Kaplan Neonate Flashcards
1
Q
Prognosis of Cephalohematoma
A
- most resolve in 2 weeks to 3 months
- may have calcium deposition for up to 1 to 5 years
2
Q
Presentation / Risk Factors for subcutaneous fat necrosis
A
- traumatic deliveries and assd with maternal cocaine use
- presents at first 6 to 10 days ofe life at sites of trauma there are well-defined, irregular, hard, purplish lesions
3
Q
Dx, Tx, and resolution of subq fat necrosis
A
- get calcium if symptoms of hypercalcemia (vomiting, irritability, lethargy, anorexia)
- if hyperca; fluids, lasix, hydrocortisone
- becomes soft within 2 months and then regresses
4
Q
when do you get imaging for a skull fracture 2/2 delivery
A
if it is depressed (XR; can consider CT if c/f brain trauma)
5
Q
Presentation and Prognosis of Facial Nerve Palsy
A
- smooth forehead, no nasolabial fold, ipsi mouth droop
- tongue not affected so can still feed
- resolves within days to weeks (if severe months)
6
Q
How long does it take subconjunctival hemorrhage to resolve
A
about 1 to 2 weeks
7
Q
Presentation Duchenne Erb
A
-C5 to C6 so arm is adducted and internally rotated with extension at elbow, forarm is pronated
8
Q
Presenation Klumpke Palsy
A
C8 to T1 so horner syndrome with hand and wrist paralyzed
9
Q
Dx, Tx, Prognosis of Birth Palsys
A
- can consider radiographs to exclude other injuries
- PT and if not corrected by 3 to 9 months may need brachial plexus surgery
- most will resolve completely
10
Q
First and then Best Imaging for Phrenic Nerve Injury
A
- plain CXR
- best is real time US
11
Q
Tx and Prognosis Phrenic Nerve Injury
A
- place baby affected side down
- tx the respiratory distress
- if no resolution in 2 months, surgical plication of diaphragm
- most recover spontaneously
12
Q
Presentation of SCM Injury
A
- results in muscular torticollis
- difficult delivery leads to hematoma which leads to scaring and muscle shortening
- may present at birth or 10-14 days after
- head goes to involved side and chin goes to opposite shoulder
13
Q
Dx, Tx, and Prognosis SCM Injury
A
- plain radiograph to exclude other pathology
- tx: PT (look in involved direction, sleep on affected side) for 6 months; then surgery
- most resolve in 2 to 3 months; if not can lead to foreshortened skull and scoliosis later on
14
Q
What is a Preterm Infant?
A
< 37 weeks
15
Q
What is LBW infant and why important?
A
< 2500g. Significant morbidity through first 28 days of life
16
Q
What is VLBW
A
BW < 1500g
17
Q
What is the most accurate predictor of neonatal mortality rate?
A
very low birth weight (<1500g)
18
Q
What are IUGR babies at risk for?
A
- hypoglycemia
- temperature instability
- asphyxia
- polycythemia
19
Q
What is symmetric IUGR?
A
- decreased length, weight, and HC due to decreased cell number
- occurs early in gestation
20
Q
What causes symmetric IUGR?
A
- chromosomal
- malformation syndromes
- teratogenic
- intrauterine infections
21
Q
What is asymmetric IUGR?
A
- head sparing so brain size is normal
- usually in 3rd trimester
22
Q
Causes asymmetirc IUGR?
A
- poor maternal nutrition
- placental problems
- maternal illness (anemia, HTN, renal)
23
Q
What are major risk factors for LGA baby?
A
maternal obesity and DM
24
Q
What are complications of LGA?
A
- congenital anomalies
- birth injuries
- higher rates of developmental delay
25
Most common causes late onset sepsis (beyond 7 days of life)
- CONS
- staph aureus
- candida
- GN organism
- GBS
26
Empiric Tx Early Onset Sepsis
- amp and gent
| - if concern for meningitis add HD 3rd generation cephalosporin as aminoglycosides to cross BBB well
27
Empiric Tx Late Onset Sepsis
-since CONS is most common, consider vancomycin
28
Tx Duration Neonatal Sepsis
7 to 10 days or 5 to 7 days after clinical imporvement
29
Presentation of Toxo infection
- chorioretinitis
- hydrocephalus
- intracranial calcifications
- hepatosplenomegaly
- premie and IUGR
30
Best initial text for toxo
-IgM ELISA or agglutination
31
Most accurate test for toxo
PCR in amniotic fluid
32
Tx mom of toxo
- prevent with spiramycin
| - if intrauterine evidence of infx pyrimethaine plus sulfadiazine (mother on folinic acid)
33
What stage of syphilus will newborn have?
second
34
Signs of newborn syphilis infection in < 2 year old
- IUGR, jaundice, hepatosplenomegaly
- SNUFFLES
- chorioetinitis
- nephrotic syndrome
- periosteitis, osteochondritis
- mucocutaneous lesions (can involve palms and soles so like desquamation)
35
Signs of Late Syphilis aka untreated
-Rhagades: linear scares from anus, nares, mouth
-saddle nose
saber shints (anterior tibia bow)
-clutton joints or painless synovitis
-mulberry molars
-hutchinson teeth (central incisors)
36
Best Initial Test for Syphilis
- screen with nontreponemal such as VDRL or RPR
| - confirm with treponemal test (FTA-ABS, TPI, MHA-TP)
37
What is the most accurate test for syphilis?
dark field micscopy or direct immunofluorescence of tissue
38
Tx Newborn Syphilis
- first week of life penicillin for 10 days
- follow until nontreponemal test is negative
- if mother received penicillin at least 4 weeks prior to delivery don't have to treat
39
Monitoring Syphilis
- nontreponemal tests decrease by 3 months and should be negative by 6 months
- will retreat if still reactive
- if neurosyphilis CSF every 6 months
40
Imaging and Workup of Syphilis
- long bone imaging
- CSF
- blood
41
When to treat for syphilis
- nontreponemal test > 4x mothers
- evidence of syphilis
- positive CDRL in CSF OR elevated CSF protein or wbc
- placental or umbilical cord positive via direct immunofluorescence
42
Presentation Congenital Varicella
- cicatrical skin lesions
- limb hypoplasia and atrophy (esp in weeks 6 to 12 GA)
- club foot
- microcephaly
- IUGR
- mental deficiency
43
DX Congenital Varicella
- history, fetal US or newborn exam
| - VZV specific IgM and IgG in CORD blood
44
TX and outcome Congenital Varicella
- once mom is infected, VZIG will not help fetus
- if mom has severe disease when pregnant acyclovir can help her but not baby
- up to half die; seizures and mental deficiency for teh rest
45
Congenital Parvovirus Presentation
-most are normal, but can have nonimmune hydrops fetalis due to severe fetal anemia especially if acquired prior to 20 weeks
46
How can a neonate get HIV?
- labor and delivery
- transplacental
- BREASTMILK
47
What correlates most to perinatal transmission?
maternal HIV RNA viral load at time of delivery
48
S/S Neonatal HIV?
- usually asymptomatic at birth
| - can have LAD, FTT, pneumonia, and oral candidiasis
49
DX for Neonatal HIV?
- PCR for HIV DNA at birth, 1 month, and 4 months (confirmed with 2 positive tests)
- can't use Elisa or western blot until 18 months
50
TX Neonatal HIV
- elective c-section prior to ROM
- no BREASTMILK in resource rich countires
- mother with oral zidovudine prenatally and IV ZDV intrapartum
- infant on ZDV immediately after birth for at least 6 weeks or until disease absence is established
51
Presentation Congenital Rubella
- oftentimes normal at birth
- postnatal growth failure
- blueberry muffin spots on head, neck, and trunk (dermal extramedullary hematopoiesis)
- congenital heart disease
- sensorineural deafnesness
- PDA
- cataracts
52
DX Congenital Rubella
- prenatal: rubella IgM in mother 7 to 14 days after rash
| - Infant: initial get IgM; most accurate is PCR for viral RNA
53
Tx Congenital Rubella
- none
| - affected kids are contagious for a year
54
Presentation Congenital CMV
- hepatosplenomegaly and direct hyperbili
- thrombocytpoenia (petechiae, purpura)
- periventricular calfircaionts
- hearing
55
Best initial Test Cong CMV
-urine PCR with 3 samples
56
Tx and outcome Cong CMV
- if severely affected ganciclovir
- terrible hearing loss and can have optic atrophy
- seiizures
57
Best test HSV
PCR
58
Tx HSV
- c-section within 4 to 6 hours ROM (remember can even cross intact membranes)
- no breastfeeding if lesions on breast
- acyclovir for symptoms
59
What drugs put neonate at risk of hypoglycemia
- B blocker
- B sympathomimetic like terbutaline
- thiazide
- salicylates
- DM meds
60
What are the 3 major causes / categories of persistent neonatal hypoglycemia?
- hyperinsulinism: Beckwith Widemann syndrome, beta cell hyperplasia
- endocrin: pituitary or adrenal prolems
- inborn erros of metabolism
61
Teratogenic Effect of Hyperglycemia
-caudal regression syndrome (lumbosacral agenesis, pelvic agenesis)
-cardiomegaly with heart failure
-obstructive asymmetric septal hypertrophy (spontaneously resolves within 6 months)
0VSD, ASD, transposition
-small left colon
-renal vein thrombosis
-hypocalemia (decrease in PTH, increase in calcitonin)
62
Presentation Renal Vein Thrombosis
flank mass, hematuria, thrombocytopenia, polycythemia
63
Cause Newborn Hyperinsunliemia
- nesidioblastosis-adenoma spectrum: basically pancreatic adenomatous beta cell hyperplasia or diffuse
- usually sporadix
64
Dx Hyperinsunliemia
- initial: check insulin with glucose
| - accurate: need pancreas tissue
65
Tx Hyperinsunliemia
-glucose -->diazodixde -->octreotide
| 0eventually need subtotal or total pancreatectomy
66
What causes Beckwith-Widemann Syndrome (congenital overgrowth syndrome)
- altered imprinting on 11p chromosome
| - can be sporadic or familial
67
Presentation Beckwith-Wiedemann syndrome
- hemihypertrophy!
- macroglossia
- macrosomia (huge muscle mass)
- assd with abdominal wall defect including omphalocele
- hypoglycemia due to pancreatic cell overgrowth
- mild to moderate mental deficiency
- tumros (wilms, adrenocorcital, hepatoblastoma)
68
What syndrome is wilms tumor assd with?
Beckwith / congenital overgrowth
69
What is the biggest complication of TTN?
pulmonary artery hypertension due to hypoxemia
70
Pathophys of Mec Aspiration
proximal airway obstruction, peripheral airway obstruction, pneumonitis--> severe VQ mismatch
-airtrapping can lead to pneumothorax and hpoxemia to pulmonary HTN
71
CXR of Mec Aspiration
-patchy infiltrates, hyperexpantion, pneumothorax
72
Key words for CDH
- scaphoid abdomen
- bowel sounds in hemithorax
- decreased breath sounds
73
Management CDH
- intubate
- allow permissive hypercarbia
- will have severe pulmonary hypertension
74
Causes of PPHN
- hhhypoxemia, hypercarbia, acidosis usually due to polycythemia or hypoglycemia
- NSAIDs and SSRIs increase risk
75
Key words of PPHN
- severe respiratory distress and cyansis
| - hypoxemia resistant to 100% oxygen
76
Best initial test PPHN
-pre vs postductal (>5% difference in SpO2 or PaO2 difference of > 20mmHg)
77
Most accurate test PPHN
ECHO
78
Management PPHN
- premissive hypercarbia, 100% oxygen
| - inhaled NO
79
Who is RDS most common in?
white males; also premature (surfactant matures and increases in quantity at 35 weeks)
80
What pneumonia looks just like RDS?
GBS pneumonia
81
What congenital Heart disease looks like RDS?
TAPVR; obstructed type
82
Most accurate test forr RDS
lung profile looking at LS ratio and PG
83
Complications of RDS
- IVH
- PDA
- ROP
- BPD
84
Phsiologic Anemia Values (term and pre)
- term is 9 to 11 between age 8 and 12
| - pre is 7 to 10 at 6 weeks
85
What is the Kleihauer-Betke test?
for anemic newborns you take moms blood and if there is significant transplacental hemorrhage you may see significant fetal Hgb and RBCs in mom
86
What does low MCV in an anemic newborn mean?
thalassemia or chronic bblood loss
87
Complications severe polycythemia
- renal vein thrombosis
- pulmonary HTN
- seizure / stroke
- NEC
88
What causes erythroblastosis fetalis?
transplacental passage of maternal antibodies against paternal red cell antigens (D / Rh, ABO, minor)
89
Can IgM or IgG cross placenta?
IgG
90
What is hydrops fetalis and what does it cause?
excessive fluid in at least 2 comparments (skin, peritoneal, pericardial, and pleural) which leads to cardiac failure and circulatory collapse
91
Antenatal Tx of Rh Incompatibility
- if setup exists you serially monitor D IgG
- significant increase get doppler US MCA
- if US shows increased doppler, get percutaneous umbilical blood sample and will have to get PRBCs for anemia (q3 to 5 weeks as needed)
- deliver at 35 to 37 weeks
92
Which are Vitamin K dependent factors? Therefore what tests will be high?
II, VII, X, and X
| so PT and PTT and INR will be high
93
What is APT test?
fetal Hgb is alkali resistant while mom's isnt so add alkali
94
What is risk of IVH proprotional to?
gestational age since germinal matrix matures after 34 weeks
95
Who is at greatest risk of IVH?
premature LBW (< 1000g is highest)
96
Where is the bleed in IVH?
subependymal germinal matrix (periventricular origin of CNS neurons and glial cells); super vascular and immature
97
When is the highest incidence of IVH?
first 3 days; less common after first week
98
Most common presentation IVH?
premature first 3 days of life with onset of apnea, pallor, twitching, decreased Hct and metabolic acidosis
99
What is best initial test for IVH?
US!
100
Who gets screened for IVH
all infants less than 32 weeks
| -VLBW gets first few days; at 7 days if larger
101
How do you monitor IVH?
serial US; final at 36 to 40 weeks GA to evaluate for perventricular leukomalacia
102
What is periventricular leukomalacia
white matter necrosis in the corticospinal tracts that leads to motor abnormalities / CP
103
What are risks of periventricular leukomalacia
rapid fluctuations in blood pressure due to constant low perfusion followed by reperfusion
104
What do you see on US with periventrciular leukomalacia?
focal necrosis so ou might see increased echodensity in first week followed by cysts
105
What test for perivent leukomalacia
MRI after US
106
Tx PVL?
VP shunt
107
Pathophys of hypoxic ischemic encephalopathy
decreased perfusion to brain leading to tissue damage
108
cause HIE
PERINATAL usually not prenatal
| --anything that causes significant hypoxia in the newborn infant
109
Key words for HIE
- intrapartum fetal distress like late decels, fetal acdiosis
- apnea, irregular respirations, bradycardia, hypotonia to hypertonia, decreased or absent reflexes, seizures
110
Best initial Test for HIE
Head CT
111
Most accurate test for HIE
MRI; EEG
112
Management HIE
hypothermia within first 6 hours of life; prevent hypoxia and hypotension; seizure control
113
What is best AED for HIE?
phenopbarb
114
Umbilical Hernia
- more common in black
- most disappear by age 1 year
- surgery if symptomatic or 4 to 5 years old
115
What syndromes are assd with omphaloceles?
Beckwith Wiedemann, trisom 13,18,21
| Also more extra GI issues (cards, neuro, GU, skeletal)
116
Most common EA+TEF?
upper esophageal blind pouch with distal TEF
117
First step if you think there is EA+/- TEF
try to pass NG; then can get CXR
118
CXR with pure EA vs with distal TEF?
- pure EA has gasless abdomen
| - distal TEF shows large air distended stomach
119
What chromsome abnormality is associated with duodenal atresia?
trisomy 21
120
First step duodenal atresia?
KUB showing double bubble with no distal bowel gas
121
What causes jejuno-ileal atresia?
intestinal vascular incident that causes necrosis and resoprtion; less related to syndrome or extra intestinal issues
122
Presentation jejuno-ileal atresia
abdominal distension and biliary emesis (vs duodenal where there is no abdominal distension); failure to pass meconium
123
Test Jejuno ileal atresia
- plain film showing uniformly dilated air fluid levels
| - confirm with small bowel follow through (must differentiate from hirschsprun, or mec ileus)
124
What are meconium plugs associated with?
- small left colon (so think IDM)
- cystic fibrosis
- if mom received mag or opiate use
125
Dx and Tx meconium plug
- KUB shows dilated loops of bowel with no air in lower bowel and rectum
- do gastrografin enema
126
What is hirschsprung?
abnormal innervation beginning at the internal anal sphincter and spreading proximally
-most are rectosigmoid
127
Presentation Hirschsprung
- no meconium in full term
| - digital exam may show fecal mass in LLQ and no air in rectum
128
Test for Hirschsprung
- rectal manometry followed by biopsy
| - -can do barium enema as initial
129
Pathophys and location of NEC
-transmural necrosis of intesting, usually in terminal ileum and proximal colon
130
What are risk factors for NEC
- biggest is prematurity
- enteral feeding
- infection
131
When should a newborn have adult levels of bilirubin?
10 to 14 days of life
132
Sequelae of Kernicterus
- etrapyramidal findings
- high frequency hearing loss
- choreoathetosis with involuntary spasms
- dyarthric speech
133
What parts of brain does kernicterus affect?
brainstem nuclei and basal ganglia
134
When do you give IVIG to a kid with isoimmune disease?
when bili is reaching exchange tranfusion despite max phototherapy
135
Conditions for Early discharge (24 to 48 hours)
- uncomplicated course all around
- vaginal
- singleton GA 38 to 42
- good UOP and passage of stool
- at least 2 successful consecutive feedings
- no jaundice
- parents are good
- have physician follow up
- hep B given
- normal vital signs in open crib
- all labs done
136
When to do newborn secreen?
must wait at least 24 hours of normal protein and lactose feeding and be done by 7 days (recommend as close to discharge as possible)
137
What happens if newborn screen is done at < 24 hours of life?
must repeat at 14 days
138
AAP timeline for detecting hearing loss
detect by 3 months and interventions done by 6 months
