Neonatology Flashcards
1
Q
GTT/GBS screening timeline
A
GTT: 24-28 wks
GBS: 35-37 wks
2
Q
choroid plexus cyst is associated with what condition
A
trisomy 18
3
Q
nuchal pad thickening is a sign of?
A
trisomy 13, 18
cystic hygroma
turners
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
5
Q
When is AFP decreased?
A
trisomy 18/21 or incorrect GA dates
6
Q
Causes of increased AFP
A
NTD abdominal wall defect renal cystic hygroma dos bebes placental probs
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
8
Q
What babies get screened for hypoglycemia?
A
IDM post term preterm SGA LGA
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
10
Q
PPROM expectant management:
what three therapies does mother receive?
A
48 hrs abx (sepsis)
steroids (lungs)
mag sulfate (CP)
11
Q
treatment of mom + baby with chorio
A
amp + gent for both
vanc if mom has pen allergy
penicillin is not sufficient
12
Q
Post term definition
A
born after 42+0
13
Q
When to induce in pre-e
A
after 34 wks if severe
after 37 if w/o severe features
14
Q
Pulse rate required on APGAR score for full credit
A
100
15
Q
DDx of hoarse cry in newborn
A
hypothyroidism
vocal cord paralysis
16
Q
aplasia cutis is assc w/ which trisomy
A
13
17
Q
which trisomy has rocker bottom feet + overlapping digits
A
18
18
Q
persistent cutis marmorata (pale mottled skin) is assc w/ which syndromes?
A
trisomies 18, 21 and cornelia de lange
19
Q
subcutaneous fat necrosis of the newborn is assc with what metabolic abnormality?
A
hypercalcemia
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
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
22
Q
coloboma ddx
A
CHARGE (coloboma, heart, choanal atresia, retarded growth, genital/ear abnormalities) trisomy 13 (along with cutis aplasia- 13 = holes)
23
Q
ocular finding in trisomy 21
A
brushfield spots (white spots on iris in concentric ring)
24
Q
triad of findings in congenital glaucoma
A
epiphora (eye watering)
photophobia
blepharospasm (twitching)
+enlarged cornea
25
infants with ear abnormalities warrant workup of what other system?
renal ultrasound is needed
26
macroglossia ddx
beckwith wiedemann
pompe
down syndrome
27
macroglossia ddx
beckwith wiedemann
pompe
down syndrome
28
pierre robin sequence triad
glossoptosis
airway obstruction
micrognathia
29
Erb vs Klumpkes palsy:
nerves involved + exam findings
which has absent grasp reflex, which is assc w horners
Erb- C5-6 waiters tip
| Klumpkes: C8-T1 claw hand absent grasp reflex 1/3 of cases have horners
30
Normal newborn SBP + BP change in aortic coarc
normal SBP 60-90
| difference of 20+ between UE and LE in favor of UE = aortic coarctation
31
when do umbilical hernias require surgical repair
persistent beyond 4-5 years or >2 cm in size
32
how to distinguish omphalocele from gastroschisis
omphalocele has covering membrane- result of herniation of intestine into the umbilical cord
gastroschisis has no covering membrane, full thickness deficit
33
Findings in prune belly syndrome apart from wrinkly skin
GI/GU anomalies (ie undescended testis, obstructive uropathy)
pulmonary hypoplasia
aka eagle barrett syndrome
34
what is the urachus?
structure connecting bladder to the umbilical cord
| may be patent or have remnants leading to dripping urine from belly button, cysts polyps etc
35
delayed separation of umbilical cord is concerning for what immunodeficiency?
LAD- leukocyte adhesion deficiency
| defective neutrophil function
36
single umbilical artery- most common assc complications
renal malformation is most common
| also assc with trisomies, heart conditions
37
hypospadias vs epispadias management/ difference
```
hypo= urethra opens at ventral aspect of penis
epi= dorsal
```
should not circumcise (need foreskin for repair)
eval for other renal/urogenital anomalies
38
reasons to further evaluate a sacral dimple
- multiple dimples
- dimple larger than 5 mm or high above the anus
- cant see base
- tuft of hair/skin tag/ skin discoloration
39
physical exam findings of preemie
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
distinguish between asymmetric vs symmetric IUGR
asymmetric- head sparing, uteroplacental insufficiency
| symmetric- involves head, early insult
41
what are the four types of twins?
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
lab findings in infants of diabetic mothers
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
management of asymptomatic vs symptomatic hypoglycemia in newborn phase
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
timeline for feeding/ screening glucose in infants at risk of hypoglycemia
screen within 30 mins feed within 1 hr
45
where and by what enzyme is bilirubin conjugated
liver by hepatic uridine diphosphate glucuronosyl transferase (UGT1A1) which does not reach full values until 14 weeks of age
46
what type of bilirubin can cross blood brain barrier
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
causes of physiologic jaundice
increased breakdown of fetal erythrocytes
| decreased levels of hepatic enzymes for conjugation and excretion
48
causes of breastfeeding jaundice + time of onset
mild dehydration and decreased meconium passage
caloric deprivation
begins in first few days of life
49
cause of breastmilk jaundice + time of onset
starts days 4-7
| thought to be 2/2 human milk inhibiting conjugating enzymes in the liver (beta glucuronidases/nonesterified fatty acids)
50
crigler najar- distinguish between types 1 and 2
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
syndrome that is similar to crigler najar is _____.
| inheritance pattern?
Gilbert- also a UGT1A1 mutation, mildly decreased activity, jaundice primarily during stress
52
three phases of bilirubin induced neuro dysfunction + at what level does this become a risk
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
chronic bili encephalopathy findings
```
athetosis/ chorea
gaze palsies
dental enamel hypoplasia
relatively normal cognition
tonic neck
delayed motor milestones
```
54
how does phototherapy work to decrease bili
converts into a water soluble compound (lumirubin)
| stop once bili is below 13-14
55
Diagnosis of late hemorrhagic disease of the newborn
elevated PT d/t low vitamin K
56
indications for ppx surfactant therapy
<27 weeks gestation or 26-30 weeks if baby needs intubated or mom did not get steroids
57
IV fluid choice in preemies
10% dextrose
58
chest xray/ abg findings in ttn vs rds
TTN:
fluid in fissures
NO hypercarbia
RDS:
ground glass (beer mug)
+hypercarbia
59
Persistent Pulmonary HTN of newborn: Physical exam clues
loud single S2
tricuspid regurg = harsh systolic murmur
pre/post ductal sat difference of 10%+ (preductal sats higher) d/t R --> L shunting
60
syndrome + drug assc with Persistent pulmonary HTN of newborn
SSRIs
| Down syndrome
61
neonatal tension pneumo treatment
thoracentesis- 22-24 gauge needle to 2nd or 3rd midclavicular line followed by thora / chest tube if not responding
62
use for measuring I/T ratio in neonatology?
>0.15 in first 24 hrs = sepsis
63
apart from +GBS screen at 35-37 wks, what are the indications for intrapartum GBS ppx?
previous infant with invasive GBS
maternal GBS bacteriuria during pregnancy
unknown GBS status + <37 weeks, prolonged rupture >18 hrs, or temp >100.4
64
treatment of infant born to mother with chorio
abx
CBC
bcx
65
management of infant with GBS+ mother
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
management of GBS+ infant
initially amp and gent --> narrow to penicillin or amp only
pneumonia or sepsis treat x 10-14 days
meningitis 14-21 days
67
classic triad for congenital toxo infection + abx treatment of choice
chorioretinitis (vision trouble, may occur at birth or later in life)
hydrocephalus
intracranial calcifications
pyrimethamine and sulfadiazine x 1 year
68
classic congenital syphilis signs/symptoms + best screening test + treatment
snuffles, Hutchinson's teeth
many other nonspecific findings, hepatomegaly seen in almost all
RPR/VDRL >>>> than treponema specific tests (do not corelate w/ disease activity)
10-14 days penicillin
69
most common cause of failure to pass meconium in first 48 hrs
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
XR findings in meconium ileus
```
soap bubble (ground glass) in the meconium
narrow intestine below the plug + dilated above
```
71
classic XR findings in NEC
```
pneumatosis intestinalis (air in the wall of the intestine)
also may see dilated loops, portal gas +/- free air
```
72
treatment of nec
npo, ng decompression, parenteral nutrition
| IV abx: amp + gent, zosyn and either clinda or metronidazole x 10-14 days
73
exam findings in CDH:
bowel sounds in chest
scaphoid abdomen
increased chest diameter
74
distinguish between mild mod and severe HIE
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
what are the four grades of IVH
I: hemorrhage confined to the germinal matrix
II: IVH w/o dilation
III: IVH w/ ventricular dilation
IV: intraparenchymal hemorrhage
76
two classic facial features of fetal alcohol syndrome
smooth philtrum
| thin upper lip
77
what infants should be screened for IVH and when
<30 wks
| at 7-14 days and 36-40 wks GA
78
Teratogen assc with:
nail hypoplasia
ID, IUGR
vitamin K deficiency
pheytoin
79
Teratogen assc with:
teratogen assc with neural tube defects, limb anomalies, cardiac/renal anomalies
80
carbamazepine exposure in fetus leads to _____
orofacial clefts
81
teratogen assc with:
facial anomalies
bone stippling
fetal bleeding/ death
warfarin
82
danazol exposure in fetus leads to ____
virilization
83
teratogen assc with:
skeletal growth issues
pigmented teeth with hypoplastic enamel
limb malformations
tetracycline
84
```
teratogen assc with:
limb defect
intracranial hemorrhage
leukomalacia
gastroschisis
intestinal atresia
```
cocaineeeee baybeee
85
two most common pathogens for early neonatal sepsis
GBS
| e coli
86
congenital infection most often assc with hydrops fetalis
parvovirus b19
87
most common TEF type
esophageal atresia with distal fistula
