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Pediatric Outpatient > Neonates > Flashcards

Neonates Flashcards

1
Q

APGAR Score

A

POSSIBLE 2 PTS EA

  • Heart Rate - absent, <100 (1 pt), > 100 (2 pts)
  • Resp Effort - absent, slow/irregular, good/regular
  • Color - blue/pale, only extremities blue, all pink
  • Muscle Tone - limp, some flexion, good flexion and movement
  • Reflex Irritability - no response, grimace only, cough or sneeze
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2
Q

Choanal Atresia

A
  • infant only having trouble when not crying then suspect
  • Intubate until can perform surgery
  • Crying allows breath thru mouth v. feeding (obligate nose breather)
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3
Q

Hyperinsulin in Fetus / Newborn

A
  • Hyperglycemia in organogenesis - neural tube defects, cardiac defects and caudal regression syndrome - (hypoplasia of sacrum and lower extremities)
  • Fetal insulin production by 2nd trimester - leads to inc glycogen which deposits in liver, lungs, heart, kidney, muscle as well as macrosomia and inc oxygen requirement
  • Hypertrophic cardiomyopathy - deposits in heart muscle
  • Inc oxygen requirement leads to polycythemia (HCT>65 and ruddy skin); can cause jaundice and venous thrombosis because viscosity increased
  • Macrosomia - inc chance shoulder dystocia and clavicle fractures
  • Insulin interferes with cortisol effect on lung maturity / surfactant production - predisposes to respiratory distress syndrome
  • Once delivered no longer in hyperglycemia environment but still high insulin so HYPOGLYCEMIA (seizures, jitter)
  • May also have hypocalcemia - sweating, seizures and irritability
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4
Q

Reasons for Jittery Newborn

A

may be normal on first day of life

hypoglycemia (get bedside glucose) or

hypocalcemia or

drug withdrawal

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5
Q

Caput Succedaneum

Cephalohematoma

A
  • Caput succedaneum - head edema that crosses suture lines (edema so does not contribute to inc bilirubin)
  • Cephalohematoma - bleeding into sub-periosteal space so does not cross suture lines (blood so may inc bilirubin)
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6
Q

Normal Umbilical Cord

A

Should have 1 vein and 2 arteries

Should fall off after 3-4 wks (>8 wks is abnormal)

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7
Q

Ortolani and Barlow

A
  • Barlow - flex knee and hip and try to displace

- Ortolani - guided abduction

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8
Q

Polyhydramnios v. Oligohydramnios

A
  • Polyhydramnios - often due to pulmonary problem (cannot swallow) or inc production
  • Oligohydramnios - too little fluid; leads to restriction and Potter syndrome (compressional deformity of face, limbs, abdomen and lung hypoplasia); often due to kidney problem like obstruction, agenesis or cysts
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9
Q

Congenital CMV

A
  • IUGR/microcephaly, blueberry muffin rash,peri-ventricular calcifications in brain, seizures, chorioretinitis
  • May use gancyclovir (mainly to prevent hearing loss)
  • Long-term #1 infectious cause of sensorineural hearing loss
  • Get urine or saliva sample w/in 21 days
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10
Q

Congenital Rubella

A

cataracts, sensorineural hearing loss, cardiac defects, developmental delay, IUGR

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11
Q

Congenital Toxoplasmosis

A

intracranial calcification and chorioretinitis, anemia, jaundice, hepatosplenomegaly

Tx = Pyrimethamine, sulfadiazine, leucovorin for 12 mo

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12
Q

Transient Tachypnea of Newborn

A
  • transient pulmonary edema from delayed clearing of fluid from lungs
  • both term and preterm babies; inc risk if C section (esp w/o labor)
  • tachypnea, nasal flaring and grunting shortly after birth
  • respiratory acidosis w/ mild to moderate hypoxia
  • CXR: interstitial markings, fluid in tissues, perihilar streaking
  • Give O2 and pos pressure if needed
  • Spont recovery in few days
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13
Q

Respiratory Distress Syndrome

A
  • insufficient surfactant
  • more common in preterm
  • progressive tachypnea and respiratory distress shortly after birth
  • resp acidosis and hypoxia
  • CXR: ground glass
  • Resp support w/ mechanical ventilation as needed
  • Prevention w/ antenatal steroids for lung maturation, can give exogenous surfactant at birth as ppx or w/in 6 hrs of birth as rescue therapy
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14
Q

Neonatal Pneumonia

A
  • may be in utero or shortly after birth (GBS)
  • signs of respiratory distress +/- sepsis (can be almost identical RDS)
  • resp acidosis and hypoxia
  • CXR: consolidation (localized, patchy or diffuse), may have pleural effusion (CXR of GBS pneumonia is almost identical to RDS CXR)
  • IV abx w/ ampicillin + cefotaxime until sensitivities grow; 10-21 day course
  • prognosis depends on CNS involvement
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15
Q

Meconium Aspiration Syndrome

A
  • Meconium in lungs leads to airway obstruction, pneumonitis and inactivation of surfactant
  • uncommon b/f 37 wks (not developed enough to have meconium); inc risk if post-term
  • progressive tachypnea, flaring, grunting w/in 12 hours; may have rhonchi or rales; barrel chest
  • sig hypoxemia and hypercapnia
  • CXR: patchy atelectasis, coarse densities throughout and areas of hyperinflation
  • suction, mechanical vent, high flow oxygen, high airway pressure
  • may lead to chronic lung disease depending on degree and duration of ventilation needed
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16
Q

What is meconium? What do you do if meconium-stained amniotic fluid?

A
  • In fetal intestine by second trimester but not able to pass until about 37 weeks; if fetus asses meconium in utero there may be meconium-stained amniotic fluid a birth - may cause fetal stress
  • If meconium-stained amniotic fluid …
  • If vigorous (>100 BPM, crying, good tone) then just suction oropharynx w/ bulb
  • If not vigorous (<100 BPM, poor cry or tone) then endotracheal suctioning
17
Q

Early Onset Neonatal Sepsis (timing, presentation, labs, tx)

A
  • First 5 days
  • Mainly organisms from mom’s vaginal tract (GBS, E coli, Listeria)
  • Presentation - cyanosis, pallor, petechiae, ileus, resp distress or apnea, hypotension
  • May be subtle at first (temp instability, poor feeding, irritability, dec tone, hypoglycemia, lethargy)
  • Labs - CBC and blood cultures; may get serial CRPs; CSF culture, differential and protein/glucose content
  • Tx (start b/f confirmed) - 10-14 days amp + gentamicin; may add ceftriaxone if meningitis
18
Q

Definition and Common Causes Conjugated Inc Bilirubin

A

(if direct bilirubin > 2 or more than 15% total) SOLUBLE

CAUSES

  • Biliary atresia
  • Neonatal hepatitis
  • Congenital infections
  • Alpha-1 Antitrypsin
  • Galactosemia
19
Q

Definition and Common Causes Unconjugated Bilirubin

A
  • (if direct bilirubin < 2 or less than 15% total) NOT SOLUBLE

CAUSES

  • Physiologic
  • Breastfeeding Jaundice
  • Breast Milk Jaundice - similar presentation to physiologic but higher peak level and lasts a little longer; peaks at day 10-14
  • Hemolysis - ABO or Rh (Coomb’s),
  • G6PD def or pyruvate kinase def, spherocytosis
  • Metabolic Disorders
    - Crigler-Najjar
    - Gilbert Syndrome
20
Q

Kernicterus

A
  • When unconjugated bilirubin exceed albumin binding capacity so crosses BBB –> basal ganglia, cerebellum, hippocampus
  • Presents w/ lethargy, irritability, hypotonia, seizures, opisthotonus (abnormal posturing that involves rigidity and severe arching of the back, with the head thrown backward)
21
Q

Physiologic v. Breast Feeding v. Breast Milk Jaundice

A

1 - Physiologic - never present b/f 24 hrs; peaks at 3 to 5 days; usually level normalizes by 3 wks

- Relative deficiency of hepatocyte proteins and UDPGT
- Lack of intestinal flora to metabolize bile

2 - Breastfeeding Jaundice - early in first wk of life when milk production is low so dec GI motility which leads to more meconium reabsorption (the β-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing an elevation of serum levels)
- May result in dehydration or malnourishment

3 - Breast Milk Jaundice - similar presentation to physiologic but higher peak level and lasts a little longer; peaks at day 10-14

- Might be due to β-glucuronidase in breast milk
- Can last 12 weeks
22
Q

Diaphragmatic Hernia

A
  • Defect in diaphragm –> abdominal contents in thorax –> compromise lung function –>pulmonary hypoplasia and pulmonary hypertension
  • L > R because no protection by liver
  • Present w/ respiratory distress, dec breath sounds on affected side, heart sounds shifted to R (because contents on L)
  • Dx - fetal US or CXR
  • Tx - ventilate, intubate, place tube to minimize GI distention so that it does not further compress lungs, ultimately surgical correction
23
Q

Omphalocele v. Gastroschisis

A
  • Omphalocele - herniation thru abdominal wall w/ covering by peritoneal membrane; may rupture during delivery
  • Gastroschisis - herniation thru abdominal wall w/o covering; surgical emergency
24
Q

Duodenal Atresia

A
  • Failure of lumen to re-canalize at 8-10 weeks gestation
  • Polyhydramnios on fetal US
  • Associated w/ other GI anomalies (annular pancreas) and trisomy 21
  • Present w/ bilious emesis and double bubble on Xray
  • Surgical correction
25
Q

Biliary Atresia

A
  • Absence of common bile duct which normally transports bile from liver to intestine
  • Present w/ high direct bilirubin, clay-colored stools (no bilirubin), dark urine (backs up into urine), hepatosplenomegaly
  • High LFTs
  • Technetium scan confirms lack of bile flow from liver
  • Tx - may do Kasai procedure if early, later conduit surgery or liver transplant (from portal HTN, fibrosis)
26
Q

Trachea-Esophageal Fistula

A
  • Esophageal atresia commonly accompanied by a communication between the trachea and esophagus
  • VACTERL (40% have other abnormalities) - vertebral, anal, cardiac, trachea, esophagus, renal, limb
  • Present w/ excessive oral secretion, inability to feed, gagging, respiratory distress, etc
  • If H-type fistula + no esophageal atresia - may present later w/ chronic cough and recurrent aspiration pneumonia
  • Imaging w/ insertion of tube shows esophagus ending in blind pouch
  • Often have polyhydramnios on fetal US (cannot swallow amniotic fluid)
  • Surgical correction - complicated by strictures
27
Q

What is the most common type of trachea-esophageal fistula?

A

esophageal atresia + distal fistula (trachea connected to distal portion of esophagus)

28
Q

When can an infant be considered for d/c before 48 hrs? (10)

A
  • Full term
  • Normal PE and maintained normal vitals
  • Urinating and stooling
  • 2 consecutive successful breastfeeding sessions
  • Hyperbilirubin assessment
  • Circumcision site is healed and not bleeding
  • GBS and prenatal labs are reassuring
  • No pos drug screen for mom
  • Metabolic screening, hearing screening and 1st Hep B vaccine
  • Parent education has been completed (back to sleep, breastfeeding, circumcision care, car seat use)
29
Q

What should voiding and stooling look like in first week of life?

A

VOIDING

  • Day 3 - should be voiding 3-4X/day
  • Day 6 - should be voiding 6-8X/day
  • Should be pale yellow by this time

STOOLING

  • Day 3 - no more meconium; poops should be yellow
  • Day 6 - 3 to 4 stools per day; may have stool with every feed
  • Concerned if loses color (acholic)
30
Q

Normal Newborn RR and HR

A

HR 90-160

RR 30-60

31
Q

Necrotizing Enterocolitis (pathophysiology, findings and tx)

A
  • Ischemic necrosis of premature gut –> inflammation; may also have gas forming organisms in muscular propria
  • Metabolic acidosis
  • Ab Xray - pneumatosis intestinalis (gas in bowel wall) + dilated loops of bowel
  • Tx
    • NPO, IV nutrition, gastric decompression, IV abx
    • If perforation … surgical consult +/- resection (may lead to short gut syndrome and malabsorption)
32
Q

Beckwith-Wiedemann Syndrome

A
  • On differential for large newborn (LGA) v. mom with DM

- Macroglossia, hemi-hypertrophy, ab wall defects, GU abnormalities

33
Q

Neonatal Abstinence Syndrome (how do babies present? score used? tx?)

A
  • Sx (24-48 hrs after birth)
    • Vomiting, diarrhea, poor wt gain
    • Irritable, jittery, shrill cry, hypertonic, myotonic, seizures
    • Fever, sweating, tachypnea
  • Finnegan Score - serial scores to assess response to treatment
  • Tx
    • Low lights, swaddle, minimal stimulation
    • May give opiates then wean by 10% ea day as sx improve
34
Q

Congenital Syphilis

A
  • Rash (bullous, peeling)
  • Metaphyseal lucencies (get Xray of long bones)
  • Rhinitis (snuffles)
  • Pneumonia
  • Later Hutchinson teeth, saddle nose, saber shins

Tx = IV PCN

35
Q

Congenital HSV

A
  • vesicular rash or scarring
  • calcifications throughout cortex
  • meningitis
  • brain destruction
  • chorioretinitis

Tx = 21+ days high dose acyclovir

Pediatric Outpatient (13 decks)

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