NEONAT Flashcards
MC cause of morbidity among preterm infants
A. IVH
B. BPD
C. Sepsis
B.BPD
Most powerful predictor of BPD is _
A. AOG
B. Maternal infection
C. Genetic make-up
A. age of gestation
> as AOG increases, BPD decreases
Define:
Extreme PT
Early
Moderate
Late
Low BW
Very low BW
Extreme PT: <28wks AOG
Early: <32
Moderate: 32-34
Late: 34-36
Low BW: <2500g
Very low BW: <1500g
Benign, slate-blue well-demarcated areas of pigmentation seen over the buttocks, back and sometimes other parts of the body
Mongolian spots
Benign small, white papules on an erythematous base 1-3 days after birth and lasts as long as 1 week, containing eosinophils
Erythema toxicum
Benign vesiculopapular lesion around the chin, neck, back, extremities, palms and soles, containing neutrophils
Pustular melanosis
> lasts 2-3days
The ff are associated with large anterior fontanel except:
A. Trisomy 21
B. Hypothyroidism
C. Congenital rubella syndrome
D. Osteogenesis imperfecta
E. None
E. None
All are asstd w large anterior fontanel
Table 113.1
Pupillary reflexes are present after _
A. 24-25 wks AOG
B. 26-27th wks AOG
C. 28th-30th wks AOG
C. 28th-30th wks AOG
Renal vein thrombosis may present as _
A. hematuria, hypotension, thrombocytosis
B. hematuria, hypertension, thrombocytopenia
C. oliguria, hypertension, thrombocytopenia
D. Anuria, hypertension, thrombocytosis
B. hematuria, hypertension, thrombocytopenia
False negative APGAR Scores (3)
- Some full term infants
- Maternal acidosis
- High fetal cathecholamines
Table 113.3
Mechanism of heat loss in neonates
Hypothermia –> Norepi release –>
activate non-shivering thermogenesis by metabolism of brown fat
> Inc muscle activity and metabolism –> O2 consumption –> hypoxemia
> Pulmonary vasoconstriction –> hypoxia
> Increase glucose utilization –> hypoglycemia
Methods of heat loss (4)
Conduction
Radiation
Convection
Evaporation
Most frequent bacteria to colonize the UC
Staph aureus
NRP guide: 3 questions to ask regarding the baby at birth.
BTT
1. Breathing or crying?
2. Tone?
3. Term?
4 clinical criteria for asphyxia
CANM
1. Cord blood pH <7.0; metab or mixed acidosis
2. APGAR 0-3 for more than 5mins
3. Neurologic sequelae in the immediate neonatal period
4. Multiorgan system dysfx in the immediate neonatal period
MC GI emergency in the neonate
NEC
Risk factors for NEC
5 Is
- Immaturity
- Infection
- Ischemia
- Immunologic
- Intake
What is the effect on the fetus is the mom has a history of Grave’s disease?
A. Neonatal hypocalcemia
B. Hypothyroidism
C. Transient neonatal thyrotoxicosis
D. Transient neonatal myasthenia
C. Transient neonatal thyrotoxicosis
Transplacental passage of IgG thyroid-stimulating ab
What is the effect on the fetus is the mom has a history of endemic goiter?
A. Neonatal hypocalcemia
B. Hypothyroidism
C. Transient neonatal thyrotoxicosis
D. Transient neonatal myasthenia
B. Hypothyroidism
iodine deficiency
What is the effect on the fetus is the mom has a history of hyperparathyroidism?
A. Neonatal hypocalcemia
B. Hypothyroidism
C. Transient neonatal thyrotoxicosis
D. Transient neonatal myasthenia
A. Neonatal hypocalcemia
Maternal Ca crosses to fetus and suppress fetal PTH gland
What is the effect on the fetus is the mom has a history of maternal phenylketonuria?
A. Neonatal hypocalcemia
B. Hypothyroidism
C. Transient neonatal thyrotoxicosis
D. microcephaly, MR
D. microcephaly, MR
elevated fetal phenylalanine values
The most serious complication of chronic oligohydramnios is:
A. Sepsis
B. Neonatal pneumonia
C. Pulmonary hypoplasia
C. Pulmonary hypoplasia
Most accurate method of assigning gestational age
A. by LMP
B. by Assisted reproductive technique
B. by Assisted reproductive technique
with EDD after 266 days after conception
Normal NST result?
Reactive= Normal
> 2 FHR accelerations
> at least 15bpm from baseline
> lasting 15 secs
> during 20mins monitoring
First line treatment of opioid dependence in pregnancy
A. Methotrexate
B. Methadone
B. Methadone
MC congenital lung lesion
A. TTNB
B. CPAM
C. PPHN
D. Atelectasis
E. Pneumothorax
B. CPAM (Congenital pulmonary airway malformation)
prev known as congenital cystic adenomatoid malformation
In Twin-twin Transfusion Syndrome, who is the arterial and venous side?
Arterial - Donor
Venous - Recipient
The artery of the donor drains in the venous system of the recipient twin
Recommended guideline for early enteral nutrition for preterms
Protein: 2g/kg in the first 24hrs after birth with a goal of supplying at least 3.5g.kg in 24-48hrs
Volume of trophic feeds
Trophic feeding: Low-volume, hypocaloric feeds
> 10-20cc/kg/day
Advancing feeds:
VLBW: 20-30cc/kg/day
ELBW: 15-25cc/kg/day
TRUE or FALSE. Not all IUGR are SGA and not SGA are IUGR
True
MC fracture of the skull in neonates
A. Linear
B. Comminuted
C. Depressed fractures
D. Ping pong fracture
Linear fractures
> No symptoms, no treatement
Depressed fractures - ping pong ball dents
> complication of forceps delivery or fetal compression
> Some may elevate spontaneously or some require treatment
> Use of breast pump or vacuum extractor may obviate the need for neurosx interventiono
A collection of blood beneath the aponeurosis that covers the scalp and serves as the insertion of the occipitofrontalis muscle
A. Caput
B. Cephalhematoma
C. Subgaleal hemorrhage
C. Subgaleal hemorrhage
Subperiosteal hemorrhage limited to the surface of one cranial bone.
A. Caput
B. Cephalhematoma
C. Subgaleal hemorrhage
B. Cephalhematoma
resorbed within 2wks to 3mos
Recommended period to perform cranial UTZ on all preterms <32wks AOG.
A. First 24-48hrs
B. First 5 days
C. 3-7 days
D. at 7 days
C. 3-7 days
> 75% of lesions are detected during this period
> Ffup UTZ at 36-40wks PMA
Most sensitive imaging modality for detecting hypoxic brain injury in the neonate.
MRI
Therapeutic hypothermia golden period.
Core or esophageal temp?
Therapeutic hypothermia should begin in the first 6 hrs and maintained for 72hr, by head or systemic cooling.
Temp of 33.5degC
Most frequently fractured bone during labor and delivery
Clavicle
* no specific treatment * immobilize the affected side for comfort * absent Moro reflex, infant not moving that arm freely
Appropriate therapies for mixed and obstructive apnea
NCPAP (nasal continuous positive airway pressure) 3-5cm H2O
HHHFNC (heated humidified high flow nasal cannula)
Common complication of BPD
pulmonary hypertension
General contraindications for indomethacin and ibuprofen treatment in PDA closure. (5)
- Thrombocytopenia <50,000plt/m3
- active hemorrhage (severe IVH)
- NEC or intestinal perforation
- Oliguria (UO <1cc/kg/hr)
- elevated plasma Crea (>1.8mg/dL)
Most frequent sites of NEC
Distal ileum and proximal colon
The ff are MAJOR risk factors for the development of severe hyperbilirubinemia EXCEPT
A. Previous sibling with jaundice
B. Previous sibling received phototherapy
C. Cephalhematoma
D. Exclusive breastfeeding
A. Previous sibling with jaundice
> minor risk factor
Table 123.2
