Neonatology Flashcards
RDS is ___ deficiency
Surfactant
Age at risk for RDS?
Preterm
Age at risk for TTN
Usually term
How does TTN happen?
Delayed resorption of fetal lung fluid
TTN CXR
Wet silhouette, fluid in fissures
Risk factor for TTN
Short labour, Elective CS
CXR in RDS
Homogenous infiltrates, Air bronchogram, Groundglass appearance
RDS prevention?
Corticosteroids prenatally
RDS treatment
Surfactant
MAS treatment
inhaled NO
MAS CXR
Patchy atelectasis
What ratio indicates lung maturity?
Lecithin/Sphinngomyelin ratio > 2:1
Fluid in fissures appears in
TTN
Complication of MAS
Pneumothorax
BRUE is >1 of:
1-Cyanosis
2-Change of tone
3-Absent/irregular breathing
4-Altered level of responsiveness
Red flags of BRUE
1- <60 days 2-Unwell upon exam 3->1 episode 4->1min 5-Born<32weeks 6-FH SIDS
BRUE low risk management
Observe 1-4 hrs, Pertussis PCR, outpatient visit
Physiologic Jaundice appears on __ day, and disappears on __ day
2-3, 7th
Physiologic Jaundice’s peak is __ mg/dL
<13 mg/dL (if term)
Physiologic Jaundice’s rate of bilirubin’s rise is __ mg/dL/d
<5 mg/dL/d
Pathological Jaundice’s rate of bilirubin’s rise is __ mg/dL/d
> 5 mg/dL/d
Pathological Jaundice appears in ___ day
First 24 hrs of life
Unconjugated bilirubin features:
Lipid soluble, crosses BBB
No urine excretion, Kernicterus
Conjugated bilirubin features:
Water soluble, Doesn’t cross BBB,
No kernicterus, + urinary excretion
Where does unconjugated bilirubin accumulate causing kernicterus?
Basal ganglia and brain stem nuclei
Kernicterus leads to _____
Sensorineural hearing loss
If jaundice was indirect, what do we think ?
Coombs + or -
Breastfeeding jaundice
- Feeding inadequate, baby dehydrated
- First time mothers
- First week of life
- Tx is breastfeeding education
Breast milk jaundice
- Problem in the MILK
- Feeding is adequate
- Second week of life, resolve by 2-3m
- Tx is phototherapy
How to deliver glucose concentration of > 12.5% in neonate with hypoglycemia?
Via central line
Biliary atresia initial test
RUQ US
Biliary atresia initial management
Kasai
Biliary atresia definitive management
Liver transplant
Type of jaundice in Biliary atresia?
Direct hyperbilirubinemia
Biliary atresia pathogenisis
Extrahepatic bile duct fibrosis
US of biliary atresia shows:
Absent/abnormal gallbladder and CBD
Cow milk deficient in
Iron, Copper, Vit C
Human milk deficient in
Vit D and Riboflavin
Caput Succedeum
Crosses suture lines
Disappears in a few days
Maximum size at birth
Cephalhematoma
Doesn’t cross suture lines
Resolves in 2 wks
Maximum size 1d after birth
Coloboma association
CHARGE
Early introduction of cow’s milk leads to
Iron deficiency anemia
When do breastfed infants need iron?
> 4 m
Newborn growth rate in grams
30 g/day
Which Ig present in colostrum?
IgA
Do not brrastfeed
Do not give expressed milk
1- Mother has HIV 2- Mother has Ebola 3- Mother has Human T-lymphotropic virus 4- Mother uses illicit drugs 5- Child has Galactosemia
Do not brrastfeed
Do not give expressed milk
(Temporarily)
Mother has untreated Brucellosis
Mother has HSV w/ lesions on breast
Mother is taking certain meds
Temporarily do not breastfeed, expressed is okay
Untreated active TB
Varicella (developed bw 5 days prior to delivery and 2 days following delivery)
Human milk stays in freezer for
6m
Human milk stays in fridge
4 d if fresh
1 d if previously frozen
Human milk stays in counter for
4 hrs if fresh
1 hr if previously frozen
Parenteral nutrition options for <3wks
Peripheral line
Central line
Parenteral nutrition options for >3wks
Peripheral dwell line
Central tunneled line
Hirschsprung disease associated with
Down Syndrome
Squirt sign present in
Hirschsprung
Hirschprung disease Tx
First stage: diverting colostomy to relieve the dilated bowel.
- Second stage: Resection of the aganglionic segment & anastomoses
Meconium ileus Tx
Enema with a contrast agent
Meconium ileus associated with
Cystic Fibrosis
Patient with Meconium plug, what to do next?
Rectal biopsy
Patient w\ Meconium ileus, what to do next?
Sweat chloride test
Triple bubble seen with
Jejunal atresia
Double bubble seen with
Duodenal atresia
Intussusception px
Currant jelly stool
Intermittent abx pain
Sausage shaped abdx mass
Intussusception Tx
Air/Saline enema
Surgery
Intussusception Dx
Target sign on US
When is surgical reduction done in Intussusception?
When a pathological lead sign is suspected
Treatment of choice for Intussusception?
Nonoperative reduction using hydrostatic or pneumatic pressure by enema
Most common cause of acute abdomen in premature infants.
NEC
NEC risk factors
Prematurity
Enteral feeding
NEC X-Ray findings
Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum
NEC Tx
Bowel rest
Abx
+/- surgery
NEC Indication of surgery:
perforation (Pneumoperitoneum), peritonitis and/or clinical worsening despite medical therapy
Cyanosis that is relieved after crying
Bilateral choanal atresia
Bilateral choanal atresia Dx
inability to pass NG tube
Bilateral choanal atresia Tx
Urgent insertion of an oropharyngeal airway as a temporary airway until surgery
asymmetrical moro reflex (absent in on side) →
Clavicular fracture (it causes Erb palsy)
Absent moro reflex →
Cerebral palsy
Total plexuses palsy (upper limb)
C5-C8 and sometime T1
Intermediate plexus palsy:
C7-C8
Extended upper plexus palsy:
C5-C7
Upper plexus palsy (Erb palsy):
C5-C6 – “Bad shoulder, good hand”
Lower plexus palsy (Klumpke palsy):
C8-T1 – “Good shoulder, bad hand”
Brachial plexuses injury risk factor
Shoulder dystocia
Which conjunctivitis presents within 2-5d of life?
N Gonorrhea
N Gonorrhea conjunctivitis Tx and prophylaxis
IM Ceftriaxone, prophylaxis is erythromycin
Which conjunctivitis presents within 7-14 d of life?
Chlamydia Trachomatis
Chlamydia Trachomatis conjunctivitis Tx and prophylaxis
Tx is oral erythromycin
No effective prophylaxis
Chemical conjunctivitis cause and Tx
Silver nitrate irritation, Tx is lubrication
Target sign is seen in
Pyloric stenosis & Intussusception
Pyloric stenosis clinical features
Projectile, non bilious vomiting
Immediate postprandial vomiting
Hungry between feeds
Pyloric stenosis management
Treat electrolyte imbalance, pyloromyotomy
Pyloric stenosis electrolyte imbalance
Hypochloremic hypokalemic metabolic alkalosis
Gastroschisis is abdominal defect ____ to umbilicus
LATERAL
Omphalocele is failure of intestines to return to abdominal cavity with gut ____ umbilicus
through
Omphalocele/Gastroschisis Tx
Surgical silo
Nasogastric suction
IVF
Surgery
Neonatal Polycythemia Hct
> 65%
Olive shaped abdx mass
Pyloric Stenosis
SIDS risk factor
Prematurity and prone sleeping
SIDS prevention
Pacifier and sleeping on the back
Epiglottitis pathogen
Haemophilus influenza
Bronchiolitis pathogen
RSV
Laryngotracheitis pathogen
Para influenza virus (croup)
Barky cough is usually with 
Croup
Focally diminished breath sounds
Foreign body
Stridor improves when prone
 Laryngomalacia
Laryngomalacia Dx
Laryngoscopy
Croup Tx
Mild: steroids and humidified air
Severe: Steroids and racemic epinephrine
How do you tell if croup is severe
Stridor at rest
Epiglottitis features
Extremely sore throat
Drooling
High fever
Sniffing position
Best initial test for epiglottitis
Laryngoscopy
Most accurate test for epiglottitis
Culture from tracheal aspirate
Most accurate test for croup
PCR of virus
Best initial test for croup
Clinical dx
Bronchiolitis vaccine
Palivizumab
Palivizumab for bronchiolitis is given to:
Chronic lung disease of prematurity
Hemodynamically significant congenital heart disease
Less than 29 weeks of gestation
Apgar score is evaluate it based on
Heart rate, respiration, color, tone, reflex irritability
Small for gestational age is defined
2 SD < mean weight for GA/<10 percentile
Most common type of skull fracture during delivery
Linear and no treatment needed
Jaundice occurs with cephalhematoma or caput?
cephalhematoma
Breast milk predominant protein:
Whey
Human milk vs cow milk, which has more of what?
Human: Lactose
Cow: Protein
Most common diaphragmatic hernia?
Bochdalek hernias
Most common diaphragmatic hernia?
Bochdalek hernias
Kcal of 1 ml of human milk vs cow
70 in human’s milk
67 in cow’s milk
