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Neonatology > Neo > Flashcards

Neo Flashcards

1
Q

what are the clinical manifestations of Fetal alcohol syndrome

A

growth failure
CNS abnormalities
cognitive defects
behavioral problems

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2
Q

head compression

A

early deceleration

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3
Q

cord compression; variable shape, abrupt onset

A

Variable deceleration

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4
Q

fetal hypoxemia, maternal hypotension

A

Late deceleration

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5
Q

Auscultation of fetal heart sounds

A

16-18 weeks

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6
Q

perception of fetal movements

A

18-20 weeks

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7
Q

Contraindications to breastfeeding

A 
Galactosemia, MSUD, PKU
HIV, Human T-cell lymphocytic virus 1 & 2
Active TB
Herpes virus lesions on breast
Radioactive substances
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8
Q

failure of closure of allantoic duct

A

Persistent urachus

tx: immediate surgical repair

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9
Q

most common defects associated with Beckwith-Wiedemann Syndrome

A

omphalocele, wilms tumor, macrosomia, hypoglycemia

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10
Q

polyhdramnios

A

> 2000ml in 3rd trimester, >24cm

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11
Q

Oligogydramnios

A

<500ml, <5cm

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12
Q

most accurate assessment of gestational age by 1st trimester

A

crown rump length

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13
Q

target plasma glucose

A

> or = 45mg/dl

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14
Q

hypoglycemia in infants

A

<40mg/dl

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15
Q

when is treatment indicated for asymptomatic patients with hypoglycemia

A

<30mg/dl

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16
Q

when should IV glucose be given?

A

persistent hypoglycemia <25mg/dl (1st 4 hours) and <35mg/dl (4-24 hours)

Give IV glucose (2ml/kg) 10% glucose

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17
Q

infant with hypoglycemia unable to tolerate oral feeding

A

IV rate 4-8 mg/kg/min

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18
Q

Neonatal tetanus

A

ability to suck at birth and 1st few days then inability to suck between 3-10 days; difficulty swallowing, spasm, stiffness, seizure and death

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19
Q

most important neonatal factor predisposing to infection

A

prematurity or low birth weight

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20
Q

most frequent neonatal hospital acquired infection

A

coagulase negative staphylococci

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21
Q

SIRS in neonates clinical manifestations

A

temperature instability
respiratory dysfunction
cardiac dysfunction
perfusion abnormalities

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22
Q

common cause of infection in neonatal period

A

GBS, E. coli, HSV, CMV, VZV, RSV, Entero, Candida

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23
Q

transferred across placenta

A

IgG

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24
Q

not transferred across placenta

A

IgA, IgE, IgM, IgD

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25
Q

Absoulte and relative contraindications to breastfeeding

A

HIV: risk must be weighed versus risk of transmitting virus to body
TB infection: contraindicated until completion of 2 weeks treatment
Varicella zoster: no direct contact to active lesions; should receive immunoglobulin
CMV: may be found in milk of mothers
Hep B: give immunoglobulin and vaccine
Hep C: not contraindicated
Alcohol: limit to 0.5g/kg/day equivalent to 2 cans of beer, 2 glasses of wine
Cigarette smoking: discouraged but not contraindicated
Chemo, radiopharmaceutical: generally contraindicated

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26
Q

what is the whey:casein ratio in infant formula

A

18:82 to 60:40

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27
Q

predominant whey in cow’s milk

A

B-globulin

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28
Q

predominant whey in breastmilk/human milk

A

alpha lactalbumin

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29
Q

principles of weaning

A

begin at 6 months of age
at proper age, encourage cup rather than bottle
Introduce 1 new food at a time
energy density should exceed breastmilk
Iron-containing foods
Zinc intake fold be encouraged
phytate intake should be low
Breastmilk should be continued until 12months
give no more than 24oz/day of cow’s milk
Fluids other breastmilk should be discouraged
Give no more than 4-6oz/day of 100% fruit juice
no sugar sweetened beverages

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30
Q

IVH occurs in

A

gelatinous subependymal germinal matrix

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31
Q

PVH occurs in

A

injury to corticospinal tracts in white matter

clinically asymptomatic until neurologic sequelae becomes apparent

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32
Q

IVH grading of hemorrhage: bleeding isolated to subependymal area

A

Grade 1 IVH

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33
Q

IVH grading of hemorrhage:bleeding within ventricle without dilation

A

Grade 2 IVH

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34
Q

IVH grading of hemorrhage:ventricular dilation

A

Grade 3 IVH

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35
Q

IVH grading of hemorrhage: IVH and parenchymal hemorrhage

A

Grade 4 IVH

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36
Q

what is the pathophysiology of HIE?

A

hypoxia/ischemia –> anaerobic metabolism –> inc lactate and inorganic phosphates
Glutamate accumulates in damaged tissue
prompting NMDA, AMPA, Kainate receptors
inc permeability to Na and Ca
intracellular accumulation of Na, Ca –> cytotoxic edema and neuronal death

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37
Q

treatment for HIE

A

hypothermia (within 6hr)
high dose erythropoietin
Sz (1st line): Phenobarbital 20mg/kg
Refractory: levetiracetam (preferred)

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38
Q

“whipple’s triad”

A

plasma concentration of <60mg/dl
concurrent CNS or cathecolamine based symptom
resolution of symptoms when glucose restored to normal

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39
Q

Phenylalanine

A

deficiency of phenylalanine hydroxylase (PAH) or its cofactor tetrahydrobiopterin (Bh4) –> accumulation of phenylalanine in body fluids and brain

severe deficiency >20mg/dl
milder between 10-20mg/dl

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40
Q

major organ damaged in PKU

A

brain

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41
Q

mousey or musty odor

A

PKU

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42
Q

manifestations of PKU

A

neurologic: seizures, spasticity, hypereflexia and tremors
EEG abnormalities
Non-PKU hyperphenylalanemia: >2mg/dl less than 20mg/dl; do not produce phenylketones

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43
Q

treatment of PKU

A

low phenylalanine diet

maintain levels at 2-6mg/dl throughout life

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44
Q

Maternal PKU

A

high risk of having offspring with intellectual disability, microcephaly, growth retardation, congenital malformations, CHD

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45
Q

patient is normal at birth then symptoms appear at 1st year; severe pain in the legs, associated with extensor hypertonia of neck and trunk

A

tyrosine

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46
Q

treatment for Tyrosinemia

A

Nitisone

titrated to the lowest most effective dose 20-40umol/L

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47
Q

ocular manifestations, skin lesions, intellectual disabilit

A

Tyrosenemia Type 2

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48
Q

What is the new BPD?

A

disease of infants born <1000g who were born at <28wks AOG; no lung disease at birth but with progressive respiratory symptoms after 1st week

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49
Q

Definition of BPD in <32 weeks

A

36 weeks PNA or discharge home treatment with >21% O2 for 28 days plus:
Mild: breathing room air at 36 weeks PNA or discharge home
Moderate: <30% O2 at 36 weeks or discharge
Severe: >30% need O2 at 36 weeks AOG

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50
Q

Definition of BPD >32 weeks

A

> 21 days to <56 postnatal age or discharge home. Treatment with 21% O2 for 28 days plus:

Mild: breathing room air by 56 days or discharge home
Moderate: <30% O2 at 56 days or discharge
Severe: >30% need O2 at 56 postnatal age

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51
Q

What are the chest xray findings in RDS?

A

air bronchograms
low lung volume
diffuse, fine, reticular granularity of parenchyma

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52
Q

What are the xray findings in TTN?

A

early onset tachypnea
clear breath sounds
chest xray: prominent perihilar pulmonary vascular markings, fluid in intralobar tissues
small pleural effusions

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53
Q

what are the chest xray fndings in BPD?

A

fine, diffuse interstitial opacities; wandering atelectasis

severe: increase O2, frank cystic changes or pneumatoceles

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54
Q

What are the chest xray findings in Meconium aspiration syndrome

A

patchy infiltrates
flattening of the diaphragm
coarse streaking of both lung fields
increase AP diameter

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55
Q

most frequently involved part in NEC?

A

distal part of ileum

proximal segment of colon

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56
Q

clinical features of kernicterus

A 
Phase 1 (1-2 days): poor suck, stupor, hypotonia, seizures
Phase 2: hypertonia of extensor muscles, opisthotonus, retrocolis, fever
Phase 3 (after 1st week): hypertonia
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57
Q

crosses suture lines

A

caput seccedaneum

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58
Q

fluid filled mass; doest not cross suture lines; not present at birth

A

Cephalhematoma

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59
Q

not restricted by boundaries; larger and more diffuse; requires prompt recognition

A

subgaleal hemorrhage

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60
Q

assymetric skull and face with ear malalignment

A

Deformational plagiocephaly

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61
Q

premature fusion of sutures

A

Cranial synostosis

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62
Q

EINC steps

A
  1. Immediate and thorough drying
  2. skin to skin contact
  3. properly timed corn clamping
  4. nonseparation of baby to mother
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63
Q

most frequent pathogenic bacteria to colonize umbilical cord

A

Staphylococcus aureus

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64
Q

recommended for infants born outside birthing centers

A

topical chlorhexidine

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65
Q

bright yellow or orange jaundice

A

Indirect bilirubin

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66
Q

Greening/ muddy yellow jaundice

A

DIrect bilirubin

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67
Q

estimate of bilirubin levels

A

face: 5mg/dl
mid abdomen: 15mg/dl
soles: 20mg/dl

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68
Q

pathologic causes of hyperbilirubinemia

A

erythroblastosis fetalis
conceled hemorrhage
sepsis or congenital infections

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69
Q

deposition of unconjugated bilirubin (Indirect) in basal ganglia and brainstem nuclei

A

Kernicterus/bilirubin encephalopathy

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70
Q

What is the problem in ABO incompatibility?

A

mother is type O, baby is non type O

occurs during 1st pregnancy

71
Q

positive DAT and positive Indirect antiglobulin test (IAT)

72
Q

in patients with jaundice, what do we request?

A

obtain blood type of mother and baby
CBC with PBS
Coombs/DAT
reticulocyte count

73
Q

eyrthroblastosis fetalis

74
Q

rarely occurs during 1st pregnancy

transfusion of RH+ blood into Rh negative mother

A

Rh incompatibility

75
Q

CHARGE syndrome is associated with

A

Choanal atresia

76
Q

Meconium ileus is associated with

A

Cystic fibrosis

77
Q

Term neonate will develop jaundice if bilirubin level is

78
Q

Antiviral agent of choice for Influenza A infection

A

Oseltamivir

79
Q

Most serious complication of 3 day measles

A

Encephalitis

80
Q

Most important and effective action in neonatal resuscitation is

A

Ventilate the baby’s lungs

81
Q

“Vigorous” is defined as

A

Strong respiratory efforts
Good muscle tone
HR >100bpm

82
Q

Indications for PPV

A

Apnea/gasping
HR <100
Persistent cebtral cyanosis despite 100% free-flow oxygen

83
Q

Imitate vertical lines

84
Q

Draw circle

85
Q

extremely premature infants should be scored within

A

12 hours of life

86
Q

Full term infants are scored as early as possible and may be reliably scored within ____ hours of life

A

72 hours of life

87
Q

Neurologic maturity

A 
Posture
Square window
arm recoil
popliteal angle
scarf sign
heel to ear
88
Q

chart used for premature infants

A

Fenton Chart

89
Q

low birth weight

90
Q

very low birth weight

91
Q

extremely low birth weight

92
Q

SGA

A

below 10th percentile

93
Q

AGA

A

between 10th to 90th percentile

94
Q

LGA

A

above 90th percentile

95
Q

lanugo hair in term infants are called

A

vellus hair

96
Q

flat, blu-gray with well defined margins usually over the buttocks and back

A

Mongolian spots

97
Q

benign, small papules or pustules on an erythematous base usually 1-3 days after birth and persist for 1 week; filled with eosinophils

A

Erythema toxicum

98
Q

small inclusion cysts; pearly white usually on the face

99
Q

lacy pattern on the skin similar to cobblestones

A

cutis marmorata

100
Q

epithelial cells on the hard palate

A

Epstein pearls

101
Q

inability to pass a feeding tube through the nares

A

Choanal atresia

102
Q

PMI in newborns

A

4th left intercostal space just medial to midclavicular line

103
Q

herniation of abdominal contents onto base of umbilical cord, abdominal contents covered by a protective membrane

A

Omphalocele

104
Q

laterally located full thickness abdominal wall defect; extruded intestine not covered by membrane

A

Gastroschisis

*usually located on the right side

105
Q

voiding must be within

106
Q

urethral orifice located on the glans or ventral surfaces of the shaft

A

hypospadia

107
Q

caudal curvature of penis

108
Q

affected in Erb-Duchenne palsy

A

C5-C6; upper trunk

*arm adducted and pronated and forearm internally rotated; absent biceps reflex and Moro reflex on the affected side

109
Q

affected in Klumpke paralysis

A

C7-C8, T1, lower trunk

  • claw hand: paralyzed, no wrist movement, absent grasp reflex
  • if no involvement of t1 sympathetic fibers: Horner syndrome
110
Q

age of disappearance:

rooting reflex

111
Q

age of disappearance:

palmar grasp

A

2-3 months

112
Q

age of disappearance:placing or stepping reflex

A

4-5 months

113
Q

age of disappearance:

Moro reflex

A

5-6 months

114
Q

age of disappearance:

tonic neck reflex (Fencing)

A

6-7 months

115
Q

age of disappearance:

plantar grasp reflex

A

7-9 months

116
Q

benefits of early skin to skin contact:

A

BLEST

Breastfeeding success
Lymphoid tissue system stimulation
exposure to maternal skin flora
sugar
thermoregulation
117
Q

Newborn screening is done at

A

after 24 hours of life but not later than 3 days of age

118
Q

for preterm infants: ideal time for NBS is at

A

5-7 days old

119
Q

if newborn is place in NICU, when can we do NBS

A

7 days old

can be done until 1 month in very sick babies

120
Q

Amino acid disorders

A 
Homocystinuria
Hypermethionemia
Adenosine transferase deficiency
MSUD
PKU
Tyrosinemia Type I, II and III
121
Q

Fatty acid disorders

A

Carnitine palmioyltransferase
Long chain Hydroxyacyl-Coa
medium and very long chain acyl coa
trifunctional protein deficiency

122
Q

organic acids

A 
glutaric acidemia type 1
Isovaleric acidemia
methylmalonic acidemia
multiple carboxylase deficiency
proprionic acidemia
123
Q

The universal Newborn Screening and Intervention Act of 2009

124
Q

Infants born in hospitals should be screened within

A

first 3 months

125
Q

if hearing loss detected, audiologic evaluation should be made before

126
Q

most important question to ask during delivery of baby

A

“Is the baby apneic/gasping or limp?”

127
Q

Steps in Newborn Resuscitation

A

Birth
Immediate and thorough drying
apnea/gasping or limp?
if yes –> call for help, change wet linen, clamp and cut cord, transfer to warmer, position airway, clear secretions if needed

PPV
SpO2

Apnea/gasping; HR <100
if yes –> ventilation corrective steps
intubate if needed

HR <60bpm?
If yes, Intubate if not yet done; PPV & chest compressions, 100% O2, Consider UVC insertion

HR <60bpm?
If yes, IV epinephrine, consider hypovolemia, consider pneumothorax

128
Q

ventilation corrective steps

A 
mask readjustment
reposition airway
suction mouth and nose
open mouth
pressure increase
airway alternative
129
Q

dose of epinephrine in newborn resuscitation

A
  1. 1 to 0.3 ml/kg of 1:10,000 via umbilical vein or

0. 5 to 1ml/kg of 1:10,000 via ET

130
Q

foremilk

A

watery

high lactose and high protein

131
Q

hindmilk

A

creamy with high fat (5x fat content)

132
Q

what is released during first 0-7 days of breastfeeding?

A

colostrum

  • protein rich
  • high concentration of secretory IgA and protective factors: lactoferrin and lysozyme
  • contains Vitamin A, E, K and growth factors
  • low levels of fat and carbohydrates
133
Q

what is transitional milk?

A

between colostrum and mature milk

rising levels of macronutrients

134
Q

what is mature milk?

A

day 10-14

same as colostrum content + high fat and lactose

135
Q

what is involutionary milk?

A

produced when breastfeeding frequency decreases
reverts to being more like colostrum with high concentration of immune factors
low content of water, fat and lactose

136
Q

what are curds and whey?

A

curds- semi-soli fraction which settles when milk is clotted; made from casein proteins

Whey: clear fluid that remains

137
Q

human milk casein:whey ratio

A

low casein:whey ratio

10: 90 early milk
40: 60 mature milk
50: 50 in late lactation

138
Q

composition of breastmilk vs formula:

protection against specific antigens

A

Maternal secretory IgA

in BM only

139
Q

composition of breastmilk vs formula:

for phagocytosis of pathogens

A

Maternal WBC

in BM only

140
Q

composition of breastmilk vs formula:

lysis of bacteria

A

Lysozyme

in BM only

141
Q

composition of breastmilk vs formula:

inhibits binding of pathogens to host cells and cause lysis of enveloped pathogens

A

milk lipids

in BM; less effective in formula

142
Q

composition of breastmilk vs formula:

inhibits pathogen binding

A

Oligosaccharides

143
Q

composition of breastmilk vs formula:

wide range of synergistic protective factors

A

lactoferrin

144
Q

a newborn was noted to have bloody stool;

what test can we request to differentiate it from maternal blood?

A

APT test; positive if blood is due to GI or pulmonary bleeding

negative: swallowed blood

145
Q

cyanosis with feeding

A

esophageal atresia

146
Q

cyanosis that disappears with crying

A

choanal atresia

147
Q

hyperalertness, normal muscle tone, weak suck, low threshold Moro, mydriasis, absence of seizures

A

Sarnat Stage 1 (Mild) HIE

148
Q

lethargic or obtunded, mild hypotonia, weak or absent suck, weak Moro, miosis and focal or multifocal seizures

A

Sarnat Stage 2 (moderate) HIE

149
Q

stuporous, flaccid muscle tone, intermittent decerebration, absent suck, absent Moro, poor pupillary light response

A

Sarnat Stage 3 (Severe) HIE

150
Q

initial drug of choice in HIE

A

Phenobarbital

Phenytoin
Diazepam
Others: correct underlying etiology, trial of Pyridoxine B6 50-100mg IV push with EEG monitoring
therapeutic hypothermia

150
Q

initial drug of choice in HIE

A

Phenobarbital

Phenytoin
Diazepam
Others: correct underlying etiology, trial of Pyridoxine B6 50-100mg IV push with EEG monitoring
therapeutic hypothermia

151
Q

always pathologic, does not cross blood brain barrier

A

Congugated bilirubin; Direct (B2)

152
Q

congugated bilirubin is considered elevated if it is:

A

> 1mg/dl for total bilirubin levels <5mg/fl or

20% of the total bilirubin for total bilirubin levels >5mg/dl

153
Q

congugated bilirubin is considered elevated if it is:

A

> 1mg/dl for total bilirubin levels <5mg/fl or

20% of the total bilirubin for total bilirubin levels >5mg/dl

154
Q

lipid soluble; may cross the blood brain barrier; bound to albumin

A

Unconjugated bilirubin; Indirect

B1

155
Q

Coomb’s positive

A

ABO/RH incompatibility

156
Q

most common cause of hemolytic disease in the newborn

A

ABO incompatibility

157
Q

recommended distance between infant and light source in phototheraphy

158
Q

pathophysiology of ROP

A 
early vasoconstriction and obliteration of capillary network in response to high oxygen concentrations
progressive neovascularization
retinal edema
retinal hemorrhages
fibrosis and traction
eventual detachment of retina
159
Q

treatment of choice for ROP

A

laser photocoagulation

160
Q

asymmetric IUGR

A
  • weight affected more than length
  • due to poor maternal nutrition
  • fetus affected late in the gestation
  • good catch up growth
161
Q

symmetric IUGR

A
  • weight, length and head circumference equally affected
  • genetic and metabolic conditions
  • fetus affected early in gestation usually <18 weeks
  • high mortality and morbidity
  • poor outcome
162
Q

most common perinatal respiratory disorder

163
Q

barrel chest due to increased AP diameter

164
Q

“fuzzy vessels”
sunburst pattern
peripheral air trapping

165
Q

also known as persistent fetal circulation

A

Persistent pulmonary hypertension (PPHN)

166
Q

4 clinical criteria of HIE

A
  1. acidosis, pH <7 umbilical cord
  2. APGAR 0-3, >5mins
  3. Neurologic outcome
  4. Multiorgan system dysfunction
167
Q

most common cause of aneuploidy

A

meiotic nondisjunction

168
Q

most common form aneuploidy

169
Q

genetic cause of moderate intellectual disability

A

Trisomy 21

170
Q

most common autosomal aneuploidy in spontaneous abortion

A

Trisomy 16

171
Q

most common cause of oligohydramnios

A

rupture of membranes

172
Q

most common cause of hemolytic disease of newborn

A

ABO incompatibility

173
Q

most common eye disease of newborn

A

Ophthalmia neonatorum

Neonatology (1 decks)

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