neonatology Flashcards by Emilio Pahina

NB resucitation: Apnea or HR<100

Provide positive-pressure ventilation

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NB resuscitation: HR<60 after PPV

continue PPV; start chest compressions

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NB resuscitation: HR<60 after compressions

administer epi IV or ET

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APGAR score: HR<100; blue; grimacing; limp; slow irregular RR

APGAR=3

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order of disappearance in a sick baby

color; respiration; muscle tone; reflex; cardiac rate

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order of appearance in a resuscitated baby

cardiac rate; color; respiration; reflex; muscle tone

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essential intrapartum newborn care

dry the baby; delayed cord clamping; early skin-to-skin contact; delayed washing; non separation of mother and NB

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NB Care

Erythromycin 0.5% ointment or Tetracyline 1%; Vit K 1mg IM; Hep B; BCG

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NB Screening test

Congenital Hypothyroidism; CAH; Galactosemia; G6PD; PKU; done at 48hrs old RA9288

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when to repeat NBS?

if blood collected <24hrs old; repeat at 2weeks old

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normal BW and BL; delayed physical; mental; and sexual dvt; sluggish; feeding difficulties; hyponatremia; edema of scrotum/genitals; prolonged physiologic jaundice

Congenital Hypothyroidism

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deficiency of 21hydroxylase; vomiting; failure to thrive; normal at birth; signs of sexual and somatic precocity

CAH

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feeding intolerance; vomiting; jaundice; convulsions; lethargy; hypotonia; MR

Galactosemia

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episodic/chronic hemolytic anemia; symptoms develop 1-2days after exposure to substance with oxidant properties; Heinz bodies; reticulocytosis; jaundice; ARF

G6PD

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substances implicated in G6PD

sulfonamides; nalidix acid; nitrofurantoin; chloramphenicol; antimalarials; vit K analogs; ASA; benzene; naphthalene

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enzyme deficient in PKU

phenylalanine HYDROXYLASE

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most common manifestation of PKU without treatment

developmental delay

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unpleasant musty odor; severe vomiting; hypertonic; hyperactive DTR’s; seizures in infant

PKU

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defective enzyme in Maple Syrup urine dse causing buildup of leucine; isoleucine; and valine

alpha ketoacid dehydrogenase

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flat blue gray with well-define margins in NB

mongolian spot

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small papules or pustules on an erythematous base filled with eosinophils

erythema toxicum

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small inclusions cysts; pearly white; usually on the face

milia

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lacy pattern on the skin similar to cobblestones; vasomotor response to cold stress

cutis mamorata

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open and closed comedones from circulating androgens

neonatal acne

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subperiosteal bleed due to birth trauma; does NOT cross suture lines

cephalhematoma

swelling of the scalp due to birth trauma; involves the presenting part; CROSSES suture lines

caput succedaneum

arm adducted; pronated; and internally rotated; (C5-C6 involvent); if with C4 involvement there is ipsilateral diaphragmatic paralysis

Erb-Duchenne palsy

claw hand; (C8-T1 involvement; if with T1 sympathetic fibers involvent: Horner Syndrome)

Klumpke palsy

reflex present at 4-6mos of life; arms adduct and extend; hands open; legs flex when loweing the entire body abruptly while the baby is supine and head; back; and legs supported

Moro reflex

most commonly fractured bone during delivery

clavicle

defect in the lid (small notch to a large cleft)

coloboma

incomplete closure of branchial clefts

branchial cleft cyst

cystic dilatation of thyroglossal duct remnants; seen in the midline

thyroglossal duct cyst

incomplete closure of the umbilical ring; associated with diastasis recti

umbilical hernia

herniation of peritoneum and abdominal contents at the base of the umbilicus; with sac

omphalocele

herniation without a sac; defect lateral to the umbilius

gastroschisis

urethral opening on the dorsal penis

epispadia

urethral opening on the ventral penis; more common

hypospadia

accumulation of fluid in the tunica vaginalis; resolves by 12mos old

hydrocele

timing of surgery in undescended testes

not later than 9-15mos old(majority descends in the first 3mos; if not; it will remain undescended)

aka IUGR;BW<3rd percentile

SGA

symmetric IUGR;earlier onset

associated with dse seriously affects fetal cell number like chromosomal; genetic malformation; teratogenc; infectious; severe maternal HTN

assymetric IUGR;late onset

associated with poor maternal nutrition or late onset/exacerbation of maternal vascular dse

hypoglycemic; plethora; increase risk of: RDS; congenital heard dse; lumbosacral agenesis; hyperbilirubinemia

LGA

increased surface tension causes alveolar collpase and V/Q mismatch and hypoia; seen in preterms

RDS I

term; delivered by C-section; resolves in 4-5days; overaeration and flat diaphragm

Transient Tachypnea of the newbord (RDS II)

causes pulmonary hypoplasia; scaphoid abdomen; bowel sounds heard over the chest

diaphragmatic hernia

most common cause of persistent pulmonary hypertension of the newborn

meconium aspiration syndrome

presents after 48th hr of life; TB increases not > 5mg/dL/day; TB peaks at 14-15 mg/dL; DB<10% of TB

Physiologic jaundice

presents in the 1st 24 hrs of lfe; TB increases by >0.5 mg/dL/hr; TB increases to >15mg/dL; DB>10% of TB

Pathologic jaundice

onset at 3-4DOL; 13% of breastfed infants; accentuated unconjugated hyperbilirubinemia; decreased milk intake; reduced caloric intake; few days duration

breastfeeding jaundice

onset after 7th DOL; increased B1 in 2% of breastfed infants; presence of glucoronidase in some breast milk

breast milk jaundice

how to reduce incidence of breastfeeding jaundice

frequent breastfeeding(>10/24hrs); rooming-in with night feeding; discouraging D5% or water supplementation; ongoing lactation support

lab test requested for indirect hyperbilirubinemia in NB

Coomb's test

(+) Coomb's test in indirect hyperbilirubinemia

Isoimmunization (Rh/ABO incompatibility)

(-) Coomb's test with increased Hb in indirect hyperbilirubinemia

polycythemia; twin-twin/ maternal-fetal transfusion; IDM

intrahepatic causes of direct hyperbilirubinemia

sepsis/TORCHS; prolonged TPN; hypothyroidism; galactosemia; cystic fibrosis; alpha-1-antitrypsin deficiency

extrahepatic causes of direct hyperbilirubinemia

choledochal cyst; biliary atresia

most common cause of hemolytic disease in the NB; most cases are mild; jaundice; mild hepatosplenomegaly; phototherapy is benificial

ABO incompatibility

rarely occurs in the 1st pregnancy due to too late for the mother to become sensitized and transmit antibody to her infant before delivery

Rh incompatibility

(-) Coomb's test with normal/decreased Hb and normal reticulocyte counts in indirect hyperbilirubinemia

enclosed hemorrhage;increased enterohepatic circulation;decreased calories(breastfeeding jaundice);disorders of conjugation(breastmilk jaundice)

(-) Coomb's test with normal/decreased Hb and increased reticulocyte count in indirect hyperbilirubinemia

with characteristic rbc morpholgy(spherocytosis;elliptocytosis); with noncharacteristic RBC morphology(G6PD deficiency; purvate kinase deficiency)

early sepsis

birth to 7th day of life

late sepsis

8th to 28day of life

risk factors for developing neonatal sepsis

maternal infection during pregnancy; PPROM(18hrs); prematurity(MC predisposing factor for infxn)

common organisms implicated in sepsis

GBS; E. coli; Listeria monocytogenes; HSV; enteroviruses

gold standard in the diagnosis of neonatal sepsis

blood and urine cultures

Tx for neonatal sepsis

ampicillin + 3rd gen cephalosporin or aminoglycoside; supportive

infection from ingestion of infected raw meat; handling cat feces

Toxoplasmosis

classic triad of toxoplasmosis

HYDROCEPHALUS; chorioretinitis; intracranial calcifications

Tx for Toxoplasmosis

Pyremethamine and sulfonamide

IUGR; cataracts; congenital heart dse(PDA); MR< deafness; blueberry muffin

Rubella

most common congenital infection

CMV

may cause chorioretinitis; microcephaly; periventricular calcifications

CMV

Tx for CMV

Ganciclovir

Tx for HSV

Acyclovir; deliver by C-section if with active lesions

maculopapular rash; snuffles; periostitis of long bones; hepatosplenomegaly

early stage(<2 yrs) syphilis

Hutchinson teeth; saddle nose

Late stage(>2yrs) syphilis

Tc for syphilis

Penicillin

most common life threatening emergency of the GIT in neonates

NEC

location of NEC

distal ileum and proximal colon

greatest risk factor in developing NEC

prematurity

initially presents as abdominal distention; gastric retention; lethargy; temperature instability; bloody stools in 25% of patients; progresses to bowel perforation; peritonitis; SIRS; shock; death

NEC

AXR finding in NEC

pneumatosis intestinalis

indications for surgery in NEC

evidence of perforation; failure of medical mgt; single fixed bowel loop on Xray; abdominal wall erythema; palpable mass