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PEDS 7500 > CLIPP 7 > Flashcards

CLIPP 7 Flashcards

0
Q

risk factors for infant resp distressw

A

GBS –>sepisis, prolonged premature rupture of membranes (>=18h), c section leading to transient tachypnea of newborn, prematurity predisposed to RDS due to lung immaturity and lack of surfactant but most infants born at 36w don’t have RDS, meconium in amniotic fluid is risk for meconium aspiration, maternal dm

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1
Q

Risk factors for infant resp distress

A

Gbs bc leads to sepsis, prolonged premature rupture of membranes (more than or equal to 18h), c section leads to transient tachypnea of newborn, prematurity (predisposed to rds due to lung immaturity and lack of surfactant but most infants born 36w don’t have rds), meconium in amniotic fluid is risk for meconium aspiration, maternal diabetes

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2
Q

RDS is caused by, occurs at, has sx of

A

deficiency of lung surfactant and delayed lung maturation , can occur as late as 37 weeks, cases tachypneia

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3
Q

most common cause of resp distress in preemies

A

RDS

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4
Q

Mom having DM is risk for

A

delayed lung mat. and low surfactant in infant

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5
Q

infants of moms w/ c section or DM or LGA infants more likely to have

A

TTN

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6
Q

infants of moms w/ c section or DM or LGA infants (and SGA?) more likely to have

A

TTN

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7
Q

PTX risk factors

A

underlying lung dz like meconium aspiration or neonatal RDS, or mechanical ventilation

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8
Q

a non specific response to hypoglycemia

A

Tachypneia

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9
Q

a non specific response to hypoglycemia

A

Tachypneia

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10
Q

BS levels in diabetic moms babies

A

hypo glycemia because of hyperinsulinemic state occurring in gestation

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11
Q

what is one group of babies have increased risk of heart defects and thus increased risk of CHF

A

IDM

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12
Q

prolonged PROM is assoc w/

A

neonatal sepsis increased incidence

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13
Q

one initial presentation of neonatal sepsis

A

tachypnea

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14
Q

congenital diaphragmatci hernia

A

Most common type (accounting for > 95% of cases) is the Bochdalek hernia, which is located posterolaterally.
This defect allows the passage of organs from the abdomen into the chest cavity and severely impairs lung development.
Most defects occur on the left side.
Absent breath sounds or presence of bowel sounds on one side of the chest are important diagnostic clues.

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15
Q

absent breath sounds or presence of bowel sounds on one side of chest can indicate

A

congenital diaphragmatic hernai

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16
Q

how does coarc cause resp distress

A

severe outflow obstruction of left vent

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17
Q

circumstances of neonatal PE

A

only if redisposing condition such as placement of a central venous catheter

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19
Q

why are preemies more likely to become hypothermic

A

bc small body size

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20
Q

how is apgar scored in general

A

5 areas (appearance/color, pulse/hr, grimace/reflex, activity/tone, respirations), each gets a score of 0-2 for a total score of 0-10. normal is 7-10, assign scores q5min as long as score is under 7. otherwise just do at min 1 and 5.

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21
Q

apgar HR scores:

A

0-absent

1- 100

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22
Q

apgar resp effort scores:

A

0 - absent
1- weak, irreg, gasp
2- good, crying

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23
Q

apgar muscle tone scores:

A

0 - flaccid
1 - some flexion of extremities
2- well flexed, or active movement of extrmieities

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24
Q

apgar relfex/irritab scores:

A

0 - no response
1 - grimace, weak cry
2- good cry / active withdrawal

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25
Q

apgar appearance/color scores:

A

0 - cyanotic or pale all over
1- extremities blue
2 - pink all over

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26
Q

factors impacting apgar score

A

gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions that may be present in the infant.

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27
Q

what does apgar represent

A

fetus to neonatal transition

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28
Q

what is a good indicator of health of intrauterine environment

A

infants weight at birth

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29
Q

percentiles for LGA, AGA, SGA

A

> 90th, 10-90th, below 10th or below 3rd

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30
Q

LGA complicatiosn and cuases

A

main cause is maternal DM

complications include brachial plexus injury, facial n palsy, fx clavicle

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31
Q

SGA/IUGR are not the same thing but share these complciatiosn

A

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

32
Q

SGA vs IUGR

A

This means that every IUGR infant is SGA, but not all SGA infants have IUGR.

33
Q

general path of flow of fetal circulation

A

oxy blood from placenta goes to UV . some of this to liver but most shunted through DV to IVC and some of this in the RA goes to LA thru PFO to coronaries/brain/upper body circ. most goes to RV and plum a, and then thru PDA as neonatal plum vasc resistance is HIGH!!!. from pDA to desc aorta.

34
Q

4 changes in circulation that occur as baby goes from fetal to neonatal life

A

pda/pfo close, plum arterial resistance DROPS, initiation of air breathing by infant, removal of low resist. placental circulation by cutting the umb cord

35
Q

how does babys first breath work

A

replaces lung fluid w/ air - fluid leaves w/ vagina contractions and absorption into plum. lymphatics. delay in this absorption–>TTN

36
Q

HR and RR in first and second hour of life

A

1st: 160-180, 60-80
2nd: HR 120-160, 40-60

37
Q

two signs of poor transition into neonatal life from fetal life

A

ttn aka persistent postnatal pulm edema, persistent pulm htn of newborn (PPHN)``

38
Q

persistnt pulm htn of newborn (PPHN)

A

Result of elevated pulmonary vascular resistance to the point that venous blood is diverted to various degrees through fetal channels (the ductus arteriosus and foramen ovale) into the systemic circulation and bypasses the lungs, resulting in systemic arterial hypoxemia.

39
Q

sx PPHN

A

Tachypnea
Tachycardia
Respiratory distress, with findings such as expiratory grunting and nasal flaring
Generalized cyanosis
Low oxygen levels, even while receiving 100% oxygen (normally ox chall test will increase Po02 if resp issue if give oxy)

40
Q

Conditions –> PPHN

A

diaphragmatic hernia, hypoplasic lungs, meconium aspiration, in utero asphyxia

41
Q

intercostal and subcostal retractions mean

A

incr WOB due to decr lung compliance from edema or primary lung pathology

42
Q

grunting

A

end of expiration, represents infant trying to increase transpulm pressure , increase lung vol and better his or her gas exchange as the exhale against partially clsoed glottis

43
Q

approach to cyanotic defects in newborn

A

resp vs cardio vs cns vs infxn vs other

common resp = ttn, rds
uncommon resp = ptx, choanal atreasia, pulm hypoplasia, diaphragmatic hernia

common cardio = tetralogy, transposion
uncmmon cardio= truncus, tricuspid atresia, TAPVR, pulm atresai

cns = IVH, sepsis/menignits, HIE

infxn = septick schok, meningitis

other = respi depression due to moms meds, hypothermia, polycythemia/hypervisc

44
Q

one risk factor for tga

A

diabmetic mohter

45
Q

normal inspiratory cxr should show __ intercostal spaces on rib fields

A

8 r more

46
Q

gold standard for dx congenital heart lesions and pphn

A

echo

47
Q

why aren’t some heart murmurs heard in early life

A

bc of high pulm vascular pressure

48
Q

oxygen chall test / hyperoxia test

A

used to differentiate between cardiac and resp causes of cyanosis - oxygen will increase PaO2 if resp lesion (except not pphn?) and will not help if its cardiac

49
Q

TTN vs RDS in 36weeer

A

TTN more likely than RDS at 36w, can distinguish often w cxr , and TTN in latepreterm or term

50
Q

what are two things that hypothermia can cause/assoc w

A

tacyhcardia, assoc w/ sepsis

51
Q

in severely ill baby w coarct, the pulses—

A

may not differ in extremities bc CO is so low

52
Q

how does maternal hyperglycemia impact fetus

A

high mom blood sugar leads to high fetus blood sugar which stimulates babys insulin–>hyperinsulinemia and after birth, will have hypogly because they have so much insulin in response to moms sugar

53
Q

does moms insulin cross placenta

A

no

54
Q

primary anabolic hromone for fetal growth

A

insulin

55
Q

how does macrocosmic infant form

A

hgih 3rd trim. levels of insulin lead to increase in size of insulin-sensitive organ systems like heart, liver and muscle and an increase in fat synth and deposition –>macrosomia. the insulin-INsensitive organs like brain and kidney are approp size and not enlarged

56
Q

incidence of major malformations is directly related to___ in IDM. what is the threshold?

A

first trim hgb A1C levels, if >12% then 12 fold increase in major malforaitmiosn

57
Q

does formula or breastmilk have lower renal solute load

A

breast milk

58
Q

feeding of the infant in rep distress

A

if 60-80 breaths/min, can tolerate oral often but may need IV or gastric tube if if distress worsens w/ oral feeds. if >80, may trouble w/ naso. may then need feeding tube.

59
Q

danger of Asymptomatic hypogly in infants

A

glucose is main substrate for brain metabolism in neonate so even asymptomatic hypogly can impact brain dvpt

60
Q

Currently, most neonatologists attempt to maintain glucose levels between __.

Proposed threshold values for initial intervention depend on the clinical situation:

Asymptomatic infants and infants at risk for hypoglycemia: __
Symptomatic infants: __

A

41 and 50 mg/dL.

61
Q

if you get a reagent test strip of <40 for sugar, you should__

A

lab analyzis to confirm the serum or plasma glucose level and tx start immediately, without waiting for the results.
tx is based on presence or not of symptoms, and if sx then use IV dextrose and if not, give formula or breast milk orally or thourgh nG tube. if sugar does not rise to >40 by the time one feeding is done, then do IV dex

62
Q

CXR in ttn

A

wet looking lungs and perihilar streaking, no air bronchograms or consolidation

63
Q

diffuse reticulogranular appearance of the lung fields (“ground glass appearance”) and air bronchograms.

A

RDS

64
Q

A radiograph shows air-filled loops of bowel in the left side of the chest, displacing the heart and mediastinum to the contralateral side

A

congenital diaphragamatic hernia

65
Q

DDH is aka and includes

A

developmental dysplasia of hip aka congenital dislocation of the hip and includes partial or complete dislocation or instability of fem head.
do exams of this til 18 mod

66
Q

risk factors for DDH

A

breech, females, fam hx

67
Q

barlow test

A

done in adduction so legs pushed back kinda like fetal position, with hands on greater trochanters so you can see if ball is in joint or not. do each side sep.

68
Q

ortolani test

A

done in abDUCtion. feel for clunk which indicates Relocation, indicating it was previously dislocated. do each side sep.

69
Q

how many wet diapers/day should infant have

A

at least 6

70
Q

how many times a day should baby feed

A

every 2-4h, 10-15m/side

71
Q

Any infant discharged from the nursery before 48 hours of life must be evaluated by a health care practitioner within __

A

48h

72
Q

“a radio-opaque line of fluid in the horizontal fissure of the right lung.”

A

TTN

73
Q

when does infant pass meconium infrequently

A

20-34w - thus most meconium asp seen in term or post term infants

74
Q

use of betamethasone

A

helps infant make surfactant

75
Q

BPD

A

result of prolonged mechanical ventilation. Our patient is at risk for developing this syndrome if he requires intubation. Chest x-ray may show atelectasis, inflammation, or pulmonary edema. With severe disease, the chest x-ray may reveal fibrosis and hyperinflation.

PEDS 7500 (32 decks)

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