Neonatal Distress Flashcards
What are 8 broad topics that could cause neonatal distress in a depressed newborn?
Prematurity, Pulmonary, Maternal Causes, CV, Infection, Hypothermia, Hypoglycemia, Birth Injury/ Congenital Malformation, hematologic, Shock
What are the pulmonary causes of a depressed newborn
RDS, Mec Asp, TTN, Pneumonia, Pneumothorax, CNS depression
What are the maternal causes of neonatal distress
meds/anesthesia, DM, Maternal Myasthenia Gravis
What are the CV causes of neonatal distress
Congenital heart disease
What are the birth injury/ congenital malformation causes of neonatal distress
Potters sequence, Phrenic Nerve Injury
What are two hematologic causes of neonatal distress?
anemia, Erthroblastosis fetalis
What does APGAR stand far?
Appearance, Pulse, Grimace (1; 2 for cry), Activity (tone), Respiration (effort)
A post-term newborn, delivered with a breech presentation, develops respiratory distress which does not improve. Chest radiograph shows streaky, linear densities, and cultures are negative.
What is the most likely diagnosis?
A. Meconium aspiration syndrome
B. Persistent pulmonary hypertension of the newborn
C. Pneumonia
D. Transient tachypnea of the newborn (TTN)
E. None of the above
Mec asp Syndrome
A 38 5/7-week estimated gestational age girl is examined in the special care nursery at 3 hours of life who developed tachypnea and mild respiratory distress 10 minutes ago. Mom’s prenatal history was uncomplicated and her prenatal labs were not concerning for infection. She required no ventilatory support at delivery. The baby has the following vital signs: temperature 36.9°C (98.4°F), heart rate 136/min, respiratory rate 83/min, blood pressure 75/42, and oxygen saturation 93%. She has some shallow breathing with mild subcostal retractions and no grunting or nasal flaring, and she is otherwise well perfused with good femoral and brachial pulses. A chest X-ray reveals a flat diaphragm, prominent vascular markings, and fluid in the interlobar fissures. No granular densities or opacities/air brochograms are seen.
What is the next step in management of this patient?
A. Continuous positive airway pressure (CPAP)
B. O2 via nasal cannula
C. Surfactant
D. Conservative management with orogastric tube feeds or IV fluids for nutrition
E. Intubation
D. Conservative management with orogastric tube feeds or IV fluids for nutrition
One hour after delivery, a 1 077-g (2-lb 6-oz) newborn is in respiratory distress. She was born at 28 weeks’ gestation following an otherwise uncomplicated pregnancy and delivery. The mother received routine prenatal care and intrapartum antibiotic prophylaxis. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. On initial examination, the newborn appeared pink and was active. Currently, her temperature is 36.4°C (97.5°F), pulse is 160/mm, respirations are 60/mm and shallow, and blood pressure is 68/44 mm Hg. Examination shows grunting, nasal flaring, and intercostal retractions A chest x-ray shows a granular appearance of the parenchyma with air bronchograms. Which of the following is the most likely diagnosis?
Meconium aspiration pneumonia
Respiratory distress syndrome of the newborn
Streptococcus agalactiae (group B) infection
Total anomalous pulmonary venous return
Transient tachypnea of the newborn
Respiratory distress syndrome of the newborn
A 3 day term infant has episodes of breathing for 10-15 seconds followed by apnea for 5 to 10 seconds. There are no changes in skin color or heart rate. Which of the following is the most appropriate step in management?
Administer caffeine Administer theophylline Apply continuous positive airway pressure Provide supplemental oxygen Reassure the parents
Reassure parents
What is the most common causes of death in neonates?
congenital anomalies
What is the most common causes of infant mortality (1 mo- 1yr)
SIDS
What causes neonatal apnea?
Apnea of perm (<34wk), Sepsis, ICH, hypoglycaemia, low Na, low Ca, CHF, Med
What do you NOT want to order for a 24h septic looking kid?
urine
What is the priority of cause for infection in neonates <72h
Lung
What are the 5 T’s of cyanotic Heart Disease?
Transposition of Great Vessels, Truncus Arteriosus, Tricuspid Atresia, Tet. of Fallot, TAPVR (total anomalous pulmonary venous return)
What are RF for Neonatal sepsis
Low apgar, PPROM, prem,
what is the most common cause of neonatal sepsis <24h
GBS
what is the most common bug in late neonatal sepsis
coagulase -ve staph infections
what is the most (general) cause of neonatal sepsis
GBS, ecoli listerio monocytogenes
How many arteries and veins does the umbilical cord have?
two arteries, one vein
most common cause of cyanotic (HD) baby in 24h
TGA
how do you treat Transposition?
Open PDA with prostaglandins
what congenital cardiac defect has an egg shaped heart?
transposition of great arteries
how do you manage tet spells
knee to chest, oxygen, morphine
when do you operate on a tetralogy of fallot
6 months
What are the 4 components of tetralogy of fallot
overriding aorta, VSD, pulmonic stenosis, RVH
Prostaglandin E infusion can be used for initial management in each of the following neonatal heart lesions EXCEPT:
Pulmonary atresia Coartaction of the aorta Tetralogy of fallot Patent ductus arteriosus Hypoplastic left heart syndrome
PDA
A 3-week-old male infant is brought into the pediatrician for several episodes of cyanotic lips during feeding. His mother notes he becomes severely agitated during his feeds and looks as though he is holding his breath. Physical examination reveals a calm male infant sleeping in his mother’s arms. Cardiac examination reveals a crescendo-decrescendo murmur best heard at the left upper sternal border and a single S2. Lungs are clear to auscultation bilaterally, with no rales or rhonchi noted. Abdomen is soft, nondistended, with normoactive bowel sounds. Skin examination reveals no signs of cyanosis. A chest x-ray is performed in the office and reveals an elongated apex of the heart
Tetralogy
When does a single S2 happen?
in pulmonic stenosis (all you are hearing is the aorta)
What is another word for elongated apex of heart?
boot shaped heart
what causes the boot shaped heart in tetralogy of fallout?
RVH
A 2 day old breast fed newborn, who was delivered at home, presents to the Emergency Department with umbilical stump bleeding. The mother has been on phenytoin during her pregnancy, PT and PTT are prolong which of the following is the most appropriate treatments?
Administer factor VIII Administer 1-2 mg of vitamin K Administer 20 ml/kg of whole blood Administer platelets Administer 10 mL/kg of packed cells
Vitamin K
Define Bronchopulmonary Dysplasia
> 28dol requiring oxygen/ intubation
Baby born in reps distress, hear BS in one side of the chest and heart sounds are distanced. What is happening.
Diaphragmatic Hernia
How does the belly feel and look with a baby with diaphragmatic hernia
scaphoid abdomen, because organs are in the chest
Do you bag a child with a diaphragmatic hernia?
NEVER
What is the first thing you do to stabilize a child with a diaphragmatic hernia?
don’t bag, just intubate until surgical repair
RF for NEC
prematurity, NICU, not enough oxygen, hypoglycaemia
what does the double bubble sign mean
duodenal atresia
What kind of disease has delayed meconium
hirschsprungs disease
what is the best way to diagnose hirschsprungs disease?
biopsy
what do you find on a rectal exam of hirschprungs kids
no stool because no ganglionic cells to get the stool down
A previously healthy 7 weeks-old boy is brought to the physician because of a 3-day history of vomiting. His mother says that he has been taking his cow milk-based formula well but vomits after every feeding. The vomiting has been increasing in amount and force; the vomitus appears to be nonbloody, nonbilious undigested formula. He appears mildly dehydrated. He is at the 25th percentile for length and 10th percentile for weight. Vital signs are within normal limits. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 130 mEq/L K+ 3.0 mEq/L (low) Cl- 85 mEq/L (low) HCO3- 34 mEq/L (high)
Pyloric Stenosis
A 1-day-old 2460-g (5-Ib 7-oz) boy has progressive abdominal distention. He was born at 38 weeks’ gestation following an uncomplicated pregnancy and delivery Since birth, he has had two episodes of bilious vomiting after feedings and has not yet passed meconium. The abdomen is distended and firm with visible loops of bowel. There are no external hernias, and the anus is patent. X-rays of the abdomen show several dilated loops of bowel with air-fluid levels A barium enema shows an abrupt change in caliber at the midsigmoid colon from normal-sized bowel to dilated bowel proximally. Immediately after the barium enema, he has a large, explosive bowel movement.
Abnormal caudal migration of ganglion cells
A nurse calls the attending physician to examine an infant born at 28 weeks in the NICU now one day of life . She mentions that the baby had been
voiding and stooling appropriately but today has been having bilious residuals
and
began experiencing some short episodes of apnea. On exam, the baby has increased abdominal girth and a distended abdomen with hypoactive bowel sounds.
Bloody stools are present in the diaper. Pulses are slightly diminished peripherally.
An abdominal film reveals dilated loops of bowel, thickening around the right colon, and pneumatosis.
NEC
