Gestation and Birth Flashcards
What is the main source of energy for a growing fetus?
Carbs - preterm babies don’t have time to build glycogen stores - more likely to be hypoglycemic
Week 1 of development
Fertilization - fallopian tube ampulla
Implantation begins
Week 2 of development
Implantation complete
Endoderm & Ectoderm form
Week 3 of development
Mesoderm formed = “tri” laminar embryo
Week 5 of development
Forebrain, midbrain and hindbrain
Week 7 of development
Heart formed
Week 8 of development
Organogenesis complete
Placentation
Week 9 of development
Permanent kidneys (metanephri) begin functioning
Week 10 of development
Midgut returns (counterclockwise rotation)
Week 24 of development
Primary alveoli are formed and surfactant production begins
Week 26 of development
Testicles descend
What is the CNS/PNS, sensory epithelia of ear/eye/nose, epidermis, mammary glands, pituitary gland, and tooth enamel formed from?
Ectoderm
What are the spinal nerves, CN, autonomic ganglia, adrenal medulla, meninges, pigment and peripheral glial cells formed from?
Neural Crest (Ectoderm)
What forms the CT, bone, striated and smooth muscle, blood/lymph, gonads, spleen, adrenal cortex and serous membranes lining body cavities?
Mesoderm
What forms the epithelial lining of the GI tract/Resp tract/ and middle ear, thymus, parathyroid/thyroid, liver, and pancreas?
Endoderm
What forms the valve of the foramen ovale?
Septum primum
What is the path of O2 from mom to fetus?
Umbilical vein - ductus venosus - IVC - *RA - foramen ovale - aorta
or *RV - pulmonary trunk - ductus arterosus - aorta
Where does fetal erythropoiesis occur?
3-8 wks = Yolk sac
6-8 wks = Liver
9-28 wks = Spleen
28 + wks = Bone Marrow
What induces primary male sex cords to develop into male gonads?
Testis-determining factor
Failure of the neural tube to close can result in __________.
Spina bifida = unfused spinal arch +/- unfused dura and spinal cord
What ratio of lecithin to sphingomyelin in the amniotic fluid indicates fetal lung maturity?
> 3
When is maternal α-fetoprotein high?
Multiple gestation
Fetal neural tube defects
Gastroschisis
**Incorrect dating**
Maternal α-fetoprotein is low in what 2 disease?
Trisomy 21 and 18
What is the most common cause for abnormal AFP?
Incorrect Dates!!!
What intrauterine infection leads to microcephaly, hydrocephalus, intracranial calcifications, chorioretinitis, and seizures?
Toxoplasmosis
Cats!
What intrauterine infection can lead to meningoencephalitis, microcephaly, cataracts, sensorineural deafness, and PDA or pulmonary artery stenosis?
Rubella - rare post-vaccine
IURG, low birth weight, jaundice, HSmegaly, chorioretinitis and intracranial calcifications can be caused by what?
CMV
What are causes of IUGR? (5)
Renal agenesis
Maternal vascular disease
Alcohol/Cocaine/Narcotics/Phenytoin
PPROM
CMV
What does this baby have?
Fetal Alcohol Syndrome
What does a newborn receive for ppx?
GC/CT eye ppx - 1% silver nitrate and erythromycin
Hemorrhagic disease of the newborn - Vitamin K
When does the anterior fontanelle close?
9-12 months
True or False: Acrocyanosis (blue hands and feet) is always pathologic in a newborn?
False, can be normal
A bulging fontanelle can indicate what?
Increased intracranial pressure
Hydrocephalus
Meningitis (Late-onset GBS)
Symmetrically small babies =
Normal HC, small body =
Early onset (<28wks): HTN, renal disease, ch. abnormalities
Late onset (>28 wks): Multiple gestation, preeclampsia
What is the most common bone fractured during delivery?
Clavicle
What is the most common cause of an abdominal mass in a newborn?
Enlarged kidney
Caput Succedaneum
Area of edema over presenting portion of scalp during vertex delivery
+/- bruising petechiae
Cephalohematoma
Bleeding below periosteum of parietal bone - usually
5-10% have skull fractures
“Claw Hand” deformity is caused by traction on what nerve roots?
C7 - C8
**Often seen with Horner’s Syndrome**
Erbs Palsy
C5-C6
“Waiter’s Tip”
How can you tell the difference between caput succedaneum and a cephalohematoma?
Caput = external to periosteum, crosses midline/suture lines
Cephalohematoma = below periosteium, doesn’t cross lines
What are risk factors for perinatal infections?
ROM > 18 hrs
Age < 37 wks
Chorio
Maternal fever
Maternal GBS+
What drug combos are used for neonatal sepsis?
Amp and Gent (Amp for listeria)
or
Amp and Cefotaxime
3 wk infant presents with paroxysmal cough and tachypnea, bilateral diffuse crackles, hyperinflation and patchy infiltrates on CXR. Had conjunctivitis at 10 days.
Chlamydia pneumonia
PO erythromycin for 2 wks
+Ortolani and Barlow tests indicate what?
Developmental Dysplasia of the hip
*Female, white, breech*
unilateral, left, short affected leg
What is the most common presentation of CF in the neonatal period?
Meconium Ileus
*Failure to pass stool, abdominal distention, vomiting*
How do you diagnose and treat Developmental Dysplasia of the Hip?
US
Pavlik harness or casting
What other problems can be seen with a diaphragmatic hernia?
Chromosomal abnormalities
LBW/IUGR
True or False: High indirect serum bilirubin in the first 24 hours of life is always pathologic.
True
A/O or B/O incompatibility
Rh iso-immunization
Infection
Liver disease
What is the cause of physiologic jaundice? When do you see it?
Inc. bilirubin 2/2 increased enterohepatic circulation
Starts at 24hrs
Peaks at 3 days
Resolves within 2 weeks
Kernicterus
Bilirubin neurotoxicity - deposits in basal ganglia
Deaf, encephalopathy, death
At what bilirubin do you treat with phototherapy? Exchange transfusion?
12-20
20-25
Premature infant
< 37 weeks
Low-birth-weight infant
Very-low-birth-weight infant
<2500 grams
<1500 grams
RDS of the newborn is caused by what? How do you diagnose it?
2/2 insufficiency of lung surfactant - alveoli don’t stay open
Fine, diffuse reticulogranular “ground glass” and air bronchograms
If an infant needs supplemental O2 > 28 days what do they have?
Bronchopulmonary Dysplasia - squamous metaplasia/hypertrophy of small airways
**Can be wheezing**
What causes Bronchopulmonary Dysplasia? (4) How do you treat it? (3)
Immature lung
Prolonged ventilation/Barotrauma
Oxygen toxicity to the lungs
O2 - PO steroids - bronchodilators
An infant that is intolerant of feeds - bilious vomit - with abdominal distention, temp instability, RDS, sepsis, etc has what?
Necrotizing Enterocolitis
**Bowel ischemia and bacterial invasion of intestinal wall**
Impression: Distended loops of bowel and pneumatosis intestinalis
What is it, how do you treat it?
Necrotizing enterocolitis
d/c feeds, ng tube, IV fluids, antibiotics, surgery
What causes retinopathy of prematurity?
Proliferation of immature retinal vessels 2/2 excessive O2 use in premie
Intraventricular Hemorrhage
Rupture of germinal matrix bv 2/2 hypoxic/hypotensive injury
dx w/ cranial US
*Correct underlying problem*
How do you diagnose Rickets of Prematurity?
XR: Cupping/fraying of metaphyses, osteopenia, subperiosteal new bone formation
What does an infant with the following have? How do you treat
- Hypotonia
- Craniotabes - occipital flattening
- Harrison’s Groove - rib indentation at the diaphragm
- Rachitic rosary - swelling of costochondral junction
Ricket’s of Prematurity - Ca/Phos occurs during 3rd trim.
Vitamin D and Calcium
**AlkPhos will also be inc.**
Do you give vaccinations based on postnatal or gestational age?
Postnatal
