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EOR Pediatrics > Chapter 2: Neonatal Medicine > Flashcards

Chapter 2: Neonatal Medicine Flashcards

1
Q

What is def of SGA?

A

Newborns w/ weights less than the 10th percentile

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2
Q

What do you monitor closely in SGA babies?

A

Blood glucose levels

-b/c they have a decreased glycogen reserve so greater risk of hypoglycemia

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3
Q

What are SGA babies at risk for?

A
  • fetal demise
  • fetal distress
  • neontal death rates are higher
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4
Q

What are the divisions of IUGR?

A

1) Early onset aka Symmetric
- before 28 weeks
- length and head circumference are proportional to weight

2) Late onset aka Asymmetric
- sparing of head circumference but weight and length are low

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5
Q

Findings consistent w/ prematurity?

A
  • paucity of sole creases
  • absence or smaller than expected breast nodules
  • fuzzy scalp hair
  • visible veins in the skin
  • absence of ear cartilage
  • undescended testes
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6
Q

What is def of LGA?

A

Weights greater than 90th percentile for gestational age

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7
Q

What is more common in LGA babies?

A
  • birth trauma
  • polycythemia
  • hypoglycemia
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8
Q

What is nevus simplex?

A

Stork bite

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9
Q

Who are mongolian patches more common in

A

90% of AA, indian, and asian infants

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10
Q

pearly white or pale yellow epidermal cysts found on the nose, chin and forehead

A

Milia

-benign; no treatment necessary

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11
Q

evanescent papules, vesicles, and pustules each on erythematous base
usually occur initially on the trunk and spread outward to the extremities
move around over time
appears 24-72 hours after birth

A

Erythema Toxicum

-resolves over 3-5 days without therapy

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12
Q

Treatment of infantile seborrhea/cradle cap

A
  • appears between 2 and 10 weeks

- baby oil to scalp for 15 minutes then wash with antidandruff shampoo

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13
Q

Neonatal acne

A
  • develops on cheeks and nose around 3-4 weeks and persists for up to 3 months
  • no treatment is required
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14
Q

Describe murmur of PDA

A
  • continuous murmur over the second left intercostal space

- appreciate in first few days of life

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15
Q

Rhonchi after delivery

A

Common: due to residual amniotic fluid

-true crackles or wheezes are pathologic!!

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16
Q

When does cord fall off?

A

Falls off within 3-4 weeks

if cord persists beyond 8 weeks it is abnormal and may signify a neutrophil disorder

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17
Q

Umbilical hernias tx

A

-Repair if large or persists beyond 3-4 years

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18
Q

Most common cause of ambiguous genitalia

A

Congenital adrenal hyperplasia

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19
Q

Considerations in babies w/ chordae and hypospadias

A
  • do not circumcise in newborn nursery

- should be done by surgical specialist

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20
Q

Cryptoorchidism tx

A
  • If testes has not descended into the scrotal sac by 1 year it is surgically relocated here.
  • *increased risk of malignancy and sterility
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21
Q

Caput sucedaneum

A

edema of the scalp tissues

**crosses midline, suture lines and is firm but pits w/ gentle pressure

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22
Q

Cephalohematoma

A

bleeding into the subperiosteal space

**swelling is limited by suture lines and does not cross midline

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23
Q

When to suspect choanal atresia

A

Cyanotic when calm or feeding but have improved color when crying
Tx: pass small catheter through each side of nose; if does not pass = strong indicator
-oral airway or intubation = short term
-surgery = long term tx

24
Q

Erb Palsy

A

-damage to C5 and C6 roots
-holds the affected arm close to the body, extended at the elbow, internally rotated, forearm fixed in pronation but hand movement is preserved
(often resolves in first 48h; improvement over 6mo; gradual improvement for up to 18 mo w/ intensive PT)

25
Q

Klumpke Paralysis

A

-damage to C7, C8, T1 roots
-upper arm is unaffected but the hand muscles are weak and the grasp reflex may not be present
(often resolves in first 48h; improvement over 6mo; gradual improvement for up to 18 mo w/ intensive PT)

26
Q

Moro Reflex

A

supine infants chest and shoulder up from flat surface
gently but suddenly allow hands and arm to move back toward bed
infants arms should abduct suddenly away midline w/ the fingers extended

27
Q

Causes of Polyhydramnios

A

**most common = impaired fetal swallowing (GI obstructions or malformations)

  • excessive fetal productions: multiple fetuses, hydrops fetalis
  • excessive maternal productions: gestational diabetes
28
Q

Causes of Oligohydraminos

A

Restricts fetal movment, lung expansion, and if severe placental blood flow
**most common cause is renal disease (esp B/L renal a genesis)

29
Q

What is potter syndrome?

A
  • compression deformities of face and limbs (clubbed feet)
  • scaphoid “prune belly”
  • Pulmonary hypoplasia
  • *majority die of respiratory insufficiency in neonatal period**
30
Q

APGAR

A

assessed at 1 and 5 minutes (10 minutes if low at 5min)

-sustained low scores are virtually always acidotic

31
Q

Meconium stained amniotic fluid

A
  • unusual before 37 weeks gestation
  • common; higher incidence in AA and post-term infants
  • more likely to have non-reassuring heart tracings
32
Q

Meconium Aspiration Syndrome

A

-deliver through meconium stained amniotic fluid
-respiratory distress
-more common in post term pregnancies and infants w/ perinatal asphyxia
-air trapping and patchy atelectasis on x-ray
meconium inactivates endogenous surfactant
Tx: Mechanical ventilation w/ high concentration O2 and high mean airway pressures

33
Q

Respiratory Distress Syndrome

A

In newborn results from insufficient surfactant
(more common in newborns)
-presently shortly after birth w/ progressive tachypnea and respiratory distress
-ground glass appearance & air bronchograms on widespread atelectasis on CXR
Tx: respiratory support
Prevention: Antenatal steroids; exogenous surfactant administration at birth

34
Q

Transient Tachypnea of the Newborn

A

More common in infants delivered via C-section
CXR: perihilar streaking
Tx: O2 therapy
spontaneous recovery within days w/ no long term complications

35
Q

Early onset sepsis

A

anytime from birth to 5ish days

36
Q

Late onset sepsis

A

affects babes during first days of life through one month of age

37
Q

Most common pathogen in sepsis

A

Group B Strep

38
Q

Risk factors for sepsis

A
  • premature or prolonged rupture of membranes (>18h)
  • chorioamnionitis
  • maternal or intrapartum fever or leukocytosis and preterm birth
39
Q

Treatment of sepsis

A

ampicillin or gentamicin for 10-14 days

-if meningitis is present add 3rd gen cephalosporin

40
Q

Physiologic Jaundice

A

indirect hyperbilirubinemia occurs in absence of underlying abnormality
-never present before 24hrs of age, peaks between 3-5days old

41
Q

Breast milk Jaundice

A

indirect hyperbilirubinemia
-levels higher and higher longer than physiologic jaundice
(dont interrupt breast feeding even when this is the cause)

42
Q

Most common cause of non-physiolgic unconjugated hyperbilirubinemia?

A 
#1 ABO incompatibility (O mothers w/ A or B children)
-hemolytic anemia
#2 Rh incompatibility (give rhogam at 28 weeks)
43
Q

What is the goal in treating unconjugated hyperbilirubinemia?

A

-avoid kernicterus aka sublethal bilirubin encephalopathy

44
Q

Causes of conjugated hyperbilirubinemia

A

-biliary atresia, hepatitis, infection, metabolic disease

45
Q

Cleft lip repair

A

repaired shortly after birth or once the infant demonstrates steady weight gain

46
Q

Cleft palate repair

A

undertaken at 9-12 mo of age

complications: speech difficulties, dental disturbances, recurrent otitis media

47
Q

Double bubble

A

Duodenal atresia
-bilious emesis within a few hours of the first feeding
Tx: surgical correction

48
Q

congential diaphragmatic hernia

A
  • compromise early lung development
  • *lethal in many cases**
  • left side most common
49
Q

Omphalocele

A

uncommon

  • abdominal viscera herniates through umbilicus and there is a sac covered by peritoneal and amniotic membrane
  • associated congenital GI and cardiac defects
50
Q

Gastrochisis

A

herniation of intestine through the abdominal wall (lateral to umbilicus)

  • no covering peritoneal membrane
  • surgical emergency
51
Q

Biliary atreais

A

absence of common bile duct

-conjugated hyperbilirubinemia

52
Q

When are babies d/c home?

A
  • 24-48 hours if no significant risk factors and vaginal delivery
  • 72 hours if c-section
53
Q

What is done before d/c

A
  • first hep B vaccine

- state lab screening

54
Q

When are health maintenance visits done

A

Within a week of discharge

55
Q

Weight loss

A

neonates lose 5-7% of their birth weight in the first few days
-should gain weight bcd by 14 days of age

-start on vitamin d drops 400IU/day in first few days of life if breastfeeding

56
Q

Physiologic nadir of hemoglobin and hematocrit

A

between 8-12 weeks of life

-hemoglobin levels as low as 9 are considered normal

EOR Pediatrics (16 decks)

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