Common Newborn Illnesses Lecture Powerpoint Flashcards
Most newborns begin effective respirations following delivery and should establish regular respirations by 1 min of age, but ___% may require some form of resuscitation and even a smaller percent require intensive interventions. What interventions do we give? (2)
10%, bag mask ventilations and temp maintenance to minimize hypothermia which will lead to adverse transitioning
Infants born before ___ weeks are at risk for adverse outcomes at birth
39 weeks (general practice promotes not performing an elective c section until at least 39 weeks for healthy babies (march of dimes))
Transient tachypnea of the newborn (TTN)/retained fetal lung fluid syndrome definition
Most common mild respiratory problem of babies that begins after birth of term or late preterm infants and lasts about three days (RR>60/min) more often seen in c section infants and presents with nonspecific tachypnea, retraction, nasal flaring, and cyanosis (hard to differentiate on presentation alone)
Signs and symptoms associated with respiratory transition difficulties in newborns (5)
- neonatal tachypnea (rr>60rpm)
- apnea (pause >20 sec or accompanied by cyanois and bradycardia)
- central cyanosis (pathologic, acral is benign)
- nasal flaring upon inspiration
- retractions
Preterm birth timeline
gestation less than 37 weeks
Late preterm birth timeline
Gestation 34-36.9 weeks
Term birth timeline
Gestation between 37-41.9 weeks
Post term birth timeline
Gestation 42 or greater weeks
Low birth weight definition
<2500 grams at birth
SGA and LGA
Small for gestational age and large for gestational age (which indicate either below 10th or above 90th percentiles)
IUGR (intrauterine growth restriction)
Infant whose growth is limited compared to potential due to environmental, genetic, or other factors, either symmetric (head size and weight symmetrically small) or assymetric (small weight but size is preserved, associated with more comorbidities)
____ account for most NICU admissions, and ___ must be evaluated promptly and accurately and involve rapid intervention
Newborn respiratory disorders, respiratory distress
Examples of initial diagnostic studies of newborn respiratory distress (6)
- chest xray
- CBC with diff
- blood culture
- blood glucose
- pulse ox
- ABG
Way to differentiate congenital cyanotic heart disease from newborn respiratory distress if suspected
ABG post hyperoxia challenge
Assessment of a newborn with respiratory distress (3)
- maternal medical history and pregnancy history (including studies like ultrasound)
- labor and delivery history
- presentation of the new born
Apgar score
measure of how healthy a baby is after birth on a scale of 1-10, with 7 or greater being healthy, comprised of five components: 1) color, 2) heart rate, 3) reflexes, 4) muscle tone, and 5) respiration, each of which is given a score of 0, 1, or 2.
Scaphoid abdomen on assessment of newborn with respiratory distress is a sign of ___, asymmetric chest movements ___, and stridor ____
congenital diaphragmatic hernia, pneumothorax, subglottic stenosis (upper airway obstruction)
Some common conditions affecting respiratory status of newborn (4)
- use of anesthesia (central depression)
- maternal diabetes (hyaline membrane disease, polycythemia, cardiomyopathy)
- premature delivery (hyaline membrane disease)
- Meconium stained amniotic fluid (meconium aspiration syndrome)
Transient tachypnea of the newborn chest x ray findings
Increased interstitial markings indicating fluid
Transient tachypnea of the newborn (TTN) treatment options (2)
- must be watched in a hospital and sometimes placed on oxygen but most recover without complication (improves with minimal ventilation)
- prevent by avoiding elective c section younger than 39 weeks gestation
Normal resting heart rate of the newborn, normal resting BP of the newborn
120-160bpm, 64/41 mmHg
Hyaline membrane disease and neonatal pneumonia common x ray finding
Uniform reticulonodualar appearance/Ground glass appearance on chest x ray
Hyaline membrane disease (respiratory distress syndrome)
newborn specific lung disease due to surfactant deficiency, occurs most always in preterm infants*** who have not produced adequate pulmonary surfactant
Hyaline membrane disease (respiratory distress syndrome) clinical presentation (4)
- respiratory stress soon after delivery and worsens with time
- tachypnea, intercostal retraction, and grunting
- hypoxia and hypercarbia
- respiratory acidosis
Hyaline membrane disease (respiratory distress syndrome) treatment options (4)
- cpap
- umbilical or radial arterial line to monitor blood gas levels
- surfactant replacement therapy (standard of treatment)***
- ampicillin + gentamycin until cultures are drawn and determined neg
Complications of Respiratory distress syndrome in the newborn (4)
- patent ductus arteriosus
- pulmonary air leaks
- pneumothorax
- retinopathy of prematurity
Treatment options for premature birth
- betamethasone** (accelerate fetal lung maturation)
- ca2+ blockers
Ways to confirm gestational age in the infant (1 and 1 discontinued)
- ultrasounds***
- amniocentesis (no longer used)
Meconium aspiration syndrome (MAS) definition
A small percentage of the subset of patients that have a meconium stained amniotic fluid (approx 12% of deliveries). can also occur during delivery, more common in term or post term deliveries*** (higher the longer the gestational age), sees hypoxia and respiratory acidosis as well as pneumothorax and persistent pulmonary hypertension
Meconium aspiration syndrome treatment options (3)
- supportive care (iv, possibly mechanical ventilation)
- ampicillin and gentamycin
- prevention by inducing labor
Congenital diaphragmatic hernia presentation (5)
- ultrasound can detect in gestation
- cyanosis
- respiratory distress and no breath sounds on one lung
- distant heart sounds
- scaphoid abdomen
Congenital diaphragmatic hernia findings on x ray
Bowel gas pattern sin upper left lung fields (contents of the abdomen above the diaphragm)
Congenital diaphragmatic hernia treatment options (3)
- immediate tracheal intubation
- NG tube placement for decompression
- surgery
Congenital diaphragmatic hernia prognosis
very poor
Esophageal atresia common x ray findings
NG or OG tube unable to be passed into stomach
Esophageal atresia/tracheoesophageal fistula diagnostic finding
Inability of being able to pass rigid NG or OG tube into stomach (checked on x ray but no contrast god forbid they aspirate) and copious secretions in the mouth
Most common infection in neonate
Pneumonia
Common pathogens in neonatal pneumonia (pre, peri, and postnatally)
- CMV antenatally
- group B strep, e coli, chlamydia trachomatis perinatally
- respiratory viruses postnatally
Neonatal pneumonia diagnostic studies (3)
- CXR
- cbc with diff
- blood culture
Neonatal pneumonia treatment options (3)
- mechanical ventilation
- IV nutrition
- ampicillin and gentamycin or vanco for coverage of staph
Neonatal pneumonia common complication (1)
persistent pulmonary hypertension
Neonatal pneumonia prevention (1)
-maternal GBS screening
Recall transposition of great vessels
-aorta arises from right ventricle, pulmonary artery from left, systemic and pulmonary circulations exist as parallel, patent ductus arteriosus and patent foramen ovale enable survival, almost 40% have VSD
Cyanotic heart diseases present ___, noncyanotic can only be found on ____
6-12 hours after birth, echocardiogram
Early presenting congenital heart diseases (4)
- transposition of great vessels
- tetralogy of fallot
- tricuspid atresia
- pulmonary stenosis
Congenital heart disease presenting symptoms (7)
- cyanosis
- shock
- murmur
- tachypnea
- abnormal heart size, shape, location
- hyperoxia challenge
- ABG normal PaCO2 and decreased PaO2 along with metabolic acidosis
Hyperoxia challenge
A test to the response of excess oxygen, PaO2 goes up to >300 in normal babies, >150 in pulmonary disease and between 50-150 in cardiac disease or severe pulmonary hypertension
2 subtypes of neonatal sepsis and risk factors of each
- early onset (<48 hours), prior GBS, maternal infection, organisms acquired form birth canal
- late onset (>48 hrs), prolonged hospitalization, malformations
Organisms acquired from birth canal (3)
- GBS
- Enteric gram -
- Listeria monocytogenes
Neonatal sepsis signs and symptoms (4)
- fever
- apnea
- bradycardia
- change in tone (floppy baby time)
Neonatal sepsis diagnostic studies (6)
- CBC with diff
- blood culture
- UA and culture
- CSF cultures
- CXR
- ABG’s
Neonatal sepsis treatment options (4)
- ampicillin
- aminoglycocide
- acyclovir
- vancomycin if CSF
Indications for intrapartum GBS prophylaxis (4)
- previous infant with invasive GBS disease
- GBS bacteriuria during current pregnancy
- positive GBS screening during pregnancy
- delivery <37 weeks gestation and unknown status
Normal full term newborn blood glucose levels (hypoglycemia of the neonate)
at least 40 mg/dL, without this they will seize within 6 hours of birth unlike something like withdrawal
Hypoglycemia of the neonate presenting symptoms (5)
- cyanosis
- apnea
- hypothermia
- seizures
- jittery/tremors
Risks for hypoglycemia of the neonate (5)
- mom with gestational diabetes
- small or large for gestational age
- infection
- erythroblastalis fetalis
- preterm
Hypoglycemia treatment options (based on blood glucose range)
- 35-45 either breast feed if asymptomatic or 5-10ml/kg iv glucose if symptomatic then maintain for 24 hr
- minibolus 5-10 ml/kg iv glucose if asymptomatic or symptomatic if below 34
Hyperbilirubinemia (physiologic jaunice) characteristics (3)
- never happens in first 24 hours
- occurs in nearly every newborn infant to a varying degree
- if conjugated bilirubin more than 20% of total or more than 2 mg/dl, suggests abnormality such as biliary atresia
First step to take in diagnosing a jaundiced infant
-fractionate conjugated and unconjugated bilirubin to determine conc of each
Total bilirubin vs age in hours
Chart that places infant in specific risk zone for development of severe hyperbilirubinemia using the nomogram by plotting points and to then determine if in high, intermediate, or low risk zone
Treatment for hyperbilirubinemia
phototherapy
Hemorrhagic disease of the newborn (vit K deficient bleeding) definition
Can occur directly after birth or many weeks later, vit K is synthesized by intesetinal bacteria, can be affected by maternal drugs, even if breastfed can still be at risk, bleeding manifests at umbilicus, circumcision, hematomas on scalp, or melena, therefore all newborns are given vit k shots as standard of treatment
Classic presentation of necrotizing enteroclolitis (NEC) (7)
- most common surgical disease of newborn
- usually affects premature and low birth weight infants in 2nd to third weeks of life***
- distension of abdomen
- air leak
- bilious (green yellow) vomiting
- history of polyhydramnios (excess amniotic fluid in the sac)
- bloody stool
Intestinal atresia/stenosis of the infant characteristic findings (7)
- first 2 days of life
- bilious vomit if distal to ampulla and not if proximal (majority distal)
- trisomy 21 patients
- history of hydramnios
- abdominal distension
- double bubble (duodenal atresia) x ray finding
- failure to pass meiconium
All atresias and stenoses require…
….surgical intervention
Hirschsprung’s disease (aganglionic megacolon) definition
Congenital absence of submucosal and myenteric plexuses of the distal intestine, often associated with down’s and other congenital abnormalities, presents as an obstruction (abdominal distension, constipation, vomting), suspected in infants whom initial passage of meconium is delayed past 24 hours
Definative diagnosis of hirschsprung’s disease and treatment options (1)
rectal biopsy, surgical resection
Midgut volvulus definition
Occurs as result of malrotation in fetal anatomic abnormality that predisposees midgut to vascular compromise, typically occurs within a month, must restore blood flow emergently
Midgut volvulus presentation, diagnostic study (1), and treatment (1)
- most present within first month, sometimes up to 1 year, anorexia and abdominal pain, bilious vomiting
- upper GI series
- surgery
