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Neonatology Flashcards

1
Q

Low birth weight

A

< 2500g

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2
Q

Very low birth weight

A

< 1500 g

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3
Q

Extremely low birth weight

A

< 1000 g

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4
Q

What do you need to look for in a baby with single artery in the cord?

A

Congenital anomalies
Consider renal US

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5
Q

4 conditions associated with a single umbilical artery

A

Trisomy 18
Renal anomalies
Cardiac anomalies
Twins

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6
Q

Conditions associated with
1. High AFP
2. Low AFP

A
  1. Neural tube defects, multiple gestation
  2. Trisomies 21, 13, and 18
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7
Q

Symptoms of hypermagensemia
(in babies whose mothers needed Mg Sulf for pre-eclampsia)

A

Resp depression
Hyporeflexia
Poor feeding
Failure to pass meconium
Lethargy
Flaccidity

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8
Q

What is POTTER syndrome?

A

Pulmonary hypoplasia
Oligohydramnios
Twisted skin (wrinkly)
Twisted face (Potter facies - low set ears, posteriorly rotated ears, micro/retrognathia, hypertelorism, flattened nose)
Extremity deformities (joint contractures, club hands/feet)
Renal agenesis (bilateral)

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9
Q

Causes of severe fetal bradycardia

A

Fetal hypoxia
Maternal fever
Hyperthyroidism
Maternal or fetal anemia
Drugs (atropine, hydroxyzine, ritodrine, terbutaline)
Chorioamnionitis
Fetal tachyarrhythmia
Prematurity

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10
Q

Causes of fetal tachycardia

A

Prolonged cord compression
Cord prolapse
Tetanic uterine contractions
Paracervical block
Epidural and spinal anesthesia
Maternal seizures
Rapid descent in the birth canal
Vigorous vaginal examination

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11
Q

APGAR scoring

A

Appearance (2=pink, 1=acro, 0=blue/pale)
Pulse (2= >100, 1=<100, 0= absent)
Grimace (2=cry/sneeze, 1=grimace, 0=nothing)
Activity (2=active, 1=flexion, 0=limp)
Respirations (2=good, crying, 1=slow, irregular, 0=absent)

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12
Q

What age do you need to give
1. Antenatal steroids
2. Antenatal Mg sulf

A
  1. < 35 (IVH, nec, lung development, mortality)
  2. < 34 (neuroprotection)
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13
Q

2 anti-epileptic medications that cause neural tube defects

A

Carbamazepine
Valproic acid

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14
Q

Neonatal effects of maternal lithium

A

Ebstein anomaly
Hypothyroid
Diabetes insipidus

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15
Q

What do babies born to mothers with lupus need
1. Antenatally
2. Postnatally

A
  1. Fetal echo in 2nd trimester, dex if heart block is present
  2. ECG at birth, echo if abnormal, repeat ECG by 12 months of age, CBC and platelets monitored until normal
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16
Q

What do you need to check in babies born to mothers with hyperthyroidism

A

TSH, T3, T4 on days 3-5 of life
Should be transient and resolve in 4-6 weeks

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17
Q

Do the umbilical arteries or veins close first?

A

Arteries then veins

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18
Q

Most common sequelae of NEC

A

Strictures

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19
Q

Well baby but maternal chorio, no other risk factors. What is needed?

A

Close observation for 24 hours
Vitals every 3-4 hours
+/- CBC at 4 hours

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20
Q

What does a baby born to a mom with known Hep B need?

A

Hep B vaccine and immunoglobulin within 12 hours of birth

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21
Q

Timing of
1. Early onset
2. Classic
3. Late onset
Vitamin K deficiency bleeding

A
  1. first 24 hours
  2. 2-7 days
  3. > 2 weeks
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22
Q

Causes of
1. Early onset
2. Classic
3. Late onset
Vitamin K deficiency bleeding

A
  1. Maternal drugs (phenytoin, warfarin, phenobarb)
  2. No prophylaxis, exclusive breastfeeding
  3. Conditions that cause malabsorption (CF, hepatitis, BA)
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23
Q

How to give PO vit K if parents are refusing IM

A

Dose at first feeding to be repeated at 2-4 weeks and 6-8 weeks
Still at risk for late onset bleeding

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24
Q

Are premature infants at higher or lower risk for NAS

A

Lower
Shorter duration of exposure, minimal fat stores, immature kidneys and liver, etc

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25
How long does monitoring for NAS need to be
Minimum of 72 hours Up to 120 hours if exposed to longer acting opioid
26
Congenital anomalies associated with IDM
Neural tube defects Cardiac defects Cadual regression (sacral agenesis or higher) Intestinal atresia Hydronephrosis Cystic kidneys Small left colon syndrome
27
Jitters vs seizures
Jitteriness can be ended by flexion or holding the limb Jitters are typically induced by a stimulus Seizures often involve eye deviation and autonomic changes
28
Group 4 classification of brachial plexus palsy
Complete flaccid paralysis AND Horner's syndrome (miosis, ptosis, anhidrosis)
29
When to refer to surgery team if incomplete recovery of brachial plexus palsy
1 month old
30
Investigations required for two vessel cord
None as long as no dysmorphisms or other red flags
31
What do to for infant born to mom with untreated 1. Gonorrhea 2. Chlamydia
1. Take cultures, treat with CTX if well, FSWU if unwell 2. Close monitoring, only treat if signs of infection occur
32
Why do premature babies need irradiated blood
To prevent GHD Immature immune system is susceptible to GVHD
33
Electrolyte abnormalities in CAH
Hyponatremia Hyperkalemia Hypoglycemia
34
NAIT (neonatal alloimmune thrombocytopenia) cause and treatment
Maternal antibodies against the HPA-1a platelet antigen Can lead to thrombocytopenia, hemorrhage, and death Tx is washed maternal platelets (can also try IVIG or antigen-compatible donor platelets)
35
Which TORCH infections have 1. Microcephaly 2. Possible macrocephaly
1. Rubella, CMV, Zika 2. Toxo
36
T21 screening needed in first month of life (5)
Echo Red reflex check Hearing test CBC TSH
37
Enzyme involved in galactosemia
Deficiency of galactose 1 phosphate uridyl transferase
38
Neonatal autoimmune thrombocytopenia
Mom has ITP or SLE, platelets cross the placenta Babies platelets then get destroyed in the spleen Nadir is 3-5 days Treat severe with IVIG
39
When should apnea of prematurity resolve
In extreme prems, should resolve by 44 weeks CGA Most will resolve by 37 weeks though
40
Which cardiac defect has the pre ductal sats lower than post ductal
TGA
41
Hemoglobin threshold for recovering ("convalescent") prem
75
42
When to investigate sacral dimples
Above gluteal folds (> 2.5 cm from anal verge) > 5 mm Associated with other cutaneous markers
43
Most common type of TEF and what it looks like
C Proximal atresia Distal esophagus connected to trachea
44
Complication of subcutaneous fat necrosis
Hypercalcemia Must follow for several months
45
Side effect of corticosteroids for BPD (old cps statement)
Hypertrophic cardiomyopathy
46
Complications from UACs and UVCs
Thrombosis Embolization Spasm Perforation Renovascular HTN Impaired circulation to abdomen or legs UVCs: same plus cardiac perforation, portal vein thrombosis
47
How to manage spasm of UAVs
Remove line, try other artery For persistent spasm = topical nitroglycerin paste, warm other leg
48
Galactosemia presentation and treatment
Typically in first few days of life after lactose meal Jaundice, HSM, vomiting, FTT< hypoglycemia, seizures, lethargy, ID Increased risk of E coli sepsis Give soy based formula, no BF, Ca supps
49
How to tell between neonatal alloimmune thrombocytopenia and neonatal autoimmune thrombocytopenia
Look at maternal platelets Allo (NAIT): maternal platelets normal Auto: maternal platelets low
50
Sarnat scoring
Way to measure encephalopathy 1 = mild (hyperalert, mydriasis) 2 = moderate (lethargic or obtunded, hypotonic, miosis) 3 = severe (stuporous, flaccid, variable pupils)
51
Findings suggestive of congenital hypothyroidism
Feeding issues, choking spells Sluggish, somnolent Resp issues (large tongue) Constipation *Open posterior fontanelle* Hypotonia
52
How to diagnose congenital hypothyroidism
If newborn screen is abnormal, do serum free T4 and TSH Can then do a thyroid scan to prove absence of thyroid tissue or ectopic thyroid
53
Lab findings in thyroid-binding globulin deficiency
Total T4 is low but free T4 and TSH are normal Clinically euthyroid, do not require treatment X-linked, more in males (congenital hypothyroid more in females)
54
Lab findings of hyperinsulinemia
Low glucose No ketones, FFAs No acidosis Elevated C peptide Inappropriate/very quick response to glucagon
55
How to manage Asymptomatic with glucose < 1.8 or unwell/symptomatic from hypoglycemia
IV glucose Can give D10W bolus of 2 mL/kg over 15 mins if symptomatic, or 40% dextrose gel (same glucose) Infusion start at 80 mL/kg/day
56
What is a pass/fail for CCHD screening
Pass: 95% or higher in right hand OR foot, AND 3% or less difference Fail: Any limb < 90%
57
How long to screen 1. At risk 2. LGA/IDM 3. SGA/prem infants for glucose?
1. At 2 hours, every 3-6 hours 2. 12 hours 3. 24 hours
58
Initial PPV settings in NRP
PIP 20-25 PEEP 5 Flow 10 L/min Rate 40-60 FiO2 21% if > 35 weeks, 21-30% if < 35 weeks
59
RBC transfusion threshold on and off respiratory support for ages 1. Week 1 2. Week 2 3. Week 3 or older
1. ON: 115, OFF: 100 2. ON: 100, OFF: 85 3. ON: 85, OFF: 75
60
How long to monitor infants for NOWS/NAS
72, up to 120 hours if long acting opioid
61
How to manage 1. Well infants with first glucose < 2.6 2. Next low (< 2.6 but 1.8 or higher)
1. Dextrose gel and breastfeed OR breastfeed plus 5 mL/kg feed 2. Dextrose gel AND feed 5mL/kg AND breastfeed OR feed 8mL/kg AND breastfeed
62
Signs of PPHN
Severe cyanosis out of proportion to CXR findings (normal, can see reduced pulmonary markings) Respiratory distress Usually term or post term infants Pre > post sat differentiation, shunting through PDA
63
Neonatal thyrotoxicosis labs and management
High total T4, free T4, T3, and TRAbs Low TSH Maternal antibody level determines severity, not TSH/T4 Resolves over 3-12 weeks Can use methimazole, iodine, or propranolol
64
Erbs palsy vs extended Erb's palsy vs Klumpke's palsy
Erbs: C5/6 (arm positioning) Extended: C5-7 (arm and hand) Klumpke's: C7-T1 (claw hand)
65
When do infants <32 weeks need head imaging
HUS at days 4-7 of life Repeat 4-6 weeks post birth Term imaging routinely for babies born < 26 weeks
66
When do infants 32- 36+6 weeks get head imaging
Only if they have additional risk factors (complicated course, microcephaly, complicated monochorionic twin preg) Then: HUS at 4-7 days, repeat 4-6 weeks if first image abnormal
67
Asymmetric crying facies
Same as congenital unilateral lower lip palsy Unilateral mouth droop during crying (symmetric forehead movement, nasolabial folds, eye opening) Can be associated with CV anomalies (do echo) Can be associated with genetic syndromes - often should screen for DiGeorge

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