Lecture 1- 9/24 Flashcards
what are some things that can happen to an infant of a diabetic mom?
hypoglycemia/ hypocalcemia
cardiac disease
big baby (possibility for birth injury)
What time period is a baby considered a neonate?
First 28 days of life
What can moms with antiphospholipid syndrome have?
Start forming clots
What can happen with a mom with lupus?
baby can have a greater chance of a heart block at birth
What can GBS + mom cause in baby?
Pneumonia, sepsis
When do congenital infections occur?
Earlier in the pregnancy and have affected the infant
If the baby was born after PROM, what is the greater risk of?
Infection
What is the amniotic fluid needed for?
Cushion
Helps to grow the lungs (baby practices breathing)
Why does polyhydramnios occur?
Baby isn’t swallowing the amniotic fluid isn’t getting in and out
What problems can polyhydramnios indicate?
intestinal obstruction, inability to swallow (inherited neuromuscular disease)
Before baby is born, was baby’s BP higher or lower than moms?
Lower
what does the Ballard exam do?
Helps us figure out how old the baby is (gestation week wise)
What are post term infants at higher risk for
Asphyxia
Meconium aspiration
Trisomies and other syndromes
WHat is SGA?
Small for Gestational Age for weight, height, head circumference.
<10% for growth parameters
What is asymmetric SGA?
Head is within normal range but rest are small.
Impacted later in development (brain growth is still following normal course)
For symmetric SGA what should you think?
Infection (TORCH)
Chromosome problem
What should you think for asymmetric SGA?
problems with placenta
Mom’s HTN (decreased BF to baby)
later infection/ stress
Within one hour what ointment do baby’s get in their eyes?
Erythromycin (GC)
What is giving within 4 hours of a baby being born?
Vit K 1 mg IM
When is HepB vaccine given?
Often before discharged.
If mom is Hep B+ give vaccine + HBIG
What does the newborn screen look for?
Set of genetic conditions, inborn errors of metabolism, sickle cell, etc
What are 5 common problems of term newborns?
Birth trauma jaundice hypoglycemia respiratory distress In utero drug exposure
What is HIE?
Hypoxic Ischemic Encephalopathy
Do whole body cooling to spare brain tissue
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
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
