Neonatology Flashcards by Huda Abdulrhman

Gestational age of screening for group B Streptococcus (GBS)

35–37weeks gestation

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Birth weight less than 1500g

Very low birth weight (VLBW)

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Newborn infant with head swelling crossing the suture lines; delivery was assisted with the use of a vacuum?

Caput succedaneum

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Mother currently GBS negative, but the previous infant had GBS disease. Is GBS prophylaxis recommended?

Yes

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Most common cause of infant deaths in the USA

Congenital malformations

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Birth weight more than the 90th percentile

Large for gestational age (LGA)

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Which group has the highest infant mortality rate in the USA?

African American infants

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Subgaleal hemorrhage

Intraventricular hemorrhage—with a head US

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Compression of the umbilical cord is associated with which type of deceleration?

Variable decelerations

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Fetal head compression is often associated with which type of deceleration?

Early deceleration (increased vagal tone)—benign tracing

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Birth weight less than the 10th percentile

Small for age (SGA)

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When is surfactant recommended to be used prophylactically after resuscitation in extremely premature neonates to protect the immature lungs?

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The name of cells that produce lung surfactant

Type 2 alveolar cells

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An 8-week-old who was born at 27weeks was intubated for several weeks and now has chronic hypoxemia, tachypnea, wheezing, along with longstanding respiratory insufficiency. Chest radiograph showed: Decreased lung volumes, areas of atelectasis, hyperinflation, and pulmonary edema

Bronchopulmonary dysplasia

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Newborn infant with respiratory distress, bowel sounds in the chest, scaphoid abdomen. Bag-mask PPV after delivery made the infant worse. Chest radiograph shows: loops of bowel in the chest, a mediastinal shift, a paucity of bowel gas in the abdomen, and the presence of the tip of a nasogastric tube in the thoracic stomach

What is the next best step in the newborn ?

Intubate immediately after delivery, insert a nasogastric tube to decompress the stomach (avoid bag-mask ventilation)

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The best course of action in cases of late deceleration

Fetal pH measurement

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Full-term infant presents with tachypnea, cyanosis only in the lower body, loud second heart sound. Chest radiograph shows clear lungs and decreased vascular markings

Persistent pulmonary hypertension of the newborn

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An infant develops cyanosis when feeding, which disappears when crying

Bilateral choanal atresia

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A post-term newborn has respiratory distress. The amniotic fluid was stained with meconium, and the point of maximal cardiac impulse is displaced

Pneumothorax

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A common complication from excessive bagging during resuscitation?

Pneumothorax

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Newborn infant with head swelling that does not cross the suture lines?

Cephalohematoma

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Meconium-stained amniotic fluid is noted at delivery, and the infant is apneic. What is the next best step?

PPV

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Meconium ileus in a newborn

Cystic fibrosis should be ruled out

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Birth weight less than 2500g

Low birth weight

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A 2-week-old preterm infant born at 26 weeks gestation started having more gastric residuals, abdominal distension, blood in stool, abdominal wall erythema. KUB shows pneumatosis intestinalis and gas in the portal vein

Necrotizing enterocolitis

Newborn with bilious vomiting, abdominal distension, and lethargy

Volvulus should be ruled out

Newborn with Down syndrome and bilious vomiting. KUB shows double bubble sign

Duodenal atresia

Differential diagnosis of white pupillary reflex

Cataract, retinoblastoma

What is the current recommendation for umbilical cord care in infants born in developed countries?

To keep it dry (use of isopropyl alcohol is no longer routine cord care)

Newborn infant with lanugo on the shoulders, creases on the entire foot, scant vernix, both testicles in the inguinal canal with good rugae has an approximate gestational age of?

39 weeks—be familiar with Ballard scoring

Anhidrosis, ptosis, miosis, and enophthalmos

Horner syndrome

Term infant 1 h after birth develops tachypnea, hypoxia, grunting. Chest radiograph showed fluid in the fissures, flattening of the diaphragm, and prominent pulmonary vasculature

Transient tachypnea of the newborn (self-limited, resolves spontaneously, and requires supportive care)

A preterm newborn with tachypnea, grunting, nasal flaring, subcostal, and intercostal retractions. Chest radiograph shows ground glass appearance. He continues to require more oxygen What is the best treatment ?

Surfactant therapy followed by rapid extubation to nasal continuous positive airway pressure (CPAP)

Newborn is not moving arm, and the arm is internally rotated in waiter’s tip position

Erb’s palsy (C5–6)

Newborn is not moving arm and hand, and the hand is held in a claw-like position

Klumpke paralysis (C8-T1)

A diagnostic test to assess associated findings with brachial plexus palsies (BPP

Chest radiograph can rule out phrenic nerve injury and clavicular fracture Fluoroscopy to confirm phrenic nerve injury

A 2-month-old infant has irritability and poor feeding, swelling, and bone lesions, elevated ESR, and alkaline phosphatase levels. Radiographs show layers of periosteal new bone formation, with cortical thickening of the long bones, mandible, and clavicle. Soft-tissue swelling is evident as well

Infantile cortical hyperostosis (Caffey disease)

A type of hemorrhage in which bleeding is significant and often presents with swelling in the posterior aspect of the head?

Subgaleal hemorrhage

A 5-day-old female with vaginal bleeding

Reassurance (maternal hormone withdrawal)

A well-appearing term neonate with bluish discoloration in hands and feet

Reassurance (peripheral cyanosis or acrocyanosis is common and benign)

Newborn with a sharply demarcated ulcerated area of absent skin is?

Aplasia cutis congenita

What is the clinical significance of a single umbilical artery?

Associated fetal anomalies (20% or more)

What are the common causes of late deceleration?

Placental insufficiency for any reason

A neonate has new-onset seizure activity but appears otherwise healthy

Refer to the emergency department immediately

Large for gestational age, lethargy, tremors, seizures, and cyanosis

Hypoglycemia

Newborn at 1 min: Heart rate is 90/min, weak irregular respiration, grimace, some flexion, blue body and limbs, APGAR score is:

Fetal tachycardia

Fetal heart rate > 160 beats/min

Fetal heart monitoring shows: Fetal heart dropped during the peak uterine contraction and recovered after the contraction had ended; the time from the onset of deceleration to the lowest point of deceleration is 30 s

Late deceleration; associated with placental insufficiency

A neonate is born to a mother with chorioamnionitis. The neonate is alert with good tone, no respiratory distress, and vital signs are normal. What is the next best step?

Obtain blood culture, complete blood cell count, and start ampicillin and gentamicin

Neonate with hypoglycemia diagnosed with glucose oxidase test strip; test strip glucose is 30 mg/dL. What is the next best step?

Order plasma glucose level (most accurate); feed infant immediately

Newborn with a micropenis that is less than 2.5 cm when stretched will require?

Endocrine evaluation

Newborn is very quiet, cries very little, and has prolonged jaundice and umbilical hernia

Hypothyroidism

The third trimester presents with Hemolysis, Elevated Liver enzymes, Low Platelet count

HELLP syndrome (complication of preeclampsia)

Jaundice, hypocalcemia, and hypoglycemia are usually associated with

Polycythemia

What is the treatment of polycythemia?

Hydration (IV fluids); if symptomatic or significant polycythemia, will need an partial exchange transfusion

Is jaundice in the first 24 h physiologic?

A condition specific for the infant of diabetic mother

Small left colon syndrome

An abdominal wall defect with uncovered abdominal contents noted right of the umbilicus is

Gastroschisis—not associated with genetic abnormalities

Maternal fever > 100.4 °F, fetal heart rate more than 160–180 beats/min, maternal tachycardia, purulent foul-smelling amniotic fluid, maternal leukocytosis, and uterine tenderness

Chorioamnionitis

An abdominal wall defect covered with a membrane that is often associated with genetic syndromes is

Omphalocele—associated with genetic abnormalities, e.g., trisomies 13, 18, and 21 and Beckwith–Wiedemann syndrome

Syndrome characterized by absent abdominal wall musculature as well as cryptorchidism is

Prune belly syndrome

A full-term newborn with missing right index, middle, and ring fingers

Amniotic band syndrome

What is the definitive treatment for preeclampsia/HELLP syndrome?

Delivery

Newborn with jitteriness, irritability, tremulousness, limb defect, leukomalacia, and intracranial hemorrhage

Cocaine abuse during pregnancy

Newborn infant is just delivered. The infant is apneic and has a heart rate

Positive pressure ventilation (PPV) for 30 s, then reassess ——- Chest compressions and PPV using 100% oxygen ——- Intubation ——- Intravenous administration of epinephrine

The best course of action if fetal scalp pH

Immediate delivery

What is the drug of choice for GBS prophylaxis?

Penicillin G

Very small for gestational age (SGA) infant, mother with multiple drug abuse during pregnancy, including alcohol, cigarette smoking, cocaine, marijuana. Which substance is most responsible for SGA?

Cocaine

The most common effect of cigarette smoking during pregnancy on newborn

Low birth weight

Uteroplacental insufficiency is associated with what type of deceleration?

Late deceleration—potentially ominous

Fetal bradycardia

Fetal heart rate < 110

Excessive exposure to hot water or hyperthermia during the first trimester of pregnancy increases the risk of

Miscarriage, neural tube defect , gastroschaisis

A virus that can cause fetal hydrops

Parvovirus B19

Newborn with microphthalmia, cataracts, blueberry muffin spots on the skin, hepatosplenomegaly, and patent ductus arteriosus

Congenital rubella syndrome

Newborn with one side of the body pink and the other side pale, with a sharp line in-between, no other symptoms

Harlequin color change

Newborn with microcephaly, and periventricular calcifications

Congenital cytomegalovirus infection

Newborn with chorioretinitis, hydrocephalus, and intracranial calcifications

Congenital toxoplasmosis

Newborn with snuffles, continuous nasal secretions, anemia, thrombocytopenia, hepatomegaly, and periostitis

Congenital syphilis

Birth weight less than 1000 g

Extremely low birth weight (ELBW)

SGA newborn with short palpebral fissures, epicanthal folds, micrognathia, smooth philtrum, thin upper lip, and microcephaly

Fetal alcohol syndrome

Lithium use during pregnancy is associated with

Ebstein anomaly

Infant born to an opiate dependent mother presents with increased irritability, fussiness, poor feeding, and sweating

Neonatal abstinence syndrome

Which maternal medication during pregnancy results in a newborn with growth restriction, renal dysgenesis, oligohydramnios, skull ossification defects?

ACE inhibitors

Which anticonvulsant is associated with fetal hydantoin syndrome?

Phenytoin

What is the most common association with aplasia cutis congenita?

Benign isolated defect (less commonly associated with other physical anomalies or malformation syndromes, e.g., trisomy 13)

A neonate is born with severely thickened skin with large, shiny plates of hyperkeratotic scales. Deep, erythematous fissures separate the scales and contraction abnormalities of the eyes (severe ectropion), ears, mouth, and appendages

Harlequin ichthyosis (autosomal recessive)

Valproic acid intake during pregnancy increases the risk of

Neural tube defect, cleft lip and palate, cardiovascular abnormalities, genitourinary defects, developmental delay, endocrine disorders, limb defects, and autism

The most common congenital defect associated with carbamazepine and valproic acid

Neural tube defect

Newborn with isolated congenital deafness

Referral to a geneticist (genetic causes probably account for the majority of cases in developed countries)

A 3-day-old infant presents with bilateral hip clunks. What is the next best step?

US of the hips at 6 week of age

An infant is delivered to HBsAg positive mother; what is the next step?

Administer both hepatitis B vaccine and HBIG within 12 h of birth

Critical congenital heart defects screening before discharge from the newborn nursery requirements in most states in the USA

Oxygen saturations should be > 95%, with no more than a 3% difference between pre-ductal and post-ductal oxygen saturations

A mother who delivers a full-term newborn has negative routine maternal labs. The infant is born by vaginal delivery and is stooling, voiding, feeding well. Tc bilirubin is normal on the 25th percentile. What is the recommended discharge time from newborn nursery and follow-up-care?

48 h after birth and follow-up in 2–3 days

Newborn initially diagnosed with transient tachypnea of the newborn is requiring more oxygen and is much worse after several days

Consider another diagnosis