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General Peds Boards > Fetal and Newborn Care > Flashcards

Fetal and Newborn Care Flashcards

1
Q

Neonatal eye prophylaxis

A
  • Erythromycin ointment
  • Prevent gonorrhea and chlamydia infection
  • Must be applied within 1 hour
  • Other option is silver nitrate but it can cause a chemical conjunctivitis
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2
Q

Signs/symptoms, diagnosis, treatment of dietary protein-induced colitis

A
  • Blood/mucus in stools, poor growth, vomiting, typically presents around 2 months of age
  • Diagnosis is made with positive blood in the stool
  • Eliminate cow milk and/or soy protein from mom’s diet or amino-acid based formula is treatment
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3
Q

Causes of facial nerve palsy at birth

A
  • Present with asymmetric cry and inability to close an eyelid
  • A/w instrumentation used at birth, macrosomia, prematurity, congenital/genetic conditions
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4
Q

Therapeutic hypothermia indications and how does it help

A
  • Indicated for concern for HIE, metabolic acidosis within first hour after birth
  • Decreases apoptosis and damage caused by oxygen free radicals
  • Side effects include bradycardia, coagulopathy, and fat necrosis.
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5
Q

Elevated AFP causes

A
  • Most common reason is incorrect dates, actual causes are RAIN
  • Renal (nephrosis, renal agenesis, polycystic kidney disease)
  • Abdominal wall defects
  • Increased number of fetuses/Incorrect dates
  • Neuro (anencephaly, spina bifida)
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6
Q

Low AFP causes

A

Trisomy 21/Trisomy 18

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7
Q

What does a non stress test measure

A

Spontaneous fetal movements and HR activity (autonomic nervous system integrity)

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8
Q

What does a contraction stress test measure

A

Uteroplacental insufficiency and tolerance of labor

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9
Q

Fetal bradycardia/tachycardia

A
  • Fetal heart block = maternal lupus

- Fetal SVT > 240 requires treatment (antiarrhythmics to mom) to prevent CHF and hydrops in the fetus

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10
Q

Definition of apnea

A

> 20 seconds

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11
Q

Causes of apnea

A

APNEA

  • Abnormal metabolism (hypoglycemia, hypocalcemia, anemia)
  • PDA and other cardiac causes
  • Neurologic (seizures, IVH, premie)
  • Epidemiologic/infecious (sepsis, RSV, pertussis)
  • Abnormal swallowing/GERD
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12
Q

Apnea treatment

A
  • Apnea of prematurity: caffeine or theophylline
  • Primary apnea: oxygen or stimulation
  • Secondary apnea: PPV
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13
Q

Transient tachypnea of the newborn (TTN) symptoms and treatment

A
  • Caused by retained fetal fluid, more common in C-sections
  • CXR: fluid in interlobar fissures and increased pulmonary markings
  • RR > 60, distressed breathing, usually resolves in 72 hours
  • Tx: NPO, monitoring, respiratory support if needed
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14
Q

Neonatal HIE lab findings

A
  • Lactic acidosis, hypoglycemia, hypocalcemia, hyponatremia

- NORMAL ANION GAP

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15
Q

Cause of neonatal RDS

A
  • Lack of surfactant in the lining of the alveoli

- Surfactant gradually increases until 33-36 weeks and then there is a surge

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16
Q

Neonatal RDS xray findings

A
  • Ground glass appearance

- Granular opacifications, air bronchograms

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17
Q

Things that mimic neonatal RDS

A
  • If not improving in 3 days, consider a PDA
  • GBS pneumonia - look for left shift (band ratio greater than 0.2), temperature instability
  • Hypoglycemia (pay attention to labs)
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18
Q

Risks for RDS

A
  • Infant of diabetic mother
  • C section delivery
  • Birth asphyxia
  • Lecithin:sphenigomyelin ratio less than 2
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19
Q

Indication for giving surfactant

A
  • Give within 2 hours of delivery if diagnosed with RDS
  • If < 30 weeks or otherwise at risk for RDS give it prophylactically
  • Expected improvements: INCREASED lung compliance, DECREASED inspiratory pressure
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20
Q

RDS complications

A
  • Pulmonary interstitial emphysema - air leaking into interstitium (precedes pneumothorax)
  • ECMO: if reversible lung disease of less than 10-14 days duration and failure of other methods
  • BPD: oxygen requirement 28 days after birth and/or continued oxygen requirement at 36 weeks corrected gestation — xray shows diffuse opacities with cystic areas and streaky infiltrates
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21
Q

Neonatal sepsis bugs and drugs

A
  • Listeria, e coli, GBS

- Amp/gent

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22
Q

Neonatal GBS stages and treatment

A
  • Early onset: first 7 days
  • Late onset: usually in first month but can be up to 90 days
  • Late late onset: up to 6 months of age
  • Tx: penicillin
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23
Q

GBS risk factors

A

Maternal colonization at birth, preterm, ROM > 18 hours, chorio, multiple gestation, nonwhite maternal race, intrapartum fever, intrauterine monitoring, postpartum maternal bacteremia, previous infant with invasive GBS

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24
Q

Listeria vs GBS

A

Listeria is more likely if mom had flu like illness, GBS is more likely if mom was asymptomatic

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25
Q

Birth clavicular fracture treatment

A
  • Monitoring, can expect the callus to recede within 2 years
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26
Q

Erb’s palsy signs/symptoms

A
  • C5-C7 stretched, associated with clavicular fracture too
  • Waiter’s tip (adducted, internally rotated, wrist/fingers flexed)
  • Phrenic nerve paralysis leading to respiratory distress can occur
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27
Q

Klumpke palsy

A
  • C8-T1
  • Claw hand, can lose ability to grasp
  • Can be associated with Horner syndrome
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28
Q

Delayed cord falling off

A
  • Normal to last up to 2 weeks

- If > 1 month think LAD (Leukocyte Adhesion Deficiency)

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29
Q

Single umbilical artery testing

A

Renal ultrasound is indicated

30
Q

SGA definition

A

Less than 10th percentile or < 2500 grams
- If they’re small due to bad uterine conditions, their growth will catch up but if it’s a congenital issue they’ll stay small

31
Q

LGA definition

A

Greater than 90th percentile or > 3900 grams

32
Q

Normal newborn pH

A
  • pO2 60-90
  • pCO2 35-45
  • scalp pH of 7.25 or higher is normal
33
Q

Apgar as predictor of long term outcomes

A
  • 1 minute reflects life in the uterus

- 5 minute reflects transition and adjustment to the new world

34
Q

Normal premie blood pressure

A

MAP should be greater than or equal to corrected gestational age

35
Q

Very low birth weight infants

A
  • < 1500 grams

- Factors impacting prognosis: gestational age (most important), morbidity while in NICU, IVH

36
Q

Meconium aspiration signs/symptoms

A
  • Mostly in term/postterm infants
  • CXR: patchy areas of atelectasis alternating with areas of hyperinflation, pneumothorax in 10-20%
  • Respiratory distress, barrel chest, rales/rhonchi, pulmonary hypertension
37
Q

Anuric infant evaluation

A
  • Check parts, fluid intake, cath urine specimen, BUN/creatinine, renal ultrasound
38
Q

Passage of meconium

A
  • Needs to happen within the first 48 hours
  • Workup: abdomen/rectum exam, assess feedings, barium enema, surgical consult, intestinal obstruction monitoring
  • Possible causes: meconium plug syndrome, Hirschsprung’s disease, imperforate anus
39
Q

NEC signs/symptoms

A
  • Associated with hypoxic injury, bacterial infections
  • Pneumatosis intestinalis on xray (gas in the bowel wall) air in the biliary tree or pneumoperitoneum
  • Often have positive blood cultures
  • Bloody stools, lethargy, apnea, poor feeding, erythema of abdominal wall, thrombocytopenia
40
Q

NEC treatment and complications

A
  • NG to intermittent suction, NPo for 3 weeks, IV fluids, antibiotics, CBC, lytes, coag studies, serial abdominal films
  • Often require surgical intervention
  • MC complication is intestinal strictures
41
Q

Normal bilirubin in full term newborn in first 24 hours

A
  1. 4

- Elevated bilirubin in the first 24 hours of life is never normal

42
Q

Breastfeeding jaundice

A
  • In first few days of life before milk comes in (due to dehydration)
  • Unconjugated hyperbilirubinemia
  • Increase in enterohepatic circulation
  • Tx: increase breastfeeding
43
Q

Human milk jaundice

A
  • Days 6-14 and may persist for 1-3 months
  • Unconjugated hyperbilirubinemia
  • Due to inherent milk factors
44
Q

Physiologic jaundice

A
  • Days 2-5 usually peaks on day 3
  • First step: check a total and direct serum bili
  • Tx: phototherapy (but can’t use in a direct hyperbili or a family history of light sensitive porphyria)
45
Q

Hemolytic disease of the newborn

A
  • Maternal antibodies to incompatible fetal RBC antigens can cause hemolysis in utero
  • Onset of jaundice in first day of life or prolonged/severe hyperbili
  • Testing: DAT positive
  • ABO incompatibility (jaundice) can cause hyperbili in first kid but Rh (significant anemia) usually happens in second kid
46
Q

Hypoglycemia in a neonate signs/treatment

A
  • Glucose < 25 in preemie or 35 in full term
  • Jitteriness, lethargy, apnea, cyanosis, seizures, tachypnea
  • Tocolytics stimulate fetal insulin so can cause hypoglycemia
  • Tx: 2-3 mL/kg D10 bolus or can use glucocorticoids
47
Q

Infant of diabetic mother complications

A

LGA, hypoplastic left colon, polycythemia

48
Q

Neonatal anemia definition

A
  • At birth 50% of hemoglobin is HgbF
  • Full term Hgb < 13 is anemic - reach nadir at 2-3 months (can be as low as 9)
  • Preemis reach nadir earlier at 1-2 months and can go as low as 7-8
  • Kleihauer Betke test detects presence of fetal cells in mom’s blood
49
Q

Polycythemia treatment indications/complications

A
  • Must be a central venous draw
  • > 70 should be treated
  • Can lead to hypoglycemia, hyperbilirubinemia, and/or thrombocytopenia
  • Tx: partial exchange transfusion
50
Q

Hyperviscosity syndrome

A
  • Results from polycythemia and can lead to lethargy, hypotonia, and irritability
  • Consider if history of twin to twin transfusion, delayed cord clamping, Down syndrome, IDM
51
Q

Omphalocele facts

A
  • Goes through base of umbilical cord
  • Covered with a membrane, can involve intestine and other organs
  • Generally happens in big babies
  • Associated with chromosomal defects (Beckwith Wiedemann), all babies need an echo
  • Tx: keep abdominal contents warm and moist by covering with saline soaked dressings, put in bowel bag
52
Q

Gastroschisis facts

A
  • Through defect in abdominal musculature to the right of the umbilicus
  • Common in small, IUGR babies
  • Only intestine, not covered with a membrane
  • Tx: keep abdominal contents warm and moist by covering with saline soaked dressings, put in bowel bag
53
Q

Diaphragmatic hernia clues

A
  • Scaphoid abdomen, decreased breath sounds on left side, heart sounds on the right
  • Tx: intubation, place NG tube, TPN, surgical repair
54
Q

Most frequent causes of neonatal seizures in full term infant

A

HIE and neonatal encephalopathy

Tx: phenobarbital

55
Q

Caput succedaneum

A
  • Crosses the suture lines

- Soft, boggy pitting

56
Q

Cephalohematoma

A
  • Does not cross suture lines

- More firm and tense

57
Q

IVH grading

A
  • 1: germinal matrix
  • 2: IVH without dilation
  • 3: IVH with dilation
  • 4: involves parenchyma
58
Q

Neonatal symptoms of maternal alcohol exposure

A

Withdrawal: Hyperactivity, irritability, hypoglycemia

59
Q

Neonatal symptoms of maternal cocaine exposure

A

Impaired uteroplacental circulation can increase risk of anomalies: cerebral infarctions, limb anomalies, urogenital defects

60
Q

Neonatal symptoms of maternal amphetamines exposure

A
  • Irritable, easily agitated, IUGR, developmental/cognitive delays
61
Q

Neonatal symptoms of maternal barbituates exposure

A

Hyperactivity, hyperphagia, irritability, crying, poor suck swallow

62
Q

Neonatal symptoms of maternal opioid exposure

A

Hyperirritability, tremors, jitteriness, hypertonia, loose stools, emesis, seizures –> can use methadone or oral morphine in the baby

63
Q

Neonatal abstinence syndrome initial management

A

Decrease stimulation, swaddling, comforting, smaller more frequent feeds

64
Q

Fetal alcohol syndrome clinical features

A
  • Characteristic facies: flat philtrum, thin vermillion border of upper lip, midface hypoplasia, short palpebral fissures
  • Deficient brain growth
  • Prental or postnatal growth retardation
  • MOST COMMON PREVENTABLE CAUSE OF INTELLECTUAL DISABILITY
65
Q

Findings in infant with maternal tobacco use

A
  • IUGR, low birth weight, miscarriage, placental abruption, prematurity
  • Cleft lip/palate
  • Asthma, otitis media, wheezing
  • SIDS
66
Q

Neonatal findings with maternal valproic acid and carbamazepine use

A
  • Facial anomalies: broad bridge nose, small anteverted nostrils, long upper lip, cleft lip
  • Neural tube defects
  • Microcephaly, IUGR
67
Q

Neonatal findings with phenytoin use

A
  • Finger stiffness, nail hypoplasia

- Cardiac defects, clubfoot deformity, ophthalmologic anomalies

68
Q

Risk factors for developing IVH

A

Lower gestational age, pneumothorax, male sex, and bolus administration of normal saline or sodium bicarbonate

69
Q

Surfactant Facts

A
  • Works by LaPlace Law
  • Made by type II alveolar cells
  • Surfactant improves compliance, functional residual capacity, oxygenation/ventilation
70
Q

What type of amniotic fluid/placenta do fraternal (non-identical) twins have?

A

Dichorionic diamniotic

71
Q

Indications to image a sacral dimple

A
  • If > 5 mm
  • Higher than 2.5 cm above the anus (lumbar area)
  • Diffuse and evenly distributed lumbosacral hair

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