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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
Klumpke Paralysis
-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
Moro Reflex
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
Causes of Polyhydramnios
**most common = impaired fetal swallowing (GI obstructions or malformations) - excessive fetal productions: multiple fetuses, hydrops fetalis - excessive maternal productions: gestational diabetes
28
Causes of Oligohydraminos
Restricts fetal movment, lung expansion, and if severe placental blood flow **most common cause is renal disease (esp B/L renal a genesis)
29
What is potter syndrome?
- compression deformities of face and limbs (clubbed feet) - scaphoid "prune belly" - Pulmonary hypoplasia * *majority die of respiratory insufficiency in neonatal period**
30
APGAR
assessed at 1 and 5 minutes (10 minutes if low at 5min) | -sustained low scores are virtually always acidotic
31
Meconium stained amniotic fluid
- unusual before 37 weeks gestation - common; higher incidence in AA and post-term infants - more likely to have non-reassuring heart tracings
32
Meconium Aspiration Syndrome
-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
Respiratory Distress Syndrome
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
Transient Tachypnea of the Newborn
More common in infants delivered via C-section CXR: perihilar streaking Tx: O2 therapy spontaneous recovery within days w/ no long term complications
35
Early onset sepsis
anytime from birth to 5ish days
36
Late onset sepsis
affects babes during first days of life through one month of age
37
Most common pathogen in sepsis
Group B Strep
38
Risk factors for sepsis
- premature or prolonged rupture of membranes (>18h) - chorioamnionitis - maternal or intrapartum fever or leukocytosis and preterm birth
39
Treatment of sepsis
ampicillin or gentamicin for 10-14 days | -if meningitis is present add 3rd gen cephalosporin
40
Physiologic Jaundice
indirect hyperbilirubinemia occurs in absence of underlying abnormality -never present before 24hrs of age, peaks between 3-5days old
41
Breast milk Jaundice
indirect hyperbilirubinemia -levels higher and higher longer than physiologic jaundice (dont interrupt breast feeding even when this is the cause)
42
Most common cause of non-physiolgic unconjugated hyperbilirubinemia?
``` #1 ABO incompatibility (O mothers w/ A or B children) -hemolytic anemia #2 Rh incompatibility (give rhogam at 28 weeks) ```
43
What is the goal in treating unconjugated hyperbilirubinemia?
-avoid kernicterus aka sublethal bilirubin encephalopathy
44
Causes of conjugated hyperbilirubinemia
-biliary atresia, hepatitis, infection, metabolic disease
45
Cleft lip repair
repaired shortly after birth or once the infant demonstrates steady weight gain
46
Cleft palate repair
undertaken at 9-12 mo of age | complications: speech difficulties, dental disturbances, recurrent otitis media
47
Double bubble
Duodenal atresia -bilious emesis within a few hours of the first feeding Tx: surgical correction
48
congential diaphragmatic hernia
- compromise early lung development * *lethal in many cases** - left side most common
49
Omphalocele
uncommon - abdominal viscera herniates through umbilicus and there is a sac covered by peritoneal and amniotic membrane - associated congenital GI and cardiac defects
50
Gastrochisis
herniation of intestine through the abdominal wall (lateral to umbilicus) - no covering peritoneal membrane - surgical emergency
51
Biliary atreais
absence of common bile duct | -conjugated hyperbilirubinemia
52
When are babies d/c home?
- 24-48 hours if no significant risk factors and vaginal delivery - 72 hours if c-section
53
What is done before d/c
- first hep B vaccine | - state lab screening
54
When are health maintenance visits done
Within a week of discharge
55
Weight loss
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
Physiologic nadir of hemoglobin and hematocrit
between 8-12 weeks of life | -hemoglobin levels as low as 9 are considered normal

EOR Pediatrics (16 decks)

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