Medical Issues of the Newborn Flashcards
When is APGAR assessed
1 minute and 5 minutes
What is APGAR
Universally-used method to assess newborn infant status immediately after birth
(Activity, Pulse, Grimace, Appearance, Respiration)
What are the benefits for baby with immediate/frequent skin-to-skin
thermoregulation
glucose regulation
lower / more stable HR
increase oxygenation / decrease apnea
neurobehavioral organization
What are the benefits for mom with immediate/frequent skin-to-skin contact
decrease postpartum cleeding
increase positive feelings
increase responsivenss
increase affectionate behavior
increase parenting confidence
decrease anxiety/stress/depression
how long does colostrum last for
aprox 3-4 days then converts to regular milk
What is “eyes and thighs”
- 0.5% erythromycin opthalmic ointment
- 1 mg IM vitamin K
- Hep B vaccine
all ~ 1 hour of life
What does LGA stand for
Large for gestational Age
what does SGA stand for
Small for gestational age
what is considered pre-term
anything before 37 weeks gestation
how much weight is lost in the first few days of life
percentage
8-10%
when is the weight regained after birth
by 2 weeks age
What are newborn screenings
Metabolic and Genetic Disorders
Hearing loss
Critical congenital heart disease
When should blood collection be done on newborns
between 24-48 hours (as close to 36 hours as possible)
required by law
What are the major newborn screenings in NH
congenital adrenal hyperplasmosis
congenital hypothyroidism
congenital toxooplasmosis
cystic fibrosis
PKU
sickle cellhemoglobin disorders
Without screening what is the age of detection of hearing loss
average 14 months
what is the goal for newborn hearing screening
diagnose < 3months, implement services < 6 months
What is pre-ductal oximetry
Right hand
how is oximetry measured on newborns
pre-ductal (right hand) and post-ductal (either foot) between 24-48 hours
what is a positive oximetry test in newborns
- 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
What are risk factors for newborn sepsis
maternal intrapartum temperatue > 100.4
membrane rupture 18 hours
delivery 37 weeks estation
chorioamnionitis
maternal GBS colonization
What is the Moro Relfex
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
What is the grasp reflex
stroking the palm of a babys hand causes baby to close finger or toes in a grasp
what is the stepping reflex
AKA “walking” or “dancing reflex”
seen when a baby is held upright or when baby’s feet ar touching the ground
What is ATNR
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
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
What are causes of indirect (unconjugated) hyperbili
increase lysis of RBC
decreased hepatic uptake and conjugation of bilirubin
increased enterohepatic reabsorption
What are causes of direct (conjugated) hyperbili
ALWAYS PATHOLOGIC
hepatocellular diseases
biliary tree abnormalities
What are the categories of bilirubin issues in newborns
physiologic jaundice (unconjugated/conjugated)
Breastmilk and breastfeeding jaundice
hyperbilirubinemia - pathologic
What type of hyperbilirubinemia is pathologic
Direct
What is BIND
Bilirubin-induced neurologic damage (BIND)
- crosses BBB and binds to developing brain
What is ABE
Acute bilirubin encephalopathy
what can cause kernicterus
chronic and permanent damage due to BIND
What are neurotoxicity risk factors
iso-immune hemolytic disease
G6PD deficiency
asphyxia
significant lethargy
temperature instability
sepsis
acidosis
albumin < 3.0 g/dL
What is the treatment for hyperbilirubinemia
Phototherapy - first line
exchange transfusion
When do we use exchange transfusion for hyperbilirubinemia
dangerouly high levels
acute bilirubin encephalopathy
failure to respond to phototherapy
what are the types of cyanosis in newborns
peripheral and central cyanosis
what are causes of peripheral cyanosis in newborns
cold exposure
acrocyanosis
shock
sepsis
neonatal polycythemia
What are the pathophysiologic causes of central cyanosis
hypoventilation disorders
pulmonary disorders
cardiac causes
hematologic causes
how is a cyanotic infant evaluated
pulse oximetry
respiratory rate
signs of respiratory distress
cardiac exam
What is the initial management for cyanosis
prompt evaluation, cardiorespiratory support
IV + O2 + monitors
Pediatric cardiology consult if suspected CHD
what is TTN
Transient Tachypnea in Newborns
What is seen on CXR with TTN
increased lung volumes, flat diaphragms, prominent central vascular markings, fluid in fissures and possible small pleural effusion
how is TTN diagnosed
Clinical diagnosis
how is TTN managed
supportive
-O2, neutral thermal environment, Nutrition
when does TTN resolve
24-72 hours
What is MAS
Meconium Aspiration syndrome
most common in post-term infants
what is the clinical presentation of MAS
develops distress almost immediately after birth
marked respiratory distress
lungs: Rales, rhonchi
What is the dx/workup for MAS
CXR
ABG
CBC
blood culture
ECHO
what is the management of MAS
maintain oxygentation/ventilation
-supplemental oxygen, intubation, surfactant, inhaled NO, ECMO
Broad spectrum abx until infection is ruled out
What is ECMO
extracorporeal membrane oxygenation
circulate blood through an artifical lung
can be used for days (rather than hours in heart-lung machine)
What are the causes of persistent pulmonary HTN of newborns
MAS
sepsis (GBS)
Pneumonia
RDS
Congenital diaphragmatic hernia
pulmonary hypoplasia
when does early onset sepsis occur
first 7 days of life
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
What are risk factors for early onset sepsis
chorioamnionitis
maternal temp > 100.4
preterm
vaginal colonization with GBS
membrane rupture > 18 hours
When does late onset sepsis occur
> 7 days of life
usually occurs in healthy newborns who has discharged to home
what are the common pathogens with Late-onset sepsis
GBS
E.coli
S. aureus
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
what is the evaluation of early onset sepsis
blood cultures
lumbar puncture
CBC with diff, glucose, VBG
CXR
what is the management of Early onset sepsis
hospitalization
broad spectrum abx until culture results
(amp and gent or amp and cefotaxamine)
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
what is the management of late onset spesis
all neonates with a fever should be admitted and recieve emperic antibiotics
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
what are the causes of neonatal hypoglycemia
inadequate supply
increase utilization of glucose
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
What is FTT
Failure to Thrive
what are causes of FTT
GI disease
Congenital abnormalities/CHD
infections
metabolic disease
neurologic disease
kidney disease
hematologic disease/immunodeficiency
child abuse and neglect
What is SIDS
Sudent infant death syndrome
THE leading cause of mortality btwen 28 days and 1 year of life in the US
when is SIDS most common
between 2 - 4 months of age
rates highest in the winter
What causes respiratory distress syndrome
Surfactant deficiency in preterm babies
what are the clinical manifestations of respiratory distress syndrome
tachypnea, nasal flaring, grunting, retractions, cyanosis
what is the management of RDS
antenatal corticosteroids to mom if premature delivery anticipated
intratracheal surfactant upon delivery
respiratory support (CPAP, nasal cannula, intubation)
What is BPD
bronchiopulmonary dysplasia
neonatal chonic lung disease
complication of prematurity
what is BPD likely due to
caused by
mechanical ventilation
oxygen toxicity
infection and inflammation
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
what is the leading cause of blindess in very low birth weight infants
ROP
What is Necrotizing Enterocolitis
most common GI emergency in newborns
ischemic necosis of intestine
what is the presentation of necrotizing enterocolitis
abd distention and pain
hematochezia/diarrhea
vomiting and non-specific signs
what is seen on x-ray with necrotizing enterocolitis
pneumatosis interstinalis (air btwn muscularis and subserosal layers)
What is the management of necrotizing enterocolitis
supportive care, no enteral feeding
empiric abx
may require surgery
how is intraventicular/periventricular hemorrhage diagnosed
cranial US
(MRI is emerging but not standard)
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
What is the management of IVH/PVH
prevention is key
What are the complications of IVH/PVH
High risk for cerebral palsy and significant intellectual disability
at minimum, at risk for developmental disability
