Fetus and the Newborn Flashcards
Harmless cyanosis of the hands and feet
acrocyanosis
Division of the body from the forehead to the pubis into red and pale halves is known as
harlequin color change
Deep, blue masses that, if large, may trap platelets and produce disseminated intravascular coagulation or interfere with local organ function
Cavernous hemangiomas
Slate-blue, well-demarcated areas of pigmentation seen over the buttocks, back, and sometimes other parts of the body
Mongolian spots
- tend to disappear within the 1st year
Fine, soft, immature hair frequently covers the scalp and brow and may also cover the face of premature infants
Lanugo
- replaced by vellus hair in term infants
Benign rash characterized as small, white papules on an erythematous base which develop 1-3 days after birth
Erythema toxicum
- persists for as long as 1 wk, contains eosinophils, and is usually distributed on the face, trunk, and extremities
A benign lesion seen predominantly in black neonates, contains neutrophils and is present at birth as a vesiculopustular eruption around the chin, neck, back, extremities, and palms or soles; it lasts 2-3 days
Pustular melanosis
Soft areas that are occasionally found in the parietal bones at the vertex near the sagittal suture
craniotabes
- more common in premature infants and in infants who have been exposed to uterine compression
Premature fusion of skull sutures, identified as a hard nonmovable ridge over the suture and an abnormally shaped skull
craniosynostosis
In the PE of the newborn, take note of symmetric facial palsy, which suggests absence or hypoplasia of the 7th nerve nucleus, otherwise known as
Mobius Syndrome
Pupillary reflexes are present from what age of gestation?
28-30 wks AOG
On the hard palate on either side of the raphe, there may be temporary accumulations of epithelial cells called
Epstein pearls
The newborn’s tongue appears relatively large; the frenulum may be short. When is it indicated to repair a tongue-tie (ankyloglossia)?
If there are problems with feedings (breast or bottle) and the frenulum is short, frenulotomy may be indicated
Premature infants may breathe periodically, with complete irregularity, also known as
Cheyne-Stokes rhythm
A solid flank mass, which becomes clinically apparent with hematuria, hypertension, and thrombocytopenia may be caused by
renal vein thrombosis
- Renal vein thrombosis in infants is associated with polycythemia, dehydration, maternal diabetes, asphyxia, sepsis, nephrosis, and hypercoagulable states such as antithrombin III and protein C deficiency
Abdominal wall defect that occurs through the umbilicus
a. omphalocoele
b. gastroschisis
a. omphalocele
A membrane often covers an omphalocele, and care should be taken to prevent its rupture.
Omphaloceles are associated with other anomalies and syndromes such as Beckwith-Wiedemann, conjoined twins, trisomy 18, meningomyelocele, and imperforate anus
Abdominal wall defect that occurs lateral to the midline
a. omphalocoele
b. gastroschisis
b. gastroschisis
- Gastroschisis is the more common defect and typically the intestines are not covered by a membrane. The exposed intestines should be gently placed in a sterile clear plastic bag after delivery.
The normal umbilical cord contains 2 arteries and 1 vein. What pathology is suggested with a single umbilical artery?
a. cardiac
b. respiratory
c. renal
c. renal
- A single umbilical artery increases the risk for an occult renal anomaly.
Genital defect that usually results in hydrometrocolpos and lower abdominal mass
imperforate hymen
True or False. The APGAR score is used to predict neurologic outcome.
False
- the score is normal in most patients in whom cerebral palsy subsequently develops, and the incidence of cerebral palsy is low in infants with Apgar scores of 0-3 at 5 min (but higher than in infants with Apgar scores of 7-10)
Low Apgar scores and umbilical artery blood pH predict neonatal death. Which is a better predictor of neonatal death in both term and preterm infants?
Low Apgar score
- An Apgar score of 0-3 at 5 min is uncommon but is a better predictor of neonatal death (in both term and preterm infants) than an umbilical artery pH ≤ 7.0; the presence of both variables increases the relative risk of neonatal mortality in term and preterm infants
What are the 5 objective signs being evaluate in the Apgar score?
Heart rate Color Respiration Muscle tone Response to catheter in nostril
Mechanisms of heat loss in newborns (4)
Convection
Conduction
Heat radiation
Evaporation
1) convection of heat energy to the cooler surrounding air
2) conduction of heat to the colder materials touching the infant
3) heat radiation from the infant to other nearby cooler objects
4) evaporation from skin and lungs.
What is the most common cause of oligohydramnios?
Rupture of membranes
What is the most serious complication of chronic oligohydramnios?
pulmonary hypoplasia
Ancillary procedure used in the second trimester (15-18 wks) to screen for open neural tube defects, gastroschisis, omphalocele, congenital nephrosis, twins, and other abnormal conditions
maternal serum alpha-fetoprotein (MSAFP)
- Low MSAFP is associated with incorrect gestational age estimates, trisomy 18 or 21, and intrauterine growth restriction
Periodic accelerations or decelerations of the fetal heart rate in response to uterine contractions may be monitored to assess fetal status. Which of the ff conditions reflect early, late, or variable decelerations?
a. associated with cord compression
b. associated with fetal hypoxemia
c. associated with head compression
a. cord compression - variable deceleration
b. fetal hypoxemia - late deceleration
c. head compression - early deceleration
What maternal condition would predispose the fetus to neonatal hypoglycemia, hypocalcemia, respiratory distress syndrome and other respiratory problems, polycythemia, macrosomia, myocardial dysfunction, jaundice, and congenital malformations?
Maternal diabetes
- There is increased risk for incidence of uteroplacental insufficiency, polyhydramnios, and intrauterine death in poorly controlled diabetic mothers.
What maternal conditions would predispose the fetus to IUGR, prematurity, and intrauterine death, all probably caused by diminished uteroplacental perfusion? (3)
- Eclampsia-preeclampsia of pregnancy
- chronic hypertension
- chronic renal disease
What maternal condition is responsible for relative infertility, spontaneous abortion, premature labor, and fetal death?
Uncontrolled maternal hypothyroidism or hyperthyroidism
A pregnant woman taking prednisone may put the fetus at risk for?
oral clefts
Administration of oxytocin to a pregnant woman may affect the newborn, putting the baby at risk for?
hyperbilirubinemia and hyponatremia
By 35 wks AOG, what is the lecithin:sphingomyelin (L:S) ratio indicative of lung maturity?
2: 1
- Lecithin is produced in the lungs by type II alveolar cells and eventually reaches the amniotic fluid via the effluent from the trachea. Until the middle of the 3rd trimester, its concentration nearly equals that of sphingomyelin; thereafter, the sphingomyelin concentration remains constant in amniotic fluid while the lecithin concentration increases
Which antielpileptic drugs taken during pregnancy predisposes the fetus to neural tube defects?
valproate and carbamazepine
- Women taking these medications should ingest 1-5 mg of folic acid/day in the preconception period.
Define very low birthweight infants
<= 1500 g
Define low birthweight infants
<= 2500 g
What is the difference between symmetric and asymmetric IUGR and what are its implications on the fetus?
In symmetric IUGR, head circumference, length, and weight are equally affected while in asymmetric IUGR there is relative sparing of head growth.
Symmetric: earlier onset; associated with diseases that seriously affect fetal cell number, eg conditions with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies
Asymmetric: late onset, demonstrates preservation of Doppler waveform velocity to the carotid vessels, and is associated with poor maternal nutrition or with late onset or exacerbation of maternal vascular disease (preeclampsia, chronic hypertension)
What is the optimal environmental temperature for minimal heat loss and oxygen consumption for an unclothed infant?
one that maintains the infant’s core temperature at 36.5-37.0 C
- depends on an infant’s size and maturity; the smaller and more immature the infant, the higher the environmental temperature required
What supplements should be given to LBW and preterm infants?
Vitamin C, E, D, A, folic acid, iron
- Although formula in amounts necessary for adequate growth probably contains adequate quantities of all vitamins, the volume of milk sufficient to satisfy these requirements may not be ingested for several weeks
- Fat soluble vitamins are usually supplemented because premature infants have decreased fat absorption increased fecal fat loss
- Anemia develops earlier in premature and LBW infants due to low iron stores and greater expansion of blood volume from more rapid growth
Infants with birthweight > the 90th percentile for gestational age
large for gestational age
- Neonatal mortality rates decrease with increasing birthweight until approximately 4,000 g, after which they increase
- higher incidence of birth injuries
Early recognition of anomalies is important from birth. What congenital anomaly should be suspected in a patient born in respiratory distress and NGT cannot be passed through the nares?
choanal atresia
consider CHARGE syndrome(coloboma of the eye, heart anomaly, choanal atresia, retardation, and genital and ear anomalies)
A patient was born with micrognathia, cleft palate, airway obstruction. What should you suspect?
Pierre Robin syndrome
What should you suspect in a patient born with a scaphoid abdomen, with bowel sounds present in chest, and in respiratory distress?
Diaphragmatic hernia
A patient born with known polyhydramnios perinatally developed aspiration pneumonia. On suctioning, there was note of excessive salivation and upon insertion, a nasogastric tube cannot be placed in the stomach. What is your initial impression?
Tracheoesophageal fistula
Suspect VATER (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia) syndrome
What should you suspect in a patient born with oligohydramnios, anuria, pulmonary hypoplasia, and pneumothorax?
Renal agenesis, Potter syndrome
Patient was born cyanotic and hypotensive with murmur on chest PE. What is your initial impression?
ductus-dependent congenital heart disease
A diffuse, sometimes ecchymotic, edematous swelling of the soft tissues of the scalp involving the area presenting during vertex delivery. It may extend across the midline and across suture lines
Caput succedaneum
- Molding of the head and overriding of the parietal bones are frequently associated with caput succedaneum and become more evident after the caput has receded; they disappear during the 1st weeks of life.
