MedU Clipp Cases 7 and 8 Flashcards
(6) Risk Factors for Noenatal Respiratory Distress?
- Maternal Diabetes –> RDS
- Prematurity - lack of Surfactant –> RDS
- Maternal Group B Strep (GBS) Infection –> Sepsis
- C-section Delivery –> Transient Tacypnea of Newborn
- Premature Rupture of Membranes > 18 hours (PROM)
- Meconium in the Amniotic Fluid
(10) DDx for Tachypnea in Newborn?
- Respiratory Distress Syndrome (RDS)
- Transient Tachypnea of Newborn (TTN)
- Pneumothorax
- Hypoglycemia
- Congestive Heart Failure (CHF)
- Neonatal Sepsis
- Congenital Diaphragmatic Hernia
- Coarctation of the Aorta
- Maternal Drug exposure
- Hypothermia
What does the APGAR score describe?
- Describes the condition of teh newborn infant immediately after birth and is a tool for standardized assessment
- Fetal - to - Neonatal transition
What does LGA, AGA, and SGA standfor?
- Large for Gestational Age (LGA)
- > 90th % by Birth weight
- Appropriate for Gestational Age (AGA)
- 10th - 90th % by Weight
- Small for Gestational Age (SGA)
- < 10th % by Weight
(3) Potential Clinical Problems a/w LGA?
- C-section, Vacuum extraction, Forceps and associated complications
- Birthing injuries - Fractured Clavicles, Brachial Plexus injuries, Facial Nerve palsy
- Hypoglycemia, especially a/w Diabetic Mothers
(3) Potential Complication of SGA?
- Temperature Instability (Hypothermia)
- Inadequate Glycogen Stores (Hypoglycemia)
- Polycythemia and Hyperviscosity
Symptoms of
Persistent Pulmonary Hyptertension of the Newborn?
(PPHN)
- Tachpnea
- Tachycardia
- Respiratory Distress w/ findings such as Expiratory Grunting and Nasal Flaring
- Generalized Cyanosis
- Low Oxygen Levels, even while recieveing 100% O2
(3) Signs of Respiratory Distress in a Newborn?
- Tachypnea
- Intercostal and Subcostal Retractions
- Grunting - at the end of Expiration
- Infant attempts to Increase Transpulmonary Pressures
- -> Increase Lung Volumes
- -> Improve Gas exchange
Respiratory Conditions for Cyanotic Newborn?
- Common
- TTN
- RDS
- Uncommon
- Pneumothorax
- Diaphragmatic Hernia
- Choanal Atresia
- Pulmonary Hypoplasia
- PPHN
Cyanotic Congenital Heart Defects?
- Common
- Tetralogy of Fallot
- Transposition of the Great Arteries (Diabetic Mom)
- Uncommon
- Truncus arteriosus
- Tricuspid atresia
- Total Anomalous Pulmonary Venous Return
- Pulmonary atresia
CNS Conditions of Cyanotic Newborn?
- Hypoxic-Ischemic Encephalopathy
- Intraventricular Hemorrhage
- Sepsis / Meningitis
Infectious Conditions of a Cyanotic Newborn?
- Septic Shock
- Meningitis
Other Conditions of Cyanotic Newborn?
- Respiratory Depression Secondary to Maternal Medications
- Hypothermia
- Polycythemia / Hyperviscosity Syndrome
(8) Studies for the Evaluation of a Cyanotic Newborn?
- Arterial Blood Gas
- Blood and CSF cultures
- CBC w/ Differential
- Chest Radiograph
- Echocardiogram
- Oxygen Challenge Test (Hyperoxia Test)
- Physical Examination
- Pulse Oximetry
How does Insulin effect the Primary Anabolic
Hormone for Fetal growth?
- High lvls of Insuline in 3rd Trimester
- -> Increased growth of Insulin-sensitive Organ Systems
- -> Heart, Liver, and Muscle
- -> and general Fat synthesis and Deposition
- Increased Body Fat, Muscle Mass, Organomegaly
- -> LGA infant
- Insulin-sensitive organs (Brain and Kidney’s)
- -> not effected and have normal size for gestational age
(6) Tests for Evaluation of Tachypnea in Newborn?
- CBC w/ Differential
- Serum or Plasma Glucose level
- Blood Culture
- CSF for Culture
- Blood gas or Pulse Oximetry Monitoring
- Chest X-ray
CXR showing:
“wet” looking lungs
No consolidation
No air Bronchograms
Transient Tachypnea of the Newborn
(TTN)
CXR showing:
Difuse Reticulogranular Appearance
of the Lung Fields
“Ground Glass Appearance”
Air Bronchograms
Respiratory Distress Syndrome
(RDS)
CXR showing:
Air-filled loops of Bowel in the Left Side of Chest
Displacement of Heart and Mediastinum
of the Contralateral Side
Diaphragmatic Hernia
CXR showing:
“Wet” or “not Wet” lungs
No Consolidation
No Air Bronchograms
Neonatal Pneumonia
Bilirubin pathway in Newborns?
- Hemoglobin released from RBCs
- -> converted to Unconjugated bilirubin
- -> insoluble in aqueous solutions
- -> binds to albumin in blood stream
- Liver: Bilirubin extracted by hepatocytes
- -> binds to cytosolic proteins
- -> conjugated w/ glucuronide by Uridine diphosphate glucuronyl transferase (UDPGT)
- Conj. Bilirubin is water soluble and excreted into the Bile and then into the Intestine
What is the Enterohepatic cirulation system in Newborns?
- Newborns lack the GI flora to metabolize bile, which allows the Beta-glucuronidase present in teh meconium to hydrolyze the conjugated bilirubin back to its uncojugated form
- Unconjugated bilirubin is then reabsorbed into the blood stream where it binds to Albumin
- Newborns absorb significant quantities of Bilirubin through this process.
What is Kernicerus?
- Term used to describe staining of the Basal Ganglia and Cranial Nerve Nuclei by Bilirubin
- Also, the Clinical condition that results fromt eh toxic effects of High levels of Unconjugated Bilirubin
- Sequelae
- Lose the Suck Reflex
- Become Lethargic
- Develop Hyperirritability and Seizure
- Opisthotonus, rigidity, Oculomotor paralysis, tremors, hearing loss, and ataxia
- Die
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(2) Risk factors for predisposing to Hyperbilirubinemia?
- Breastfeeding
- Mediterranean ethnicity
Causes of Physiologic Jaundice in Newborns?
- Increased Bilirubin production
- Relative def. of Hepatocyte proteins and UDPGT
- Lack of Intestinal Flora to Metabolize Bile
- High levels of Beta-glucuronidase in Meconium
- Minimal Oral (Enteral) intake in the first 2-4 days of life
- -> resulting in a slow excretion of Meconium (esp. common w/ breastfed infants)
What is the Typical Breastfeeding Pattern?
- Nurses 8 - 12x / 24 hours
- Feedings may initially last up to 60 minutes
- Gradually become shorter in duration
- ~10 - 15 minutes per breast
What is G6PD Deficiency?
- X-linked recessive inheritance pattern
- Decreased Bilirubin Conjugation
- Jaundiced w/out anemia
- Decreased conjugation
- Similar to Gilbert’s Syndrome
Voiding Pattern in Newborns?
- Urination changes in the first days after birth
- Day 3: voiding 3 - 4x / day
- Day 6: voiding 6 - 8x / day
- Urine should be paie yellow
Stooling Pattern in Newborns?
- Stooling pattern changes
- Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow
- Day 6 or 7: Most newborns have 3-4 stools per day, although many infnats pass stoll w/ every feeding.
What Vitamin Supplementation is req’d for exclusively breastfed babies?
- Vitamin D
- Avoid Rickets - 400 IU of Vitamin D
- Sunlight is req’d to Hydroxylate Vit. D
- Rickets generally appears between 6 and 24 months
- Iron - is req’d for infants after 4 mo. of age
- Fluoride - after 6 mo. of age if water supply lacks
( < 0.3 ppm)
What are (2) common findings that contribute to Hyperbilirubinemia in a Newborn?
- Cephalohematoma
- Does not extend across the suture line
- Blood is reabsorbed
- Bruising - birth trauma
- Broken downa and reabsorbed
(3) Risk Factors for Development of Hip Dysplasia?
- Breach Position (30-50% of DDH cases)
- Gender (9:1 Female predominance)
- Family History
(12) DDx for Diagnosis of Jaundice in Newborn?
- Breast milk jaundice
- Physiologic jaundice
- Hemolysis
- Hypothyroidism
- Metabolic disease
- Biliary atresia
- Intrinsic Liver disease
- Birth trauma
- Sepsis
- TORCH
- Gilber Syndrome - Glucouronyltransferase enzyme def.
- Crigler-Najjar Syndrome - absence of UDP glucuronosyltransferase 1 family, polypeptide A1
- Type 1: Severe
- Type 2: Mild/Moderate
Lab Tests for Neonatal Hyperbilirubinemia?
- Maternal ABO and Rh typing, Isoimmune Antibodies
- Cord blood ABO and Rh typing
- G6PD screen
- Total serum bilirubin (TSB)
- Direct Bilirubin w/ urine dipstick
- CBC or hemoglobin lvl
- Reticulocyte count and Blood Smear
- Neonatal screening
- Newborn Sepsis Tests
- TORCHS congenital Infections
(4) Tests for Newborn Sepsis?
- CBC and a Differential Cell count
- C-reactive protein
- Blood cultures
- Lumbar puncture w/ Chemistry and Cultures
(8) Signs and Symptoms of Untreated
Congenital Hypothyroidism?
- Prolonged jaundice
- Lethargy
- Large fontanelles
- Macroglossia (enlarged tongue)
- Umbilical hernia
- Constipation
- Abdominal distention
- Severe developmental delay
