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Pediatrics > Neonatal and Newborn Med > Flashcards

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
Q

What if mom is 42 yo?

A

does mom know about Down sx?

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26
Q

What to review in mom hx?

A

age
PMH
family hx
pregnancy complications

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27
Q

What type of mom PMH to ask?

A

drugs/meds
TORCH infxn
prenatal screen
blood group

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28
Q

What if mom is on chronic pain meds?

A

baby may have drug withdrawal

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29
Q

What pregnancy complications?

A

oligohydramnios (renal dz d/t family hx)

polyhydramnios (GI dz d/t family hx)

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30
Q

What is the MOST COMMON of poor infant?

A

BRAIN DEVELOPMENT

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31
Q

What is fetal alcohol sydnrome?

A

babies have low IQ/mental retardation
may be subtle sx:
-ADHD
-increased risk of criminal activity (ODD, CD)

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32
Q

FAS - PE?

A

THIN UPPER LIPS W/ SMOOTH PHILTRUM (NO PHILTRUM)- FAS until proven otherwise
short nose
short fingers
cleft lip/palate

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33
Q

FAS- labs?

A

aFP

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34
Q

aFP is high?

A

neural tube defects

abdominal wall defects

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35
Q

aFP is low?

A

trisomies (Down syndrome)

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36
Q

What is TORCH infxn?

A 
Toxoplasmosis
Other (Syphilis, parovirus, VZV, Hep B, HIV)
Rubella
CMV
HSV
checking/screening for infxn
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37
Q

What infxn causes hydrocephalus?

A

Toxoplasmosis

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38
Q

What is toxoplasmosis?

A

d/t cat feces

DO NOT CLEAN LITTER BOX (preg)

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39
Q

Toxoplasmosis - triad?

A

during 2nd trimester:
Chorioretinitis
Hydrocephalus
Intracranial calcifications

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40
Q

What is chorioretinitis?

A

inflammation of the choroid

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41
Q

Toxoplasmosis - dx?

A

maternal ELISA test - mom is preg

isolating organism in placenta or infant CSF - after baby is born

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42
Q

Congenital syphilis - PE born?

A

asymptomatic

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43
Q

Congenital syphilis - PE 2 mo?

A

rash

hepatomegaly

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44
Q

Congenital syphilis - PE 2yrs+?

A 
perforaitn of hard palate
Hutchinson teeth
saddle nose
deafness
Bony lesions
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45
Q

Congenital syphilis - dx?

A

ALL MOTHERS ARE SCREENED

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46
Q

Congenital syphilis - tx?

A

PCN G

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47
Q

Congenital syphilis - dx born baby?

A

chord blood - VDRL

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48
Q

Congenital syphilis - tx baby?

A

IV PCN G

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49
Q

HBV - PE born?

A

asymptomatic

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50
Q

HBV - tx?

A

no tx until 2+yo

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51
Q

HBV - dx?

A

ALL MOTHERS ARE SCREENED

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52
Q

HBV - pos moms or unknown?

A

hep B vaccine + HB Ig at birth

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53
Q

Which TORCH are asymptomatic at birth?

A

Congenital syphilis
HBV
HIV
HSV

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54
Q

Which TORCH should all moms get screened?

A

Congenital syphilis
HBV
HIV

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55
Q

Which TORCH is bad news bears?

A

VZV (other) - CHICKEN POX (NOT shingles)

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56
Q

VZV - infxn < 20wks?

A

utero death

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57
Q

VZV - infxn > 20 wks?

A

mortality

  • CNS infxn and microcephaly
  • limb anamolies
  • blindness
  • pneumonias
  • skin lesions/scarring
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58
Q

VZV - tx moms?

A

VZ Ig + Acyclovir

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59
Q

VZV - tx babies?

A

VZ Ig + Acyclovir (bad news in the end)

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60
Q

Parvovirus - infxn early in preg?

A

utero death

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61
Q

Parvovirus - infxn later in preg?

A

IUGR (Intrauterine Growth Restriction)
pericardial effusion
pleural effusion
anemia

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62
Q

Parvovirus - tx?

A

supportive

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63
Q

What is IUGR?

A

Intrauterine Growth Restriction

fetal wt is <10%

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64
Q

HIV - PE birth?

A

asymptomatic UNTIL T cell dysfxn

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65
Q

HIV - dx?

A

ALL MOTHERS ARE SCREENED

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66
Q

HIV - tx pos mom?

A

ANTIRETROVIRAL THERAPY

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67
Q

HIV - babies w/ pos mom?

A

ANTIRETROVIRAL THERAPY until 6 wks of life

68
Q

HIV - pos mom contraindication?

A

NURSING

69
Q

What TORCH has intracranial calcification?

A

CMV - PERIVENTRICULAR

Toxoplasmosis - diffuse

70
Q

Rubella - complication infxn during 1st trimester?

A

microcephaly

blueberry muffin spots

71
Q

Rubella - complication infxn after 1st trimester?

A

congenital rubella triad

1) carditis
2) opthalmitis
3) sensorneural hearing loss

72
Q

Rubella - dx?

A

infant rubella IgM titers

73
Q

Rubella - tx?

A

supportive

74
Q

CMV + Rubella = PE?

A

blueberry muffin spots

75
Q

CMV - neonatal sx?

A

microcephaly

periventricular intracranial calcification

76
Q

Which TORCH has microcephaly?

A

Rubella

CMV

77
Q

CMV - tx?

A

Gancyclovir

78
Q

Herpes Simplex - birth PE?

A

asymptomatic

79
Q

Herpes Simplex - dx?

A

HSV titers

CSF PCR

80
Q

Herpes Simplex - tx?

A

mom: suppressive therapy: Valtrex @ 36wks
baby: Acyclovir IV if mom is active w/ lesions

81
Q

Herpes Simplex - prevention to baby?

A

C section BUT if mom is taking Valtrex and NO lesions/active = vaginal is OK

82
Q

Newborn exam entails?

A 
HEENT
Cardiac
Pulmonary
Abdomen 
Genitalia
Back/trunk
Extremities
Skin
Neuro
83
Q

Newborn HEENT exam - checking for what?

A

any genetic abnormalities or TORCH infxn

  • fontanels
  • scalp hematomas
  • red reflex/epicanthal folds (down syndrome)
  • low set ears
  • nasal deformities
  • clefting lips/palate
84
Q

What are scalp hematomas- caput?

A

bruise
d/t tough delivery
keep eye on it b/c its a “bruise” –> hyper bilirubin

85
Q

What are subgalial bleed?

A

d/t vacuuming of the head –> blood vessels break –> BLEEDING

86
Q

Newborn exam - cardiac?

A 
murmurs
pulses
O2
perfusion
cyanosis
87
Q

Newborn exam- pulmonary?

A

grunting
flares
retractions
pectus anoamlies

88
Q

Newborn exam - abdomen?

A

masses
distension
umbilicus
check ANUS

89
Q

If there is umbilical muscle malformation?

A

check anus, genital, renal fxn

90
Q

Newborn exam - gentialia?

A

testes
penile
hydroceles

91
Q

Newborn exam - back/trunk?

A

hair futs
spina bifida occulta
spina bifida memingocele

92
Q

Newborn exam - skin?

A

wrinkled, smooth, mottled
aplasai cutis (congenital scars)
pigmented lesions
simain crease

93
Q

Newborn exam neuro?

A

tone
nerve palsies
primitive reflexes

94
Q

What are primitive reflexes- at birth and disappear 6mo?

A

mono
hand grasp
galant reflex
toe grasp

95
Q

What are primitive reflexes - at 2 wks and disappear 6mo?

A

ATNR

96
Q

What are primitive reflexes - appear 4mo+ and persists voluntarily?

A

head righting
protective equilibrium
parachute

97
Q

What is erythromycin ophthalmic ointment?

A

PREVENTION of gonococcal eye infxn

DOES NOT prevent eye infxn caused by chlamydia

98
Q

What to be aware of in teenage preg?

A

prenatal care

Gonorrhea

99
Q

What does AAP recommend prophylaxis of newborn infants?

A

0.5% erythromycin ophthalmic ointment

100
Q

If mom has known clinical gonorrhea infxn?

A

IV abx

101
Q

How many shots does baby get?

A

2

1) Hep B
2) Vit K

102
Q

Why does babies need vita K shot?

A

conversion of inactive precursors in active clotting factors

103
Q

Why is vita K important?

A

co-factor required for synthesis of coagulation factors II, VII, IX, and X

104
Q

What if baby has lack of vita K?

A 
oozing from injection site
bleeding from umbilical stump
bleeding after circumcision
high PT/INR, PTT
BLEEDING DOES NOT STOP
105
Q

What is important to screen for in newborns?

A

hyperbilirubinemia
total bili
unconjugated bilirubin = total - direct
conjugate bilirubin

106
Q

What is indirect bilirubin?

A

before liver

107
Q

What is direct bilirubin?

A

after liver

108
Q

Do newborns have high or low hemoglobin concentration?

A

high

decrease uptake and conjugation by the liver –> increased levels of total circulating bilirubin

109
Q

What is kernicterus?

A

bilirubin that goes through BBB –> bilirubin encephalopathy

110
Q

Where does bilirubin go after BBB?

A

basal ganglia

111
Q

Kernicterus - PE?

A

movement disorders

112
Q

Hyperbilirubinemia- tx?

A

first line: phototherapy
-converts bilirubin into water soluble form –> excrete via feces/urine
final resort: exchange tranfusion

113
Q

Breast feeding and bilirubin?

A

bilirubin gets concentrated d/t dehydration: mom is not able to produce milk after 2-4 days

114
Q

Breast milk and bilirubin?

A

1-3 wks –> mild jaundice –> milk has enzyme that inhibits conjugations of bilirubin

115
Q

What is the goal in re: to bilirubin?

A

HYDRATION

116
Q

Bilirubin discharge?

A

f/u w/in 48hrs

  • w/in 3 days
  • 24-48 hrs –> w/in 4 days
  • 48-72 hrs –> w/in 5 days
117
Q

AAP re: bilirubin screening?

A

TOTAL BILIRUBIN W/IN 24HRS

118
Q

What to manage before discharge?

A 
hearing
newborn screen
hep B vaccine
Vita K
erythromyocin
bilirubin
119
Q

How to care for umbilicus?

A

do not bathe baby until chord is off and dry

120
Q

Baby has fever?

A

ER

121
Q

What is omphalitis?

A

inflammation (HRPS) from umbilicus

122
Q

Omphalitis-tx?

A

IV abx

123
Q

Omphalitis - cx?

A

gram + staph

124
Q

Umbilical hernia-tx?

A

reassurance

surgical if not better by >5yrs

125
Q

Gastroschisis?

A

defect in abdominal wall –> extrusion of abdominal contents
MEDICAL EMERGENCY
SEVERE and ACUTE

126
Q

Gastroschisis-tx?

A

broad abx and surgery

127
Q

Omphalocele?

A

failure of obliteration of inguinal ring –> abdominal contents in amniotic sac
actually prevents infxn –> sepsis is RARE

128
Q

Omphalocele - other sx?

A

bladder anamolies

129
Q

What is normal crying?

A

2-3 hrs/day from birth - 6wks

130
Q

What is colic?

A

unexplained crying

3+hrs/day for more than 3x/wk

131
Q

Colic - PE?

A

legs arched

gassy

132
Q

What is spitting up?

A 
normal
less than <5ml
NOT green
normal wt
NO lyte changes
133
Q

What is vomiting?

A

5+ml
green
poor wt gain (metabolic alkalosis)

134
Q

How often should baby be waken?

A

cannot sleep throughout the night without sleep –> hypoglycemic

135
Q

Erythema toxicum neonatrum?

A

rash

136
Q

Erythema toxicum neonatrum - tx?

A

self limiting (48-72hrs)

137
Q

Cradle Cap/seborrhea dermatitis?

A

lipophilic yeast around sebaceous gland

138
Q

Cradle cap- tx?

A

self limiting
diluted head shoulders/selsun blue
if colonized –> low dose hydrocortisone

139
Q

Acne neonatorum?

A

acne

closed comedones

140
Q

Acne neonatroum - tx?

A

4mo - self limiting

141
Q

Milia/milaria?

A

heat rashes

142
Q

Milia/milaria-tx?

A

2mo - self limiting

143
Q

Irritant diaper dermatitis vs candidal diaper dermatitis?

A

irritant: NOT in skin folds
candidal: IN skin folds

144
Q

Irritant diaper dermatitis -tx?

A

topical zinc oxide

STAY AWAY FROM 1% HYDROCCORTISONE CREAM

145
Q

Candidal diaper dermatitis - timeline?

A

rash 5+days

146
Q

Candidal diaper dermatitis- PE?

A

beefy red

satellite lesion

147
Q

Seborrhea dermatitis-area?

A

body

scalp

148
Q

Seborrhea dermatitis-tx?

A

nyastatin

149
Q

Baby injury prevention?

A

<120F bathes
no shaking
sleeping position - on back
co sleeping

150
Q

Co sleeping risks?

A

suffocation
strangulation
falls
SID

151
Q

Co sleeping instead?

A

crib/bassinet in same room

152
Q

Crib safety?

A

slants <2 3/8 in

DO NOT put fluffy material

153
Q

Pacifiers for bed?

A

decrease SID

154
Q

SIDS vs SUIDS?

A

SIDS: under 1yo that cannot be explained
SUID: describe sudden death during infancy

155
Q

SIDS -RF?

A 
premature
IUGR
smoke
male
AA or native american
winter season
co sleeping
156
Q

SIDS prevention?

A

DO NOT SLEEP IN CAR SEAT
wedges UNDER mattress
NO BUMPER PADS

157
Q

What is plagiocephaly?

A

flat head

158
Q

Plagiocephaly - tx?

A

tummy time

159
Q

Tobacco exposure?

A 
increase risk:
-URI infxn
-reactive airway dz
-otitis media infxn
-pneumonia
SIDs
160
Q

Infant wt changes?

A

baby can lose wt first 7-10days

161
Q

How much can baby eat?

A

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
Q

Breast feeding - WHO?

A

MUST 6mo –> 2yrs

163
Q

Breast feeding- AAP?

A

MUST 6mo –> 1yr

164
Q

Why is breast milk good?

A

high IgA and macrophages
reduces viruses and bacteria
reduces URI
inhibit E coli

165
Q

Breast feeding GOOD-mom?

A

decrease bleeding
decrease risk for breast cancer
increase bonding w/baby
wt loss

166
Q

Breast feeding GOOD - baby?

A

more immunologic factors = less infxn
decreased chronic dz
higher IQ, vision
decrease SID

167
Q

Breast feeding- contraindication?

A

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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