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Kaplan Neonate > Kaplan Neonate > Flashcards

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

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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

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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
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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)

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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)
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6
Q

How long does it take subconjunctival hemorrhage to resolve

A

about 1 to 2 weeks

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7
Q

Presentation Duchenne Erb

A

-C5 to C6 so arm is adducted and internally rotated with extension at elbow, forarm is pronated

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8
Q

Presenation Klumpke Palsy

A

C8 to T1 so horner syndrome with hand and wrist paralyzed

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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
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10
Q

First and then Best Imaging for Phrenic Nerve Injury

A
  • plain CXR

- best is real time US

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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
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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
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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
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14
Q

What is a Preterm Infant?

A

< 37 weeks

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15
Q

What is LBW infant and why important?

A

< 2500g. Significant morbidity through first 28 days of life

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16
Q

What is VLBW

A

BW < 1500g

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17
Q

What is the most accurate predictor of neonatal mortality rate?

A

very low birth weight (<1500g)

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18
Q

What are IUGR babies at risk for?

A
  • hypoglycemia
  • temperature instability
  • asphyxia
  • polycythemia
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19
Q

What is symmetric IUGR?

A
  • decreased length, weight, and HC due to decreased cell number
  • occurs early in gestation
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20
Q

What causes symmetric IUGR?

A
  • chromosomal
  • malformation syndromes
  • teratogenic
  • intrauterine infections
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21
Q

What is asymmetric IUGR?

A
  • head sparing so brain size is normal

- usually in 3rd trimester

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22
Q

Causes asymmetirc IUGR?

A
  • poor maternal nutrition
  • placental problems
  • maternal illness (anemia, HTN, renal)
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23
Q

What are major risk factors for LGA baby?

A

maternal obesity and DM

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24
Q

What are complications of LGA?

A
  • congenital anomalies
  • birth injuries
  • higher rates of developmental delay
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25
Q

Most common causes late onset sepsis (beyond 7 days of life)

A
  • CONS
  • staph aureus
  • candida
  • GN organism
  • GBS
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26
Q

Empiric Tx Early Onset Sepsis

A
  • amp and gent

- if concern for meningitis add HD 3rd generation cephalosporin as aminoglycosides to cross BBB well

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27
Q

Empiric Tx Late Onset Sepsis

A

-since CONS is most common, consider vancomycin

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28
Q

Tx Duration Neonatal Sepsis

A

7 to 10 days or 5 to 7 days after clinical imporvement

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29
Q

Presentation of Toxo infection

A
  • chorioretinitis
  • hydrocephalus
  • intracranial calcifications
  • hepatosplenomegaly
  • premie and IUGR
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30
Q

Best initial text for toxo

A

-IgM ELISA or agglutination

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31
Q

Most accurate test for toxo

A

PCR in amniotic fluid

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32
Q

Tx mom of toxo

A
  • prevent with spiramycin

- if intrauterine evidence of infx pyrimethaine plus sulfadiazine (mother on folinic acid)

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33
Q

What stage of syphilus will newborn have?

A

second

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34
Q

Signs of newborn syphilis infection in < 2 year old

A
  • IUGR, jaundice, hepatosplenomegaly
  • SNUFFLES
  • chorioetinitis
  • nephrotic syndrome
  • periosteitis, osteochondritis
  • mucocutaneous lesions (can involve palms and soles so like desquamation)
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35
Q

Signs of Late Syphilis aka untreated

A

-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)

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36
Q

Best Initial Test for Syphilis

A
  • screen with nontreponemal such as VDRL or RPR

- confirm with treponemal test (FTA-ABS, TPI, MHA-TP)

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37
Q

What is the most accurate test for syphilis?

A

dark field micscopy or direct immunofluorescence of tissue

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38
Q

Tx Newborn Syphilis

A
  • 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
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39
Q

Monitoring Syphilis

A
  • nontreponemal tests decrease by 3 months and should be negative by 6 months
  • will retreat if still reactive
  • if neurosyphilis CSF every 6 months
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40
Q

Imaging and Workup of Syphilis

A
  • long bone imaging
  • CSF
  • blood
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41
Q

When to treat for syphilis

A
  • 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
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42
Q

Presentation Congenital Varicella

A
  • cicatrical skin lesions
  • limb hypoplasia and atrophy (esp in weeks 6 to 12 GA)
  • club foot
  • microcephaly
  • IUGR
  • mental deficiency
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43
Q

DX Congenital Varicella

A
  • history, fetal US or newborn exam

- VZV specific IgM and IgG in CORD blood

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44
Q

TX and outcome Congenital Varicella

A
  • 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
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45
Q

Congenital Parvovirus Presentation

A

-most are normal, but can have nonimmune hydrops fetalis due to severe fetal anemia especially if acquired prior to 20 weeks

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46
Q

How can a neonate get HIV?

A
  • labor and delivery
  • transplacental
  • BREASTMILK
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47
Q

What correlates most to perinatal transmission?

A

maternal HIV RNA viral load at time of delivery

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48
Q

S/S Neonatal HIV?

A
  • usually asymptomatic at birth

- can have LAD, FTT, pneumonia, and oral candidiasis

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49
Q

DX for Neonatal HIV?

A
  • 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
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50
Q

TX Neonatal HIV

A
  • 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
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51
Q

Presentation Congenital Rubella

A
  • 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
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52
Q

DX Congenital Rubella

A
  • prenatal: rubella IgM in mother 7 to 14 days after rash

- Infant: initial get IgM; most accurate is PCR for viral RNA

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53
Q

Tx Congenital Rubella

A
  • none

- affected kids are contagious for a year

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54
Q

Presentation Congenital CMV

A
  • hepatosplenomegaly and direct hyperbili
  • thrombocytpoenia (petechiae, purpura)
  • periventricular calfircaionts
  • hearing
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55
Q

Best initial Test Cong CMV

A

-urine PCR with 3 samples

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56
Q

Tx and outcome Cong CMV

A
  • if severely affected ganciclovir
  • terrible hearing loss and can have optic atrophy
  • seiizures
57
Q

Best test HSV

A

PCR

58
Q

Tx HSV

A
  • c-section within 4 to 6 hours ROM (remember can even cross intact membranes)
  • no breastfeeding if lesions on breast
  • acyclovir for symptoms
59
Q

What drugs put neonate at risk of hypoglycemia

A
  • B blocker
  • B sympathomimetic like terbutaline
  • thiazide
  • salicylates
  • DM meds
60
Q

What are the 3 major causes / categories of persistent neonatal hypoglycemia?

A
  • hyperinsulinism: Beckwith Widemann syndrome, beta cell hyperplasia
  • endocrin: pituitary or adrenal prolems
  • inborn erros of metabolism
61
Q

Teratogenic Effect of Hyperglycemia

A

-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
Q

Presentation Renal Vein Thrombosis

A

flank mass, hematuria, thrombocytopenia, polycythemia

63
Q

Cause Newborn Hyperinsunliemia

A
  • nesidioblastosis-adenoma spectrum: basically pancreatic adenomatous beta cell hyperplasia or diffuse
  • usually sporadix
64
Q

Dx Hyperinsunliemia

A
  • initial: check insulin with glucose

- accurate: need pancreas tissue

65
Q

Tx Hyperinsunliemia

A

-glucose –>diazodixde –>octreotide

0eventually need subtotal or total pancreatectomy

66
Q

What causes Beckwith-Widemann Syndrome (congenital overgrowth syndrome)

A
  • altered imprinting on 11p chromosome

- can be sporadic or familial

67
Q

Presentation Beckwith-Wiedemann syndrome

A
  • 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
Q

What syndrome is wilms tumor assd with?

A

Beckwith / congenital overgrowth

69
Q

What is the biggest complication of TTN?

A

pulmonary artery hypertension due to hypoxemia

70
Q

Pathophys of Mec Aspiration

A

proximal airway obstruction, peripheral airway obstruction, pneumonitis–> severe VQ mismatch
-airtrapping can lead to pneumothorax and hpoxemia to pulmonary HTN

71
Q

CXR of Mec Aspiration

A

-patchy infiltrates, hyperexpantion, pneumothorax

72
Q

Key words for CDH

A
  • scaphoid abdomen
  • bowel sounds in hemithorax
  • decreased breath sounds
73
Q

Management CDH

A
  • intubate
  • allow permissive hypercarbia
  • will have severe pulmonary hypertension
74
Q

Causes of PPHN

A
  • hhhypoxemia, hypercarbia, acidosis usually due to polycythemia or hypoglycemia
  • NSAIDs and SSRIs increase risk
75
Q

Key words of PPHN

A
  • severe respiratory distress and cyansis

- hypoxemia resistant to 100% oxygen

76
Q

Best initial test PPHN

A

-pre vs postductal (>5% difference in SpO2 or PaO2 difference of > 20mmHg)

77
Q

Most accurate test PPHN

A

ECHO

78
Q

Management PPHN

A
  • premissive hypercarbia, 100% oxygen

- inhaled NO

79
Q

Who is RDS most common in?

A

white males; also premature (surfactant matures and increases in quantity at 35 weeks)

80
Q

What pneumonia looks just like RDS?

A

GBS pneumonia

81
Q

What congenital Heart disease looks like RDS?

A

TAPVR; obstructed type

82
Q

Most accurate test forr RDS

A

lung profile looking at LS ratio and PG

83
Q

Complications of RDS

A
  • IVH
  • PDA
  • ROP
  • BPD
84
Q

Phsiologic Anemia Values (term and pre)

A
  • term is 9 to 11 between age 8 and 12

- pre is 7 to 10 at 6 weeks

85
Q

What is the Kleihauer-Betke test?

A

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
Q

What does low MCV in an anemic newborn mean?

A

thalassemia or chronic bblood loss

87
Q

Complications severe polycythemia

A
  • renal vein thrombosis
  • pulmonary HTN
  • seizure / stroke
  • NEC
88
Q

What causes erythroblastosis fetalis?

A

transplacental passage of maternal antibodies against paternal red cell antigens (D / Rh, ABO, minor)

89
Q

Can IgM or IgG cross placenta?

A

IgG

90
Q

What is hydrops fetalis and what does it cause?

A

excessive fluid in at least 2 comparments (skin, peritoneal, pericardial, and pleural) which leads to cardiac failure and circulatory collapse

91
Q

Antenatal Tx of Rh Incompatibility

A
  • 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
Q

Which are Vitamin K dependent factors? Therefore what tests will be high?

A

II, VII, X, and X

so PT and PTT and INR will be high

93
Q

What is APT test?

A

fetal Hgb is alkali resistant while mom’s isnt so add alkali

94
Q

What is risk of IVH proprotional to?

A

gestational age since germinal matrix matures after 34 weeks

95
Q

Who is at greatest risk of IVH?

A

premature LBW (< 1000g is highest)

96
Q

Where is the bleed in IVH?

A

subependymal germinal matrix (periventricular origin of CNS neurons and glial cells); super vascular and immature

97
Q

When is the highest incidence of IVH?

A

first 3 days; less common after first week

98
Q

Most common presentation IVH?

A

premature first 3 days of life with onset of apnea, pallor, twitching, decreased Hct and metabolic acidosis

99
Q

What is best initial test for IVH?

A

US!

100
Q

Who gets screened for IVH

A

all infants less than 32 weeks

-VLBW gets first few days; at 7 days if larger

101
Q

How do you monitor IVH?

A

serial US; final at 36 to 40 weeks GA to evaluate for perventricular leukomalacia

102
Q

What is periventricular leukomalacia

A

white matter necrosis in the corticospinal tracts that leads to motor abnormalities / CP

103
Q

What are risks of periventricular leukomalacia

A

rapid fluctuations in blood pressure due to constant low perfusion followed by reperfusion

104
Q

What do you see on US with periventrciular leukomalacia?

A

focal necrosis so ou might see increased echodensity in first week followed by cysts

105
Q

What test for perivent leukomalacia

A

MRI after US

106
Q

Tx PVL?

A

VP shunt

107
Q

Pathophys of hypoxic ischemic encephalopathy

A

decreased perfusion to brain leading to tissue damage

108
Q

cause HIE

A

PERINATAL usually not prenatal

–anything that causes significant hypoxia in the newborn infant

109
Q

Key words for HIE

A
  • intrapartum fetal distress like late decels, fetal acdiosis
  • apnea, irregular respirations, bradycardia, hypotonia to hypertonia, decreased or absent reflexes, seizures
110
Q

Best initial Test for HIE

A

Head CT

111
Q

Most accurate test for HIE

A

MRI; EEG

112
Q

Management HIE

A

hypothermia within first 6 hours of life; prevent hypoxia and hypotension; seizure control

113
Q

What is best AED for HIE?

A

phenopbarb

114
Q

Umbilical Hernia

A
  • more common in black
  • most disappear by age 1 year
  • surgery if symptomatic or 4 to 5 years old
115
Q

What syndromes are assd with omphaloceles?

A

Beckwith Wiedemann, trisom 13,18,21

Also more extra GI issues (cards, neuro, GU, skeletal)

116
Q

Most common EA+TEF?

A

upper esophageal blind pouch with distal TEF

117
Q

First step if you think there is EA+/- TEF

A

try to pass NG; then can get CXR

118
Q

CXR with pure EA vs with distal TEF?

A
  • pure EA has gasless abdomen

- distal TEF shows large air distended stomach

119
Q

What chromsome abnormality is associated with duodenal atresia?

A

trisomy 21

120
Q

First step duodenal atresia?

A

KUB showing double bubble with no distal bowel gas

121
Q

What causes jejuno-ileal atresia?

A

intestinal vascular incident that causes necrosis and resoprtion; less related to syndrome or extra intestinal issues

122
Q

Presentation jejuno-ileal atresia

A

abdominal distension and biliary emesis (vs duodenal where there is no abdominal distension); failure to pass meconium

123
Q

Test Jejuno ileal atresia

A
  • plain film showing uniformly dilated air fluid levels

- confirm with small bowel follow through (must differentiate from hirschsprun, or mec ileus)

124
Q

What are meconium plugs associated with?

A
  • small left colon (so think IDM)
  • cystic fibrosis
  • if mom received mag or opiate use
125
Q

Dx and Tx meconium plug

A
  • KUB shows dilated loops of bowel with no air in lower bowel and rectum
  • do gastrografin enema
126
Q

What is hirschsprung?

A

abnormal innervation beginning at the internal anal sphincter and spreading proximally
-most are rectosigmoid

127
Q

Presentation Hirschsprung

A
  • no meconium in full term

- digital exam may show fecal mass in LLQ and no air in rectum

128
Q

Test for Hirschsprung

A
  • rectal manometry followed by biopsy

- -can do barium enema as initial

129
Q

Pathophys and location of NEC

A

-transmural necrosis of intesting, usually in terminal ileum and proximal colon

130
Q

What are risk factors for NEC

A
  • biggest is prematurity
  • enteral feeding
  • infection
131
Q

When should a newborn have adult levels of bilirubin?

A

10 to 14 days of life

132
Q

Sequelae of Kernicterus

A
  • etrapyramidal findings
  • high frequency hearing loss
  • choreoathetosis with involuntary spasms
  • dyarthric speech
133
Q

What parts of brain does kernicterus affect?

A

brainstem nuclei and basal ganglia

134
Q

When do you give IVIG to a kid with isoimmune disease?

A

when bili is reaching exchange tranfusion despite max phototherapy

135
Q

Conditions for Early discharge (24 to 48 hours)

A
  • 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
Q

When to do newborn secreen?

A

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
Q

What happens if newborn screen is done at < 24 hours of life?

A

must repeat at 14 days

138
Q

AAP timeline for detecting hearing loss

A

detect by 3 months and interventions done by 6 months

Kaplan Neonate (2 decks)

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