Neonatology Flashcards
What part of the Tdap vaccine provides protection for the child when given to pregnant women?
Pertussis
Tdap should be given with each pregnancy
(vaccines is recommended for people that will have contact with the child)
Why is folic acid important in pregnant women?
helps prevent neural tube defects (spina bifida)
ideally start 1 month before pregnancy
0.4 - 0.8 mg/day
Pregnant patients are screened for which pathogen?
GBS
Which screening test is often performed on babies?
PKU (phenylketonuria -> CNS)
-sickle cell
-genetic test (maple syrup urine disease)
-> to improve health outcomes
-> its different in every state
How are GBS infections treated in pregnant women during labor or in neonates?
IV Ampicillin
What is the most common cause of respiratory distress?
Undeveloped lungs
(it is the last organ that is formed)
Which drug is used to keep the patent ductus anterior (PDA) open?
!!!
Prostaglandin E1
specific dosing, check pack insert for dosing !!! (will be on the EXAM but it is easy math
Which drug is given to women in premature labor to mature the lungs of the premature infant?
!!!
Betamethasone
it stresses the lungs to develop more quickly
What is the treatment for bronchopulmonary dysplasia (BPD) to reduce inflammation?
!!!
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
At what HR is CPR needed in babies?
at an HR below 60 (59)
Assessing neonates -> A, B, C
Appearance
Breathing
Circulation
Which drug is given to premature infants to decrease the side effects of prematurity of the lungs?
Surfactant
makes alveoli more flexible, and it prevents the alveoli from collapsing
What does breast milk contain that formula baby milk doesn’t have?
the breast milk has immunoglobulins -> protecting the baby’s GI tract from pathogens
Every newborn is treated to prevent gonococcal ophthalmia (Prophylaxis) with which drug?
!!!
0.5% Erythromycin ointment (topical)
(Chlamydia that causes eye conjunctivitis needs oral treatment)
Which drugs are given to a newborn?
!!!
-0.5% Erythromycin ointment
-0.5-1 mg IM Vitamin K to prevent hemorrhagic disease of the newborn (Vitamin K deficient bleeding -> causes stroke)
Which drugs help with respiratory distress syndrome?
-preventing early labor with tocolytics
-Betamethasone (stimulates the development of premature lungs by promoting the production of stimulants) - before labor
-surfactants (post delivery)
Which tocolytic is most commonly used to prevent labor?
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
Which sleep disorder is common in premature baby’s?
Apnea
-> can cause Hypoxemia (low O2 in the blood), relfex bradycardia, may need resuscitation, brain damage
What helps with Apnea in neonates?
!!!
Caffeine citrate
-20 mg/kg load and 5mg/kg per day (FYI)
MOA of Caffeine
inhibition of adenosine -> increase in alertness
Neonatal sepsis is caused by which pathogens?
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)
Signs of Neonatal Sepsis
unspecific
-Respiratory (tachypnea, grunting, apnea, cyanosis)
-Cardiac (pallor, poor capillary, perfusioon, edema)
-Metabolic (hypo or hyperglycemia, acidosis, jaundice)
-GI: necrotizing enterocolitis (NEC)
Which pathogens cause early-onset neonatal sepsis?
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
Which drugs are used for early-onset infections causing neonatal sepsis?
-Ampicillin (kills Listeria) + Gentamicin or another aminoglycoside (gram-negative coverage)
-Cefepime, Ceftazidime (if worried about kidney function)
Which pathogens cause late-onset neonatal sepsis?
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)
Which drugs are used for late-onset infections causing neonatal sepsis?
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
Which antibiotics should be avoided in neonates?
Ceftriaxone
Bactrim
highly protein bound -> causing bilirubin displacement
Which diseases may be passed to the child at birth?
TORCH
-Toxoplasmosis (don’t change cat litter box (cat stool) if pregnant)
-Other (syphilis, varicella zoster, parvovirus B19)
-Rubella
-Cytomegalovirus
-Herpes infections
How is congenital Syphilis in babies treated and for how long?
Penicillin G for 10 days
What does Cytomegalovirus cause in neonates?
-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)
Which antibiotic is used for Chlamydia and pneumonia?
Erythromycin or Azithromycin
How is the baby treated if the mother has Hepatitis B?
Hep B vaccine + HBIG (HB immunoglobulin) within the first 12 months of birth
How are neonates with congenital herpes treated?
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
What are the signs of Neonatal abstinence syndrome (NAS)?
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
A neonatal patient presents with redness around the belly button (umbilicus). What should be done?
send them to the ER !!!
-could be necrotizing fascitis
A neonatal patient presents with grunting, low O2 saturation, poor feeding, and nasal flaring. What might be the cause?
respiration distress can be caused by an open PDA
to close the DPA use: Indomethacin, Ibuprofen, or Tylenol
Which lab values may be abnormal in overweight babies at birth?
blood glucose -> hypoglycemia
often if the mother is diabetic -> the baby was exposed to glucose and secretes more insulin than normal
Know how to prepare baby formula
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
