Neonatology Flashcards
Most common reason for elevated AFP
Inaccurate dating of pregnancy
Causes of increased AFP
Renal (nephrosis, renal agenesis, PKD)
Abdominal wall defects
Increased # of fetuses/Incorrect dates
Neuro (anencephaly, spina bifida)
Causes of decreased AFP
Trisomy 21
Trisomy 18
Management of apnea of prematurity
Caffeine
Theophylline
Pressure required to inflate lungs for first breath
60 mmHg
Cause of Transient Tachypnea of Newborn (TTN)
Retained fetal fluid
Xray findings for TTN
Fluid in interlobar fissures
Increased interstitial markings
Cause of RDS (Hyaline Membrane Disease)
Surfactant deficiency (< 36 wk GA)
CXR finding for RDS
Ground glass appearance
Granular opacifications
Air bronchograms
Increases risk for RDS
Infancy of diabetic mothers
C-section
Birth asphyxia
Decreases risk for RDS
Prolonged rupture of membrane
Prenatally administered steroids
Criteria for ECMO
> 34 wk GA
2 kg
Reversible lung disease < 10-14 days duration
Refractory to other treatment
No hemorrhage
No CHD
Arrest of normal lung development in premature infants
Management
Bronchopulmonary disease (BPD)
Tx: Diuretics
CXR for BPD
Diffuse opacities
Cystic areas with streaky infiltrates
Ground glass appearance
Most common causes of coma and lethargy in infants
Sepsis
Metabolic disturbances
Asphyxia
Empiric treatment for sepsis in newborn
Ampicillin + gentamicin
Early GBS
First 7 days
Sepsis or pneumonia
Late GBS
First month of life to 90 days
Bacteremia or meningitis
Late-Late GBS
Up to 6 months of age
Preterm infants
Antenatal screening for GBS
36 0/7 to 37 6/7 weeks GA
Treatment for GBS
Penicillin G
Caput succadaneum
Crosses suture lines
Soft, boggy pitting
Cephalohematoma
Cause
Cannot cross suture lines
Firm
Caused by prolonged labor or instrument-assisted delivery. Or underlying skull fractures
Subalgeal hematoma
Vacuum-assisted deliveries
Bleed between epicranial aponeurosis and skull periosteum
Erb’s Palsy
C5-7 injury
Excessive lateral neck flexion
Phrenic nerve paralysis
Waiter’s tip
Klumpke palsy
C8-T1 injury
Horner syndrome
Anisocoria
Claw hand
SGA definition
Lower 10th percentile
< 2500g
LGA definition
Above 90th percentile
> 3900g
Risk factors for SGA
IUGR
Mothers with chronic illness
Teenage mothers
Complications of SGA
Higher morbidity and mortality
Temperature instability
Polycythemia
Hypoglycemia
Causes of Symmetric IUGR
(proportional head and body)
Early pregnancy
Infections
Genetic abnormalities
Chronic alcohol/tobacco use
Causes of asymmetric IUGR
(Head larger than body)
Later pregnancy
Placental issues
Hypertension
Preeclampsia
Characteristics of posterm infants (>42 wk GA)
Peeling dry skin
Long fingernails
Decreased lanugo on the back
Ears with strong recoil
Most common cause of fetal demise
Chromosomal abnormalities
Congenital malformations
MAP in preemie
No less than corrected GA in weeks
Factors which impact prognosis in VLBW (<1500g)
Gestational age (most important)
Morbidity while in NICU
intracranial hemorrhage
Symptoms of meconium aspiration
Barrel chest
Rales/tho chi on auscultation
CXR for meconium aspiration
Patchy areas of atelectasis alternating with areas is hyperinflation
Most likely complication of meconium aspiration
Persistent pulmonary hypertension
Causes of delayed passing of meconium (no stool in first 48 hrs)
Meconium plug syndrome
Hirschsprung’s disease
Imperforate anus
Risk factors for NEC
Hypoxia
Bacterial infection
Objective data for NEC
Positive blood culture
Pneumotosis intestinalis
Air in biliary tree
Pneumoperitoneum
Long term complication of NEC
Intestinal strictures
Causes of indirect hyperbilirubinemia
Gilbert disease
Hypothyroid, hypopituitary
Obstruction, pyloric stenosis
Meconium ileus, ileus, Hirschsprung
Lucy Driscoll syndrome
Hemolysis
Galactossemia, Tyrosinosis, CF
Hemorrhage/hematomas
Physiologic jaundice
Unconjugated hyperbilirubinemia
Occurs day 2-5
Last 1 week
Healthy infant
Increased rate of bilirubin production (shorter lifespan of fetal RBC)
Diminished bilirubin excretion
Reaches max values of 5-9 mg/dL between 72 and 96 hrs of age in full term
Abnormal Bili level in newborn
Elevated level during first 24 hours (>13)
Bilirubin level of 17 after 120 hours
Contraindications for phototherapy
Conjugated (direct) bilirubin (bronze baby syndrome)
Family h/o light sensitivity porphyria
Breastfeeding jaundice
Unconjugated hyperbilirubinemia (most common cause)
First days of life
Decreased caloric intake (increased enterohepatic circulation) or delayed passage of meconium
Human milk jaundice
Inherent human milk factors
6-14 days after birth
Persist 1-3 months
Management for hypoglycemia (BG < 40) in newborn
2-3 ml/kg D10 bolus
Increased enteral feeds or dextrose fluids
Maintain good body temperature
Complications of infants of diabetic mothers
LGA
Hypoglycemia
Polycythemia
RDS
Cardiac abnormalities
Colon abnormalities
Caudal regression syndrome Dr Dr Sx
Anemia nadir
Term: 2-3 mo
Preterm: 1-2 mo
Polycythemia of newborn
Management
Central venous HCT of > 65
Associated with hypoglycemia
Tx: partial exchange transfusion (if Sx)
Risk factors for hyperviscosity syndrome
Twin-twin transfusion
Delayed cord clamping
Down syndrome
IDM
Omphalocele
Protrusion of bowel and other organs through base of umbilical cord
Bowel contents cover with membrane
Risk factors for omphalocele
Large babies
Chromosomal defects
Beckwith Wiedemann
Gastroschisis
Germination of bowel through defect in abdominal musculature to right of umbilicus.
Limited to intestinal contents
Not covered with membrane
Risk factors for gastroschisis
Small (IUGR) infants
Vascular accidents
Vasoactive medications/drugs
Scaphoid abdomen
Decreased breath sounds on Left
Heart sounds on right
Diaphragmatic hernia
Most likely cause of neonatal seizure within 24 hours of birth
Birth asphyxia
Typical characteristics of neonatal seizures
Staring spells
Decreased motor activity
Lip smacking
Abnormal facial movements
Most frequent cause of neonatal seizures in full term infant
Neonatal encephalopathy
HIE
Management of neonatal seizures
Phenobarbital
Grading Intraventricular hemorrhage
Grade 1 - germinal matrix
Grade 2 - IVH without dilation
Grade 3 - IVH with dilation
Grade 4 - above + parenchyma involvement
Risk factors for hypoglycemia in newborn
IDM (insulin)
Polycythemia (Hct > 65)
Tocolytics
Beta adrenergics (terbutaline)
Maternal alcohol use
Prematurity (< 37 wk GA)
Sepsis
Hypothermia
Respiratory depression
Apnea
Generalized hypotonia
GI hypomobility
Meconium plug syndrome
Mother treated for preeclampsia
Neonatal hypermagnesemia
Colonic obstruction involving a significant caliber reduction in the sigmoid and descending colon
Small left colon syndrome
Associated with maternal diabetes
Microcephaly
Hypertonia
Arthrogryposis
Zika virus
Teratogenic effects of ACEi
Septal defects
PDA
neural tube defects
Renal anomalies/failure
IUGR
Oligohydramnios
Pulmonary hypoplasia
Limb anomalies
Nasal hypoplasia
Stippled epiphyses
Fetal warfarin syndrome
Abnormal development of lymphatic system leading to obstruction of normal lymphatic flow and sequestration of lymphatic fluid
Lateral neck.
Transilluminates
Cystic hygroma
Asymmetry of gluteal folds
Asymmetry in knee height (Galeazzi sign)
Diagnosis
Developmental dysplasia is the Hip (DDH)
Hip US in infants < 4 mo
Complication of twin-to-twin transfusion syndrome
Hydrops details in both infants
Well-circumscribed
Nontender
Nonfluctuant
Reddish-purple nodules
Hypercalcemia
Subcutaneous fat necrosis of the newborn
Self-limited
Gross hematuria
Flank mass
Thrombocytopenia
Renal vein thrombosis
