Neonatologia 1

Question 1

Hipoglicemia neonatal e’ definida como…

Answer 1

concentracao plasmatica baixa o suficiente para causar sintomas/sinais de disfuncao cerebral

Question 2

Hipoglicemia sintomatica no RN<48h:

Answer 2

<47 (AAP)

Question 3

Hipoglicemia sintomatica no RN >48h:

Answer 3

<60

Question 4

Glicemia capilar e’ 10-15% menor que plasmativa (V/F)

Answer 4

Verdadeiro

Question 5

Glicose plasmatica pode vir falsamente baixa por…

Answer 5

quebra de glicose pelos eritrocitos (pode ser evitada com inibidores glucoliticos como fluor)

Question 6

RNs amamentados tem …… concentracao de cetonas que os que usam formula

Answer 6

maior (acredita-se que toleram menores concentracoes de glicose serica)

Question 7

Hipoglicemia neonatal e ……. Se dura menos de 3 dias

Answer 7

Transitoria

Question 8

Hipoglicemia neonatal e ……. Se dura mais de 3 dias

Answer 8

Persistente

Question 9

Causa mais comum de hipoglicemia peristente

Answer 9

Hiperinsulinismo

Question 10

Indicacoes de investigaco na hipoglicemia neonatal:

Answer 10

TIG>10; Duracao>10dias; glicemia <60 apos 48h de vida

Question 11

Conduta no RN com sintomas “severos” com glicemia<40

Answer 11

Glicose IV

Question 12

Resgate glicemico em caso de nao ter AVP

Answer 12

Glucagon IM 0.03mg/kg/dose

Question 13

Tx de escolha no hiperinsulinismo congenito

Answer 13

Diazoxido (inibe secrecao de insulina)

Question 14

Efeito colateral comum do diazoxido

Answer 14

Retencao liquida (pode levar a ICC e HP)

Question 15

Alternativa apos falha com diazoxido

Answer 15

Octreotida (analogo da somatostatina)

Question 16

Principal causa de hipoglicemia apos o primeiro mes

Answer 16

Erros inatos do metabolismo

Question 17

Principais hormonios glicogenoliticos (2)

Answer 17

Glucagon//Epinefrina

Question 18

Reservas de glicogeno sao estabelecidas no ___ trimestre

Answer 18

Terceiro

Question 19

Sintomas hipoglicemicos sao divididos em 2:

Answer 19

Neurogenicos e neuroglicopenicos

Question 20

Hipoglicemia “assintomatica” no RN<4h:

Answer 20

<25

Question 21

Hipoglicemia “assintomatica” no RN 4-24h:

Answer 21

<35

Question 22

Vit K dependant coagulation factors low at birth (6)

Answer 22

II-VII-IX-X-Protein C, Protein S; also antithrombin

Question 23

Trombin generation and platelet funcion are ____ in NB

Answer 23

altered

Question 24

Bleeding symptoms in a sick neonate are, usually, secondary to:

Answer 24

Underproduction or consumption of coagulation factors and/or platelets

Question 25

Hemorragic disease of the NB is being replaced by the term:

Answer 25

Vit K deficiency bleeding

Question 26

Most frequent sites of bleeding in Vit K DB (5)

Answer 26

GI; Nasal; Subgaleal; Intracranial; postcircumcision

Question 27

Labs altered in VitK DB (3)

Answer 27

Prothrombin (PT); Partial thromboplpastin time (TTPA); levels of prothrombin (II) and VII-XI-X

Question 28

VitK DB occurs early as in:

Answer 28

day 2 to 7

Question 29

Breasatfed infants who do not received profilaxis with VitK are less likely to have VitK DB (T/F)

Answer 29

False; breastmilk is a poor source of vitK

Question 30

Prematurity is a protective factor for VitKDB

Answer 30

False; risk factor

Question 31

Early onset VitK DB (<24h) is associated with:

Answer 31

Use of certain drugs that interfere with vitk absorption or function

Question 32

Drugs that interfere with vitk absorption or function: (5)

Answer 32

Anticoagulants (warfarin); anticonvulsivants (phenytoin; phenobarbital); cholesterol lower meds; rifampin; Isoniazid

Question 33

If the mother is using drugs that interact with vitk:

Answer 33

Pt should be measured in cord blood; 1-2mg vitk STAT to the NB; if refractory bleeding> 10-15ml fresh-frozen plasma

Question 34

Late onset VitK DB (>2wk) is associated with:

Answer 34

Malabsorption of fat-soluble vitk (cystic F; neo hepatitis; biliary atresia

Question 35

Vit K profilaxys is 100% effective in prevention of VitK DB (T/F)

Answer 35

False; some (specially breasfed) NB may present bleeding; slow IV infusion of 1-5mg vitK

Question 36

Oral VitK scheme:

Answer 36

1-2mg at birth; at discharge and at 3-4 wk; less effective than IM vitK

Question 37

Bleeding in the NB that doesn’t respond to VitK:

Answer 37

Consider other bleeding disorders

Question 38

Incidence of classic VitK DB

Answer 38

2% of infants that didn’t received VitK profilaxis