR

Question 20

G - scoring [G]rimace or “reflex irritability” in APGAR?

Answer 20

2 - Good cry or active withdrawal; 1 - Grimace or weak cry; 0 - No response

Question 21

A - scoring [A]ctivity/Tone in APGAR?

Answer 21

2 - Well flexed, or active mov’ts of extremities; 1 - some flexion of extremities; 0 - flaccid

Question 22

R - scoring [R]espiratory effort in APGAR?

Answer 22

2 - Good, crying; 1 - Weak, irregular, or gasping; 0 - absent

Question 23

Which is Ortolani and which is Barlow?

Answer 23

“Ortolani goes out and Barlow pushes back.”

Question 24

Risk factors for RDS?

Answer 24

IDM (due to delayed lung maturation); Sibling w/ ho RDS; Male; C-section w/o labor; Perinatal asphyxia

Question 25

Normal inspiratory films in an infant should have ??how many?? intercostal spaces of lung fields on both sides.

Answer 25

8 or more

Question 26

CXR findings of TTN?

Answer 26

1. Perihilar streaking (d/t interstitial fluid and engorged lymphatics); 2. Coarse, fluffy densities that represent fluid-filled alveoli; 3. Fluid in pleural space and fissures

Question 27

CXR findings in RDS?

Answer 27

Air bronchograms and “Ground-glass” (Diffuse reticulogranular appearance of lung fields)