5 Is 1. Immaturity 2. Infection 3. Ischemia 4. Immunologic 5. Intake

NEONAT Flashcards by Maria Cristina Mariano

MC cause of morbidity among preterm infants

A. IVH
B. BPD
C. Sepsis

B.BPD

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Most powerful predictor of BPD is _

A. AOG
B. Maternal infection
C. Genetic make-up

A. age of gestation

> as AOG increases, BPD decreases

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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

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Benign, slate-blue well-demarcated areas of pigmentation seen over the buttocks, back and sometimes other parts of the body

Mongolian spots

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Benign small, white papules on an erythematous base 1-3 days after birth and lasts as long as 1 week, containing eosinophils

Erythema toxicum

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Benign vesiculopapular lesion around the chin, neck, back, extremities, palms and soles, containing neutrophils

Pustular melanosis
> lasts 2-3days

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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

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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

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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

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False negative APGAR Scores (3)

Some full term infants
Maternal acidosis
High fetal cathecholamines

Table 113.3

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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

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Methods of heat loss (4)

Conduction
Radiation
Convection
Evaporation

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Most frequent bacteria to colonize the UC

Staph aureus

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NRP guide: 3 questions to ask regarding the baby at birth.

BTT
1. Breathing or crying?
2. Tone?
3. Term?

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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

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MC GI emergency in the neonate

NEC

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Risk factors for NEC

5 Is

Immaturity
Infection
Ischemia
Immunologic
Intake

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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)

1. Thrombocytopenia <50,000plt/m3 2. active hemorrhage (severe IVH) 3. NEC or intestinal perforation 4. Oliguria (UO <1cc/kg/hr) 5. 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