General Flashcards
Neonatal hyperthyroidism symptoms
Jaundice Facial flushing Eye wide open Alert Fever Hyper reflexia CHD
CHARGE syndrome
Coloboma Heart defect Atresia of cloanae Renal Gu/growth Ear defect
Conjugated hyperbilirubinemia
Biliary atresia
Intra hepatic cholestasis- progressive familial, alagille syndrome, idiopathic neonatal hepatitis, TPN cholestasis, choledochal cyst, infection, alpha 1 antitrypsin, galactosemia.
Ambiguous genitalia
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
What are causes of a large ant fontanelle
hydrocephalus IUGR, prem syndrome - trisomies, OI, Achondroplasia, Russel-silver arachnoid cysts parenchymal brain lesion subdural bleed def
what does a third fontanelle suggest?
T21 and seen in prem
What is Mobius syndrome?
BL facial palsy suggests issues with CN 7
What are risk factors for IVH
prematurity** RDS** HIE, hypotensive event reperfusion injury - acidosis hypervolemia TX HTN
when does IVH tend to occur?
50% on D1
75 % by day 3
few have between d14-30
what is grade 1 IVH?
within subependymal matrix
What is grade 2 IVH
into ventricles but no dstention
what is grade 3 IVH
clot distends the ventricles and extends to more than half way length of ventricle
what is grade IV IVH
intraparenchymal extension
what percentage of VLBW will develop a post bleed hydrocephalus?
3-5%
highest risk group trio for IVH?
less than 4
less than 750g
APGAR less than 3 at 1min
what are the stages of PVL?
can be present at birth
Echodense phase - 3-10d
echolucent cystic phase d14-20
what is PVL?
ischemic brain injury leading to focal necrosis
what is the screening schedule for HUS for premeis
DOL 3
2weeks
6 weeks
term
What is NEC?
a serious bowel injury after a combination ofmetabolic, vascular and mucosal insults
what are risk factors for NEC
prematurity sepsis PDA/congenital heart disease male /black early enteral feeds asphyxia - any decrease CO bacterial colonization polycythemia transfusion NSAIDS ranitidine UAC
what are complications or NEC
- colonic strictures 10-20%
- Recurrent NEC in 5%
- FTT
4.Short bowel syndrome - post resection. can live with 20cm + ileocecal valve
or 40 cm - without valve
what are possible complications of polycythemia?
hyperbili Sz NEC renal failure illeu renal vein thrombosis hyPOcalcemia Congestive heart failure Priapism stroke spontaneous intestinal perforation
what is anemia of prematurity?
nadir - 4-8 weeks suppressed postnatal response to EPO sampling increase in blood volume with growth short RBC life span
what are transfusion threashold for babies not requiring vent support at week 1,2,3
week 1 100
- 85
- 75
what are transfusion threashold for babies requiring vent support at week 1,2,3
- 115
- 100
- 85
what are causes of cyanosis
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
what are complications of forceps or vaccum delivery
facial marks bruising skull fracture facial nerve injury lacerations hematoma intracranial bleeds subgaleal hematoma
what is the hyperoxic test?
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
What are possible neonatal complications of GDM?
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
what are possible issues if mom has SLE?
congenital HB rash hepatitis low PLT low WBC neuro
what are clinical features of congenital hypothyroidism?
prolonged jaundice poor feeding delayed MEC large fontanelles post date LGA eyelid edema delayed osseous dev
what are causes of neonatal goiter
inborn error of metabolism of thyroid hormones
maternal goitrogen - med used to treat thyroid issues
severe iodine def
what are causes of of no MEC for 48 hrs
anorectal malformation mec ileus med plug hirschsprung malrotation atresia - ileal, duodenal... incarcerated hernia small left colon syndrome ileus - spesis,hypokalemia, NEC, hypothyroidism, narcotics, prem
what are the benefits of kangaroo care?
temp stability improves sleep organization and duration of quiet sleep neurodev outcomes improves BF modulates response to pain good for mom- better attachment
what are recommendations for the use of steroids in CLD in prem?
- 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
what is SSRI neonatal behavioural syndrome?
occurs in 10-30% of babbies exposed to SSRI tachypnea cyanosis jittery and tremors inc msl tone feeding disturbances rarely sz
what can impair surfactant production and or secretion?
hypoxemia acidosis hypothermia hypotension prematurity MEC infant of DM
what are possible side effects of surfactant therapy?
pulm haemorrhage due to increased pulm blood flow clinical PDA blockage of ETT bradycardia hypotension transient hypoxia and hypercapnia
what is the patho-phys of physiologic jaundice
high RBC matss
short RBC life span
immature liver with lower uptake of bili
decreased activity of glucutonyl transferase - lower conjugation
How do you manage a baby of a mom who is GBS + but incomplete Abx
the risk of invasive GBS is 1%
monitor closely for 24 hours - 95 % will should CF in first 24 hrs
What medications are contraindicated in breastfeeding
Antineoplastic agents Bromocriptine Clozapine Doxorubicin Immunosuppressants Lithium *** Methimazole Thiouracil
if a mom is on lithium, what do you do
keep her on it
aim for lowest dose
what are potential effetcs of neonatal exposure to Lithium
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
what are features of FAS
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
When does hemorrhagic disease of the newborn occur? 3
early - 0-24h
classic - 2-7 days
late - 1-6 mo
what are causes of EARLY hemorrhargic disease of the newborn
0-24 hrs
maternal drugs: rifampin, phenytoin,phenobarbital, warfarin, INH
bleed: skull, brain, GI
what are causes of CLASSIC hemorrhargic disease of the newborn
2-7 days:
Vit K def
BF and low vit K
bleed: GI, H&N, intracranial, circumcision
what are causes of LATE hemorrhargic disease of the newborn
1-6 mo
cholecystitis leading to vit K malabsorption: CF, biliary atresia, hepatitis
Bleed:intracranial, cutaneous
what lab results are consistent with hemorrhagic disease of the newborn?
HIGH aPTT and PT
Low prothrombin, factor VII, IX and X
rest all normal
baby found to have “conjunctivitis” at 12 hrs of age. DDx
chemical irritation from Erythromycin oint
conjunctivitis at 1-2 d olf life. DDX
Bacterial - staph aureus usually
when does gonorrhea conjunctivitis present?
DOL 2-4
May Need FSWU and cefotaxime IM x1 for sure
complication = corneal perforation
when does Chlamydia conjunctivitis present?
> DOL 5-14
erythromycin OINT does not prevent
need PO Rx
what maternal drugs can cause neonatal apnea?
MgSO4
opiates
what are red flags when it comes to hyperbili
if < 24 hrs if signs of hemolysis if HSM if dark urine and pale stools if unwell
what are causes of hyperbili occuring < 24 hrs
- sepsis - GBS, TORCH
2. Hemolysis - Rh or ABO
what are the indications for cooling?
> 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
What are 2 causes of neonatal hypothyroidism
hypoplasia/aplasia - 85%
maternal Ab - thyrotropin receptor blocking Ab
Maternal meds-amiodarone, PTU, methimazole, iodine
Thyroid hormone defect
baby found to have a goiter, what is you DDx
thyroid hormone synthesis defect
mat thyroid meds
severe iodine def or excess
