Fetus and Newborn Flashcards
Which race has the highest infant mortality rate?
African Americans
Which specific groups have the highest mortality rate?
- Caucasian infants <500 grams
- Male infants have higher mortality rates than female infants
- Prenatal care delayed until after first trimester is associated with higher infant mortality
What is the leading cause of infant mortality?
Congenital malformation is leading cause of infant death in the US
25% of infant mortality
Intrauterine Growth Restriction
less than 5th percentile of growth for gestational age
What is the most common umbilical cord abnormality?
The most common umbilical abnormality is having 1 artery
40% of these infants will die or have a major congenital abnormality such as trisomy 18
Obtain renal ultrasound on all infants with single umbilical artery
Placental Accreta
abnormally deep attachment of the placenta, through the endometrium and into the myometrium
Increase risk in females who have an uterus that lacks normal membranes secondary to previous trauma such as:
- curettage
- myomectomy
- C-Section
Placental Percreta
The placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall).
This variant can lead to the placenta attaching to other organs such as the rectum or bladder
Most severe form
Placental Abruption
the placental lining separates from the uterus of the mother causing hemorrhage
Chorangioma
non-neoplastic, hamartoma-like growth in the placenta consisting of blood vessels
arises from fetal circulation, may become large and interfere with fetal circulation causing heart failure and hydrops
Monozygomatic Twins
Dichromic twins
Monochromic membranes form identical twins, one ovum divides into two
Dichromic twins are fraternal twins with two placentas
When does prenatal screening for GBS occur?
Do prenatal screening for vaginal and rectal GBS of all pregnant women between 35-37 weeks gestation, valid for 5 weeks
Give antibiotics prophylaxis (penicillin/Ampicillin) in:
- women who delivered a previous infant with GBS disease whether currently colonized or not
- Women with GBS bactriuria during any trimester of current pregnancy
- Women who are GS positive at 35-37 weeks
- Women in labor who have unknown GBS status who delivery at less than 37 week gestation, fever, rupture of membranes for >18hrs
Preterm labor
less than 37 weeks gestation
Preterm Rupture of Membranes
rupture of the membrane of the amniotic sac and chorion more than one hour before the onset of labor
Attempt to keep baby until 34 weeks of gestational age even if fetal lungs are mature unless there is an infection
HELLP syndrome
- hemolysis
- elevated liver enzymes
- low platelet count
Get positive D-dimer test
Complications of Maternal Diabeties
Get glucose levels under control before conception
Defects include:
- sacral agenesis
- situs abnormalities
- holprosencepaly
- congenital heart disease
- microcolon
Electrolyte abnormalities include:
- QT interval prolongation
- Hypocalcaemia
- hypomagnesaemia
- hypophosphatemia
Nonstress testing
detects the fetal heart rate fetal movement and uterine activity by external methods
a reactive test is 2 accelerations of the fetal heart rate in 20 minutes. This is associated with fetal survival of 99% for another week
A non reactive test is associated with poor fetal outcome in 20% of cases, continue with biophysical profile
Biophysical profile
- fetal movement
- tone
- reactivity
- breathing
- amniotic fluid volume
Nonreassuring fetal heart recordings
In infant with nonreassuring patterns on FHR recordings perform:
- fetal scalp stimulation
- pH measurement (normal >7.25, if <7.20, immediately deliver)
Persistent tachycardia greater than 180 beats per minute and maternal fever is chorioamnionitis
Fetal bradycardia is baseline heart rate of less than 120 beats per minute
A) Early decels
B) Late decels
C) Variable decels
A) Early decels are due to fetal head compression during uterine contraction, normal
B) Late decels are usually at the beginning or after the peak of the uterine contraction with return of the fetal heart rate after the contraction has ended. Potentially ominous, uteroplacental insufficiency
C) Variable decels have variable recovery period, may be due to hypoxia
Size of Endotracheal tube based on weight
Length of Endotracheal tube based on weight
Size of ET tube:
<1.5kg: 2.5 mm tube diameter
1.5-2/5kg: 3mm in diameter
>2.5kg 3.5mm tube diameter
Length of tubes:
1kg: 7cm
2kg: 8cm
3kg: 9cm
4kg: 10cm
Epinephrine
Epinephrine:
- stimulates the alpha adrenergic receptors
- enhances cardiac contractility
- constricts peripheral circulation beta adrenergic effects on the receptors in the heart
- increase rate and effectiveness of cardiac contraction
Crouzons
multiple sutures fuse prematurely
cause craniosynostosis
see increase bone density along the suture
maxillary hypoplasia
Caput Succedaneum
edema crosses suture lines and the midline of the skull
Caput is external the periosteum
Cephalohematoma
collection of blood under the peristeum of the outer surface of the skull
Due to rupture of blood vessels, will not cross suture lines
Subgaleal Hemorrhage
bleeding from beneath the scalp
Firm, fluctuant swelling over the scalp that extends to the neck or in front of the ears
Erb’s paralysis
damage to the upper part of the brachial plexus in the 5th and 6th cervical roots
Palpate for ipsilateral clavicle fractures
Waiter’s tip sign
Klumpke Paralysis
involve the 7th and 8th cervical roots and 1st thoracic component of the brachial plexus
claw like posturing of the hand
Less likely to improve spontaneously
Horner’s Syndrome
ptosis
miosis
anhidrosis
delayed pigmentation of the iris
due to injury to the sympathic fibers of T1
What cardiac abnormality is associated with maternal SLE?
Maternal SLE is associated with an infant with heart block
What condition is suspected if there is a difference between upper extermity and lower extremity blood pressures?
Coarctation upper extremity blood pressure is greater than 20 in the upper extremities than the lower extremities
What is an abnormal penile length for a newborn?
Penile length less than 2.5cm is abnormal and needs endocrine workup
What disease is suspected in an infant who fails to pass meconium in the first 48 hours of life?
Failure to pass meconium stool may be associated with Hirsch sprung disease
Complication of Hirsch sprung disease is toxic mega colon
Teratoma
Tumor of spine at birth is a teratoma
Who is at risk for congenital hip dysplasia?
- all daughters of affected mothers with developmental dysplasia of the hip
- Females in breech position
Hyaline membrane disease
due to lack of surfactant and lack of development of alveoli
at risk if less than 28 weeks gestational age
mature levels of surfactant found in infants greater than 35 weeks gestational age
Prophylaxes infants less than 28 weeks gestation with surfactant therapy
Lecithin makes 65% of surfactant and surfactant is stored in Type II alveolar cells
Chest X Ray shows ground glass haziness
Persistent Pulmonary Hypertension of the Newborn
syndrome due to:
- meconium aspiration
- infection
- hyaline membrane disease
- sepsis
Meconium Aspiration
During first hour after birth, infants are hypoxemic with metabolic acidosis
Commonly see pneumothoraxes and pneumomediastinum
Use of prophylactic antibiotics have not been shown to improve outcomes and increases risk of developing resistant organism
Patchy infiltrates on the Chest X Ray
Interstitial Pulmonary fibrosis/Wilson-Mikity Syndrome
seen in infants without a history of hyaline membrane disease who are less than 32 weeks of age with a birth weight of less than 1,500 grams
Gradual onset over the first month of life
Chest X Ray: bilateral reticular infiltrates with development of multi-cystic lesions
Group B Streptococcus Pneumonia
infection with GBS
early onset is less than 7 days of life and is most common late onset is 4 weeks of age
See severe leukopenia and thrombocytopenia with abnormal PT/PTT
Patent ductus arteriosus
Patenet ductus arteriosus is seen commonly in premature infants.
Ductus normally closes within 10-15 hours of birth
- continuous machinery like murmur
- Best heard below the left Clavicle
- worsening respiratory status
- bounding peripheral pulses
- a wide pulse pressure
Side effect of indomethacin: oliguria and dilutional hyponatremia and intestinal perforation.
Do not use indomethacin if there is:
- NEC
- serum creatinine is greater than 1.6
- decrease urine output of less than 1ml/kg
- bleeding
- platelets less than 50,000
Meconium Plugs
Meconium plugs are more common in infants with:
- small left colon syndrome
- cystic fibrosis
- hypothyroidism
- Hirsprung
- maternal drug abuse
- magnesium sulfate therapy for preeclampsia
Meconium ileus
lower intestinal obstruction from impaction of meconium
the abdomen is “doughy” because the bowel loops are filled with meconium instead of air
Necrotizing Enterocoliits
mainly a disease of preterm infants
the distal ileum and proximal colon are more commonly affected
Generally presents in the first 2 weeks of life but may occur up tot 3 months of age
See pneumatosis intestinalis: gas accumulation in the submucosa of the bowel wall or air in the hepatic portal system
Start antibiotics of ampicillin with gentamicin
Erythroblastosis fetalis
hemolytic disease of the newborn occurs when maternal antibodies are active against RBC antigens of the infants resulting in increased RBC destruction
The baby may become pancytopenia
Give anti D globulin during her third trimester and again during delivery of D positive infant at each pregnancy
