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Pediatrics: Case Files > MedU Clipp Cases 7 and 8 > Flashcards

MedU Clipp Cases 7 and 8 Flashcards

1
Q

(6) Risk Factors for Noenatal Respiratory Distress?

A
  • 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
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2
Q

(10) DDx for Tachypnea in Newborn?

A
  • 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
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3
Q

What does the APGAR score describe?

A
  • Describes the condition of teh newborn infant immediately after birth and is a tool for standardized assessment
  • Fetal - to - Neonatal transition
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4
Q

What does LGA, AGA, and SGA standfor?

A
  • 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
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5
Q

(3) Potential Clinical Problems a/w LGA?

A
  • C-section, Vacuum extraction, Forceps and associated complications
  • Birthing injuries - Fractured Clavicles, Brachial Plexus injuries, Facial Nerve palsy
  • Hypoglycemia, especially a/w Diabetic Mothers
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6
Q

(3) Potential Complication of SGA?

A
  • Temperature Instability (Hypothermia)
  • Inadequate Glycogen Stores (Hypoglycemia)
  • Polycythemia and Hyperviscosity
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7
Q

Symptoms of
Persistent Pulmonary Hyptertension of the Newborn?

(PPHN)

A
  • Tachpnea
  • Tachycardia
  • Respiratory Distress w/ findings such as Expiratory Grunting and Nasal Flaring
  • Generalized Cyanosis
  • Low Oxygen Levels, even while recieveing 100% O2
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8
Q

(3) Signs of Respiratory Distress in a Newborn?

A
  • Tachypnea
  • Intercostal and Subcostal Retractions
  • Grunting - at the end of Expiration
    • Infant attempts to Increase Transpulmonary Pressures
  • -> Increase Lung Volumes
  • -> Improve Gas exchange
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9
Q

Respiratory Conditions for Cyanotic Newborn?

A
  • Common
    • TTN
    • RDS
  • Uncommon
    • Pneumothorax
    • Diaphragmatic Hernia
    • Choanal Atresia
    • Pulmonary Hypoplasia
    • PPHN
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10
Q

Cyanotic Congenital Heart Defects?

A
  • Common
    • Tetralogy of Fallot
    • Transposition of the Great Arteries (Diabetic Mom)
  • Uncommon
    • Truncus arteriosus
    • Tricuspid atresia
    • Total Anomalous Pulmonary Venous Return
    • Pulmonary atresia
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11
Q

CNS Conditions of Cyanotic Newborn?

A
  • Hypoxic-Ischemic Encephalopathy
  • Intraventricular Hemorrhage
  • Sepsis / Meningitis
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12
Q

Infectious Conditions of a Cyanotic Newborn?

A
  • Septic Shock
  • Meningitis
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13
Q

Other Conditions of Cyanotic Newborn?

A
  • Respiratory Depression Secondary to Maternal Medications
  • Hypothermia
  • Polycythemia / Hyperviscosity Syndrome
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14
Q

(8) Studies for the Evaluation of a Cyanotic Newborn?

A
  • Arterial Blood Gas
  • Blood and CSF cultures
  • CBC w/ Differential
  • Chest Radiograph
  • Echocardiogram
  • Oxygen Challenge Test (Hyperoxia Test)
  • Physical Examination
  • Pulse Oximetry
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15
Q

How does Insulin effect the Primary Anabolic
Hormone for Fetal growth?

A
  • 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
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16
Q

(6) Tests for Evaluation of Tachypnea in Newborn?

A
  • CBC w/ Differential
  • Serum or Plasma Glucose level
  • Blood Culture
  • CSF for Culture
  • Blood gas or Pulse Oximetry Monitoring
  • Chest X-ray
17
Q

CXR showing:

“wet” looking lungs

No consolidation

No air Bronchograms

A

Transient Tachypnea of the Newborn

(TTN)

18
Q

CXR showing:

Difuse Reticulogranular Appearance
of the Lung Fields

“Ground Glass Appearance”

Air Bronchograms

A

Respiratory Distress Syndrome

(RDS)

19
Q

CXR showing:

Air-filled loops of Bowel in the Left Side of Chest

Displacement of Heart and Mediastinum
of the Contralateral Side

A

Diaphragmatic Hernia

20
Q

CXR showing:

“Wet” or “not Wet” lungs

No Consolidation

No Air Bronchograms

A

Neonatal Pneumonia

21
Q

Bilirubin pathway in Newborns?

A
  • 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
22
Q

What is the Enterohepatic cirulation system in Newborns?

A
  • 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.
23
Q

What is Kernicerus?

A
  • 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
      *
24
Q

(2) Risk factors for predisposing to Hyperbilirubinemia?

A
  • Breastfeeding
  • Mediterranean ethnicity
25
Q

Causes of Physiologic Jaundice in Newborns?

A
  • 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)
26
Q

What is the Typical Breastfeeding Pattern?

A
  • Nurses 8 - 12x / 24 hours
  • Feedings may initially last up to 60 minutes
  • Gradually become shorter in duration
    • ~10 - 15 minutes per breast
27
Q

What is G6PD Deficiency?

A
  • X-linked recessive inheritance pattern
  • Decreased Bilirubin Conjugation
  • Jaundiced w/out anemia
  • Decreased conjugation
  • Similar to Gilbert’s Syndrome
28
Q

Voiding Pattern in Newborns?

A
  • 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
29
Q

Stooling Pattern in Newborns?

A
  • 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.
30
Q

What Vitamin Supplementation is req’d for exclusively breastfed babies?

A
  • 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)
31
Q

What are (2) common findings that contribute to Hyperbilirubinemia in a Newborn?

A
  • Cephalohematoma
    • Does not extend across the suture line
    • Blood is reabsorbed
  • Bruising - birth trauma
    • Broken downa and reabsorbed
32
Q

(3) Risk Factors for Development of Hip Dysplasia?

A
  • Breach Position (30-50% of DDH cases)
  • Gender (9:1 Female predominance)
  • Family History
33
Q

(12) DDx for Diagnosis of Jaundice in Newborn?

A
  • 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
34
Q

Lab Tests for Neonatal Hyperbilirubinemia?

A
  • 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
35
Q

(4) Tests for Newborn Sepsis?

A
  • CBC and a Differential Cell count
  • C-reactive protein
  • Blood cultures
  • Lumbar puncture w/ Chemistry and Cultures
36
Q

(8) Signs and Symptoms of Untreated
Congenital Hypothyroidism?

A
  • Prolonged jaundice
  • Lethargy
  • Large fontanelles
  • Macroglossia (enlarged tongue)
  • Umbilical hernia
  • Constipation
  • Abdominal distention
  • Severe developmental delay
37
Q
A

Pediatrics: Case Files (16 decks)

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