Lecture 1- 9/24 Flashcards by Meg Dolohanty

what are some things that can happen to an infant of a diabetic mom?

hypoglycemia/ hypocalcemia
cardiac disease
big baby (possibility for birth injury)

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What time period is a baby considered a neonate?

First 28 days of life

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What can moms with antiphospholipid syndrome have?

Start forming clots

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What can happen with a mom with lupus?

baby can have a greater chance of a heart block at birth

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What can GBS + mom cause in baby?

Pneumonia, sepsis

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When do congenital infections occur?

Earlier in the pregnancy and have affected the infant

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If the baby was born after PROM, what is the greater risk of?

Infection

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What is the amniotic fluid needed for?

Cushion

Helps to grow the lungs (baby practices breathing)

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Why does polyhydramnios occur?

Baby isn’t swallowing the amniotic fluid isn’t getting in and out

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What problems can polyhydramnios indicate?

intestinal obstruction, inability to swallow (inherited neuromuscular disease)

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Before baby is born, was baby’s BP higher or lower than moms?

Lower

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what does the Ballard exam do?

Helps us figure out how old the baby is (gestation week wise)

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What are post term infants at higher risk for

Asphyxia
Meconium aspiration
Trisomies and other syndromes

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WHat is SGA?

Small for Gestational Age for weight, height, head circumference.
<10% for growth parameters

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What is asymmetric SGA?

Head is within normal range but rest are small.

Impacted later in development (brain growth is still following normal course)

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For symmetric SGA what should you think?

Infection (TORCH)

Chromosome problem

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What should you think for asymmetric SGA?

problems with placenta
Mom’s HTN (decreased BF to baby)
later infection/ stress

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Within one hour what ointment do baby’s get in their eyes?

Erythromycin (GC)

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What is giving within 4 hours of a baby being born?

Vit K 1 mg IM

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When is HepB vaccine given?

Often before discharged.

If mom is Hep B+ give vaccine + HBIG

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What does the newborn screen look for?

Set of genetic conditions, inborn errors of metabolism, sickle cell, etc

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What are 5 common problems of term newborns?

Birth trauma
jaundice
hypoglycemia
respiratory distress
In utero drug exposure

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What is HIE?

Hypoxic Ischemic Encephalopathy

Do whole body cooling to spare brain tissue

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What are some reasons for jaundice?

Baby not pooping
Liver not working
Lot of RBCs breaking down (making a lot of bilirubin) from Rh incompatibility
Large hematoma due to extraction

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When does jaundice peak in a term baby?

Days 3-5

When does jaundice peak in a preterm baby?

Days 5-7 or more

What does kernicteris cause?

Irreversible damage in the basal ganglia | bilirubin encephalopathy

In newborns, what is hypoglycemia?

<40 mg/dl

When can newborns be hypoglycemic?

LGA (high insulin) SGA (little glucose stores) stressed (used all glucose) IDM

What is TTN?

Transient tachypnea of the Newborn | happens from a slow transition of amniotic fluid otu of the lungs

Are pneumonias typically symmetric or asymmetric?

Asymmetric

What is one way to diagnose TTN?

No crisp border around the heart ("shaggy border") fluid is layering out between the lungs

What is congenital diaphragmatic hernia?

Intestines have grown where the lungs should be

Do cocaine and meth cause withdrawal in the baby?

No, but can cause small babies because of vasoconstriction

What is the most common preventable cause of mental retardation?

Alcohol

What infants will have withdrawal?

Moms on opioids

What is RDS?

Respiratory Distress Syndrome | Means you are missing surfactant

What are symptoms of RDS?

grunting cyanosis tachypnea CXR showing underexpansion, haziness with air bronchograms

Why do premies have apnea?

immature brainstem

How do you treat apnea of prematurity?

Caffeine

Are PDAs more of a problem for preterm or term babies?

Preterm

What is NEC?

Necrotizing Enterocolitis movmenet of gut flora into the bowel wall/ musculature leads to infection, necrosis, and perf

How do you treat NEC?

antibiotics if early and no perf | surgery if perf

What are symptoms of NEC?

emesis abdominal distention blue abdomen bloody stool

When should you listen to an infant's heart lungs and abdomen.

When the infant is quiet, in the beginning

What is the average head circumference of an infant?

34-35cm

Is phimosis normal in a infant male?

Yes

What infant population is intraventricular hemorrhage common (IVH) in?

Born <30 weeks due to cluster of vessels near the center of the brain

What grade of IVH is with blood at germinal matrix, has spontaneous resolution.

Grade 1

What grade IVH has blood in ventricles with enlargement of ventricle.

Grade 3

What grade of IVH has blood in ventricles, usually spontaneous resolution.

Grade 2

What grade of IVH has bleeding beyond ventricles into the parenchyma. Can possibly lead to cerebral palsy

Grade 4

How do you diagnose IVH?

Head ultrasound

How do you treat IVH?

Supportive therapy

Early onset newborn infection is how many days?

0-7 days

Late Onset newborn infection is how many day?

8-28 days

What are 4 things that can cause early onset neonatal infections?

GBS E. Coli Klebsiella Listeria

How do you treat early onset neonatal infections

Ampicillin and Gentamicin 7-10 or 14-21 days

How do infants with early onset neonatal infections present?

pale respiratory failure hypotensive DIC

If a infant presents after they had went home from the hospital and are lethargic, have poor feeding, fever, bulging fontanel, and seizures what should you suspect?

Late onset sepsis

What are some main causes of bacteremia?

E. Coli S. aureus S. epi

What are some main causes of osteomyelitis?

GBS | Staph aureus

What labs will you order for an infant with sepsis?

``` CBC w/ diff blood culture CRP Urinalysis and culture CSF Blood gas Chem 7 CXR ```

What does TORCH stand for?

``` Toxoplasmosis Other (syph, parovirus, varicella) Rubella CMV HSV, HIV ```

What tests do you use for TORCH conditions?

IgM

If a infant presents with a blueberry muffin rash (petechiae) and thromobycytopenia what should you suspect?

Congenital rubella

What problems can result from congenital rubella syndrome?

Eye lesions- cataracts, glaucoma | Sensorineural deafness

What is the most common congenital infection?

CMV

What does human parovirus B19 cause?

Aplastic anemia | Bone marrow suppression

If an infant presents with peeling rash on soles of feed and hands and bone lesions what should you suspect?

Congenital syphilis

How do you treat congenital syphilis?

Penicillin

If an infant presents with microcephaly, prominent eyes, blue sclerae, recurrent infections, what should you suspect?

HIV

How is transmission of HIV from mom to baby decreased?

AZT and c-section

birth defect in which an infant's intestines stick out of the body through a defect on one side of the umbilical cord. Just the intestines

Gastroschisis

s a birth defect in which the infant's intestine or other abdominal organs stick out of the belly button (navel). Still a sack

Omphalocele

Why is large labia major common in female infants?

Maternal hormones

Describing a bend or curvature of the fifth fingers (the "little fingers") toward the adjacent fourth fingers

Clinodactyly

A condition where 2 or more digits are fused together

syndactyly

single line that runs across the palm of the hand.

Simian crease

What reflex is where you stroke fingernail along spine and infant should curve laterally to that side.

Gallant reflex

Reflex where you drop the infant's head a few inches and their arms and fingers should extend.

Moro reflex

Reflex where you stroke at the corner of the babies' mouth, they will open their mouth and turn to the stimulated side.

Rooting reflex

a swelling over one or both parietal bones that is contained within suture lines

Cephalohematoma

Edema of the scalp over presenting parts that crosses suture lines

caput succedaneum