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Royal Super 4th Year Brain > Neonatology > Flashcards

Neonatology Flashcards

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1
Q

Two major and minor manifestations of neonatal lupus

A
  • Cardiac: heart block
  • Cutaneous: peri-orbital and scalp rash
  • Minor: hepatic, hematologic
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2
Q

Antenatal screening results that suggest trisomies

A
  • High HCG
  • Low PAPP-A
  • Low AFP
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3
Q

What class of medications impairs maternal vitamin K metabolism?

A

AEDs

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4
Q

If parents refuse IM vitamin K injection then what is the next best step?

A

Give 2.0mg PO vitamin K during first feeding –> repeat at 2-4 weeks –> repeat at 6-8 weeks

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5
Q

Who should we not give soy-based infant formulas to and why?

A
  • Congenital hypothyroidism

- Due to phytoestrogens

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6
Q

Most common long term complication of NEC

A

Stricture

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7
Q

GA cut off for HIE cooling

A

Greater than 36wk

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8
Q

TTTS vs TAPS

A
  • TTTS = overarching term, characterized by volume differences from large AV anastomoses
  • TAPS = atypical chronic form, characterized by recipient/polycythemic twin
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9
Q

If mom has untreated gonorrhea, what would you do for the baby?

A

CTX IM and eye culture

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10
Q

Discontinuing resus efforts when no detectable heart rate

A

20 minutes

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11
Q

Most common cause of HTN in neonates

A

Renovascular

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12
Q

Why do we irradiate blood for prems?

A

Decrease rates of GVHD

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13
Q

Criteria for polycythemia with HCT

A

> 0.65

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14
Q

What is the first step in symptomatic polycythemia?

A

IV dextrose

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15
Q

When to treat congenital CMV (x3)

A
  • CNS disease
  • chorioretinitis
  • severe single or multi-organ disease
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16
Q

When do signs of Neonatal Myasthenia Gravis present?

A

By day 3 of life

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17
Q

TORCH

A
  • Toxoplasma
  • Other
  • Rubella
  • CMV
  • HSV
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18
Q

When do you ONLY give the Hep B vaccine in the NICU?

A

If primary caregiver other than the mother is a known carrier (e.g., Father)

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19
Q

What and when to give to a newborn if mother is HbsAg+ or at high risk?

A

HBIG + Hep B vaccine - within 12 hours of birth

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20
Q

What is the time-line for neonatal HSV symptoms to present?

A

Within 4-6 weeks

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21
Q

Chance of transmission of HSV for first primary occurrence and with recurrent episode for mother?

A

60% and <2%

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22
Q

What to do if baby born to mother with presumed first primary genital HSV infection following a cold C/S?

A

Mucous membrane swab >24 hours of life

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23
Q

When to give baby VZIG? And what is the alternative treatment?

A

If signs of maternal chickenpox develop from 5 days before to 2 days after delivery. Can give IVIG.

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24
Q

What nerves could be involved with Brachial Plexus Injury?

A

C5-T1

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25
Q

What type of twins is most likely to have TTTS?

A

Monochorionic diamniotic twins

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26
Q

TAPS vs TTTS

A

TAPS - chronic intertwin transfusion to create a twin anemia-polycythemia sequence

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27
Q

Grades of IVH

A 
I = germinal matrix
II = ventricle
III = enlarged ventricle
IV = parenchymal bleed
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28
Q

What should you think about when IVH in term infants?

A

Sinovenous thrombosis

Consider NAIT

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29
Q

Most common ischemic brain injury in premature infants and long-term complication

A

Periventricular leukomalacia

CP

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30
Q

When does PVL really start to appear on cranial ultrasound after insult?

A

4-6 weeks

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31
Q

Most common form of CP in premature infants with PVL

A

Spastic diplegia

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32
Q

What stage of encephalopathy of HIE would you consider for cooling to fulfill “criteria C”?

A

Sarnat stage 2 and 3

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33
Q

With what complications would you consider stopping cooling for HIE?

A

Coagulopathy develops, severe hypotension, increased ICP, PHTN

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34
Q

Risks of cooling

A 
Hypotension/bradycardia
Thrombocytopenia
PHTN
Prolonged bleeding time
Pain/discomfort
Subcutaneous fat necrosis +/- hypercalcemia
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35
Q

Who will get NEC first - prem or term babe?

A

Term (within first few days)

Pre-term (within weeks)

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36
Q

Why may a term or late preterm have NEC?

A

Poor perfusion - cardiac (consider echo) and CNS (HIE)

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37
Q

What type of TEF/EA has x2 fistulas?

A

Type D

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38
Q

What system has abnormalities most closely associated with TEF?

A

Cardiac

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39
Q

What syndrome is most closely associated with TEF?

A

VACTERL

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40
Q

What side is most likely to be involved with CDH?

A

80% of the time = left

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41
Q

What are the associated genetic syndromes with omphalocele?

A

VACTERL, BW, Trisomy 13/18/21

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42
Q

Difference between meconium ileus vs plug? How to differentiate? Associated condition.

A

Ileus at level of small bowel - CF
Plug at the level of the colon - CF, Hirschsprungs
Water soluble contrast enema

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43
Q

Why do we not give EPO for anemia in newborn?

A

Increase risk of ROP

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44
Q

Volume of blood to given to newborn during transfusion

A

20 mL/kg

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45
Q

Types of vitamin K deficiency

A 
Early = first 24h of life
Classic = between 24h to 7 days
Late = between 2nd week and 6th month
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46
Q

Timeframe to give vitamin K to newborn

A

Within first 6 hours after birth

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47
Q

DDH risk factors

A
  • First pregnancy
  • +fmhx
  • Female infant
  • Oligohydramnios
  • Breech
  • Increased BW
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48
Q

7th N palsy ddx for peripheral causes

A

Trauma, hypoplasia/aplasia, Bell palsy, infection (e.g., AOM), GBS, inflammatory disorder, tumor of brainstem

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49
Q

Peripheral vs central 7th N palsy

A

Peripheral - no forehead furrow + cannot close affected eye

Central - facial nucleus cells receive bilateral innervation from both hemispheres

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50
Q

x2 dx for neonatal asymmetric crying facies

A

Congenital absence or hypoplasia of depressor anguli oris muscle and facial nerve palsy secondary to forceps delivery

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51
Q

Benefits of circumcision

A
  • Ease of hygiene
  • Decreased risk of UTI, phimosis, infection, STI
  • Avoidance of procedure later in life
  • Cancer reduction (penile, female cervical)
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52
Q

Risks of circumcision

A
  • Minor bleeding
  • Pain
  • Local infection
  • Unfavourable cosmetic result
  • Meatal stenosis
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53
Q

Contraindication of circumcision

A

-Hypospadias

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54
Q

What is included in First Trimester Screen + timing?

A

FTS = nuchal translucency + B-hCG/PAPP-A (12 weeks)

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55
Q

What is included in maternal serum screen + timing?

A

-B-hCG, E, AFP (15-20 weeks)

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56
Q

Integrated prenatal screen - what is included

A

FTS + MSS

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57
Q

NIPT - what does it stand for, what is it, and what does it look for?

A
  • Non-invasive prenatal testing
  • Looks at fetal DNA within maternal blood
  • Trisomies + sex chromosome aneuploidy
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58
Q

What x2 assessments are considered “fetal assessments” in antenatal screening? And when are they performed?

A
  • Choriovillus = 9-12 weeks

- Amniocentesis = >16 weeks

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59
Q

What is the pathophysiology for blueberry muffin rash?

A

= extra-medullary hematopoiesis

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60
Q

Neonatal effect of maternal Graves Disease (x3)?

A
  • Hyperthyroidism (because Ab’s cross placenta)
  • IUGR
  • Prematurity
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61
Q

Neonatal effect of maternal PIH (x3)?

A
  • Thrombocytopenia
  • Neutropenia
  • IUGR (from placental insufficiency)
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62
Q

Neonatal effect of maternal hyperparathyroidism (x2)?

A
  • Hypoparathyroidism

- HypoCa

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63
Q

Effects on fetus/newborn with maternal NSAID use (x2)?

A
  • PDA closure

- PPHN

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64
Q

Effects on fetus/newborn with maternal AED (x3)?

A
  • Midface hypoplasia
  • NTD
  • Hemorrhage (vitamin K deficiency)
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65
Q

Effects on fetus/newborn with maternal ACEi use (x3)?

A
  • Renal failure
  • Oligohydramnios
  • Fetal hypocalvaria
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66
Q

Effects on fetus/newborn with maternal B-blockers use (x2)?

A
  • Bradycardia

- Hypoglycemia

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67
Q

Effects on fetus/newborn with maternal lithium use (x2)?

A
  • Hypothyroidism

- Ebstein’s anomaly

68
Q

Effects on fetus/newborn with maternal cocaine use (x1)?

A

-Placental abruption

69
Q

What is a potential amniotic fluid complication in setting of IUGR?

A

Oligohydramnios - secondary to placental insufficiency or syndrome

70
Q

x4 new questions to ask prior to delivery in NRP 8th edition?

A
  1. Gestational age
  2. Fluid - clear?
  3. Any risk factors?
  4. Umbilical cord plan
71
Q

ETT size and depth for neonates

A
  • Size: >35 weeks (3.5-4.0), >1kg (3.0), <1.0kg (2.5)

- Depth = weight + 6cm

72
Q

When to consider d/c resus during neonatal resus?

A

After 20 minutes of no HR following appropriate resus

73
Q

At what gestational age threshold do you consider using a plastic bag?

A

<32 weeks

74
Q

Management (including things to avoid) for PPHN?

A
  • Mgmt = iNO, oxygen, vasopressor support, prostaglandins to keep duct open
  • Avoid = stress/cold, hypercarbia, acidosis
75
Q

What associated anomalies to look for with TEF?

A

VACTERL

76
Q

Does surfactant prevent chronic lung pathology?

A

No

77
Q

Risks of surfactant therapy?

A
  • Bradycardia
  • Plugged ETT
  • Pulmonary hemorrhage
  • Pneumothorax
78
Q

Definition of BPD

A

O2 dependence by 28 days or 36 weeks post-GA

79
Q

Weight categorization for preterm infants - LBW, VLBW, and ELBW

A
  • LBW <2500kg
  • VLBW <1500kg
  • ELBW <1000kg
80
Q

x3 types of apnea

A

Central, obstructive, and mixed

81
Q

Typical time of PDA closure

A

5-7 day of life

82
Q

Contraindications of indomethacin

A
  • Thrombocytopenia

- Renal insufficiency

83
Q

Presentation of a PDA (including timing of symptoms)

A
  • Term = 4-6 weeks onset
  • Preterm = 1-2 weeks onset
  • Machinery/continuous murmur, active precordium, bounding pulses, cardiac decompensation (resp distress, apnea, HSM, CHF, tachycardia, hypoxia)
84
Q

Threshold for preterm infants for routine neonatal brain imaging

A

<1500g or <31+6 weeks

85
Q

If preterm baby meets criteria for routine brain imaging, when is the first HUS?

A

4-7 days of life

86
Q

Four stages of neonatal IVH

A
  1. Subependymal/germinal matrix
  2. Intraventricular involvement, <50% volume, no ventricular dilation
  3. Ventricular dilation, >50% volume
  4. Parenchymal involvement
87
Q

What is periventricular leukomalacia, when does it show up on imaging, and what is the prognosis?

A

=softening of white matter around ventricles

  • 10-21 days of life
  • CP
88
Q

x2 criteria for ROP screening

A
  • <1250g

- <31 weeks GA

89
Q

When do you screen for ROP

A
  • At 4 weeks of life

- OR at 31 weeks corrected

90
Q

x2 therapies for ROP

A
  • Laser photocoagulation

- Anti-vascular endothelial growth factor

91
Q

x4 risk factors for ROP (apart from preterm)

A
  • Hypotension
  • Ventilation (prolonged)
  • Oxygen therapy
  • Slow post-natal growth
92
Q

If incomplete recovery, when should you refer a patient with brachial plexus injury?

A

If incomplete recovery by 1 month of age

93
Q

What x3 risk factors are most important to consider for brachial plexus injury? hint: in terms of events/injuries that occur at delivery

A
  • Shoulder dystocia
  • Clavicle fracture
  • Humeral fracture
94
Q

HIE criteria

A

-Must have A or B plus C and be >35 weeks GA
A = ph <7 and BE > -16
B = pH 7.01-7.15 or BE -10 to -15 AND perinatal insult AND APGAR <5 at 10 min or x10min of PPV
C = moderate to severe encephalopathy

95
Q

Side effects of cooling in HIE

A
  • Fat necrosis
  • Hypotension
  • Bradycardia
  • Coagulopathy
  • PPHN
96
Q

How to stage HIE

A

-With Sarnat clinical staging - state 1-3 (mild to severe)

97
Q

Renal and metabolic systemic effects of HIE

A

Oliguria, hematuria, ATN, hyperK, hypoCa, hyperPO4, hypoglycemia

98
Q

Window to start cooling for HIE

A

within 6 hours

99
Q

x4 causes of HIE

A
  • Disruption of umbilical flow = prolapse
  • Failure of placental gas exchange = abruption
  • Compromised fetus (not tolerating labour) = IUGR, anemia
  • Failure of post-natal transition
100
Q

Causes of neonatal seizures

A
  • HIE
  • IVH
  • Metabolic: hypoglycemia, hypoCa, IEM
  • Other: stroke, NAS, infection, brain malformations
101
Q

DDx for a floppy baby

A
  • CNS: perinatal depression, HIE, stroke/bleed
  • Spine: trauma, stenosis
  • Anterior horn: SMA
  • Nerve root: brachial plexus
  • NMJ: myasthenia gravis
  • Muscle: congenital muscular dystrophy, congenital myotonic dystrophy
  • Genetic: T21, Prader Willi
102
Q

x3 types of brachial plexus injury with associated features and prognosis

A
  • Upper/middle, C5/6/7 = Erb Palsy, favourable prognosis, watch for phrenic nerve involvement (respiratory distress)
  • Lower, C8-T1 = Klumpke’s palsy, rare
  • Complete, C5-T1, less favourable prognosis, associated with Horner’s
103
Q

Spectrum of nerve injury in neonatal brachial plexus injury

A
  • Neuropraxia = temporary conduction block due to interruption of sheath, will full recovery
  • Axonotmesis = disruption of nerve fibers, incomplete recovery
  • Neurotmesis = nerve disruption + avulsion, no recovery
104
Q

If the first HUS in abnormal for a preterm infant, when should this be repeated?

A

7-10 days

105
Q

When to consider HUS in infant who is moderate to late preterm (x6 RF’s)?

A
  • Complicated monochorionic twin pregnancy
  • Lower GA
  • HC <3rd%tile
  • Need for resuscitation at birth
  • Complicated critical care course
  • Post-natal complications (sepsis, NEC, surgery)
106
Q

Risk factors (x7) that lead to fluctuations in cerebral blood flow in neonates?

A
  • Acidosis
  • PDA
  • Variation in BP
  • Anemia
  • Hypo/hypercarbia
  • Severe RDS
  • PTX
107
Q

When does the GM completely involute by?

A

34-36 weeks

108
Q

x11 recommendations from CPS for neuroprotection of preterm infants

A
  • PPROM + preterm delivery anticipated = Abx; Infants should be investigated + treated especially if chorio
  • <35 weeks with risk of delivery = CC’s within 7 days
  • Consider MgSO4 if imminent delivery
  • Delayed cord clamping if no need for immediate resus
  • Prevent hypothermia - bag, thermal mattress, warmer, hat for all <32 weeks
  • Avoid inotropes to treat hypotension unless other clinical signs present
  • Prophylactic indomethacin - targets to high risk, extremely preterm infants with RF’s
  • Prevent PVL and IVH, a PCO2 45-55 mmHg should be targeted
  • Volume targeted ventilation during first 72 hours
  • Neutral, midline, and 30 deg elevation for HOB
  • Transfer at risk mothers to tertiary care center
109
Q

GIR calculation

A

(%dextrose x IV rate in mL/hr) / (wt x 6)

110
Q

DDx for neonatal hypoglycemia

A
  • Decreased substrate: SGA, preterm
  • Increased utilization: stress (asphyxia), hyperinsulinism, polycythemia
  • Abnormal utilization: IEM
  • Other: CAH, hypopit
111
Q

When do you discontinue BG testing in (a) LGA/IDM vs (b) SGA?

A

(a) After 12 hours

(b) After 24 hours

112
Q

What is the initial therapeutic target for a neonatal glucose level (a) initially after birth vs (b) after transition period?

A

(a) <2.6

(b) <3.3

113
Q

Dosing for dextrose gel for neonatal hypoglycemia

A

5 mL/kg D40W

114
Q

if neonate is symptomatic secondary to hypoglycemia, what bolus dosing do you give?

A

2 mL/kg D10W

115
Q

Findings that you would see on gas and ammonia level for (1) Urea cycle defect, (2) organic acidemias, and (3) galactosemia?

A

(1) Normal gas, high ammonia
(2) Acidosis, +/- high ammonia
(3) Hypoglycemia, normal gas, normal ammonia

116
Q

Red flag features for hyperbilirubinemia?

A
  • Onset before 24 hours
  • Hemolysis
  • Pallor
  • Unwell
  • HSM
  • Pale stools, dark urine
  • Conjugated
117
Q

TSB threshold for (a) severe and (b) critical

A

(a) >340

(b) >425

118
Q

Transfusion Hb threshold for week 1 of age (a) with respiratory support and (b) without respiratory support

A

(a) 115

(b) 100

119
Q

Transfusion Hb threshold for week 2 of age (a) with respiratory support and (b) without respiratory support

A

(a) 100

(b) 85

120
Q

Transfusion Hb threshold for week 3 of age (a) with respiratory support and (b) without respiratory support

A

(a) 85

(b) 75

121
Q

Hydrops fetalis - definition

A

-Fluid in 2 or more fetal compartments

122
Q

Hydrops fetalis - causes

A
  • Immune: hemolytic disease of the newborn
  • Non-immune: chronic anemia (a-thal), renal failure, cardiac failure, TORCH (CMV), congenital malformations, genetic syndromes (Turner, Noonan, Trisomy)
123
Q

DDx for neonatal thrombocytopenia

A
  • Increased destruction: NAIT, maternal (SLE, ITP, drugs, toxins), infection (TORCH = CMV, bacterial), pre-eclampsia
  • Decreased production: BM failure syndromes, BM suppression, IUGR
  • Increased consumption: DIC, Kassabach-Merritt
124
Q

Complications of polycythemia

A
  • Hyper-viscosity: CNS (apnea, lethargy, seizures), renal (RVT, decreased GFR, oliguria), CVS (PPHN), GI (NEC)
  • Hypoglycemia
  • Hyperbilirubinemia
  • Other: low platelets, hypoxia, acidosis
125
Q

What is the recipient twin at risk for in TTS?

A
  • Polyhydramnios
  • CHF
  • Hydrops
  • CHD - valves/septum
  • Polycythemia
126
Q

Scoring threshold + dosing of morphine for NAS (including titration scheme)

A
  • If scores =/>8 x3 or =/>12 x2
  • 0.32 mg/kg divided q4-6
  • Increase by 0.16 mg/kg or decrease by 10%
127
Q

Why is naloxone not used in neonatal resuscitation?

A

Seizures

128
Q

CPS recommended NAS scoring system

A

Finnegan scoring system

129
Q

DDx for NAS (x4)

A
  • Hyperthyroidism
  • Hypoglycemia, hypoCa
  • CNS injury
  • Infection
130
Q

When do NAS symptoms typically present for most opioids vs methadone?

A
  • Within 72 hours

- Within 5-7 days

131
Q

What population is at decreased risk of NAS?

A

Preterm infants

132
Q

What would a borderline result be on pulse oximetry screening for neonatal CHD?

A

Sats 90-94% OR >3% difference between right hand + foot

133
Q

How many borderline assessments until you declare a failed pulse oximetry neonatal screening?

A

x3

134
Q

What neonates should we do pulse oximetry screen for and what is the best timeframe?

A
  • ALL term and preterm infants

- Between 24-36 hours of life

135
Q

Suggested protocol for premedication for neonatal intubation (including drug class)

A
  • Vagolytic = Atropine 20 ug/kg IV
  • Analgesic = Fentanyl 3-5 ug/kg IV
  • Muscle relaxant = succinylcholine 2mg/kg
136
Q

What x4 physiological changes occur with intubation?

A
  • Systemic + pulmonary hypertension
  • Bradycardia
  • Intracranial hypertension
  • Hypoxia
137
Q

Most common presentation of neonatal cortical stroke

A

Focal seizure

138
Q

Rubella eye thing

A

Cataract

139
Q

IDM - neuro and GI affects

A
  • Caudal regression

- Small left colon syndrome

140
Q

What oxygen saturation differential do you need for persistent pulmonary hypertension diagnosis?

A

> 20 mmHg between pre + post-ductal

141
Q

How long do you observe a newborn exposed to SSRI?

A

x48 hours

142
Q

If neonate remains hypoxemic despite supplemental oxygen what is the other dx you must think about in addition to congenital cardiac disease?

A

Pulmonary hypertension

143
Q

What timing of HUS is recommended for <32 weeks?

A
  • First = 4-7 days of life
  • Repeat = 4-6 weeks post-birth
  • Term corrected imaging = only for <26 weeks
144
Q

What timing of HUS is recommended for 32-36 weeks?

A
  • First = 4-7 days of life

- Repeat = 4-6 weeks if first imaging is abnormal

145
Q

How many pharmacological trials can be attempted for PDA before moving on to surgical intervention?

A

x2

146
Q

What is first and second line for PDA treatment?

A 
First = ibuprofen
Second = indomethacin, tylenol
147
Q

Complications of PDA?

A
  • Pulmonary congestion = BPD, respiratory failure, pulm hemorrhage, PHTN, death
  • Systemic hypoperfusion = NEC, renal failure/acidosis, white matter brain injury, delayed feeding
148
Q

Why do we not want to use NSAIDs and steroids for neonates at the same time?

A

Increases risk for spontaneous intestinal perforation

149
Q

Early onset neonatal sepsis - timeline for (a) preterms and (b) terms

A

(a) <72 hours

(b) <7 days

150
Q

Categories of HIE Sarnat scoring

A
  1. Mild
  2. Moderate
  3. Severe
151
Q

Difference in pupils for Sarnat scoring

A
  1. Mydriasis
  2. Miosis
  3. Variable, asymmetric
152
Q

Difference in reflexes for Sarnat scoring

A
  1. Hyper
  2. Hyper
  3. Hypo/absent
153
Q

Differences in potential for seizures for Sarnat scoring

A
  1. None
  2. Common
  3. Uncommon
154
Q

Term newborn born to a with mother with GDM. First glucose done at 2 hours of life is 2.1. What is the next step in management?

A

-Feed + check in 30 minutes

155
Q

What is the minimum time for observation for NAS? And what to consider if long-acting opioid (e.g., methadone)?

A

72 hours

120 hours

156
Q

When should the first ROP assessment be done for a 29 weeker?

A

At 33 weeks (4 weeks chronological age)

157
Q

When should the first ROP assessment be done for a 26 weeker?

A

At 31 weeks (5 weeks chronological age)

158
Q

Incubation period for HSV neonatal infection?

A

2 weeks

159
Q

When can you discontinue neonatal resuscitation efforts if no HR has been confirmed?

A

20 minutes

160
Q

Threshold for when ROP assessments should be done

A

<31 weeks

<1250 grams

161
Q

Approximate bili thresholds for low risk term babe at (a) 24 hours, (b) 48 hours, (c) 72 hours, and (d) >72 hours?

A

(a) 200
(b) 250
(c) 300
(d) 360

162
Q

Approximate bili thresholds for low risk term babe at >72 hours?

A

306

163
Q

When does the germinal matrix involute?

A

GA 34-36 weeks

164
Q

If the first HUS is abnormal for a neonate, when should you repeat the imaging?

A

in 7-10 days

165
Q

In what group of neonates will you do a third HUS at corrected term GA?

A

For <26 weeks

166
Q

When will you consider HUS for late prem (32-36 wk)?

A

If there are other risk factors present

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