neonatal Flashcards
adeq gbs px?
1 dose more than 4 hrs
abx for mom if pcn allergy
clinda, vanc
normal fetal growth?
5g / day at 16 wk
35 g/ day at 35 wks
testes descend at what GA
33-34wk
no matter what if mom had chorio?
treat baby!
well appearing infant, mom adequate treatment.
?
discharge as early as 24 hrs
< 37 wks, > 18 hr ROM, but otherwise well appearing baby?
eval, but don’t need to tx right away
Def of SGA?
< 10th percentile, and < 2500g
IUGR?
rate of growth less than potential (a change)
fetal hb curve?
to the left, incr O2 binding affinity
htn causes what kind of IUgR?
asymmetric, late
fetal blood flow preferentially where?
placenta, brain, adrenals
higher MCA blood flow in fetus, sign of what?
late asymmetric IUGR (spares head)
symmetric growth restriction, when was insult?
early: chromosomal, torch…
common issue in IUGR?
hypoglycemia, incr mortality
LGA:
2 SD above the mean
>3900g
upper 10% for wt for GA
creases in soles of feet, all the way vs 1st 3rd
full, < 36wks
% premature births in US?
12.5%
Prematurity defined?
<37 wks
calculate chronological age of baby:
ex: 8 month old, former 28 wks
correct to 40 wks!
5 mos
biggest risk factor for premature baby?
previous preemie
high fetal fibronectin/
incr prematurity risk
prenatal corticosteroids
-effective when
24-48 hrs –> 7 days
steroids prenatally does what w/ lung stuff
decr RDS, but no change in ventilatory/BPS
doses of dexameth vs beta for prenatal steroids?
4 doses
post term def?
> 42 wks
meds that decr vit K level in baby?
AEDs! (esp early bleeding < 48h)
vit K less in what population of baby?
breast fed vs formula
cleft lip, neural tube defects in what teratogen
AED
prolonged PT in what
vit K def
vit K dosing
1mg IM at birth, preemies 1/2mg IM
Treatment of chlamydia in newborn (conjunctivitis…)
PO erythromycin 2 wks! (pna + conjunctivitis), often at 2 wks of age.
total body water
highest at newborn, extracellular until 3mos, then intracellular
newborn caloric requirement
90-100cal/kg/day
carbo, fat, protein, fa req percentages for enteral feeding
30-60% total calories
55% fat
20% protein, 2-5% essential fatty acids (lineloaic)
carbo3.4
protein4
fat 9
cal/gram of each?
nutrition
glucose rate
6-8mg/kg/min,
D5 vs D10
D10 100mg/mL
D5: 50mg/ML
why intralipids 20% in newborn
3g/kg/day requirement
essential fatty acid deficiency? whats missing, what do you see?
linelaic and omega 3 fatty acids
see very scaly skin
protein req
2.5-3.5g/day
1kg baby, what fluids needed?
100ml/kg/day
how does fetus get glucose in utero
facilitated diffusion of glucose
lowest glucose timing for baby
30-90 min
what glucose should be treated in newborn
<40, feed
who is hyperinsulinemic?
Beckwith biedemann
why is IUGR hypoglycemic
not enough glycogen
big baby with relative microcephaly?
Beckwith weidemann
2mL D10? how much glucose
200mg
max glucose infusion in piv?
12.5
desired hct?
55
RPR + mom?, how do you know if baby has it?
4x greater titer than mom
confirmatory syphilis test
FTA- stays pos for life
only acceptable tx of syphilis for mom?
PCN 4 wks before delivery, needs 4 fold decr in titers
successful tx of syphilis
FTA pos, RPR neg
peeling of hands, feet in baby?
syphilis
snuffles in baby?
syphilis
test pku when
after feed 48-72hrs
essential AA in PKU?
tyrosine
if mom has inappropriate pku tx?
teratogenic- miscarriage, SGA, iugr
cause for very high tsh in newborn
surge in first 24 hours… normal
hospital hearing screen?
ABR: quick, early, detects auditory dysynchrony at 35 decibels
what % of infants get referred for formal hearing test?
5%
percent that fail hearing test that have actual hearing loss?
80% are fine,
discharge criteria for newborn
1 stool 48 hr
1 urine 24 hr
VS nl 12 hr
>7% wt loss in first 48 hrs
drug causing jaundice in baby b/c disrupts albumin: bili ratio?
ceftriaxone
% newborns w/ jaundice
25%
breast milk jaundice
2 wks with very high bili… BUT not, “breast not feeding jaundice”
shrill cry
kernicterus
acquired hearing loss baby
kernicterus, meningitis
lungs are filled with what during intrauterine life
fetal lung fluid
delayed clearance of fetal lung fluid in baby born by C/S
Dx and Tx
TTN, give supplemental O2, monitoring…
RDS CXR finding?
fine reticulogranular pattern, ground glass, air bronchograms, granular opacifications, symmetric
TTN lung findings on CXR
perihilar streaking, no air bronchograms
fluid in fissures
good lung volumes
incr interstitial markings
peak severity of RDS?
24-72hrs
amniotic fluid test for lung maturity?
What is the other ratio test and why don’t we use it?
phosphatidylglycerol (late appearing surfactant component)
LS ratio: Lecithin : Sphingomyelin ratio, >2:1 indicates lung maturity (Lecithin increases throughout gestation, while sphingomyelin stays constant) Problem is can’t trust if there is blood or mec…
complication of surfactant admin?
pulm hemorrhage
CXR finding in mec aspiration
coarse, patchy infiltrates, hyperinflation
best way to eval PPHN?
echo
pre / post ductal splitting may or may not be present in what condition (change in SaO2 >10%)
mec aspiration (may just have cardiac shunting, not ductal…)
the missed bacterial sepsis in early onset neonatal sepsis after GBS, Ecoli, Listeria? (2)
Strep viridans
non typeable H flu
Common causes of late onset neonatal sepsis ((4)
coag neg staph, s. aureus, GNRs, Candida
Sepsis in baby previously discharged from hospital?
GBS, listeria, Ecoli, Salmonella
late onset sepsis in high risk newborns (NICU babies)
coag neg staph (48%), GNR (20%), S aureus, Candida, enterococci (2%)
Most common clinical features of early onset GBS
apnea and pna
which has higher mortality? early or late GBS?
Early has higher mortality (risk of septic shock higher, often premature)
dx if granulomatosis infantisepticum (red rash w/ 1-2mm pale nodules on skin, pharynx - path granuloma)
Listeria
I:T ratio?
Immature > total >0.2 –> sepsis
When shouldn’t you use amp/gent as first line in neonatal sepsis?
ONLY Late onset:
VLBW infants in NICU might need oxacillin/Vanc + gent or 3rd gen in late onset sepsis OR
community acquired - amp / 3rd gen cephalosporin
duration and type of treatment for neonatal meningitis (GNR)
3 weeks. Start w/ amp/gent as empiric, then can do cefotax + gent
bug likely to cause brain abscess and GN meningitis?
Citrobacter koseri (diversus)»_space; Enterobacter, Serratia marcescens
preferred drug for mother if PCN allergy for GBS
Cefazolin
Is Prophylaxis of GBS needed if c/s before labor?
NO
Does neonate with HIV look like sepsis?
No
risk of HSV trm in primary infx vs recurrent?
50% vs 5%
Tx of neonatal HSV? Duration
IV ACyclovir only
14 d for mucosal/skin/eyes dz only
21 d for disseminated / CNS
Most common congenital infx, most common presentation, most common sx
1% of all infants CMV,
most common presentation is asx (90%)
Commonest sx: TCP/petechiae, jaundice
risk of chorioretinitis w/ CMV infx
10%
most significant sequelae of CMV in neonates that are asx at birth?
deafness
blueberry muffin, microcephaly, b/l cataracts.
Most likely CHD?
Rubella.
PDA, also pulmonic stenosis
Salt and pepper retinopathy in TORCH is what instead of what
rubella/syphilis instead of toxo/CMV which is focal retinitis
Congenital toxo causes what even if asx at birth
neurological and visual problems by adulthood:(
Y ou need a maternal PRIMARY infx for congenital what?
How do mom’s get it?
Congenital Toxo… need primary infx. from raw beef or cat feces
intraparenchymal calcifications vs perventricular
intraparenchymal: toxo
periventricular: CMV
Tx of toxo?
Mom and baby
mom: spiramycin to decr transmission, pyramethamine and sulfadiazine if infx after 17 wks
baby: pyrimethamine and sulfadiazine for 1 yr
very common and unique manifestation of congenital syphilis besides snuffles (bloody mucus), rash, HSM, LAD?
periostitis: lots of bone issues - osteomyelitis, periostitis, osteochondritis
Neonate w/ hydrops, most common infx?
parvo B19 (from severe anemia and HOCF)
normal fetal / placental weight ratio should be what
6.5-7 at term (or if less, decreased fetal growth)
when should preemie growth be “caught up”
by yr 2
Caloric requirement for preemie
120cal/kg/day
optimal whey/casein ratio for preemies
lipid source
extra of what
cal/oz
60/40 Whey/Casein
MCTs
higher Ca and phos
24 / oz
long term complication of NEC
intestinal strictures
bad things that actually DECrease jaundice in neonate
maternal heroin, smoking, alcohol, Phenytoin/PB
What is Lucy Driscoll Syndrome
transient neonatal uncong hyperbili Uenzyme defect (metabolic)
exchange transfusion s/es?
Hi K
low Ca
low volume
tcp
Hypoglycemia management?
3mL/kg D10 bolus
mechanism of late hypocalcemia in infant?
cows milk given by accident causing major phosphate load and hypocalcemia results
Full term anemia def
Test to do?
HB < 13
Due Kleihauer Betke test to look for fetal cells in mom’s blood
TReatment for what HCT that is too high/
Sx? (3)
70
causes hyperbili, hypoglycemia, TCP
immediate irritability tremors, tachycardia/SVT dx?
in the immediate newborn period, its neonatal thyrotoxicosis
firm and tense bulge of blood in newborn
cephalohematoma
soft, boggy, pitting, swelling of head crossing suture
caput succedaneum
Three syndromes assoc w/ cleft lip/palate
Crouzon, Apert, Treacher/collins
neonate with alcohol withdrawal presents how
hyperactive, irritable, hypoglycemia
neonate w/ cocaine w/d?
NO SX
Neonate w/ amphetamine w/d?
drug effects decline over several days, but NO w/d
Neonate w/ barbiturate w/d?
hyperactive, hyperphagia, irritability, crying, poor suck/swallow
Neonate w/ opioid w/d and its tx?
hyperirritability, tremor, jitters, hypertonia, loose stools, emesis, feeding difficulty
Sz
Tx w/ methadone, oral morphine
what does low calcium do to ekg?
prolonged QT
define hypocalcemia
ical < 4.5
total cal < 8.5
(bound is 50%)
causes of high AFP
BADRAIN: Bladder extrophy/Anencephaly/Defects *NTD Renal: agenesis, polycystic kids Abd wall defects Incorrect dates / multIPle pregnancy Neuro: NTD
BPP includes what
Fetal Movement Reactive HR Breathing Tone Volume of amniotic fluid
Non stress test measures what
spontaneous fetal movement HR activity (autonomic nervous system integrity)
Contraction stress test measures what
Bad sign?
fetal HR w/ contraction: uteroplacental insufficiency and labor tolerance
Bad sign would be late decels after 50% of contractions
Risk for RDS increased in (3) Decreased in (2)
Increased RDS: DM moms, C-section, birth asphyxia
Decreased RDS: PROM, prenatal steroids
LS ratio? problem with it
Lecithin: Sphingomyelin > 2 is low RDS risk
but maternal DM interferes
when do you need mechanical ventilation for RDS?
pH 60
Tx goal: PO2 50-70
Changes in lungs with small cystic changes and fine lacy infiltrates without hx of prolonged O2 exposure/ventilation or RDS?
Wilson Mikity syndrome
Types of early GBS infx?
PNA, meningitis, sepsis
late onset GBS
assoc w/ prematurity
most common infx
w/in 1 mo, usu meningitis
NOT assoc w/ preemies
The deal w/ TOXO and timing of pregnancy infx / outcomes
Mom sx?
Early exposure: lower fetal infx chance, but severe if does
Late exposure: hi fetal infx, but less severe
Infx in mom may just be LAD
Sx of TOXOplasmosis in neonate at birth and later
GONDII: Greatly small head: microceph On the brain is water Nothing - asx neonate Diffuse calcific I=eyes/chorioretinitis Icterus/HSM
Longterm: deafness, vision, seizures, cognition
MRI signs of toxo?
ring enhancing lesions in encephalitis
diffuse calcifications
Dx and Tx of toxo
Dx: IFA
Tx: pyrimethamine, sulfadiazine, folinic acid
palsies to look for in clavicular frx and their sx
when does callus heal/recede
Erb’s palsy - high C5-C7: Waiter’s tip but they can grab money
Phrenic nerve palsy - resp distress
2 yrs for callus to recede
Klumpke paralysis: where / sx
Possible assoc?
C8-T1: claw hand (born grabbing Klump of sand, but then can’t grasp later)
May be assoc w/ Horner’s (SNS near T1)
test to do in setting of 1 umbilical artery
renal US
Umbilical cath complications
NEO CATH:
Necrosis, Emboliz of liver, Ompalitis, Compromised fetal pulse, Accidental hemorr, Traumatic perf renal artery/aorta, hepatic dysfunction
(infx, punctures, ischemia/hemorrhage, liver)
Low umbilical vs high umbilical
Low: L3-L5
High (x2): T6-T10
normal P02 and PCO2
P02 60-90
PCO2 35-45
Normal scalp pH >7.25
silver nitrate vs emycin eye ointment/drops
silver does NOT prevent chlamydia only gonorrhea
Emycin does both
