Fetal and Newborn Care Flashcards
Neonatal eye prophylaxis
- 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
Signs/symptoms, diagnosis, treatment of dietary protein-induced colitis
- 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
Causes of facial nerve palsy at birth
- Present with asymmetric cry and inability to close an eyelid
- A/w instrumentation used at birth, macrosomia, prematurity, congenital/genetic conditions
Therapeutic hypothermia indications and how does it help
- 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.
Elevated AFP causes
- 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)
Low AFP causes
Trisomy 21/Trisomy 18
What does a non stress test measure
Spontaneous fetal movements and HR activity (autonomic nervous system integrity)
What does a contraction stress test measure
Uteroplacental insufficiency and tolerance of labor
Fetal bradycardia/tachycardia
- Fetal heart block = maternal lupus
- Fetal SVT > 240 requires treatment (antiarrhythmics to mom) to prevent CHF and hydrops in the fetus
Definition of apnea
> 20 seconds
Causes of apnea
APNEA
- Abnormal metabolism (hypoglycemia, hypocalcemia, anemia)
- PDA and other cardiac causes
- Neurologic (seizures, IVH, premie)
- Epidemiologic/infecious (sepsis, RSV, pertussis)
- Abnormal swallowing/GERD
Apnea treatment
- Apnea of prematurity: caffeine or theophylline
- Primary apnea: oxygen or stimulation
- Secondary apnea: PPV
Transient tachypnea of the newborn (TTN) symptoms and treatment
- 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
Neonatal HIE lab findings
- Lactic acidosis, hypoglycemia, hypocalcemia, hyponatremia
- NORMAL ANION GAP
Cause of neonatal RDS
- Lack of surfactant in the lining of the alveoli
- Surfactant gradually increases until 33-36 weeks and then there is a surge
Neonatal RDS xray findings
- Ground glass appearance
- Granular opacifications, air bronchograms
Things that mimic neonatal RDS
- 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)
Risks for RDS
- Infant of diabetic mother
- C section delivery
- Birth asphyxia
- Lecithin:sphenigomyelin ratio less than 2
Indication for giving surfactant
- 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
RDS complications
- 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
Neonatal sepsis bugs and drugs
- Listeria, e coli, GBS
- Amp/gent
Neonatal GBS stages and treatment
- 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
GBS risk factors
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
Listeria vs GBS
Listeria is more likely if mom had flu like illness, GBS is more likely if mom was asymptomatic
Birth clavicular fracture treatment
- Monitoring, can expect the callus to recede within 2 years
Erb’s palsy signs/symptoms
- 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
Klumpke palsy
- C8-T1
- Claw hand, can lose ability to grasp
- Can be associated with Horner syndrome
Delayed cord falling off
- Normal to last up to 2 weeks
- If > 1 month think LAD (Leukocyte Adhesion Deficiency)
Single umbilical artery testing
Renal ultrasound is indicated
SGA definition
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
LGA definition
Greater than 90th percentile or > 3900 grams
Normal newborn pH
- pO2 60-90
- pCO2 35-45
- scalp pH of 7.25 or higher is normal
Apgar as predictor of long term outcomes
- 1 minute reflects life in the uterus
- 5 minute reflects transition and adjustment to the new world
Normal premie blood pressure
MAP should be greater than or equal to corrected gestational age
Very low birth weight infants
- < 1500 grams
- Factors impacting prognosis: gestational age (most important), morbidity while in NICU, IVH
Meconium aspiration signs/symptoms
- 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
Anuric infant evaluation
- Check parts, fluid intake, cath urine specimen, BUN/creatinine, renal ultrasound
Passage of meconium
- 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
NEC signs/symptoms
- 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
NEC treatment and complications
- 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
Normal bilirubin in full term newborn in first 24 hours
- 4
- Elevated bilirubin in the first 24 hours of life is never normal
Breastfeeding jaundice
- In first few days of life before milk comes in (due to dehydration)
- Unconjugated hyperbilirubinemia
- Increase in enterohepatic circulation
- Tx: increase breastfeeding
Human milk jaundice
- Days 6-14 and may persist for 1-3 months
- Unconjugated hyperbilirubinemia
- Due to inherent milk factors
Physiologic jaundice
- 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)
Hemolytic disease of the newborn
- 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
Hypoglycemia in a neonate signs/treatment
- 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
Infant of diabetic mother complications
LGA, hypoplastic left colon, polycythemia
Neonatal anemia definition
- 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
Polycythemia treatment indications/complications
- Must be a central venous draw
- > 70 should be treated
- Can lead to hypoglycemia, hyperbilirubinemia, and/or thrombocytopenia
- Tx: partial exchange transfusion
Hyperviscosity syndrome
- 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
Omphalocele facts
- 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
Gastroschisis facts
- 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
Diaphragmatic hernia clues
- Scaphoid abdomen, decreased breath sounds on left side, heart sounds on the right
- Tx: intubation, place NG tube, TPN, surgical repair
Most frequent causes of neonatal seizures in full term infant
HIE and neonatal encephalopathy
Tx: phenobarbital
Caput succedaneum
- Crosses the suture lines
- Soft, boggy pitting
Cephalohematoma
- Does not cross suture lines
- More firm and tense
IVH grading
- 1: germinal matrix
- 2: IVH without dilation
- 3: IVH with dilation
- 4: involves parenchyma
Neonatal symptoms of maternal alcohol exposure
Withdrawal: Hyperactivity, irritability, hypoglycemia
Neonatal symptoms of maternal cocaine exposure
Impaired uteroplacental circulation can increase risk of anomalies: cerebral infarctions, limb anomalies, urogenital defects
Neonatal symptoms of maternal amphetamines exposure
- Irritable, easily agitated, IUGR, developmental/cognitive delays
Neonatal symptoms of maternal barbituates exposure
Hyperactivity, hyperphagia, irritability, crying, poor suck swallow
Neonatal symptoms of maternal opioid exposure
Hyperirritability, tremors, jitteriness, hypertonia, loose stools, emesis, seizures –> can use methadone or oral morphine in the baby
Neonatal abstinence syndrome initial management
Decrease stimulation, swaddling, comforting, smaller more frequent feeds
Fetal alcohol syndrome clinical features
- 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
Findings in infant with maternal tobacco use
- IUGR, low birth weight, miscarriage, placental abruption, prematurity
- Cleft lip/palate
- Asthma, otitis media, wheezing
- SIDS
Neonatal findings with maternal valproic acid and carbamazepine use
- Facial anomalies: broad bridge nose, small anteverted nostrils, long upper lip, cleft lip
- Neural tube defects
- Microcephaly, IUGR
Neonatal findings with phenytoin use
- Finger stiffness, nail hypoplasia
- Cardiac defects, clubfoot deformity, ophthalmologic anomalies
Risk factors for developing IVH
Lower gestational age, pneumothorax, male sex, and bolus administration of normal saline or sodium bicarbonate
Surfactant Facts
- Works by LaPlace Law
- Made by type II alveolar cells
- Surfactant improves compliance, functional residual capacity, oxygenation/ventilation
What type of amniotic fluid/placenta do fraternal (non-identical) twins have?
Dichorionic diamniotic
Indications to image a sacral dimple
- If > 5 mm
- Higher than 2.5 cm above the anus (lumbar area)
- Diffuse and evenly distributed lumbosacral hair
