NEONATOLOGY Flashcards
Birth weight less than the 10th percentile
Small for age (SGA)
Birth weight more than the 90th percentile
Large for gestational age (LGA)
Birth weight less than 2500 g
Low birth weight
Birth weight less than 1500 g
Very low birth weight (VLBW)
Birth weight less than 1000 g
Extremely low birth weight (ELBW)
Gestational age of screening for group B Streptococcus (GBS)
35–37 weeks gestation
What is the drug of choice for GBS prophylaxis?
Penicillin G
Mother currently GBS negative, but the previous infant had GBS disease. Is GBS prophylaxis recommended?
Yes
Which group has the highest infant mortality rate in the USA?
African American infants
Most common cause of infant deaths in the USA
Congenital malformations
What is the clinical significance of a single umbilical artery?
Associated fetal anomalies (20% or more)
The third trimester presents with Hemolysis, Elevated Liver enzymes, Low Platelet count
HELLP syndrome (complication of
preeclampsia)
What is the definitive treatment for preeclampsia/ HELLP syndrome?
Delivery
he best course of action if fetal scalp pH < 7.20
Immediate delivery
Fetal heart rate > 160 beats/min
Fetal tachycardia
Fetal heart rate < 110 beats/min
Fetal bradycardia
Fetal head compression is often associated with which type of deceleration?
Early deceleration (increased vagal tone)— benign tracing
Compression of the umbilical cord is associated with which type of deceleration?
Variable decelerations
Fetal heart monitoring shows: Fetal heart dropped during the peak uterine contraction and recovered after the contraction had ended; the time from the onset of deceleration to the lowest point of deceleration is 30 s
Late deceleration; associated with placental insufficiency
What are the common causes of late deceleration?
Placental insufficiency for any reason
Uteroplacental insufficiency is associated with what type of deceleration?
Late deceleration—potentially ominous
The best course of action in cases of late deceleration
Fetal pH measurement
Newborn at 1 min: Heart rate is 90/min, weak irregular respiration, grimace, some flexion, blue body and limbs, APGAR score is:
4
Newborn infant is just delivered. The infant is apneic and has a heart rate < 100. What is the next best step?
Positive pressure ventilation (PPV) for 30s, then reassess
In the previous example, the infant’s heart rate is < 60 bpm despite adequate ventilation for 30 s. What is the next step?
Chest compressions and PPV using 100% oxygen
In the previous example, the PPV is ineffective, and chest compressions are being performed. What is the next step?
Intubation
In the previous example, the infant’s heart rate remains < 60 bpm despite adequate ventilation and chest compressions. What is the next step?
Intravenous administration of epinephrine
Newborn infant with lanugo on the shoulders, creases on the entire foot, scant vernix, both testicles in the inguinal canal with good rugae has
an approximate gestational age of?
39 weeks—be familiar with Ballard scoring
Newborn with one side of the body pink and the other side pale, with a sharp line in-between, no other symptoms
Harlequin color change
A neonate is born with severely thickened skin with large, shiny plates of hyperkeratotic scales. Deep,
erythematous fissures separate the scales and contraction abnormalities of the eyes (severe ectropion), ears, mouth, and appendages
Harlequin ichthyosis (autosomal recessive)
Newborn with a sharply demarcated ulcerated area of absent skin is?
Aplasia cutis congenita
What is the most common association with aplasia cutis congenita?
Benign isolated defect (less commonly
associated with other physical anomalies or malformation syndromes, e.g., trisomy 13)
Newborn infant with head swelling crossing the suture lines; delivery was assisted with the use of a
vacuum?
Caput succedaneum
Newborn infant with head swelling that does not cross the suture lines?
Cephalohematoma
A type of hemorrhage in which bleeding is significant and often presents with swelling in the posterior aspect of the head?
Subgaleal hemorrhage
A 7-day-old, 28-week premature infant should be screened for which type of hemorrhage and with which modality?
Intraventricular hemorrhage—with a head US
Maternal fever > 100.4 °F, fetal heart rate more than 160–180 beats/min, maternal tachycardia, purulent foul-smelling amniotic fluid, maternal leukocytosis, and uterine tenderness
Chorioamnionitis
A neonate is born to a mother with
chorioamnionitis. The neonate is alert with good tone, no respiratory distress, and vital signs are normal. What is the next best step?
Obtain blood culture, complete blood cell count, and start ampicillin and gentamicin
An infant develops cyanosis when feeding, which disappears when crying
Bilateral choanal atresia
Term infant 1 h after birth develops tachypnea, hypoxia, grunting. Chest radiograph showed fluid in the fissures, flattening of the diaphragm, and
prominent pulmonary vasculature
Transient tachypnea of the newborn (selflimited, resolves spontaneously, and requires supportive care)
Newborn initially diagnosed with transient tachypnea of the newborn is requiring more oxyge and is much worse after several days
Consider another diagnosis
A preterm newborn with tachypnea, grunting, nasal flaring, subcostal, and intercostal retractions. Chest radiograph shows ground glass appearance. He continues to require more oxygen
Respiratory distress syndrome
What is the best treatment in the previous case of respiratory distress syndrome?
Surfactant therapy followed by rapid extubation to nasal continuous positive airway pressure (CPAP)
When is surfactant recommended to be used prophylactically after resuscitation in extremely premature neonates to protect the immature lungs?
< 27 weeks gestation (some institutions give surfactant as rescue therapy)
The name of cells that produce lung surfactant
Type 2 alveolar cells
An 8-week-old who was born at 27 weeks was intubated for several weeks and now has chronic hypoxemia, tachypnea, wheezing, along with longstanding respiratory insufficiency. Chest radiograph showed: Decreased lung volumes, areas of atelectasis, hyperinflation, and pulmonary edema
Bronchopulmonary dysplasia
Newborn infant with respiratory distress, bowel sounds in the chest, scaphoid abdomen. Bag-mask
PPV after delivery made the infant worse. Chest radiograph shows: loops of bowel in the chest, a mediastinal shift, a paucity of bowel gas in the
abdomen, and the presence of the tip of a nasogastric tube in the thoracic stomach
Diaphragmatic hernia
What is the next best step in the newborn with the diaphragmatic hernia in the previous example?
Intubate immediately after delivery, insert a nasogastric tube to decompress the stomach (avoid bag-mask ventilation)
Full-term infant presents with tachypnea, cyanosis only in the lower body, loud second heart sound. Chest radiograph shows clear lungs and decreased vascular markings
Persistent pulmonary hypertension of the newborn
A post-term newborn has respiratory distress. The amniotic fluid was stained with meconium, and the point of maximal cardiac impulse is displaced
Pneumothorax
A common complication from excessive bagging during resuscitation?
Pneumothorax
Meconium-stained amniotic fluid is noted at delivery, and the infant is apneic. What is the next best step?
PPV
Meconium ileus in a newborn
Cystic fibrosis should be ruled out
A 2-week-old preterm infant born at 26 weeks gestation started having more gastric residuals, abdominal distension, blood in stool, abdominal wall erythema. KUB shows pneumatosis intestinalis and gas in the portal vein
Necrotizing enterocolitis
Newborn with bilious vomiting, abdominal distension, and lethargy
Volvulus should be ruled out
Newborn with Down syndrome and bilious vomiting. KUB shows double bubble sign
Duodenal atresia
Differential diagnosis of white pupillary reflex
Cataract, retinoblastoma
Anhidrosis, ptosis, miosis, and enophthalmos
Horner syndrome
Newborn is not moving arm, and the arm is internally rotated in waiter’s tip position
Erb’s palsy (C5–6)
Newborn is not moving arm and hand, and the hand is held in a claw-like position
Klumpke paralysis (C8-T1)
A diagnostic test to assess associated findings with brachial plexus palsies (BPP)
Chest radiograph can rule out phrenic nerve injury and clavicular fracture
A 2-month-old infant has irritability and poor feeding, swelling, and bone lesions, elevated ESR, and alkaline phosphatase levels. Radiographs show
layers of periosteal new bone formation, with cortical thickening of the long bones, mandible, and clavicle. Soft-tissue swelling is evident as well
Infantile cortical hyperostosis (Caffey disease)
A 5-day-old female with vaginal bleeding
Reassurance (maternal hormone withdrawal)
A well-appearing term neonate with bluish discoloration in hands and feet
Reassurance (peripheral cyanosis or
acrocyanosis is common and benign)
A neonate has new-onset seizure activity but appears otherwise healthy
Refer to the emergency department immediately
Large for gestational age, lethargy, tremors, seizures, and cyanosis
Hypoglycemia
Neonate with hypoglycemia diagnosed with glucose oxidase test strip; test strip glucose is 30 mg/dL. What is the next best step?
Order plasma glucose level (most accurate); feed infant immediately
Newborn with a micropenis that is less than 2.5 cm when stretched will require?
Endocrine evaluation
Newborn is very quiet, cries very little, and has prolonged jaundice and umbilical hernia
Hypothyroidism
Jaundice, hypocalcemia, and hypoglycemia are usually associated with
Polycythemia
What is the treatment of polycythemia?
Hydration (IV fluids); if symptomatic or
significant polycythemia, will need an exchange transfusion
Is jaundice in the first 24 h physiologic?
No
A condition specific for the infant of diabetic mother
Small left colon syndrome
An abdominal wall defect with uncovered abdominal contents noted right of the umbilicus is
Gastroschisis—not associated with genetic abnormalities
An abdominal wall defect covered with a membrane that is often associated with genetic syndromes is
Omphalocele—associated with genetic
abnormalities, e.g., trisomies 13, 18, and 21 and Beckwith–Wiedemann syndrome
Syndrome characterized by absent abdominal wall musculature as well as cryptorchidism is
Prune belly syndrome
A full-term newborn with missing right index, middle, and ring fingers
Amniotic band syndrome
Newborn with jitteriness, irritability, tremulousness, limb defect, leukomalacia, and intracranial hemorrhage
Cocaine abuse during pregnancy
Very small for gestational age (SGA) infant, mother with multiple drug abuse during pregnancy, including alcohol, cigarette smoking, cocaine, marijuana. Which substance is most responsible for SGA?
Cocaine
The most common effect of cigarette smoking during pregnancy on newborn
Low birth weight
Excessive exposure to hot water or hyperthermia during the first trimester of pregnancy increases the risk of
Miscarriage, neural tube defect
A virus that can cause fetal hydrops
Parvovirus B19
Newborn with microphthalmia, cataracts, blueberry muffin spots on the skin, hepatosplenomegaly, and patent ductus arteriosus
Congenital rubella syndrome
Newborn with microcephaly, and periventricular calcifications
Congenital cytomegalovirus infection
Newborn with chorioretinitis, hydrocephalus, and intracranial calcifications
Congenital toxoplasmosis
Newborn with snuffles, continuous nasal secretions, anemia, thrombocytopenia, hepatomegaly, and
periostitis
Congenital syphilis
SGA newborn with short palpebral fissures, epicanthal folds, micrognathia, smooth philtrum, thin upper lip, and microcephaly
Fetal alcohol syndrome
Lithium use during pregnancy is associated with
Ebstein anomaly
Infant born to an opiate dependent mother presents with increased irritability, fussiness, poor feeding,
and sweating
Neonatal abstinence syndrome
Which maternal medication during pregnancy results in a newborn with growth restriction, renal dysgenesis, oligohydramnios, skull ossification defects?
ACE inhibitors
Which anticonvulsant is associated with fetal hydantoin syndrome?
Phenytoin
Valproic acid intake during pregnancy increases the risk of
Neural tube defect, cleft lip and palate,
cardiovascular abnormalities, genitourinary defects, developmental delay, endocrine disorders, limb defects, and autism
The most common congenital defect associated with carbamazepine and valproic acid
Neural tube defect
Newborn with isolated congenital deafness
Referral to a geneticist (genetic causes probably account for the majority of cases in developed countries)
A 3-day-old infant presents with bilateral hip clunks. What is the next best step?
US of the hips
An infant is delivered to HBsAg positive mother; what is the next step?
Administer both hepatitis B vaccine and HBIG within 12 h of birth
Critical congenital heart defects screening before discharge from the newborn nursery requirements
in most states in the USA
Oxygen saturations should be > 95%, with no more than a 3% difference between pre-ductal and post-ductal oxygen saturations
A mother who delivers a full-term newborn has negative routine maternal labs. The infant is born by vaginal delivery and is stooling, voiding, feeding
well. Tc bilirubin is normal on the 25th percentile. What is the recommended discharge time from newborn nursery and follow-up-care?
48 h after birth and follow-up in 2–3 days
What is the current recommendation for umbilical cord care in infants born in developed countries?
To keep it dry (use of isopropyl alcohol is no longer routine cord care)
