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PEDIA 1 > HIGH-RISK INFANTS > Flashcards

HIGH-RISK INFANTS Flashcards

1
Q

4 main groups of High risk infant

A
  • Preterm
  • Infants with special health care needs
  • Infants at risk because of family issues
  • Infants with anticipated early death
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2
Q

present with either monozygotic or dizygotic twin

A

Single placenta

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3
Q
  • Result from simultaneous maturation of multiple ovarian follicles
  • Occur in many women treated for infertility
A

Polyovular pregnancies

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4
Q

Twinning results from the splitting of a single conceptus, with the timing resulting in differing amnionicity and chorlonicity

A

Fission theory

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5
Q

Inner cell mass of trophectoderm fuse after the initial 2-cell splitting stage

A

Fussion theory

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6
Q

obligate monozygotes

A

Conjoined twin

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7
Q
  • Result from later fission of a single zygote (0-14 days) or from fusion of 2 zygotes
  • Majority are female
  • Site of connection:
    > Thoracoomphalopagus (28%)
    > Thoracopagus (18%)
    > Omphalopagus (10%)
    > Craniopagus (6%)
    > Incomplete duplication (10%)
A

Atypical twinning

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8
Q
  • smaller and less completely developed member of a pair of conjoined twins
  • Has embryonic demise but remains vascularized by the surviving independent twin (autocyte)
A

Parasitic twin

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9
Q

for asymmetrically attached conjoined twins in whom one twin is dependent on the cardiovascular system of the intact autocye

A

Exoparasitic twin

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10
Q

one fetus exists as a benign mass in the autocyte

A

Endoparasitic twins

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11
Q
  • fertilization of an ovum by an insemination that takes place after 1 ovum has already been fertilized
  • fertilization and subsequent development of an embryo when a fetus is already present in the uterus
A
  • Superfecundation
  • Superfetation
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12
Q

high fatality; intertwining of cords with multiple gestation

A

Monoamniotic twins

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13
Q

Placental vascular anastomoses occur in monochorionic placentas

A

Twin Syndromes (TRAP, TTTS)

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14
Q
  • twin reversed arterial perfusion
  • Acardiac fetus - combination of a-a and v-v anastomoses
A

TRAP syndrome

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15
Q
  • artery from one twin acutely or chronically delivers blood that is drained into the vein of the other
  • Common in monozygotic twin and affects 30% of monochorionic twins
A

TTTS

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16
Q

Diagnosis of Twin Syndromes

A
  • Uterine size greater than that expected for gestational age
  • Auscultation of 2 fetal hearts
  • Elevated maternal serum AFP or HCG levels
  • Confirmed by UTZ
17
Q

Tx of Twin Syndromes

A
  • Elective delivery of twins at 37 wks or earlier for
    monochorionic, monoamniotic twins
  • Close observation and attendance by a pediatric team
18
Q

Duration for Extremely and very preterm infants

  • Preterm:
  • Extremely PT or extremely low gestational age
    newborns:
  • Very preterm:
  • Moderate and late preterm:
A
  • Preterm: <37 wks from the 1st day of LMP
  • Extremely PT or extremely low gestational age
    newborns: <28 wks
  • Very preterm: 28wks and 31 6/7 wks
  • Moderate and late preterm: 32 wks and 36 6/7 wk
    gestation
19
Q

BIRTHWEIGHT CATEGORIES

  • Extremely LBW:
  • Very low birthweight infant -
  • Low birthweight - born
A
  • Extremely LBW: <1000 grams
  • Very low birthweight infant - <1500gms
  • Low birthweight - born <2500gms
20
Q

classified as reduced birthweight and appear to have a disproportionately larger head relative to body size

A

IUGR

21
Q

Assessment of Gestational age

  • Symmetric
  • Asymmetric
A
  • Symmetric :
    > earlier onset
    > asstd with diseases that affect fetal cell number
  • Asymmetric :
    > late onset
    > associated with poor maternal nutrition
22
Q

Nursery Care

  • Thermal control
  • Oxygen therapy
A
  • Thermal control
    > Incubators and radiant warmers
    > Maintain infants core temp at 36.5-37C (97.7-98.6F)
    > Kangaroo Mother Care
    > Maintain relative humidity of 40-60%
  • Oxygen therapy
    > Reduce the risk of injury from hypoxia and circulatory insufficiency
    > ROP and BPD
    > O02 saturation range: 90-95%
23
Q

Fluid Requirements and Nutrition

  • Early Parenteral Nutrition
  • Human milk
  • Enteral Nutrition
A
  • Early Parenteral Nutrition
    > Minimum of 2g/kg of amino acid given in the 1% 24h after birth to at least 3.5g/kg within 24-48hr after birth
  • Human milk: lower incidence of NEC
  • Enteral Nutrition
    > Starts between 6 and 48hr with some period of trophic/ minimal enteral feeding volume
    > Slowly advance 15-30 mi/kg/day with target of 110-135 kcal/kg/day and 3.5-4.5g protein/kg/day
24
Q
  • 32 and 33 6/7wks. Risk of postnatal morbities: poor feeding, wt loss, RDS, NEC, hypothermia
  • 34 and 36 6/7 wks. Increase incidence of congenital anomalies, requires resuscitation, hypoglycemia, respiratory distress, apnea, feeding difficulties and jaundice
A
  • Moderate PT
  • Late preterm:
25
Q
  • Early term:
  • Full term:
  • Late term:
A
  • Early term: 37 - 38 6/7wks
  • Full term: 39 - 40 6/7wks
  • Late term: 41 - 41 6/7 wks
26
Q

Large for Gestational Age

  • Birthweight
  • Decreases mortality
  • Predisposing factors
A
  • Birthweight > the 90” percentile for gestational age
  • Neonatal mortality decreases with increasing BW until 4000 gms; increase after
  • Predisposing factors: maternal diabetes and obesity
27
Q
  • Born after 42 completed weeks of gestaiton from
    the LMP
  • Common complication
    > Perinatal depression, meconium aspiration, PPHN, hypoglycemia, hypocalcemia and polycythemia
  • Mgt:
    > monitor (NST, BPP, Doppler velocimetry)
    > Induction of labor
A

Postterm Infants

28
Q

Infant of Diabetic Mothers

  • 1st trimester
  • 2nd trimester
    3rd trimerster
A
  • 1st trimester
    > Major congenital anomalies and fetal growth
    restriction
  • 2nd trimester
    > Chronic hyperinsulinism
    -3rd trimerster
    Multiple d/o or dses presenting after delivery

PEDIA 1 (12 decks)

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