Neonatology

Question 1

What part of the Tdap vaccine provides protection for the child when given to pregnant women?

Answer 1

Pertussis

Tdap should be given with each pregnancy
(vaccines is recommended for people that will have contact with the child)

Question 2

Why is folic acid important in pregnant women?

Answer 2

helps prevent neural tube defects (spina bifida)

ideally start 1 month before pregnancy
0.4 - 0.8 mg/day

Question 3

Pregnant patients are screened for which pathogen?

Answer 3

GBS

Question 4

Which screening test is often performed on babies?

Answer 4

PKU (phenylketonuria -> CNS)
-sickle cell
-genetic test (maple syrup urine disease)

-> to improve health outcomes
-> its different in every state

Question 5

How are GBS infections treated in pregnant women during labor or in neonates?

Answer 5

IV Ampicillin

Question 6

What is the most common cause of respiratory distress?

Answer 6

Undeveloped lungs
(it is the last organ that is formed)

Question 7

Which drug is used to keep the patent ductus anterior (PDA) open?

!!!

Answer 7

Prostaglandin E1

specific dosing, check pack insert for dosing !!! (will be on the EXAM but it is easy math

Question 8

Which drug is given to women in premature labor to mature the lungs of the premature infant?

!!!

Answer 8

Betamethasone

it stresses the lungs to develop more quickly

Question 9

What is the treatment for bronchopulmonary dysplasia (BPD) to reduce inflammation?

!!!

Answer 9

Diuretic combination (helps with edema?)

Chlorothiazide and Spironolactone (for K-sparing effect, helps with electrolyte abnormality caused by the thiazide)
(loops tend to be too potent)

BPD: lungs are not developed well -> inflammation, edema

Question 10

At what HR is CPR needed in babies?

Answer 10

at an HR below 60 (59)

Question 11

Assessing neonates -> A, B, C

Answer 11

Appearance
Breathing
Circulation

Question 12

Which drug is given to premature infants to decrease the side effects of prematurity of the lungs?

Answer 12

Surfactant

makes alveoli more flexible, and it prevents the alveoli from collapsing

Question 13

What does breast milk contain that formula baby milk doesn’t have?

Answer 13

the breast milk has immunoglobulins -> protecting the baby’s GI tract from pathogens

Question 14

Every newborn is treated to prevent gonococcal ophthalmia (Prophylaxis) with which drug?
!!!

Answer 14

0.5% Erythromycin ointment (topical)

(Chlamydia that causes eye conjunctivitis needs oral treatment)

Question 15

Which drugs are given to a newborn?
!!!

Answer 15

-0.5% Erythromycin ointment
-0.5-1 mg IM Vitamin K to prevent hemorrhagic disease of the newborn (Vitamin K deficient bleeding -> causes stroke)

Question 16

Which drugs help with respiratory distress syndrome?

Answer 16

-preventing early labor with tocolytics
-Betamethasone (stimulates the development of premature lungs by promoting the production of stimulants) - before labor
-surfactants (post delivery)

Question 17

Which tocolytic is most commonly used to prevent labor?

Answer 17

Magnesium sulfate (large dose, 20g -> will make the baby lethargic until Mg level drops)

others:
Indomethacin - if given, then earlier in pregnancy bc it can close the PDA
CCB - if used, then given later in pregnancy

Question 18

Which sleep disorder is common in premature baby’s?

Answer 18

Apnea

-> can cause Hypoxemia (low O2 in the blood), relfex bradycardia, may need resuscitation, brain damage

Question 19

What helps with Apnea in neonates?
!!!

Answer 19

Caffeine citrate

-20 mg/kg load and 5mg/kg per day (FYI)

Question 20

MOA of Caffeine

Answer 20

inhibition of adenosine -> increase in alertness

Question 21

Neonatal sepsis is caused by which pathogens?

Answer 21

early onset (first 7 days): bacteria from the mother
-> Pneumonia, breathing in during delivery

late onset (up to 90 days): bacteria from the environment + from the mother
-> Meningitis and sepsis (they may not have meningitis, still meningitis dosing is used when they have sepsis bc meningitis is more likely with sepsis)

Question 22

Signs of Neonatal Sepsis

Answer 22

unspecific

-Respiratory (tachypnea, grunting, apnea, cyanosis)
-Cardiac (pallor, poor capillary, perfusioon, edema)
-Metabolic (hypo or hyperglycemia, acidosis, jaundice)
-GI: necrotizing enterocolitis (NEC)

Question 23

Which pathogens cause early-onset neonatal sepsis?

Answer 23

bacteria from the mother (in the vagina passed during birth)

-Group B Strep (Strep agal.)
-E. coli
-H. flu
-Listeria m.

often Pneumonia from the mother

Question 24

Which drugs are used for early-onset infections causing neonatal sepsis?

Answer 24

-Ampicillin (kills Listeria) + Gentamicin or another aminoglycoside (gram-negative coverage)

-Cefepime, Ceftazidime (if worried about kidney function)

Question 25

Which pathogens cause late-onset neonatal sepsis?

Answer 25

could be anything, worry about neonatal sepsis and meningitis

-Coagulase-negative Staph epidermis (CONS) - Methicilin-resistant Staph epidermis -> need Vancomycin

-Staph aureus
-Group B Strep
-E. coli
-Klebsiella
-Pseudomonas
-Enterobacter
-Serratia
-Haemophilus influenzae
-Listeria m.
-Candida (needs antifungal)

Question 26

Which drugs are used for late-onset infections causing neonatal sepsis?

Answer 26

late-onset = infection after 7 days -> need broad-spectrum antibiotics

-Cefepime, meropenem + vancomycin (to cover CONS)

for EXAM: if the baby is more than 7 days old choose cefepime/meropenem + vancomycin

Question 27

Which antibiotics should be avoided in neonates?

Answer 27

Ceftriaxone
Bactrim

highly protein bound -> causing bilirubin displacement

Question 28

Which diseases may be passed to the child at birth?
TORCH

Answer 28

-Toxoplasmosis (don’t change cat litter box (cat stool) if pregnant)
-Other (syphilis, varicella zoster, parvovirus B19)
-Rubella
-Cytomegalovirus
-Herpes infections

Question 29

How is congenital Syphilis in babies treated and for how long?

Answer 29

Penicillin G for 10 days

Question 30

What does Cytomegalovirus cause in neonates?

Answer 30

-hearing loss !!!
-blindness
-development delays
-mental retardation

it is worse if the mother is infected during pregnancy

prevention: washing hands, avoiding kissing the baby (it is secreted in the urine, saliva, stool)

treatment: Ganciclovir, Valganciclovir (oral) - not well studied but done in practice (FYI)

Question 31

Which antibiotic is used for Chlamydia and pneumonia?

Answer 31

Erythromycin or Azithromycin

Question 32

How is the baby treated if the mother has Hepatitis B?

Answer 32

Hep B vaccine + HBIG (HB immunoglobulin) within the first 12 months of birth

Question 33

How are neonates with congenital herpes treated?

Answer 33

high dose acyclovir then lower dose of acyclovir (oral) for 6-12 months, have to take it every day!

if the herpes comes back it is way worse for the child

Question 34

What are the signs of Neonatal abstinence syndrome (NAS)?

Answer 34

withdrawal from opioids
-crying, not sleeping, tremors, increased muscle tone, yawning, vomiting, diarrhea (on EXAM all of the above is probably the answer)

treatment:
may give opioids (morphine!!!, methadone, clonidine)

non-pharmacology: Eat, sleep, Console (is also effective)

prevention: discuss women in child-bearing age who use opioids

Question 35

A neonatal patient presents with redness around the belly button (umbilicus). What should be done?

Answer 35

send them to the ER !!!
-could be necrotizing fascitis

Question 36

A neonatal patient presents with grunting, low O2 saturation, poor feeding, and nasal flaring. What might be the cause?

Answer 36

respiration distress can be caused by an open PDA

to close the DPA use: Indomethacin, Ibuprofen, or Tylenol

Question 37

Which lab values may be abnormal in overweight babies at birth?

Answer 37

blood glucose -> hypoglycemia

often if the mother is diabetic -> the baby was exposed to glucose and secretes more insulin than normal

Question 38

Know how to prepare baby formula

Answer 38

check: Pediatric Patient Assessment and Preventative Care

2 fl oz water with 1 scoop formula (8.3 g)
4 fl oz water with 2 scoop formula
6 fl oz water with 3 scoop formula
8 fl oz water with 4 scoop formula

mix baby formula to 24 calories per ounce