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Nicu > General > Flashcards

General Flashcards

0
Q

Neonatal hyperthyroidism symptoms

A 
Jaundice
Facial flushing
Eye wide open
Alert
Fever
Hyper reflexia
CHD
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1
Q

CHARGE syndrome

A 
Coloboma
Heart defect
Atresia of cloanae
Renal
Gu/growth
Ear defect
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2
Q

Conjugated hyperbilirubinemia

A

Biliary atresia
Intra hepatic cholestasis- progressive familial, alagille syndrome, idiopathic neonatal hepatitis, TPN cholestasis, choledochal cyst, infection, alpha 1 antitrypsin, galactosemia.

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3
Q

Ambiguous genitalia

A

Undervirilized male- androgen resistance (complete or partia), defects in androgen syntesis

Virilized female - excess androgen (CAH, 21 H def), maternal androgen exposure, medication, adrenal tumor, XO/XY

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4
Q

What are causes of a large ant fontanelle

A 
hydrocephalus
IUGR, prem
syndrome - trisomies, OI, Achondroplasia, Russel-silver
arachnoid cysts
parenchymal brain lesion
subdural bleed def
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5
Q

what does a third fontanelle suggest?

A

T21 and seen in prem

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6
Q

What is Mobius syndrome?

A

BL facial palsy suggests issues with CN 7

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7
Q

What are risk factors for IVH

A 
prematurity**
RDS**
HIE, 
hypotensive event
reperfusion injury - acidosis
hypervolemia
TX
HTN
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8
Q

when does IVH tend to occur?

A

50% on D1
75 % by day 3
few have between d14-30

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9
Q

what is grade 1 IVH?

A

within subependymal matrix

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10
Q

What is grade 2 IVH

A

into ventricles but no dstention

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11
Q

what is grade 3 IVH

A

clot distends the ventricles and extends to more than half way length of ventricle

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12
Q

what is grade IV IVH

A

intraparenchymal extension

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13
Q

what percentage of VLBW will develop a post bleed hydrocephalus?

A

3-5%

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14
Q

highest risk group trio for IVH?

A

less than 4
less than 750g
APGAR less than 3 at 1min

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15
Q

what are the stages of PVL?

A

can be present at birth
Echodense phase - 3-10d
echolucent cystic phase d14-20

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16
Q

what is PVL?

A

ischemic brain injury leading to focal necrosis

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17
Q

what is the screening schedule for HUS for premeis

A

DOL 3
2weeks
6 weeks
term

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18
Q

What is NEC?

A

a serious bowel injury after a combination ofmetabolic, vascular and mucosal insults

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19
Q

what are risk factors for NEC

A 
prematurity
sepsis
PDA/congenital heart disease
male /black
early enteral feeds
asphyxia - any decrease CO
bacterial colonization
polycythemia
transfusion
NSAIDS
ranitidine
UAC
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20
Q

what are complications or NEC

A
  1. colonic strictures 10-20%
  2. Recurrent NEC in 5%
  3. FTT
    4.Short bowel syndrome - post resection. can live with 20cm + ileocecal valve
    or 40 cm - without valve
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21
Q

what are possible complications of polycythemia?

A 
hyperbili
Sz
NEC
renal failure
illeu
renal vein thrombosis
hyPOcalcemia
Congestive heart failure
Priapism
stroke
spontaneous intestinal perforation
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22
Q

what is anemia of prematurity?

A 
nadir - 4-8 weeks
suppressed postnatal response to EPO
sampling
increase in blood volume with growth
short RBC life span
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23
Q

what are transfusion threashold for babies not requiring vent support at week 1,2,3

A

week 1 100

  1. 85
  2. 75
24
Q

what are transfusion threashold for babies requiring vent support at week 1,2,3

A
  1. 115
  2. 100
  3. 85
25
Q

what are causes of cyanosis

A 
resp issues- Mec, TTN,RDS pneumonia
pneumothorax
cngenital lung issues
sepsis/shock
Cyanotic heart disease
PPHN
polycythemia
HIE/sz/IVH
hypothermia
hypoglaycemia
methemoglobin
upper airway obstruction
26
Q

what are complications of forceps or vaccum delivery

A 
facial marks
bruising
skull fracture
facial nerve injury
lacerations
hematoma
intracranial bleeds
subgaleal hematoma
27
Q

what is the hyperoxic test?

A

to diffenciate if cyanosis is cardiac or resp

do art gas - place infant on 100% o2 for 10-15 min
repeat gas
if > 150 NOT cardiac and probably resp
if < 150 = cardiac
PPHN and severe resp may not see big increase with O2

28
Q

What are possible neonatal complications of GDM?

A 
hypoglycemia
LGA
polycythemia
myocardial hypertrophy, congenital heart disease
renal vein thrombosis
Congenital abn X3
RDS
hyperbili
lumbosacral agenesis
renal aplasia, dysplasia, double ureter
neural tube defects
hypoplastic left colon
duodenal or anorectal atresia
hypocalcemia!
hypomagnesia!
situs inversus
29
Q

what are possible issues if mom has SLE?

A 
congenital HB
rash
hepatitis
low PLT
low WBC
neuro
30
Q

what are clinical features of congenital hypothyroidism?

A 
prolonged jaundice
poor feeding
delayed MEC
large fontanelles
post date
LGA
eyelid edema
delayed osseous dev
31
Q

what are causes of neonatal goiter

A

inborn error of metabolism of thyroid hormones
maternal goitrogen - med used to treat thyroid issues
severe iodine def

32
Q

what are causes of of no MEC for 48 hrs

A 
anorectal malformation
mec ileus
med plug
hirschsprung
malrotation
atresia - ileal, duodenal...
incarcerated hernia
small left colon syndrome
ileus - spesis,hypokalemia, NEC, hypothyroidism, narcotics, prem
33
Q

what are the benefits of kangaroo care?

A 
temp stability
improves sleep organization and duration of quiet sleep
neurodev outcomes
improves BF
modulates response to pain
good for mom- better attachment
34
Q

what are recommendations for the use of steroids in CLD in prem?

A
  • only for vent dependent at risk of severe CLD or who have severe CLD
  • use low dose dex .15mg/kg/day (initial se) to .2
  • tapering short course over 7-10 days
35
Q

what is SSRI neonatal behavioural syndrome?

A 
occurs in 10-30% of babbies exposed to SSRI
tachypnea
cyanosis
jittery and tremors
inc msl tone
feeding disturbances
rarely sz
36
Q

what can impair surfactant production and or secretion?

A 
hypoxemia
acidosis
hypothermia
hypotension
prematurity
MEC
infant of DM
37
Q

what are possible side effects of surfactant therapy?

A 
pulm haemorrhage due to increased pulm blood flow
clinical PDA
blockage of ETT
bradycardia
hypotension
transient hypoxia and hypercapnia
38
Q

what is the patho-phys of physiologic jaundice

A

high RBC matss
short RBC life span
immature liver with lower uptake of bili
decreased activity of glucutonyl transferase - lower conjugation

39
Q

How do you manage a baby of a mom who is GBS + but incomplete Abx

A

the risk of invasive GBS is 1%

monitor closely for 24 hours - 95 % will should CF in first 24 hrs

40
Q

What medications are contraindicated in breastfeeding

A 
Antineoplastic agents
Bromocriptine
Clozapine
Doxorubicin
Immunosuppressants
Lithium ***
Methimazole
Thiouracil
41
Q

if a mom is on lithium, what do you do

A

keep her on it

aim for lowest dose

42
Q

what are potential effetcs of neonatal exposure to Lithium

A

Ebstein’s anomaly
congenital goiter
nephrogenic diabetes insipidus
transient hypothermia, cyanosis, bradycardia, shallow respirations, poor suck, hypotonia, and altered T waves on electrocardiography immediately after birth.
Can stop for a few days right before birth and start right after

43
Q

what are features of FAS

A 
short palpebrae, 
long smooth philtrum
thin upper lip 
radioulnar synostosis  
VSD
IUGR
small distal phalanges
fifth-fingernail hypoplasia
hockey stick” upper palmar crease,
“railroad track” upper helix of the ear, 
ptosis
strabismus
vertebral segmentation defects
renal anomalies
optic nerve hypoplasia
hearing loss
pectus deformities
44
Q

When does hemorrhagic disease of the newborn occur? 3

A

early - 0-24h
classic - 2-7 days
late - 1-6 mo

45
Q

what are causes of EARLY hemorrhargic disease of the newborn

A

0-24 hrs
maternal drugs: rifampin, phenytoin,phenobarbital, warfarin, INH
bleed: skull, brain, GI

46
Q

what are causes of CLASSIC hemorrhargic disease of the newborn

A

2-7 days:
Vit K def
BF and low vit K
bleed: GI, H&N, intracranial, circumcision

47
Q

what are causes of LATE hemorrhargic disease of the newborn

A

1-6 mo
cholecystitis leading to vit K malabsorption: CF, biliary atresia, hepatitis
Bleed:intracranial, cutaneous

48
Q

what lab results are consistent with hemorrhagic disease of the newborn?

A

HIGH aPTT and PT
Low prothrombin, factor VII, IX and X
rest all normal

49
Q

baby found to have “conjunctivitis” at 12 hrs of age. DDx

A

chemical irritation from Erythromycin oint

50
Q

conjunctivitis at 1-2 d olf life. DDX

A

Bacterial - staph aureus usually

51
Q

when does gonorrhea conjunctivitis present?

A

DOL 2-4
May Need FSWU and cefotaxime IM x1 for sure

complication = corneal perforation

52
Q

when does Chlamydia conjunctivitis present?

A

> DOL 5-14
erythromycin OINT does not prevent
need PO Rx

53
Q

what maternal drugs can cause neonatal apnea?

A

MgSO4

opiates

54
Q

what are red flags when it comes to hyperbili

A 
if < 24 hrs
if signs of hemolysis
if HSM
if dark urine and pale stools
if unwell
55
Q

what are causes of hyperbili occuring < 24 hrs

A
  1. sepsis - GBS, TORCH

2. Hemolysis - Rh or ABO

56
Q

what are the indications for cooling?

A 
> 35-36 weeks
signs of moderate to severe encephalopathy
and  2:
- APGAR < 5 at 10 min
- ventilation at 10 min
- Ph < 7 or BD > 16 on cord bld
57
Q

What are 2 causes of neonatal hypothyroidism

A

hypoplasia/aplasia - 85%
maternal Ab - thyrotropin receptor blocking Ab
Maternal meds-amiodarone, PTU, methimazole, iodine
Thyroid hormone defect

58
Q

baby found to have a goiter, what is you DDx

A

thyroid hormone synthesis defect
mat thyroid meds
severe iodine def or excess

Nicu (2 decks)

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