Neonatal case conference

Question 1

Gestational Age

Answer 1

number of weeks of pregnancy from last normal menstrual period

Question 2

AGA

Answer 2

(Appropriate for Gestational Age)-birth weight between the 10th and 90th percentiles for a given gestational age

Question 3

SGA

Answer 3

(Small for Gestational Age)-birth weight less than 10th percentile for the given gestational age

Question 4

LGA

Answer 4

> 90th percentile for the given gestational age

Question 5

LBW

Answer 5

Low Birth Weight Infant)- an infant who weighs less than 2,500 grams

Question 6

VLBW

Answer 6

(Very Low Birth Weight Infant)- less than 1,500 g

Question 7

preterm

Answer 7

less than 38 weeks gestation

Question 8

term

Answer 8

38-42 weeks gestation

Question 9

post term

Answer 9

more than 42 weeks gestation

Question 10

infant death

Answer 10

a death occurring any time from birth to but not including 1 year of age

Question 11

perinatal death

Answer 11

a death occurring between the 28th week of gestation and the 28th day of life

Question 12

Total Body Water (TBW)

considerations in the newborn

Answer 12

In early fetal development TBW constitutes almost 95 % of total body weight
At birth in the term infant TBW is approximately 75% of the total weight
During the first week of life term infants will typically loss about 10% of their birth weight
After decreased urinary output in the first 24-48 hours a diuresis occurs with loss of extracellular water
In preterm infants the weight loss can be up to 15%

Question 13

Sodium Balance in the Newborn

Answer 13

Total sodium content determines the volume of ECF. So renal sodium handling is a critical component in maintaining proper volume
Sodium is freely filtered by the glomerulus and almost completely reabsorbed in the tubular system
In term infants, like adults fractional sodium excretion is less than 1%
In preterm infants sodium loss is inversely proportional to gestational age, with infants at 28 weeks gestation having fractional excretion at 5-6%

Question 14

Parameters Associated with Fluid Management in the Newborn

Answer 14

Urine output-1-3 ml/kg/hr
Hypernatremia- Sodium > 150mmol/L
Hyponatremia-Sodium less than 130mmol/l

Question 15

Signs of excessive water loss

Answer 15

Excessive wt loss
Dry oral mucosa
Sunken anterior fontanelle
Capillary refill > 3seconds
Tachycardia
Decreased BP
Metabolic acidosis

Question 16

A 10 day old male infant presents to the ED with lethargy, poor feeding and decreased urine output.

What are your initial thoughts/concerns?

Answer 16

Sepsis
Metabolic defect (IEM)
Intracranial bleed
Hypoxic/ischemic encephalopathy
Feeding difficulties/Dehydration
Renal malformations
Renal vein thrombosis

Question 17

Definition of ARF in the newborn is based on

Answer 17

a rapid elevation in the concentration in the blood of BUN, creatinine and other cellular waste products resulting from diminished GFR
Cannot define a specific creatinine level to call ARF as measurements immediately after birth reflect the mother’s creatinine as well as the infant
Normal creatinine levels depend on gestational age
Urine output can be used as an indicator of ARF-usually less than 0.5 ml/kg/hour

Question 18

Prerenal Causes of acute renal failure in the newborn

Answer 18

Sepsis
Hypovolemia
Hemorrhage
Hypoxia/Ischemia 
Cardiac Failure
Hypotension
Hyperviscosity

Question 19

Renal (Intrinsic ) Causes of ARF in the newborn

Answer 19

ATN (ATI)

• Hypoxia-ischemia
• Toxins

Drugs

• Aminoglycosides
• Contrast Agents

ACE inhibitors

Vascular
- Renal vein or artery thrombosis

Congenital parenchymal disease

Maternal drugs

Transient acute renal failure of the newborn

Question 20

Post Renal Causes (Obstructive) of renal failure in the newborn

Answer 20

Congenital obstruction

• Ureteral
• Urethral
• Bladder
• Pelvic mass

Calculi

Question 21

Hypernatremic dehydration in the neonatal period

Answer 21

is well described arising from disproportionate deficit of body water relative to body sodium coupled with the extracellular water loss that occurs in this age range

Most common cause is lactation failure

Infants can loose water through the skin at a rapid rate, especially with non bullous ichthyosis