Neonatology Flashcards
[Neo/Basic]
Preterm/term baby differentiating gestational week
37 week
(≥ 37 weeks term, ≤36 weeks and 6 days preterm)
[Neo/Basic]
Categories and gestational ages for preterm baby?
Extreme: ___
Very: ___
Moderate: ___
Late: ___
Extreme preterm: < 28 weeks
Very preterm: 28 weeks ≤ and < 32 weeks
Moderate preterm: 32 weeks ≤ and < 34 weeks
Late preterm: 34 weeks ≤ and < 37 weeks
[Neo/Basic]
Categories and gestational age for term baby?
Early: ___
Full: ___
Late: ___
Post: ___
Early term: 37 weeks ≤ and < 39 weeks
Full term: 39 weeks ≤ and < 41 weeks
Late term: 41 weeks ≤ and < 42 weeks
Post term: ≥ 42 weeks
[Neo/Basic]
Categories for low birth weight?
Extremely low: ___
Very low: ___
Low: ___
Extremely low birth weight: < 1000 g
Very low birth weight: 1000 g ≤ and < 1500 g
Low birth weight: 1500 g ≤ and < 2500 g
[Neo/Basic]
Dates of cleavage and chorion/amnion structures of twin
Morula (___ days) -> chorion/amnion (fraternal/identical)
Blastocyst (___ days) -> chorion/amnion (identical)
Implanted blastocyst (___ days) -> chorion/amnion (identical)
Formed embryonic disc (___ days) -> chorion/amnion (identical)
Morula (1-3 days) -> Dichorion/Diamnion (fraternal/identical)
Blastocyst (4-8 days) -> Monochorion/Diamnion (identical)
Implanted blastocyst (8-13 days) -> Monochorion/Monoamnion (identical)
Formed embryonic disc (13-15 days) -> cojoined twins (identical)
[Neo/Prenatal]
Prenatal schedule and purpose:
6-8 weeks: ___
10-14 weeks: ___
16-20 weeks: ___
22-26 weeks: ___
28 weeks: ___
32 weeks, 36 weeks, weekly after: ___
Prenatal schedule and purpose:
6-8 weeks: 1st prenatal visit and labs
10-14 weeks: fetal heart tones
16-20 weeks: blood work for NTD and chromosomal abnormalities, anatomic scans
22-26 weeks: routine return visit
28 weeks: glucose tolerance test, repeat CBC, Rh immunoglobulin
32 weeks, 36 weeks, weekly after: GBS at 36w ≤ < 38w
[Neo/Prenatal/GBS]
Prophylaxis indication for GBS (6)
- Previous history of infant with invasive GBS disease
- Positive GBS bacteriuria during any trimester of current pregnancy
- Positive GBS culture or NAAT positive (unless C-section before labor)
- < 37 weeks of gestation (Before GBS test at 36)
- ≥ 18 hours of rupture of membrane
- Mother fever 100.4 F
[Neo/Prenatal/GBS]
Prophylaxis choice if allergic to penicillin for GBS prophylaxis?
Low risk for anaphylaxis: ___
High risk for anaphylaxis: ___
High risk and resistant: ___
Low risk for anaphylaxis: Cefazolin
High risk for anaphylaxis: Clindamycin
High risk and resistant to clindamycin: Vancomycin
[Neo/Prenatal/PROM]
Delivery is recommended in PROM
if ____ is confirmed
and
gestational age is ___
Delivery is recommended in PROM
if _FETAL LUNG MATURITY _is confirmed
and
gestational age is ≥ 34 WEEKS
[Neo/Prenatal/Preeclampsia]
Symptoms of hypermagnesemia in newborn (4)
Lab value Mg > ___ mg/dL
Lab value Mg > 5 mg/dL
- Respiratory depression
- Failure to pass meconium
- Lethargy, flaccidity, hyporeflexia
- Poor feeding
[Neo/Prenatal/Preeclampsia]
Treatment of hypermagnesemia in newborn
IV Ca2+ and diuresis
[Neo/Prenatal/Preeclampsia]
Laboratory findings of newborn from preeclampsia mother (3)
- Hypermagnesemia
- Low WBC
- Low Platelet
(all three are often transient)
[Neo/Prenatal/BPP]
Biophysical profile measurements at 32 and 36 weeks
Mneumonic:
M
R
H
A
T
Movement
Respiration
Heart rate reactivity
Amniotic fluid volume
Tone
[Neo/Delivery]
Weight and endotracheal tube size
< 1 kg: __
1-2 kg: __
> 2 kg: __
Weight and endotracheal tube size
< 1 kg: 2.5 mm
1-2 kg: 3.0 mm
> 2 kg: 3.5 mm
[Neo/Delivery]
Formula for length of tube to the baby’s lip
6 + weight in kg
[Neo/Delivery]
Epinephrine dose for neonatal resuscitation
IV: __
ET: __
IV: 0.02 mg/kg, 0.2 ml/kg of 1:10,000 epinephrine
ET: 0.1 ml/kg
[Neo/Delivery]
Which GA to use plastic wrap for resuscitation
< 29 weeks
[Neo/GA]
180 degree heel to ear
Sticky, friable, transparent skin
No lanugo
Imperceptible breast
Flat, smooth scrotum or prominent clitoris, flat labia
20 weeks
[Neo/GA]
Posture limbs extended
Gelatinous, red, translucent skin
Sparse lanugo
No plantar crease
Empty scrotum, faint rugae, or prominent clitoris and small labia minora
24 weeks
[Neo/GA]
Posture flexed on wrists and knees
Skin smooth, pink, visible veins
Abundant lanugo
Faint plantar crease
Flat areola, no bud
Slow recoil of ears
Tests in upper inguinal canal, rage rugae, or prominent clitoris, enlarging minora
28 weeks
[Neo/GA]
Posture flexed mildly on elbows and knees
Positive scarf sign, elbow at the midline
Skin superficial peeling, few veins
Thinning of lanugo
Plantar anterior transverse crease only
Stippled areola, no breast buds
Well curved pinna, soft, ready recoil ears
Testes descending, few rugae or majora and minora equally prominent
32 weeks
[Neo/GA]
Posture flexed
Negative scarf sign
Skin cracking pale areas, rare veins
Bald areas of lanugo
Plantar creases anterior 2/3
Raised areola, 1-2 mm breast buds
Formed and firm ears, instant recoil
Testes descended, good rugae, or majora large, minora small
36 weeks
[Neo/GA]
Posture flexed
Skin with parchment, deep cracking, no vessels
Almost no lanugo
Plantar creases over the entire sole
Full areola, 7-10 mm breast buds
Thick cartilage, stiff ears
Deep rugae or majora covers clitoris and minora
40 weeks
[Neo/Neonatal conjunctivitis]
Neonatal conjunctivitis usual onset and its treatment?
Neisseira: ___ days, treatment: ___
Chlamydia: ___ days, treatment: ___
Neisseria: 3-5 days, treatment: 3rd gen cephalosporin, prevented by topical erythromycin ointment
Chlamydia: 5-12 days, treatment: PO erythromycin or azithromycin
[Neo/Normal Newborn]
Periodic breathing patterns of neonate
is predominant at ____ age
resolves by ___ age
normal periodic breading if lasts ___ sec
Periodic breathing patterns of neonate
is predominant at 2-4 weeks age
resolves by 6 mo age
normal periodic breading if lasts <20 sec
[Neo/Normal Newborn]
Diastais recti surgical indication
If hernia persists till ___ age
or size increases between ___ and ___ age
Diastais recti surgical indication
If hernia persists till 5-6 age
or size increases between 1 and 2 age
[Neo/Maternal exposure]
Which teratogenic drugs?
Diagnosis?
Growth deficiency, developmental delays, craniofacial anomalies,
hypoplastic nails
Phenytoin
Fetal hydantoin syndrome
[Neo/Maternal exposure]
High risk of congenital anomaly caused by carbamazepine or valproic acid (2)?
Spina bifida
Neural tube defects
[Neo/Maternal exposure]
Which teratogenic drugs?
Limb anomalies, ear malformation with deafness
Medication used for leprosy, HIV, multiple myeloma
Thalidomide
[Neo/Maternal exposure]
Which teratogenic drugs?
Craniosynostosis, craniofacial anomalities, limb defects
Methotrexate
[Neo/Maternal exposure]
Which teratogenic drugs?
Cardiac defects,
Neural tube defects,
Renal dysgenesis, oligohydramnios, pulmonary hypoplasia, limb defects,
Skull ossification defects
Angiotensin-converting enzyme inhibitors (ACEis)
[Neo/Maternal exposure]
Which teratogenic drugs?
Uterine abnormalities, vaginal adenosis, male infertility
Diethylstilbestrol (DES)
[Neo/Maternal exposure]
Which teratogenic drugs?
Ebstein anomaly, congenital heart block
Lithium
[Neo/Maternal exposure]
Which teratogenic drugs?
Similar to DiGeorge syndrome,
Microcephaly, facial nerve palsies, microtia, external auditory canal anomalies, cardiac defects, thymic hypoplasia, GU anomalies
Retinoids
[Neo/Maternal exposure]
Streptomycin causes ____ in infant
Hearing loss
[Neo/Maternal exposure]
Which teratogenic drugs?
Tooth discoloration
Growth defect
Tetracyclin
[Neo/Maternal exposure]
Which teratogenic drugs?
Nasal hypoplasia
Stippled epiphyses
Warfarin
[Neo/Maternal exposure/FAS]
Fetal alcohol syndrome diagnosis criteria (3)
All three categories
1. Facial abnormality, 2 of the following
Shortened palpebral fissures
Epicanthal folds
Hypoplastic nasal root
Short, upturned nose
Hypoplastic or absent philtrum
Thin upper lip
Midface hypoplasia
- Pre- or postnatal growth deficiency, 1 of the following
Weight < 10th percentile
Microcephaly
Length-to-height ratio < 10th percentile - Cognitive abnormality
[Neo/Maternal exposure/Mercury]
Characteristics of newborns with mercury exposure?
Cerebral atrophy, seizures, developmental delay
[Neo/Maternal exposure/Substance]
Which substance abuse?
Miscarriage, still birth, premature delivery
Placental abruption
Intracranial hemorrhage
Newborn abstinence syndrome: jitteriness, irritable, tremulous, rigidity, short half life
Cocaine
[Neo/Maternal exposure/Substance]
Which substance abuse?
Miscarriage, still birth, prematurity
Low birth weight
Risk for sudden infant death
Cigarette
[Neo/Maternal Medical condition]
What is mother’s medical condition?
Still birth, prematurity
Congenital heart block, cardiomyopathy, structural anomalies
Rash (raccoon eyes)
Elevated LFT, hepatosplenomegaly
Cytopenia
Systematic lupus erythematosus (SLE)
(Neonatal lupus)
[Neo/Cong Infection]
Which prenatal infection?
Severe anemia, heart failure, hydrops fetalis
Human parvovirus B19
[Neo/Cong Infection]
Which prenatal infection?
IUGR
Limb reduction defects
Microphthalmia, chorioretinitis,
skin scarring
Microcephaly
Varicella
[Neo/Cong Infection]
Which prenatal infection?
IUGR
Microcephaly
Periventricular calcifications
Hearing loss
Intellectual disability
Cytomegalovirus (CMV)
(Toxo parenchymal calcification, CMV CircuMVent calcification)
[Neo/Cong Infection]
Which prenatal infection?
Blueberry muffin rash
Up to 8 weeks: deafness
9-12 weeks: cataracts
12-30 weeks: heart defects
Rubella
[Neo/Cong Infection]
Which prenatal infection?
Hydrocephalus
Choreoretinitis
Parenchymal cerebral calcification
Hepatosplenomegaly
Intellectual disability
Toxoplasmosis
(Toxo parenchymal calcification, CMV CircuMVent calcification)
[Neo/Cong Infection]
Which prenatal infection?
Abnormal teeth/bones, intellectual disability,
Hutchinson triad (Teeth, cranial nerve 8 palsy, interstitial keratitis)
Syphilis
[Neo/Cong Infection/Syphilis]
Treatment for
Category 1 (highly likely: abnormal newborn finding, ≥ 4 fold in VDRL or RPR)
And
Category 2 (less likely: <4 fold in VDRL or RPR and normal PE, mother was not treated)
Category 1
IV Penicillin G for 10 days
Category 2
Penicillin G IM one dose
[Neo/Cong Infection/Syphilis]
Newborn investigation for
Category 1 (highly likely: abnormal newborn finding, ≥ 4 fold in VDRL or RPR)
And
Category 2 (possible: <4 fold in VDRL or RPR and normal PE, mother was not treated)
Category 2
CSF for VDRL, cell count, protein
CBC
Long bone x-rays
Category 1
Plus LFT, Chest x-ray, head ultrasounds, eye/hearing exam
[Neo/Cong Infection/Syphilis]
Criteria for Category 3 (less likely) and category 4 (unlikely)
Category 3
Normal newborn finding AND
Titer < 4 folds AND
Treated at least > 4 weeks before delivery
-> one time Penicillin G IM
Category 4
AND treated before pregnancy
AND titer remained low during pregnancy
-> no treatment
[Neo/Cong Infection/Syphilis]
Investigation and treatment for
Category 3 (less likely: treated before delivery, normal titer)
Category 4 (unlikely: treated before pregnancy, remained low titer)
Category 3
No newborn investigation
Penicillin G IM once
Category 4
No investigation, no treatment
[Neo/neonatal sepsis]
Invasive GBS sepsis treatment?
Early onset: __
Late onset: __
Early onset: Penicillin G
Late onset: ampicillin and cefotzime or ceftazime (≤28 days), or ceftriaxone ( >28 days)
[Neo/Maternal exposure]
Which teratogenic drugs?
Persistent pulmonary hypertension
neonatal withdrawal,
prematurity,
low birth weight
Selective Serotonin Reuptake inhibitor (SSRI)
[Neo/Perinatal injury]
Klumpke injury
Which nerve involvement?
Horner syndrome, anisocoria, harlequine sign
T1 involvement: Horner
Klumpke injury (C7-T1)
[Neo/GA]
Maximum vernix coverage at ____ weeks
37 weeks
[Neo/GA]
Absent breast tissue till ___ weeks
Raised areola at ___ weeks
No breast till 33 weeks
Raised areola 34 weeks
[Neo/GA]
Ear well defined incurving to lobe at ___ weeks
39
[Neo/GA]
1-2 anterior sole crease at ___ weeks
32 weeks
[Neo/GA]
Lanugo covers entire body till ___ weeks
Absent from the fact at ___ weeks
Full lanugo at 32 weeks
No face lanugo at 34 weeks
[Neo/GA]
Lanugo disappears from the face between ___ and ___ weeks
32 to 37 weeks
[Neo/GA]
Testicles palpable upper scrotum between ___ and ___ weeks
36 and 39 weeks
[Neo/Newborn finding]
Diagnosis?
Infants followed by birth injury, hypoxia, meconium aspiration, forceps delivery
Self-limited 6-8 weeks
Hypercalcemia during the first 6 months
Subcutaneous fat necrosis
[Neo/Cong infection]
Name of congenital infection?
Transverse bands of indreased density across metaphyses
Patchy areas of bony destruction in the diaphysis
Periosteal new bone formation
Congenital syphilis
[Neo/Maternal exposure/FAS]
Congenital anomalies commonly seen in fetal alcohol syndrome (FAS)? (2)
Cardiac septal anomalies (VSD)
Minor joint and limb anomalies
[Neo/TTTS]
Twin to twin transfusion syndrome
Donor child
CBC: ___
Amniotic fluid: ___
Recipient child
CBC: ___
Amniotic fluid: ___
Donor child
CBC: anemia
Amniotic fluid: oligohydramnions
Recipient child
CBC: polycythemia, hyperbilirubinemia
Amniotic fluid: polyhydramnios
[Neo/Cong anomaly]
Most common site for congenital diaphragmatic hernia?
Left, posterolateral defect
[Neo/Cong infection]
Which prenatal infection?
3-7 days of life
Myocarditis
Fulminant hepatitis
Encephalitis/meningitis
Enterovirus: coxsackievirus, enterovirus,
[Neo/Cong infection]
Which prenatal infection?
Microcephaly
Seizure
Arthrogryposis
Sensorineural hearing loss
Zika virus
[Neo/neonatal spesis]
Which bacteria?
Preterm birth
Pneumonia
Septicemia
Granulomatosis infantisepticum (erythematous rash with papules)
Listeria
