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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
Q

What is Galant reflex

A

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

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26
Q

What are causes of indirect (unconjugated) hyperbili

A

increase lysis of RBC
decreased hepatic uptake and conjugation of bilirubin
increased enterohepatic reabsorption

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27
Q

What are causes of direct (conjugated) hyperbili

A

ALWAYS PATHOLOGIC
hepatocellular diseases
biliary tree abnormalities

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28
Q

What are the categories of bilirubin issues in newborns

A

physiologic jaundice (unconjugated/conjugated)
Breastmilk and breastfeeding jaundice
hyperbilirubinemia - pathologic

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29
Q

What type of hyperbilirubinemia is pathologic

A

Direct

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30
Q

What is BIND

A

Bilirubin-induced neurologic damage (BIND)
- crosses BBB and binds to developing brain

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31
Q

What is ABE

A

Acute bilirubin encephalopathy

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32
Q

what can cause kernicterus

A

chronic and permanent damage due to BIND

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33
Q

What are neurotoxicity risk factors

A

iso-immune hemolytic disease
G6PD deficiency
asphyxia
significant lethargy
temperature instability
sepsis
acidosis
albumin < 3.0 g/dL

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34
Q

What is the treatment for hyperbilirubinemia

A

Phototherapy - first line
exchange transfusion

35
Q

When do we use exchange transfusion for hyperbilirubinemia

A

dangerouly high levels
acute bilirubin encephalopathy
failure to respond to phototherapy

36
Q

what are the types of cyanosis in newborns

A

peripheral and central cyanosis

37
Q

what are causes of peripheral cyanosis in newborns

A

cold exposure
acrocyanosis
shock
sepsis
neonatal polycythemia

38
Q

What are the pathophysiologic causes of central cyanosis

A

hypoventilation disorders
pulmonary disorders
cardiac causes
hematologic causes

39
Q

how is a cyanotic infant evaluated

A

pulse oximetry
respiratory rate
signs of respiratory distress
cardiac exam

40
Q

What is the initial management for cyanosis

A

prompt evaluation, cardiorespiratory support
IV + O2 + monitors
Pediatric cardiology consult if suspected CHD

41
Q

what is TTN

A

Transient Tachypnea in Newborns

42
Q

What is seen on CXR with TTN

A

increased lung volumes, flat diaphragms, prominent central vascular markings, fluid in fissures and possible small pleural effusion

43
Q

how is TTN diagnosed

A

Clinical diagnosis

43
Q

how is TTN managed

A

supportive
-O2, neutral thermal environment, Nutrition

43
Q

when does TTN resolve

A

24-72 hours

43
Q

What is MAS

A

Meconium Aspiration syndrome
most common in post-term infants

43
Q

what is the clinical presentation of MAS

A

develops distress almost immediately after birth
marked respiratory distress
lungs: Rales, rhonchi

43
Q

What is the dx/workup for MAS

A

CXR
ABG
CBC
blood culture
ECHO

43
Q

what is the management of MAS

A

maintain oxygentation/ventilation
-supplemental oxygen, intubation, surfactant, inhaled NO, ECMO
Broad spectrum abx until infection is ruled out

43
Q

What is ECMO

A

extracorporeal membrane oxygenation
circulate blood through an artifical lung
can be used for days (rather than hours in heart-lung machine)

43
Q

What are the causes of persistent pulmonary HTN of newborns

A

MAS
sepsis (GBS)
Pneumonia
RDS
Congenital diaphragmatic hernia
pulmonary hypoplasia

43
Q

when does early onset sepsis occur

A

first 7 days of life

44
Q

what causes early onset sepsis

A

bacteria from mom’s GU tract: 2/3 of infections from 2 strains:
- Group B strep (GBS)
- E.coli
often begins in-utero

44
Q

What are risk factors for early onset sepsis

A

chorioamnionitis
maternal temp > 100.4
preterm
vaginal colonization with GBS
membrane rupture > 18 hours

44
Q

When does late onset sepsis occur

A

> 7 days of life
usually occurs in healthy newborns who has discharged to home

44
Q

what are the common pathogens with Late-onset sepsis

A

GBS
E.coli
S. aureus

44
Q

what is the presentation of sepsis

A

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
Q

what is the evaluation of early onset sepsis

A

blood cultures
lumbar puncture
CBC with diff, glucose, VBG
CXR

45
Q

what is the management of Early onset sepsis

A

hospitalization
broad spectrum abx until culture results
(amp and gent or amp and cefotaxamine)

46
Q

what is the late onset sepsis evaluations

A

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
Q

what is the management of late onset spesis

A

all neonates with a fever should be admitted and recieve emperic antibiotics

48
Q

who are at higher risk of neonatal hypoglycemia

A

perterm
LGA, SGA
or infacnts of mothers with diabetes or who recieve beta adrenergic or oral anti-hyperglycemic agents

49
Q

what are the causes of neonatal hypoglycemia

A

inadequate supply
increase utilization of glucose

50
Q

what are the signs/symptoms of neonatal hypoglycemia

A

jitterineess/tremors
sweating
irritability
tachypnea or apnea
pallor
poor suck or poor feeding
weak or high-pitched cry
lethargy

51
Q
A
52
Q

What is FTT

A

Failure to Thrive

53
Q

what are causes of FTT

A

GI disease
Congenital abnormalities/CHD
infections
metabolic disease
neurologic disease
kidney disease
hematologic disease/immunodeficiency
child abuse and neglect

54
Q

What is SIDS

A

Sudent infant death syndrome
THE leading cause of mortality btwen 28 days and 1 year of life in the US

55
Q

when is SIDS most common

A

between 2 - 4 months of age
rates highest in the winter

56
Q

What causes respiratory distress syndrome

A

Surfactant deficiency in preterm babies

57
Q

what are the clinical manifestations of respiratory distress syndrome

A

tachypnea, nasal flaring, grunting, retractions, cyanosis

58
Q

what is the management of RDS

A

antenatal corticosteroids to mom if premature delivery anticipated
intratracheal surfactant upon delivery
respiratory support (CPAP, nasal cannula, intubation)

59
Q

What is BPD

A

bronchiopulmonary dysplasia
neonatal chonic lung disease
complication of prematurity

60
Q

what is BPD likely due to

caused by

A

mechanical ventilation
oxygen toxicity
infection and inflammation

61
Q

What is ROP

A

Retinopathy of Prematurity
developmental proliferative vascular disorder/incomplete retinal vascularization
acute and chronic effects of oxygen on developing blood vessels in the retina

62
Q

what is the leading cause of blindess in very low birth weight infants

A

ROP

63
Q

What is Necrotizing Enterocolitis

A

most common GI emergency in newborns
ischemic necosis of intestine

64
Q

what is the presentation of necrotizing enterocolitis

A

abd distention and pain
hematochezia/diarrhea
vomiting and non-specific signs

65
Q

what is seen on x-ray with necrotizing enterocolitis

A

pneumatosis interstinalis (air btwn muscularis and subserosal layers)

66
Q

What is the management of necrotizing enterocolitis

A

supportive care, no enteral feeding
empiric abx
may require surgery

67
Q

how is intraventicular/periventricular hemorrhage diagnosed

A

cranial US
(MRI is emerging but not standard)

68
Q

when is intraventricular/periventricular hemorhage common

A

preterm infants in the first 5 days of life
higher incidence with earlier gestational age and lwoer birth weight

69
Q

What is the management of IVH/PVH

A

prevention is key

70
Q

What are the complications of IVH/PVH

A

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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