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Neonatology > Neonatology > Flashcards

Neonatology Flashcards

1
Q

GTT/GBS screening timeline

A

GTT: 24-28 wks
GBS: 35-37 wks

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2
Q

choroid plexus cyst is associated with what condition

A

trisomy 18

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3
Q

nuchal pad thickening is a sign of?

A

trisomy 13, 18
cystic hygroma
turners

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4
Q

cause of early variable and late decels

A

early- head compression d/t uterine contraction
variable- compression of the cord
late- uteroplacental insufficiency

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5
Q

When is AFP decreased?

A

trisomy 18/21 or incorrect GA dates

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6
Q

Causes of increased AFP

A 
NTD 
abdominal wall defect
renal 
cystic hygroma 
dos bebes 
placental probs
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7
Q

HR below which you start PPV?
compressions?
O2 required for PPV during compressions ?

A

100 for PPV

60 for compression – O2 @ 100% during compressions

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8
Q

What babies get screened for hypoglycemia?

A 
IDM 
post term 
preterm 
SGA
LGA
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9
Q

definition of premature ROM
definition of preterm pemature ROM
definition of prolonged ROM

A

PROM- >37 weeks water breaks before labor
PPRN- <37 weeks water breaks before labor
prolonged ROM >24 hours

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10
Q

PPROM expectant management:

what three therapies does mother receive?

A

48 hrs abx (sepsis)
steroids (lungs)
mag sulfate (CP)

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11
Q

treatment of mom + baby with chorio

A

amp + gent for both
vanc if mom has pen allergy
penicillin is not sufficient

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12
Q

Post term definition

A

born after 42+0

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13
Q

When to induce in pre-e

A

after 34 wks if severe

after 37 if w/o severe features

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14
Q

Pulse rate required on APGAR score for full credit

A

100

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15
Q

DDx of hoarse cry in newborn

A

hypothyroidism

vocal cord paralysis

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16
Q

aplasia cutis is assc w/ which trisomy

A

13

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17
Q

which trisomy has rocker bottom feet + overlapping digits

A

18

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18
Q

persistent cutis marmorata (pale mottled skin) is assc w/ which syndromes?

A

trisomies 18, 21 and cornelia de lange

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19
Q

subcutaneous fat necrosis of the newborn is assc with what metabolic abnormality?

A

hypercalcemia

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20
Q

at what age do anterior and posterior fontanelles close?

what changes are seen to these in hypothyroidism?

A

18 mo anterior
shortly after birth posterior
may be enlarged in hpothyroid or have delayed closure

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21
Q

subgaleal hemorrhage-
location
cause
what should be monitored

A

ruptured emissary veins b/n aponeurosis and periosteum
most commonly 2/2 vacuum assisted delivery
monitor BP Hct and bili

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22
Q

coloboma ddx

A 
CHARGE (coloboma, heart, choanal atresia, retarded growth, genital/ear abnormalities)
trisomy 13 (along with cutis aplasia- 13 = holes)
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23
Q

ocular finding in trisomy 21

A

brushfield spots (white spots on iris in concentric ring)

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24
Q

triad of findings in congenital glaucoma

A

epiphora (eye watering)
photophobia
blepharospasm (twitching)

+enlarged cornea

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25
Q

infants with ear abnormalities warrant workup of what other system?

A

renal ultrasound is needed

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26
Q

macroglossia ddx

A

beckwith wiedemann
pompe
down syndrome

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27
Q

macroglossia ddx

A

beckwith wiedemann
pompe
down syndrome

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28
Q

pierre robin sequence triad

A

glossoptosis
airway obstruction
micrognathia

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29
Q

Erb vs Klumpkes palsy:
nerves involved + exam findings
which has absent grasp reflex, which is assc w horners

A

Erb- C5-6 waiters tip

Klumpkes: C8-T1 claw hand absent grasp reflex 1/3 of cases have horners

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30
Q

Normal newborn SBP + BP change in aortic coarc

A

normal SBP 60-90

difference of 20+ between UE and LE in favor of UE = aortic coarctation

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31
Q

when do umbilical hernias require surgical repair

A

persistent beyond 4-5 years or >2 cm in size

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32
Q

how to distinguish omphalocele from gastroschisis

A

omphalocele has covering membrane- result of herniation of intestine into the umbilical cord
gastroschisis has no covering membrane, full thickness deficit

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33
Q

Findings in prune belly syndrome apart from wrinkly skin

A

GI/GU anomalies (ie undescended testis, obstructive uropathy)
pulmonary hypoplasia

aka eagle barrett syndrome

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34
Q

what is the urachus?

A

structure connecting bladder to the umbilical cord

may be patent or have remnants leading to dripping urine from belly button, cysts polyps etc

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35
Q

delayed separation of umbilical cord is concerning for what immunodeficiency?

A

LAD- leukocyte adhesion deficiency

defective neutrophil function

36
Q

single umbilical artery- most common assc complications

A

renal malformation is most common

also assc with trisomies, heart conditions

37
Q

hypospadias vs epispadias management/ difference

A 
hypo= urethra opens at ventral aspect of penis 
epi= dorsal

should not circumcise (need foreskin for repair)
eval for other renal/urogenital anomalies

38
Q

reasons to further evaluate a sacral dimple

A
  • multiple dimples
  • dimple larger than 5 mm or high above the anus
  • cant see base
  • tuft of hair/skin tag/ skin discoloration
39
Q

physical exam findings of preemie

A

vernix/lanugo coat whole body
testes undescended and scrotum with minimal rugae
no sole creases
labia minora/clitoris are prominent (as opposed to majora)

40
Q

distinguish between asymmetric vs symmetric IUGR

A

asymmetric- head sparing, uteroplacental insufficiency

symmetric- involves head, early insult

41
Q

what are the four types of twins?

A

dizygotic: two ova are fertilized

monozygotic: one ova splits, depending on timing may have the same or amnions and chorions
within 2-3 days: dichorionic diamniotic
within days 4-8: mono-di
after day 9: mono-mono

42
Q

lab findings in infants of diabetic mothers

A

low glucose 2/2 hyperinsulinism (beta cell hypertrophy 2/2 maternal hyperglycemia in pregnancy)
low calcium and mag, platelets
iron def, polycythemia d/t chronic fetal hypoxia leading to increased erythropoiesis
hyperbili d/t the polycythemia

43
Q

management of asymptomatic vs symptomatic hypoglycemia in newborn phase

A

If <25 for baby 0-4 hrs old or <35 for 4+:
feed and recheck in 1 hr
if remains low then 2 ml/kg of 10% dextrose followed by maintenance fluids

If at any point the infant is symptomatic, should provide IV rather than trialing feeds

44
Q

timeline for feeding/ screening glucose in infants at risk of hypoglycemia

A

screen within 30 mins feed within 1 hr

45
Q

where and by what enzyme is bilirubin conjugated

A

liver by hepatic uridine diphosphate glucuronosyl transferase (UGT1A1) which does not reach full values until 14 weeks of age

46
Q

what type of bilirubin can cross blood brain barrier

A

unbound unconjugated
bili is usually bound to albumin before going to the liver for conjugation.
it can be displaced by meds like rocephin and then reach the brain which is not ideal

47
Q

causes of physiologic jaundice

A

increased breakdown of fetal erythrocytes

decreased levels of hepatic enzymes for conjugation and excretion

48
Q

causes of breastfeeding jaundice + time of onset

A

mild dehydration and decreased meconium passage
caloric deprivation
begins in first few days of life

49
Q

cause of breastmilk jaundice + time of onset

A

starts days 4-7

thought to be 2/2 human milk inhibiting conjugating enzymes in the liver (beta glucuronidases/nonesterified fatty acids)

50
Q

crigler najar- distinguish between types 1 and 2

A

both cause unconjugated hyperbili d/t UGT1A1 def but
type 1= more severe, AR, leads to bilirubin encephalopathy in early life
type 2= less severe, AD, typically bili <20, no encephalopathy

51
Q

syndrome that is similar to crigler najar is _____.

inheritance pattern?

A

Gilbert- also a UGT1A1 mutation, mildly decreased activity, jaundice primarily during stress

52
Q

three phases of bilirubin induced neuro dysfunction + at what level does this become a risk

A

20-25

phase 1: sleepy poor feeder and hypotonic first few days of life
phase 2: hypertonia with retrocollis/ opisthotonus variable onset
phase 3: week or after- hypotonia

53
Q

chronic bili encephalopathy findings

A 
athetosis/ chorea 
gaze palsies 
dental enamel hypoplasia 
relatively normal cognition 
tonic neck
delayed motor milestones
54
Q

how does phototherapy work to decrease bili

A

converts into a water soluble compound (lumirubin)

stop once bili is below 13-14

55
Q

Diagnosis of late hemorrhagic disease of the newborn

A

elevated PT d/t low vitamin K

56
Q

indications for ppx surfactant therapy

A

<27 weeks gestation or 26-30 weeks if baby needs intubated or mom did not get steroids

57
Q

IV fluid choice in preemies

A

10% dextrose

58
Q

chest xray/ abg findings in ttn vs rds

A

TTN:
fluid in fissures
NO hypercarbia

RDS:
ground glass (beer mug)
+hypercarbia

59
Q

Persistent Pulmonary HTN of newborn: Physical exam clues

A

loud single S2
tricuspid regurg = harsh systolic murmur
pre/post ductal sat difference of 10%+ (preductal sats higher) d/t R –> L shunting

60
Q

syndrome + drug assc with Persistent pulmonary HTN of newborn

A

SSRIs

Down syndrome

61
Q

neonatal tension pneumo treatment

A

thoracentesis- 22-24 gauge needle to 2nd or 3rd midclavicular line followed by thora / chest tube if not responding

62
Q

use for measuring I/T ratio in neonatology?

A

> 0.15 in first 24 hrs = sepsis

63
Q

apart from +GBS screen at 35-37 wks, what are the indications for intrapartum GBS ppx?

A

previous infant with invasive GBS
maternal GBS bacteriuria during pregnancy
unknown GBS status + <37 weeks, prolonged rupture >18 hrs, or temp >100.4

64
Q

treatment of infant born to mother with chorio

A

abx
CBC
bcx

65
Q

management of infant with GBS+ mother

A

if appropriately treated >4h before birth + >37 weeks: normal care
if not appropriately treated but infant is term and no prolonged rom: keep in hospital for at least 48 hrs
if not treated and prolonged rom or <37 weeks: lab them up + keep 48 hours

66
Q

management of GBS+ infant

A

initially amp and gent –> narrow to penicillin or amp only
pneumonia or sepsis treat x 10-14 days
meningitis 14-21 days

67
Q

classic triad for congenital toxo infection + abx treatment of choice

A

chorioretinitis (vision trouble, may occur at birth or later in life)
hydrocephalus
intracranial calcifications

pyrimethamine and sulfadiazine x 1 year

68
Q

classic congenital syphilis signs/symptoms + best screening test + treatment

A

snuffles, Hutchinson’s teeth
many other nonspecific findings, hepatomegaly seen in almost all
RPR/VDRL&raquo_space;» than treponema specific tests (do not corelate w/ disease activity)
10-14 days penicillin

69
Q

most common cause of failure to pass meconium in first 48 hrs

A

meconium plug syndrome –> XR followed by hyperosmolar gastrograffin enema
*this impaction is more distal than meconium ileus and is assc with a number of conditions in addition to cf

70
Q

XR findings in meconium ileus

A 
soap bubble (ground glass) in the meconium
narrow intestine below the plug + dilated above
71
Q

classic XR findings in NEC

A 
pneumatosis intestinalis (air in the wall of the intestine)
also may see dilated loops, portal gas +/- free air
72
Q

treatment of nec

A

npo, ng decompression, parenteral nutrition

IV abx: amp + gent, zosyn and either clinda or metronidazole x 10-14 days

73
Q

exam findings in CDH:

A

bowel sounds in chest
scaphoid abdomen
increased chest diameter

74
Q

distinguish between mild mod and severe HIE

A

mild: tired/irritable, brisk reflex, resolves in a few days
mod: lethargic, absent reflex may take a couple of weeks, + long term sequelae
severe: comatose, no dolls eye/ no reflex, need intubated, frequent death

75
Q

what are the four grades of IVH

A

I: hemorrhage confined to the germinal matrix
II: IVH w/o dilation
III: IVH w/ ventricular dilation
IV: intraparenchymal hemorrhage

76
Q

two classic facial features of fetal alcohol syndrome

A

smooth philtrum

thin upper lip

77
Q

what infants should be screened for IVH and when

A

<30 wks

at 7-14 days and 36-40 wks GA

78
Q

Teratogen assc with:
nail hypoplasia
ID, IUGR
vitamin K deficiency

A

pheytoin

79
Q

Teratogen assc with:

A

teratogen assc with neural tube defects, limb anomalies, cardiac/renal anomalies

80
Q

carbamazepine exposure in fetus leads to _____

A

orofacial clefts

81
Q

teratogen assc with:
facial anomalies
bone stippling
fetal bleeding/ death

A

warfarin

82
Q

danazol exposure in fetus leads to ____

A

virilization

83
Q

teratogen assc with:
skeletal growth issues
pigmented teeth with hypoplastic enamel
limb malformations

A

tetracycline

84
Q 
teratogen assc with:
limb defect 
intracranial hemorrhage 
leukomalacia 
gastroschisis 
intestinal atresia
A

cocaineeeee baybeee

85
Q

two most common pathogens for early neonatal sepsis

A

GBS

e coli

86
Q

congenital infection most often assc with hydrops fetalis

A

parvovirus b19

87
Q

most common TEF type

A

esophageal atresia with distal fistula

Neonatology (1 decks)

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