Neonate Flashcards
What are signs of hypocalcemia in the neonatal period?
Often infants of diabetic mothers, symptoms manifest between 48 and 96 hours of life. Symptoms of hypocalcemia may include irritability, sweating, tremors, twitches, seizures, and arrhythmias. Treatment of symptomatic infants is intravenous calcium
gluconate.
What is a subgaleal hemorrhage/hematoma?
It is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis. The diagnosis is generally a clinical one, with a fluctuant boggy mass developing over the scalp (especially over the occiput) with superficial skin bruising. The swelling develops gradually 12–72 hours after delivery, although it may be noted immediately after delivery in severe cases. The hematoma spreads across the whole calvaria as its growth is insidious and may not be recognized for hours. If enough blood accumulates a visible fluid wave may be seen. Patients can develop raccoon eyes.
Patients with subgaleal hematoma may present with hemorrhagic shock (a large volume of blood may accumulate in the potential space). The neonate should be transferred to the NICU for monitoring and possible fluid resuscitation. The prognosis is generally good.
What is considered hypocalcemia in a neonate?
Level below 7.5-8 mg/dL. It is normal for calcium levels to fall transiently in the neonatal period
What is “hyperviscosity syndrome” in a neonate?
A persistent venous hematocrit of greater than 65% in a neonate is regarded as polycythemia and will be accompanied by an increase in blood viscosity. Manifestations of the “hyperviscosity syndrome” include tremulousness or jitteriness that can progress to seizure activity because of sludging of blood in the cerebral microcirculation or frank thrombus formation; renal vein thrombosis; NEC; and tachypnea. Simple phlebotomy, while decreasing blood volume, will also decrease systemic arterial pressure and thus increase viscosity (based on Poiseuille’s law of flow). Therapy by
partial exchange transfusion with saline or lactated Ringer solution is preferred, and may be more likely to be useful if performed prophylactically before significant symptoms have developed. Often due to decrease in uteroplacental blood flow in utero.
What is physiologic jaundice?
Physiologic jaundice becomes apparent on the second or third day of life, peaks to levels no higher than about 12 mg/dL on the fourth or fifth day, and disappears by the end of the first week of life. The rate of rise is less than 5 mg/dL per 24 hours and levels of conjugated bilirubin do not exceed about 1 mg/dL.
What are common causes of apnea in a term infant (term infants almost always have an identifiable cause for apnea)?
Sepsis, gastroesophageal reflux, congenital heart disease, seizures, RSV, hypoglycemia, central hypoventilation (Ondine’s curse), and airway obstruction can all cause apnea in term newborns
What is caput succedaneum?
Soft-tissue swelling of the scalp involving the presenting delivery portion of the head. This lesion is sometimes
ecchymotic and can extend across the suture lines. The edema may be pitting, and resolves in the first few days of life.
What are cephalohematomas?
Cephalohematomas do not cross the suture line, since they are subperiosteal hemorrhages. No discoloration of the scalp is seen, and the swelling usually progresses over the first few hours of life. Occasionally, skull fractures are present as well. Most cephalohematomas resolve within the first few weeks or months of life without residual findings.
What complications are SGA newborns at risk for?
Hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, and polycythemia. The polycythemia is due to increased EPO secretion in response to fetal hypoxia
Up to what percentage birth weight loss is considered normal?
7%
Under what heart rate should chest compressions be initiated in a neonate?
<60 bpm
What are the chest xray findings in transient tachypnea of the newborn?
Hyperinflated lungs with fluid in the interlobar fissures (note that infants will have clear lung sounds)
What is the biggest risk factor for cerebral palsy?
Prematurity
