Neonatology Flashcards
Newborn with C8-T1 nerve root injury (name 3 findings)
Klumpke palsy. Clx: hand paralysis and Horner syndrome (ptosis, miosis, anhidrosis/harlequin sign = impaired facial flushing), and heterochromia (iris pigment in first few months is under sympathetic control.
Vascular accident involving the right umbilical vein or the right omphalomesenteric artery
Gastroschisis
Newborn with symptomatic hypoglycemia (tx)
Give D10W 2 cc/kg (NOT oral glucose since symptomatic)
Breastmilk jaundice duration
Usually start 3-5 DOL, peaks 2 weeks, may be present up to 2-3 months
Post-term infant physical exam findings
Dry peeling skin, less than normal SQ tissue, long fingernails, +/- meconium staining of skin/cord/nails
Newborn with mom having Maternal Hep B
Give HBV and HepB immunoglobulin
IUGR complications
Metabolic syndrome, hypertension, non-EtOH fatty liver without cirrhosis, and minimal decrease IQ/executive fx
Vascular accident of right umbilical vein or omphalomesenteric artery
Gastroschisis (premature involution or disruption of said veins => necrosis of lateral abdominal wall => gastroschisis)
Baby girl with fleshy-colored smooth surfaced lesion protruding from inferior portion of the vagina
Hymenal tag, benign, no workup needed (VS. Sarcoma botryoids - appear in young children, appearance of bunches of grapes).
Hepatitis B newborn vaccine recommendations
If mom HBsAg (-) => wait until 1 month for 1st dose. If mom HBsAg (+) => get HepB vaccine (dose not count toward 3-dose series) and HBIG within 12 hours of birth => get HepB vaccine at 1, 2, and 6 months of chronological age.
Normal newborn penis length
> 2 cm (if less than 2 cm, needs endocrine evaluation)
Normal newborn liver examination
Can be palpable up to 3 cm in normal infant
Normal newborn kidney examination
Lower portion palpable, especially in 1st DOL before bowels fill with gas
When are premies expected to catch up with peers in growth parameters
Most by 2 YEARs of age
Erb’s palsy treatment
PT and observe
Erb’s palsy treatment
PT and observe
Test for SCID in newborn screen
T-cell receptor excision circles (TREC)
10 day old with seizure, has not been feeding well, has fever, emesis, lethargy, jaundice, hepatomegaly, and cataracts
Classic galactosemia with E. coli sepsis
Causes of symmetrical IUGR
Early effects => chronic EtOH, genetic dz, early infection, chronic anemia, chronic hypertension, chronic cigarette, SLE
Causes of asymmetrical IUGR
Later in pregnancy => uteroplacental insufficiency, acute HTN, multiple gestation, abnormal placental structure, late pregnancy substance use
Neonate with generalized hypotonia (what other findings might you expect?)
Polyhydramnios (pharyngeal weakness => difficulty swallowing amniotic fluid => polyhydramnios)
Single umbilical artery (management)
Comprehensive physical exam, not necessarily routine renal ultrasound (but increase risk of RENAL abnormalities. Other anomalies also occur)
Fetal tracing shows lowest point of deceleration at peak of contraction with uniform wave shape
Early deceleration 2/2 increase vagal tone from head compression = benign
Fetal tracing shows varied shape, peak, and duration of deceleration without correlation with contraction
Variable deceleration 2/2 compression of umbilical cord
Fetal tracing shows deceleration with lowest point after peak of contraction
Late deceleration 2/2 associated with placental insufficiency (possibly bad => get fetal scalp pH measurement)
Neonate with severely thickened skin with large, shiny plates of hyperkeratotic scales. Deep erythematous fissures separate the scales and contraction abnormalites of eyes, ears, mouth, and appendages (dz?)
Harlequin ichthyosis
Term infant develops tachypnea, hypoxia, and grunting 1 hour after birth. CXR shows fluid in fissures, flattening of diaphragm, and prominent pulmonary vasculature (dz and tx)
Transient tachypnea of newborn, self-resolves => supportive
Term infant with tachypnea, cyanosis only in lower body, loud 2nd heart sound. CXR shows clear lungs and decrease vascular markings. (Dz and association)
Persistent pulmonary hypertension of newborn (associated with maternal SSRI use)
LGA newborn with lethargy, tremors, cyanosis, and seizures
Hypoglycemia
Newborn with jaundice, hypocalcemia, and hypoglycemia (assciation)
Polycythemia
Abdominal wall defect with covered membrane (associations)
Omphalocele => Beckwith-Wiedemann, Trisomies
Absent abdominal wall musculature, cryptorchidism, and urinary tract malformation
Prune belly syndrome aka Eagle-Barrett syndrome (belly looks wrinkled and like a prune)
When is chorionic villus sampling preformed?
At 10-12 weeks of pregnancy (late 1st trimester)
When is amniocentesis preformed?
At 12-16 weeks of pregnancy (early 2nd trimester)
Jaundice in the first 24 hours of life (management)
Likely non-physiologic => CBC, reticulocyte, Tbili and Dbili, and Coombs (Blood culture unnecessary if well appearing)
