CLIPP 7 Flashcards
risk factors for infant resp distressw
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
Risk factors for infant resp distress
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
RDS is caused by, occurs at, has sx of
deficiency of lung surfactant and delayed lung maturation , can occur as late as 37 weeks, cases tachypneia
most common cause of resp distress in preemies
RDS
Mom having DM is risk for
delayed lung mat. and low surfactant in infant
infants of moms w/ c section or DM or LGA infants more likely to have
TTN
infants of moms w/ c section or DM or LGA infants (and SGA?) more likely to have
TTN
PTX risk factors
underlying lung dz like meconium aspiration or neonatal RDS, or mechanical ventilation
a non specific response to hypoglycemia
Tachypneia
a non specific response to hypoglycemia
Tachypneia
BS levels in diabetic moms babies
hypo glycemia because of hyperinsulinemic state occurring in gestation
what is one group of babies have increased risk of heart defects and thus increased risk of CHF
IDM
prolonged PROM is assoc w/
neonatal sepsis increased incidence
one initial presentation of neonatal sepsis
tachypnea
congenital diaphragmatci hernia
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.
absent breath sounds or presence of bowel sounds on one side of chest can indicate
congenital diaphragmatic hernai
how does coarc cause resp distress
severe outflow obstruction of left vent
circumstances of neonatal PE
only if redisposing condition such as placement of a central venous catheter
why are preemies more likely to become hypothermic
bc small body size
how is apgar scored in general
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.
apgar HR scores:
0-absent
1- 100
apgar resp effort scores:
0 - absent
1- weak, irreg, gasp
2- good, crying
apgar muscle tone scores:
0 - flaccid
1 - some flexion of extremities
2- well flexed, or active movement of extrmieities
apgar relfex/irritab scores:
0 - no response
1 - grimace, weak cry
2- good cry / active withdrawal
apgar appearance/color scores:
0 - cyanotic or pale all over
1- extremities blue
2 - pink all over
factors impacting apgar score
gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions that may be present in the infant.
what does apgar represent
fetus to neonatal transition
what is a good indicator of health of intrauterine environment
infants weight at birth
percentiles for LGA, AGA, SGA
> 90th, 10-90th, below 10th or below 3rd
LGA complicatiosn and cuases
main cause is maternal DM
complications include brachial plexus injury, facial n palsy, fx clavicle
SGA/IUGR are not the same thing but share these complciatiosn
Temperature instability (hypothermia)
Inadequate glycogen stores (hypoglycemia)
Polycythemia and hyperviscosity
SGA vs IUGR
This means that every IUGR infant is SGA, but not all SGA infants have IUGR.
general path of flow of fetal circulation
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.
4 changes in circulation that occur as baby goes from fetal to neonatal life
pda/pfo close, plum arterial resistance DROPS, initiation of air breathing by infant, removal of low resist. placental circulation by cutting the umb cord
how does babys first breath work
replaces lung fluid w/ air - fluid leaves w/ vagina contractions and absorption into plum. lymphatics. delay in this absorption–>TTN
HR and RR in first and second hour of life
1st: 160-180, 60-80
2nd: HR 120-160, 40-60
two signs of poor transition into neonatal life from fetal life
ttn aka persistent postnatal pulm edema, persistent pulm htn of newborn (PPHN)``
persistnt pulm htn of newborn (PPHN)
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.
sx PPHN
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)
Conditions –> PPHN
diaphragmatic hernia, hypoplasic lungs, meconium aspiration, in utero asphyxia
intercostal and subcostal retractions mean
incr WOB due to decr lung compliance from edema or primary lung pathology
grunting
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
approach to cyanotic defects in newborn
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
one risk factor for tga
diabmetic mohter
normal inspiratory cxr should show __ intercostal spaces on rib fields
8 r more
gold standard for dx congenital heart lesions and pphn
echo
why aren’t some heart murmurs heard in early life
bc of high pulm vascular pressure
oxygen chall test / hyperoxia test
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
TTN vs RDS in 36weeer
TTN more likely than RDS at 36w, can distinguish often w cxr , and TTN in latepreterm or term
what are two things that hypothermia can cause/assoc w
tacyhcardia, assoc w/ sepsis
in severely ill baby w coarct, the pulses—
may not differ in extremities bc CO is so low
how does maternal hyperglycemia impact fetus
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
does moms insulin cross placenta
no
primary anabolic hromone for fetal growth
insulin
how does macrocosmic infant form
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
incidence of major malformations is directly related to___ in IDM. what is the threshold?
first trim hgb A1C levels, if >12% then 12 fold increase in major malforaitmiosn
does formula or breastmilk have lower renal solute load
breast milk
feeding of the infant in rep distress
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.
danger of Asymptomatic hypogly in infants
glucose is main substrate for brain metabolism in neonate so even asymptomatic hypogly can impact brain dvpt
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: __
41 and 50 mg/dL.
if you get a reagent test strip of <40 for sugar, you should__
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
CXR in ttn
wet looking lungs and perihilar streaking, no air bronchograms or consolidation
diffuse reticulogranular appearance of the lung fields (“ground glass appearance”) and air bronchograms.
RDS
A radiograph shows air-filled loops of bowel in the left side of the chest, displacing the heart and mediastinum to the contralateral side
congenital diaphragamatic hernia
DDH is aka and includes
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
risk factors for DDH
breech, females, fam hx
barlow test
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.
ortolani test
done in abDUCtion. feel for clunk which indicates Relocation, indicating it was previously dislocated. do each side sep.
how many wet diapers/day should infant have
at least 6
how many times a day should baby feed
every 2-4h, 10-15m/side
Any infant discharged from the nursery before 48 hours of life must be evaluated by a health care practitioner within __
48h
“a radio-opaque line of fluid in the horizontal fissure of the right lung.”
TTN
when does infant pass meconium infrequently
20-34w - thus most meconium asp seen in term or post term infants
use of betamethasone
helps infant make surfactant
BPD
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.
