Neonatology Flashcards
1
Q
Normal measurements of neonate
Lentgh - weight - HC - Pulse - BP - RR
A
- Length : 50 cm
- Weight : 2500 ~ 4000 gm
- HC : 33 ~35
- Pulse : 120 ~ 160 /min
- BP : 70~85/40~60
- RR : 30 ~ 40/ min (<60)
2
Q
To assess physical and Neuromuscular maturity of the newborn (GA of newborn)
A
New Ballard Score
3
Q
predominant posture of newborn is
A
partial flexion
4
Q
best time for breastfeeding / bonding
A
quiet alert
5
Q
Cutis Marmarota indicates
A
Vasomotor instability
6
Q
significance of dryness and peeling
A
extensive peeling / transverse fissuring over the abdomen denotes dysmaturity
7
Q
Regarding Mongolian spots
A
no pathological significance
8
Q
when does umbilical stump falls
A
by the end of the first week
9
Q
mid-point of stature in the newborn is
A
the umbilicus (not symphysis pubis)
10
Q
breast tissue size of neonate
A
10 mm at term
11
Q
causes of prolonged separation of umbilical stump
A
- Immune deficiency
- Hypothyroidism
- Omphalitis
- Prematurity
- Poor cord care
- Umbilical Granuloma
- EDS
12
Q
Stool progression in neonate
A
- First 24h → Meconium (Black)
- After BF (3rd / 4th day) → Transitional stool (Greenish brown)
- finally → Golden yellow (contain milk curds)
13
Q
frequency of motions
A
3 / 5 per day
14
Q
causes of Melena in newborn
A
- Swallowed maternal blood → HbA
- Hemorrhagic disease of newborn → HbF
15
Q
Regarding renal function of the newborn
A
- first urination occurs in 1st 24h in most Term infants
- may be delayed → 72h (external atmosphere Temp.)
16
Q
Normal Hb level if newborn
A
17 - 19 gm/dl
mild reticulocytosis & normoblastemia
17
Q
TLC in newborn
A
- 1st 24h → relative neutrophilia (25x10^9)
- after 1st week → relative lymphocytosis (15x10^9)
18
Q
bilateral absence of Moro reflex indicates
A
- UMNL
- CNS depression (Narcotics /Anaesethia)
- Bilateral injury of brachial plexus
- Prematurity
19
Q
asymmetrical response to Moro reflex indicates
A
- Erb’s palsy
- fracture clavicle
20
Q
when to start resuscitation of the newborn
A
- Is not breathing spontaneously or has difficulty breathing
- Has poor muscle tone
- Has a heart rate less than or equal to 100 beats/minute
- Has persistent central cyanosis
at 1 minute
21
Q
gold standard in neonatal manipulation
A
Minimal handling
22
Q
sclera appears jaundiced when total bilirubin exceeds
A
2 mg/dl
23
Q
Skin appears jaundiced when total bilirubin exceeds
A
5 mg/dl
24
Q
maximum intensity of physiological jaundice in which day
A
4 ~ 5 day → Preterm
7th day → Term
does not exceed 15 mg/dl – Not detectable after 14 days
25
differential diagnosis for Jaundice appearing within 1st 24h
* Hemolytic disease of newborn
* STORCH
* G6PD deficiency
26
differential diagnosis for Jaundice appearing 24 ~ 72h
* Physiological
* Sepsis neonatorum
* Polycythemia
* Concealed hemorrhages:
cephalhematoma, subarachnoid
bleed, IVH.
* Increased enterohepatic circulation
27
how does hypothyroidism cause indirect hyperbilirubinemia
* immature UGT enzyme
* Chronic constipation
28
newborn with jaundice, pallor and normal urine was treated and then the jaundice increased, and urine became dark
inspissated bile syndrome
29
sings indicating pathological jaundice
* Clinical jaundice detected before 24 hours of age
* Rise in serum bilirubin by more than 5 mg/ dl/ day
* Serum bilirubin more than 15 mg/ dl
* Clinical jaundice persisting beyond 14 days of life
* Clay/white colored stool and/or dark urine staining the clothes yellow
* Direct bilirubin >2 mg/ dl at any time
30
mention risk factors for severe NNJ
* Jaundice in 1st 24h
* A sibling who had jaundice as a neonate
* Unrecognized hemolysis
* non-optimal suckling
* G6PD deficiency
* Infections
* Cephalhematoma / bruising
31
BIND score depends on
1. Mental status
2. Muscle Tone
3. Cry pattern
## Footnote
used to assess Acute Bilirubin Encephalopathy
32
Regarding Breast milk jaundice
* may present as prolonged physiological jaundice
* may appear for the first time after 1st week
* maximum intensity 10 ~ 14 days
* Bilirubin levels are never high (<15 mg/dl)
* Cessation of Breast milk for 48h
33
workup for pathological jaundice
1. Total and direct Bilirubin
2. ABO and Rh for mother and infant
3. LFT and TFT
4. direct Coombs on baby
6. Hematocrit
7. Peripheral blood film
8. TORCH titres
34
Mode of inheritance in Crigler-Najjar $
AR
35
TTT of Crigler-Najjar type II
Phenobarbitone
36
wave length of Phototherapy
450 ~ 460 nm
(blue - cool white - Green)
37
distance of light in phototherapy
30 ~ 50 cm
38
If a baby is on phototherapy, how often to check for serum bilirubin
every 12h
39
when to discontinue phototherapy
if two serum bilirubin values are < 10 mg/dl
40
when to check for rebound hyperbilirubinemia
6 ~ 8 hours after stopping phototherapy
41
in neonatal asphyxia, acidosis is ....
mixed (both metabolic and respiratory)
42
therapeutic window of HIE
2 ~ 6 hours (therapeutic hypothermia)
## Footnote
cooling to 33.5 c for 72 hours
43
44
diagnosis of HIE
* Profound metabolic or mixed acidemia pH≤7.0 or a base deficit of ≥16 within
first hour
* Apgar score of 0-3 for longer than 5minutes (≥10 minutes)
45
TTT of cephalhematoma
conservative
** NO ASPIRATION **
46
causes of Facial palsy in neonates
* Direct pressure of forceps blades
* HIE
* IVH
* CMV / HSV perinatal infection
* Möbius syndrome
## Footnote
absent rooting reflex
could be misdiagnosed with hypoplasia of depressor anguli oris
47
upper trunk brachial plexus injury
* Erb palsy
* waiter's tip position
* C5 / C6
## Footnote
hand moves properly with asymmetrical Moro reflex.
48
lower trunk Brachial plexus injury
* Klumpke palsy
* claw hand deformity / Horner
* C7 / C8 / T1
## Footnote
1. MCP Extended
2. IPJ flexed
49
phrenic nerve injury
C4 / C5
X-Ray (flouroscopy)→ elevated copula of affected side + see saw movement
50
regarding subgaleal hemorrhage
* Boggy fluctuant mass
* may shift from side to side with movement
* associated with pallor / tachycardia / hypotension
51
investigation of choice in IVH
US
52
fetal lung fluid production rate
250-300 mL/d
53
duration of TTN
Onset → within 6 hours of delivery
persistence → 12 ~ 24 hours
x-ray show complete resolution in 48 ~ 72 hours
54
regarding TTN
* Usually good air entry
* Spontaneous improvement
* Wet lung / ↑ BVM / ↑ perihilar streaking
* No role for diuretics
* No risk of residual pulmonary
dysfunction
55
peak of RDS
* within 3 days
* first appears minutes after birth (may be delayed for hours when rapid shallow breathing occurs)
56
the major cause of death in Neonatal period
hyaline membrane disease
57
when is surfactant produced
24 weeks of gestation
type II pneumocytes
58
CXR in HMD
ground-glass appearance (diffuse reticulogranular pattern)
59
prevention of HMD
1. prevention of prematurity
2. Tocolytics + in-utero transfer to equipped center
3. Adminstration of betamethazone 3/4 days B4 delivery **( 24 ~ 34 wks)**
4. Antibiotics for PPROM
5. Avoid unnecessary CS
6. prophylactic surfactant adminstration for **< 27 wks **
60
nutrition of a patient with HMD
* Glucose → 10% with a rate of 65 - 80 ml/kg
* Amino acids → 2.5 / 3 gm/kg
## Footnote
given IV for the first 48h
61
oxygen therapy in HMD
warm humidified O2 at a concentration of 89 ~ 94 %
## Footnote
measured by pulse oxymeter over the right hand
62
indications of HMD
* Arterial blood pH less than 7.2.
* Arterial blood CO2 more than 60 mm Hg.
* Arterial blood O2 less than 50 mm Hg at O2 concentration of 60-70 %.
* Persistent or recurrent life threatening apnea.
63
CCC of HMD
1. IVH / encephalopathy
2. ROP
3. Broncho-pulmonary dysplasia
4. tension pneumothorax
5. sepsis / NEC
64
incidence of Meconium aspiration $
10 ~ 15 % of term / post term
** pre term is unusual**
65
X-Ray findings in MAS
* Patchy infiltrates
* Coarse streaking
* Flattening of diaphragm
## Footnote
patchy atelectasis + extensive pneumonitis
66
regarding Meconium aspiration $
* Suctioning of oropharynx by obstetricians before delivery of shoulders is **NOT recommended.**
* Endotracheal suctioning before ambu-bagging should be done **only if the baby is not vigorous**
* mortality rate 50%
67
CCC of meconium aspiration $
1. air leak
2. permenant PHTN
3. Pneumonia / BPD
67
prevention of air leak $
* Judicious use of ventilatory support
* Close attention to distending pressures and
inspiratory time
* Appropriate weaning of MV
68
first line management in tension pneumothorax
butterfly needle / IV catheter for aspiration followed by chest tube placement (2nd / 3rd IC)
## Footnote
butterfly needle 21 or 23 gauge connected to
10-20 ml syringe with a 3-way stopcock attached.
69
chest tube measurements for infants
* No.10 Fr for infants <2,000 gm
* No.12 Fr for infants >2,000 gm
70
how to differentiate between congenital pneumonia and MAS
Congenital pneumonia → absence of hyperinflation
71
A neonate with pneumonia and pneumatoceles suggestive of
Staph pneumonia
72
A neonate aged 3wks & suffering from staccato cough, low grade fever, and unresolving eye discharge.
chlamydia pneumonia
73
A **small bell-shaped thorax** with rudimentary lungs
consistent with the diagnosis of
lung hypoplasia
