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Neonatal and Newborn Med Flashcards

1
Q

How many weeks is a newborn?

A

37-42 wks gestation

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2
Q

How many weeks is premature?

A

< 37 wks gestation

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3
Q

How many weeks is post mature?

A

> 42 wks gestation

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4
Q

How can you figure out the gestational age?

A

of wks AFTER mom’s LAST MENSTRUAL period

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5
Q

How can you figure out the gestational age after baby is born?

A

Ballard Scoring

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6
Q

How many weeks is compatible with life?

A

24 wks gestation

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7
Q

What are some complication of prematurity?

A 
IF RAN
Intraventricular hemorrhage
Fluid & lyte imbalance
Retinopathy
ARDS
Necrotizing enterocolitis
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8
Q

What happens if there are complications of prematurity?

A

incubation needed

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9
Q

What are the different types of preterm infants?

A

normal
low birth wt (LBW)
very low birth wt (VLBW)
extremely low birth wt (ELBW)

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10
Q

What wt is preterm infant- normal?

A

2500-4500g (5lbs-9lbs)

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11
Q

What wt is preterm infant- LBW?

A

<2500g (5lbs)

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12
Q

What wt is preterm infant- VLBW?

A

<1500g (3lbs)

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13
Q

What wt is preterm infant- ELBW?

A

<1000g (2lbs)

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14
Q

What is ELBW also called?

A

micropremies

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15
Q

Prematurity- cx (mom)?

A 
premature rupture
trauma
cervical incompetence
vaginal infxn
multiple birth 
smoking/drugs
eclampsia/pre-eclampsia (HTN)
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16
Q

What is eclampsia?

A

seizure d/t pre-eclampsia (pregnancy HTN)

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17
Q

Prematurity - cx (baby)?

A

fetal growth/distress (poor growth)
macrosomia/LGA (baby too large)
polyhydramnios (too much amniotic fluid)

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18
Q

Macrosomia can happen in…?

A

diabetes

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19
Q

Post maturity - complications?

A

growth failure
meconium aspiration
neonatal hypoglyecmia

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20
Q

Gestational wt - types?

A

SGA (small): 90%

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21
Q

What is the APGAR used for?

A

ONLY for that time re: resuscitation efforts

NOT for long term prognosis

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22
Q

When do you take the APGAR?

A

1 min
5min
every 5 min for 20 min
total: 5x

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23
Q

What does APGAR mean?

A 
Appearance 
Pulse
Grimace (reflex)
Activity (muscle tone)
Respiration 
max: 10 
rank: 0-2
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24
Q

What if mom is 16yo?

A

does mom have social support?

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25
What if mom is 42 yo?
does mom know about Down sx?
26
What to review in mom hx?
age PMH family hx pregnancy complications
27
What type of mom PMH to ask?
drugs/meds TORCH infxn prenatal screen blood group
28
What if mom is on chronic pain meds?
baby may have drug withdrawal
29
What pregnancy complications?
oligohydramnios (renal dz d/t family hx) | polyhydramnios (GI dz d/t family hx)
30
What is the MOST COMMON of poor infant?
BRAIN DEVELOPMENT
31
What is fetal alcohol sydnrome?
babies have low IQ/mental retardation may be subtle sx: -ADHD -increased risk of criminal activity (ODD, CD)
32
FAS - PE?
THIN UPPER LIPS W/ SMOOTH PHILTRUM (NO PHILTRUM)- FAS until proven otherwise short nose short fingers cleft lip/palate
33
FAS- labs?
aFP
34
aFP is high?
neural tube defects | abdominal wall defects
35
aFP is low?
trisomies (Down syndrome)
36
What is TORCH infxn?
``` Toxoplasmosis Other (Syphilis, parovirus, VZV, Hep B, HIV) Rubella CMV HSV checking/screening for infxn ```
37
What infxn causes hydrocephalus?
Toxoplasmosis
38
What is toxoplasmosis?
d/t cat feces | DO NOT CLEAN LITTER BOX (preg)
39
Toxoplasmosis - triad?
during 2nd trimester: Chorioretinitis Hydrocephalus Intracranial calcifications
40
What is chorioretinitis?
inflammation of the choroid
41
Toxoplasmosis - dx?
maternal ELISA test - mom is preg | isolating organism in placenta or infant CSF - after baby is born
42
Congenital syphilis - PE born?
asymptomatic
43
Congenital syphilis - PE 2 mo?
rash | hepatomegaly
44
Congenital syphilis - PE 2yrs+?
``` perforaitn of hard palate Hutchinson teeth saddle nose deafness Bony lesions ```
45
Congenital syphilis - dx?
ALL MOTHERS ARE SCREENED
46
Congenital syphilis - tx?
PCN G
47
Congenital syphilis - dx born baby?
chord blood - VDRL
48
Congenital syphilis - tx baby?
IV PCN G
49
HBV - PE born?
asymptomatic
50
HBV - tx?
no tx until 2+yo
51
HBV - dx?
ALL MOTHERS ARE SCREENED
52
HBV - pos moms or unknown?
hep B vaccine + HB Ig at birth
53
Which TORCH are asymptomatic at birth?
Congenital syphilis HBV HIV HSV
54
Which TORCH should all moms get screened?
Congenital syphilis HBV HIV
55
Which TORCH is bad news bears?
VZV (other) - CHICKEN POX (NOT shingles)
56
VZV - infxn < 20wks?
utero death
57
VZV - infxn > 20 wks?
mortality - CNS infxn and microcephaly - limb anamolies - blindness - pneumonias - skin lesions/scarring
58
VZV - tx moms?
VZ Ig + Acyclovir
59
VZV - tx babies?
VZ Ig + Acyclovir (bad news in the end)
60
Parvovirus - infxn early in preg?
utero death
61
Parvovirus - infxn later in preg?
IUGR (Intrauterine Growth Restriction) pericardial effusion pleural effusion anemia
62
Parvovirus - tx?
supportive
63
What is IUGR?
Intrauterine Growth Restriction | fetal wt is <10%
64
HIV - PE birth?
asymptomatic UNTIL T cell dysfxn
65
HIV - dx?
ALL MOTHERS ARE SCREENED
66
HIV - tx pos mom?
ANTIRETROVIRAL THERAPY
67
HIV - babies w/ pos mom?
ANTIRETROVIRAL THERAPY until 6 wks of life
68
HIV - pos mom contraindication?
NURSING
69
What TORCH has intracranial calcification?
CMV - PERIVENTRICULAR | Toxoplasmosis - diffuse
70
Rubella - complication infxn during 1st trimester?
microcephaly | blueberry muffin spots
71
Rubella - complication infxn after 1st trimester?
congenital rubella triad 1) carditis 2) opthalmitis 3) sensorneural hearing loss
72
Rubella - dx?
infant rubella IgM titers
73
Rubella - tx?
supportive
74
CMV + Rubella = PE?
blueberry muffin spots
75
CMV - neonatal sx?
microcephaly | periventricular intracranial calcification
76
Which TORCH has microcephaly?
Rubella | CMV
77
CMV - tx?
Gancyclovir
78
Herpes Simplex - birth PE?
asymptomatic
79
Herpes Simplex - dx?
HSV titers | CSF PCR
80
Herpes Simplex - tx?
mom: suppressive therapy: Valtrex @ 36wks baby: Acyclovir IV if mom is active w/ lesions
81
Herpes Simplex - prevention to baby?
C section BUT if mom is taking Valtrex and NO lesions/active = vaginal is OK
82
Newborn exam entails?
``` HEENT Cardiac Pulmonary Abdomen Genitalia Back/trunk Extremities Skin Neuro ```
83
Newborn HEENT exam - checking for what?
any genetic abnormalities or TORCH infxn - fontanels - scalp hematomas - red reflex/epicanthal folds (down syndrome) - low set ears - nasal deformities - clefting lips/palate
84
What are scalp hematomas- caput?
bruise d/t tough delivery keep eye on it b/c its a "bruise" --> hyper bilirubin
85
What are subgalial bleed?
d/t vacuuming of the head --> blood vessels break --> BLEEDING
86
Newborn exam - cardiac?
``` murmurs pulses O2 perfusion cyanosis ```
87
Newborn exam- pulmonary?
grunting flares retractions pectus anoamlies
88
Newborn exam - abdomen?
masses distension umbilicus check ANUS
89
If there is umbilical muscle malformation?
check anus, genital, renal fxn
90
Newborn exam - gentialia?
testes penile hydroceles
91
Newborn exam - back/trunk?
hair futs spina bifida occulta spina bifida memingocele
92
Newborn exam - skin?
wrinkled, smooth, mottled aplasai cutis (congenital scars) pigmented lesions simain crease
93
Newborn exam neuro?
tone nerve palsies primitive reflexes
94
What are primitive reflexes- at birth and disappear 6mo?
mono hand grasp galant reflex toe grasp
95
What are primitive reflexes - at 2 wks and disappear 6mo?
ATNR
96
What are primitive reflexes - appear 4mo+ and persists voluntarily?
head righting protective equilibrium parachute
97
What is erythromycin ophthalmic ointment?
PREVENTION of gonococcal eye infxn | DOES NOT prevent eye infxn caused by chlamydia
98
What to be aware of in teenage preg?
prenatal care | Gonorrhea
99
What does AAP recommend prophylaxis of newborn infants?
0.5% erythromycin ophthalmic ointment
100
If mom has known clinical gonorrhea infxn?
IV abx
101
How many shots does baby get?
2 1) Hep B 2) Vit K
102
Why does babies need vita K shot?
conversion of inactive precursors in active clotting factors
103
Why is vita K important?
co-factor required for synthesis of coagulation factors II, VII, IX, and X
104
What if baby has lack of vita K?
``` oozing from injection site bleeding from umbilical stump bleeding after circumcision high PT/INR, PTT BLEEDING DOES NOT STOP ```
105
What is important to screen for in newborns?
hyperbilirubinemia total bili unconjugated bilirubin = total - direct conjugate bilirubin
106
What is indirect bilirubin?
before liver
107
What is direct bilirubin?
after liver
108
Do newborns have high or low hemoglobin concentration?
high | decrease uptake and conjugation by the liver --> increased levels of total circulating bilirubin
109
What is kernicterus?
bilirubin that goes through BBB --> bilirubin encephalopathy
110
Where does bilirubin go after BBB?
basal ganglia
111
Kernicterus - PE?
movement disorders
112
Hyperbilirubinemia- tx?
first line: phototherapy -converts bilirubin into water soluble form --> excrete via feces/urine final resort: exchange tranfusion
113
Breast feeding and bilirubin?
bilirubin gets concentrated d/t dehydration: mom is not able to produce milk after 2-4 days
114
Breast milk and bilirubin?
1-3 wks --> mild jaundice --> milk has enzyme that inhibits conjugations of bilirubin
115
What is the goal in re: to bilirubin?
HYDRATION
116
Bilirubin discharge?
f/u w/in 48hrs - w/in 3 days - 24-48 hrs --> w/in 4 days - 48-72 hrs --> w/in 5 days
117
AAP re: bilirubin screening?
TOTAL BILIRUBIN W/IN 24HRS
118
What to manage before discharge?
``` hearing newborn screen hep B vaccine Vita K erythromyocin bilirubin ```
119
How to care for umbilicus?
do not bathe baby until chord is off and dry
120
Baby has fever?
ER
121
What is omphalitis?
inflammation (HRPS) from umbilicus
122
Omphalitis-tx?
IV abx
123
Omphalitis - cx?
gram + staph
124
Umbilical hernia-tx?
reassurance | surgical if not better by >5yrs
125
Gastroschisis?
defect in abdominal wall --> extrusion of abdominal contents MEDICAL EMERGENCY SEVERE and ACUTE
126
Gastroschisis-tx?
broad abx and surgery
127
Omphalocele?
failure of obliteration of inguinal ring --> abdominal contents in amniotic sac actually prevents infxn --> sepsis is RARE
128
Omphalocele - other sx?
bladder anamolies
129
What is normal crying?
2-3 hrs/day from birth - 6wks
130
What is colic?
unexplained crying | 3+hrs/day for more than 3x/wk
131
Colic - PE?
legs arched | gassy
132
What is spitting up?
``` normal less than <5ml NOT green normal wt NO lyte changes ```
133
What is vomiting?
5+ml green poor wt gain (metabolic alkalosis)
134
How often should baby be waken?
cannot sleep throughout the night without sleep --> hypoglycemic
135
Erythema toxicum neonatrum?
rash
136
Erythema toxicum neonatrum - tx?
self limiting (48-72hrs)
137
Cradle Cap/seborrhea dermatitis?
lipophilic yeast around sebaceous gland
138
Cradle cap- tx?
self limiting diluted head shoulders/selsun blue if colonized --> low dose hydrocortisone
139
Acne neonatorum?
acne | closed comedones
140
Acne neonatroum - tx?
4mo - self limiting
141
Milia/milaria?
heat rashes
142
Milia/milaria-tx?
2mo - self limiting
143
Irritant diaper dermatitis vs candidal diaper dermatitis?
irritant: NOT in skin folds candidal: IN skin folds
144
Irritant diaper dermatitis -tx?
topical zinc oxide | STAY AWAY FROM 1% HYDROCCORTISONE CREAM
145
Candidal diaper dermatitis - timeline?
rash 5+days
146
Candidal diaper dermatitis- PE?
beefy red | satellite lesion
147
Seborrhea dermatitis-area?
body | scalp
148
Seborrhea dermatitis-tx?
nyastatin
149
Baby injury prevention?
<120F bathes no shaking sleeping position - on back co sleeping
150
Co sleeping risks?
suffocation strangulation falls SID
151
Co sleeping instead?
crib/bassinet in same room
152
Crib safety?
slants <2 3/8 in | DO NOT put fluffy material
153
Pacifiers for bed?
decrease SID
154
SIDS vs SUIDS?
SIDS: under 1yo that cannot be explained SUID: describe sudden death during infancy
155
SIDS -RF?
``` premature IUGR smoke male AA or native american winter season co sleeping ```
156
SIDS prevention?
DO NOT SLEEP IN CAR SEAT wedges UNDER mattress NO BUMPER PADS
157
What is plagiocephaly?
flat head
158
Plagiocephaly - tx?
tummy time
159
Tobacco exposure?
``` increase risk: -URI infxn -reactive airway dz -otitis media infxn -pneumonia SIDs ```
160
Infant wt changes?
baby can lose wt first 7-10days
161
How much can baby eat?
gain wt min of 20-30g/daily --> double birth wt in 6mo normal: 100-110kcal/kg/daily premature/LBW: 120-140 kcal/kg/day
162
Breast feeding - WHO?
MUST 6mo --> 2yrs
163
Breast feeding- AAP?
MUST 6mo --> 1yr
164
Why is breast milk good?
high IgA and macrophages reduces viruses and bacteria reduces URI inhibit E coli
165
Breast feeding GOOD-mom?
decrease bleeding decrease risk for breast cancer increase bonding w/baby wt loss
166
Breast feeding GOOD - baby?
more immunologic factors = less infxn decreased chronic dz higher IQ, vision decrease SID
167
Breast feeding- contraindication?
baby has galactosemia | mom: has HIV, active TB, T cell lymphotropic virus (type I/II), illicit drug, cancer chemo, radiation

Pediatrics (12 decks)

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