Fetus and Newborn Flashcards
Despite adequate resuscitation (intubated, chest compressions), a newborn still has HR < 60 bpm. What is the next thing to do?
a. Check ET
b. Give epinephrine IV or Intrathecal
B. give epinephrine
NTP: Pediatric advanced life support bradycardia algorithm
heart rate less than 60 beats/min with poor perfusion is an indication to begin chest compressions. If despite adequate oxygenation and ventilation, bradycardia persists, give epinephrine
providers should assess and treat factors known to cause bradycardia, referred to collectively as the 6 Hs (hypoxia, hypovolemia, hydrogen ions [acidosis], hypokalemia or hyperkalemia, hypoglycemia, hypothermia), and 4 Ts (toxins, tamponade, tension pneumothorax, and trauma [causing hypovolemia, intracranial hypertension, cardiac compromise or tamponade])
Newborn screening is best done: a. after 24 hours b. after 72 hours c. At birth d. Anytime
a. after 24 hours
Which reason will make repair of neonatal tongue-tie valid?
a. Interference with feeding
b. possible interference with speech
a. interference with feeding
b. possible interference with speech - for an older child, this may be the answer, but for neonatal tongue-tie, interference with feeding makes repair justified
CH 307 Common lesions of the Oral Cavity
“Ankyloglossia or “tongue-tie” is characterized by an abnormally short lingual frenum that may hinder the tongue movement but rarely interferes with feeding or speech. The frenum may spontaneously lengthen as the child gets older. If the extent of the ankyloglossia is severe, speech may be affected and surgical correction indicated”
CH 88.2 Care of the Newborn
“ankyloglossia is rarely a reason for cutting it. If there are problems with feedings (breast or bottle) and the frenulum is short, frenulotomy may be indicated.”
Newborn with HIE (mahaba ang case description, di ko na maalala), what is the most important diagnostic approach?
a. MRI
b. CT scan
c. EEG
d. MRI + EEG
a. MRI
*Nelson’s:
UTZ – limited utility in HIE in the term infant, preferred in preterms
CT - limited ability to identify cortical injury during the 1st few days of life
MRI – preferred imaging modality because of increased Sn and Sp early in the disease and its ability to outline topography of the lesion.
aEEG – (amplitude integrated EEG) promising modality to determine which infants are at highest risk for significant brain injury, good reliability, a positive predictive value of 85%, and a negative predictive value of 91-96% for infants who will have adverse neurodevelopmental outcome. Helpful in prognostication, not diagnosis.
Mother was diagnosed with chorioamnionitis on delivery of her baby. Baby had an APGAR of 8,8, term, but was noted to be tachypneic with RR > 60. What is your approach to management?
a. CBC, CXR
b. CBC, Blood CS x 2, CXR
c. CBC, Blood CS x 2, CXR, start antibiotics
d. CBC, Blood CS x 2, Lumbar tap, CXR, start antibiotics
c. CBC, Blood CS x 2, CXR, start antibiotics
NTP 19th: Diagnostic evaluation (including blood culture) is indicated for asymptomatic infants born to mothers with chorioamnionitis. All symptomatic infants should be treated with antibiotics after blood cultures are obtained. There is controversy over whether an LP is necessary for all term infants with suspected early-onset sepsis. If the blood culture result is positive or if the infant becomes symptomatic, LP should definitely be performed.
Mother was given high doses of Vitamin B6 for morning sickness during pregnancy. Her baby then developed neonatal seizures. What is the diagnosis for the seizures?
a. B6 deficiency
b. B6 excess
c. B6 dependence
c. B6 dependence
* Nelson’s 18th: Infants of mothers who have received large doses of pyridoxine during pregnancy are at increased risk for seizures from pyridoxine dependence.
Newborn on initial physical examination was found to exhibit a “clunk” on one of your hip maneuvers. What will you do?
a. Do a hip ultrasound
b. Do a hip CT scan
c. Refer to Ortho
a. Do a hip ultrasound
Nelson’s 18th: In infants younger than 6mos of age, the acetabulum and proximal femur are cartilaginous and not visible on plain radiographs and are best visualized with ultrasonography.
Giving which drug during pregnancy will lead to cleft lip in the baby?
a. Valproate
b. Coccaine
c. Phenytoin
d. Prednisone
d. Prednisone
* Nelson’s 18th: See Table 96-3 Agents acting on pregnant women that may adversely affect the structure or function of the fetus and the newborn
Prednisone - oral clefts
Valproate - CNS (spina bifida), facial and cardiac anomalies, limb defects, impaired neurologic function
Cocaine/crack - Microcephaly, LBW, IUGR, behavioral disturbances
Phenytoin - Congenital anomalies, IUGR, neuroblastoma, bleeding (vitamin K deficiency)
A mother asked about circumcision for her newborn baby boy. What will you advise her?
a. There is no support for routine Circumcision during the newborn period.
b. It decreased penile cancer.
c. It is a safe procedure with no complications.
a. There is no support for routine Circumcision during the newborn period.
* PPS
Which of the following measurements are not consistent with a fullterm newborn?
a. Birth weight of 3.2kg
b. Height of 47cm
c. HC of 35cm
d. CC of 35cm
d. CC of 35cm
- A mother with gestational DM was worried about her baby, who had symptomatic hypoglycemia. What will you advise her?
a. Brain development will be normal
b. Baby will have a higher risk for developing DM in adulthood
c. Baby will need to be restricted on sugar in his diet.
b. Baby will have a higher risk for developing DM in adulthood
* Nelson’s 18th: The subsequent incidence of DM in these infants is increased compared to the general population
A preterm who is purely breastfed has to be given vitamin supplementation because:
a. LBW infants are found to have higher energy needs
b. Volume of Breastmilk ingested will not be able to provide adequate nutrients in the first weeks of life.
c.
LBW and preterm infants should be given supplemental vitamins.
Decreased fat absorption with increased fecal fat loss may be associated with decreased absorption of vitamin D, other fat-soluble vitamins, and calcium in premature infants.
For a 5 day old with HIE, who already coded twice, when should you stop aggressive measures? (actually mas mahaba ang description ng case – basta fulfills brain death criteria in 2 separate examinations—)
a. 12 hours apart
b. 24 hours apart
c. 48 hours apart
c. 48 hours apart- 1wk to 2 mos
a. 12 hours apart- >1yr old
b. 24 hours apart – 2mos to 1 yr old
c. 48 hours apart- 1wk to 2 mos
Nelson’s 18th: see table 67-1 Age specific criteria for brain death and 67-2 Diagnosis for brain death
The recommended length of this period of observation varies by age.
1 wk to 2 mos - 2 exams, 48h apart
2 mos to 1 yr - 2 exams, 24h apart
>1yr - 2 exams, 12h apart
If the cause of the coma is hypoxic-ischemic brain injury and the first exam is performed shortly after the insult, a period of at least 24 hr is recommended before the second exam.
Which of the following has the highest hypoglycemia (ito yung term nila)
a. Preterms
b. IDM
c. Low birth weight infant
d. Asphyxiated infant
No answer given
Risk Factor for NEC: A. prematurity B. C. D.
A prematurity
Nelson’s 19 th edition:
Many factors may contribute to the development of a necrotic segment of intestine, gas accumulation in the submucosa of the bowel wall (pneumatosis intestinalis), and progression of the necrosis to perforation, peritonitis, sepsis, and death. The distal part of the ileum and the proximal segment of colon are involved most frequently; in fatal cases, gangrene may extend from the stomach to the rectum. Although NEC is a multifactorial disease primarily associated with intestinal immaturity, the concept of ―risk factors‖ for NEC is controversial. The triad of intestinal ischemia (injury), enteral nutrition (metabolic substrate), and bacterial translocation has classically been linked to NEC. The greatest risk factor for NEC is prematurity. The disorder probably results from an interaction between loss of mucosal integrity due to a variety of factors (ischemia, infection, inflammation) and the host’s response to that injury (circulatory, immunologic, inflammatory), leading to necrosis of the affected area. Coagulation necrosis is the characteristic histologic finding in intestinal specimens. Clustering of cases suggests a primary role for an infectious agent. Various bacterial and viral agents, including Escherichia coli, Klebsiella, Clostridium perfringens, Staphylococcus epidermidis, astrovirus, norovirus, and rotavirus, have been recovered from cultures. Nonetheless, in most situations, no pathogen is identified. NEC rarely occurs before the initiation of enteral feeding and is much less common in infants fed human milk. Aggressive enteral feeding may predispose to the development of NEC.
