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Clin Med IV: Pediatrics > Medical Issues of the Newborn > Flashcards

Medical Issues of the Newborn Flashcards

1
Q

When is APGAR assessed

A

1 minute and 5 minutes

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2
Q

What is APGAR

A

Universally-used method to assess newborn infant status immediately after birth
(Activity, Pulse, Grimace, Appearance, Respiration)

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3
Q

What are the benefits for baby with immediate/frequent skin-to-skin

A

thermoregulation
glucose regulation
lower / more stable HR
increase oxygenation / decrease apnea
neurobehavioral organization

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4
Q

What are the benefits for mom with immediate/frequent skin-to-skin contact

A

decrease postpartum cleeding
increase positive feelings
increase responsivenss
increase affectionate behavior
increase parenting confidence
decrease anxiety/stress/depression

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5
Q

how long does colostrum last for

A

aprox 3-4 days then converts to regular milk

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6
Q

What is “eyes and thighs”

A
  • 0.5% erythromycin opthalmic ointment
  • 1 mg IM vitamin K
  • Hep B vaccine
    all ~ 1 hour of life
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7
Q

What does LGA stand for

A

Large for gestational Age

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8
Q

what does SGA stand for

A

Small for gestational age

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9
Q

what is considered pre-term

A

anything before 37 weeks gestation

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10
Q

how much weight is lost in the first few days of life

percentage

A

8-10%

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11
Q

when is the weight regained after birth

A

by 2 weeks age

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12
Q

What are newborn screenings

A

Metabolic and Genetic Disorders
Hearing loss
Critical congenital heart disease

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13
Q

When should blood collection be done on newborns

A

between 24-48 hours (as close to 36 hours as possible)
required by law

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14
Q

What are the major newborn screenings in NH

A

congenital adrenal hyperplasmosis
congenital hypothyroidism
congenital toxooplasmosis
cystic fibrosis
PKU
sickle cellhemoglobin disorders

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15
Q

Without screening what is the age of detection of hearing loss

A

average 14 months

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16
Q

what is the goal for newborn hearing screening

A

diagnose < 3months, implement services < 6 months

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17
Q

What is pre-ductal oximetry

A

Right hand

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18
Q

how is oximetry measured on newborns

A

pre-ductal (right hand) and post-ductal (either foot) between 24-48 hours

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19
Q

what is a positive oximetry test in newborns

A
  • O2 sat < 90% at any time
  • O2 sat 90-94% in both extremities on 3 seperate measurements
  • O2 sat with >4% absolute difference between right hand and either foot on 3 sperate measurements
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20
Q

What are risk factors for newborn sepsis

A

maternal intrapartum temperatue > 100.4
membrane rupture 18 hours
delivery 37 weeks estation
chorioamnionitis
maternal GBS colonization

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21
Q

What is the Moro Relfex

A

AKA startle reflex
sudden, slight dropping of head from slightly raised supine position: opening of hands, extension and abduction of arms (and legs), then flexion of arms (and legs) and crying

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22
Q

What is the grasp reflex

A

stroking the palm of a babys hand causes baby to close finger or toes in a grasp

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23
Q

what is the stepping reflex

A

AKA “walking” or “dancing reflex”
seen when a baby is held upright or when baby’s feet ar touching the ground

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24
Q

What is ATNR

A

Asymmetrical tonic neck reflex
when babys head is hurned to one side, the arm on that side stretches out and oposite arm bends up at elbow

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25
What is Galant reflex
aka truncal incurvation relfex hold newborn in ventral suspension (face down) and stroke along one side of the spine; normal reactions i lateral flexion toward stimuated side
26
What are causes of indirect (unconjugated) hyperbili
increase lysis of RBC decreased hepatic uptake and conjugation of bilirubin increased enterohepatic reabsorption
27
What are causes of direct (conjugated) hyperbili
ALWAYS PATHOLOGIC hepatocellular diseases biliary tree abnormalities
28
What are the categories of bilirubin issues in newborns
physiologic jaundice (unconjugated/conjugated) Breastmilk and breastfeeding jaundice hyperbilirubinemia - pathologic
29
What type of hyperbilirubinemia is pathologic
Direct
30
What is BIND
Bilirubin-induced neurologic damage (BIND) - crosses BBB and binds to developing brain
31
What is ABE
Acute bilirubin encephalopathy
32
what can cause kernicterus
chronic and permanent damage due to BIND
33
What are neurotoxicity risk factors
iso-immune hemolytic disease G6PD deficiency asphyxia significant lethargy temperature instability sepsis acidosis albumin < 3.0 g/dL
34
What is the treatment for hyperbilirubinemia
Phototherapy - first line exchange transfusion
35
When do we use exchange transfusion for hyperbilirubinemia
dangerouly high levels acute bilirubin encephalopathy failure to respond to phototherapy
36
what are the types of cyanosis in newborns
peripheral and central cyanosis
37
what are causes of peripheral cyanosis in newborns
cold exposure acrocyanosis shock sepsis neonatal polycythemia
38
What are the pathophysiologic causes of central cyanosis
hypoventilation disorders pulmonary disorders cardiac causes hematologic causes
39
how is a cyanotic infant evaluated
pulse oximetry respiratory rate signs of respiratory distress cardiac exam
40
What is the initial management for cyanosis
prompt evaluation, cardiorespiratory support IV + O2 + monitors Pediatric cardiology consult if suspected CHD
41
what is TTN
Transient Tachypnea in Newborns
42
What is seen on CXR with TTN
increased lung volumes, flat diaphragms, prominent central vascular markings, fluid in fissures and possible small pleural effusion
43
how is TTN diagnosed
Clinical diagnosis
43
how is TTN managed
supportive -O2, neutral thermal environment, Nutrition
43
when does TTN resolve
24-72 hours
43
What is MAS
Meconium Aspiration syndrome most common in post-term infants
43
what is the clinical presentation of MAS
develops distress almost immediately after birth marked respiratory distress lungs: Rales, rhonchi
43
What is the dx/workup for MAS
CXR ABG CBC blood culture ECHO
43
what is the management of MAS
maintain oxygentation/ventilation -supplemental oxygen, intubation, surfactant, inhaled NO, ECMO Broad spectrum abx until infection is ruled out
43
What is ECMO
extracorporeal membrane oxygenation circulate blood through an artifical lung can be used for days (rather than hours in heart-lung machine)
43
What are the causes of persistent pulmonary HTN of newborns
MAS sepsis (GBS) Pneumonia RDS Congenital diaphragmatic hernia pulmonary hypoplasia
43
when does early onset sepsis occur
first 7 days of life
44
what causes early onset sepsis
bacteria from mom's GU tract: 2/3 of infections from 2 strains: - Group B strep (GBS) - E.coli often begins in-utero
44
What are risk factors for early onset sepsis
chorioamnionitis maternal temp > 100.4 preterm vaginal colonization with GBS membrane rupture > 18 hours
44
When does late onset sepsis occur
> 7 days of life usually occurs in healthy newborns who has discharged to home
44
what are the common pathogens with Late-onset sepsis
GBS E.coli S. aureus
44
what is the presentation of sepsis
subtle or frank (ill-appearing or not) temp instability irritability, high-pitched cry lethargy respiratory distress, apnea poor feeding tachy jaundice hypotension, abdnormal perfusion
44
what is the evaluation of early onset sepsis
blood cultures lumbar puncture CBC with diff, glucose, VBG CXR
45
what is the management of Early onset sepsis
hospitalization broad spectrum abx until culture results (amp and gent or amp and cefotaxamine)
46
what is the late onset sepsis evaluations
blood cultures lumbar puncture CBC with diff, glucose, VBG CXR PLUS U/A, gram stain and culture culture for any potential focus of infection
47
what is the management of late onset spesis
all neonates with a fever should be admitted and recieve emperic antibiotics
48
who are at higher risk of neonatal hypoglycemia
perterm LGA, SGA or infacnts of mothers with diabetes or who recieve beta adrenergic or oral anti-hyperglycemic agents
49
what are the causes of neonatal hypoglycemia
inadequate supply increase utilization of glucose
50
what are the signs/symptoms of neonatal hypoglycemia
jitterineess/tremors sweating irritability tachypnea or apnea pallor poor suck or poor feeding weak or high-pitched cry lethargy
51
52
What is FTT
Failure to Thrive
53
what are causes of FTT
GI disease Congenital abnormalities/CHD infections metabolic disease neurologic disease kidney disease hematologic disease/immunodeficiency child abuse and neglect
54
What is SIDS
Sudent infant death syndrome THE leading cause of mortality btwen 28 days and 1 year of life in the US
55
when is SIDS most common
between 2 - 4 months of age rates highest in the winter
56
What causes respiratory distress syndrome
Surfactant deficiency in preterm babies
57
what are the clinical manifestations of respiratory distress syndrome
tachypnea, nasal flaring, grunting, retractions, cyanosis
58
what is the management of RDS
antenatal corticosteroids to mom if premature delivery anticipated intratracheal surfactant upon delivery respiratory support (CPAP, nasal cannula, intubation)
59
What is BPD
bronchiopulmonary dysplasia neonatal chonic lung disease complication of prematurity
60
what is BPD likely due to | caused by
mechanical ventilation oxygen toxicity infection and inflammation
61
What is ROP
Retinopathy of Prematurity developmental proliferative vascular disorder/incomplete retinal vascularization acute and chronic effects of oxygen on developing blood vessels in the retina
62
what is the leading cause of blindess in very low birth weight infants
ROP
63
What is Necrotizing Enterocolitis
most common GI emergency in newborns ischemic necosis of intestine
64
what is the presentation of necrotizing enterocolitis
abd distention and pain hematochezia/diarrhea vomiting and non-specific signs
65
what is seen on x-ray with necrotizing enterocolitis
pneumatosis interstinalis (air btwn muscularis and subserosal layers)
66
What is the management of necrotizing enterocolitis
supportive care, no enteral feeding empiric abx may require surgery
67
how is intraventicular/periventricular hemorrhage diagnosed
cranial US (MRI is emerging but not standard)
68
when is intraventricular/periventricular hemorhage common
preterm infants in the first 5 days of life higher incidence with earlier gestational age and lwoer birth weight
69
What is the management of IVH/PVH
prevention is key
70
What are the complications of IVH/PVH
High risk for cerebral palsy and significant intellectual disability at minimum, at risk for developmental disability

Clin Med IV: Pediatrics (16 decks)

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