Neonatology

Question 1

APGAR Criteria

Answer 1

Appearance: cyanosis, acrocyanosis, pink
Pulse: none, 100
Grimace: absent, grimace, active cry
Activity: limp, hypotonic/flexed, active
Resp: none, irregular, regular

<7 - eval and intervene, 7-9 normal

Question 2

Cephalohematoma

Answer 2

Subperiosteal bleed confined to the surface of one cranial bone
No overlying color changes
Usually spontaneously resolves
May create transient indirect hyperbilirubinemia responsive to phototherapy

Question 3

Caput Succedaneum

Answer 3

Diffuse, dark, edematous swelling of scalp soft tissue that extends across sutures

Question 4

Complications of Shoulder Dystocia

Answer 4

Clavicle Frx - no tx needed, crepitus over frx, decreased moro
Humerus Frx - decreased moro and normal reflex (grip and bicep)
Erb Duchenne - decreased moro and bicep, normal grasp, waiters tip position
Klumpke - nl. moro and bicep, claw hand, possible horners

Question 5

Early Onset IUGR

Answer 5

Type of small for gestational age (<10%ile)
Symmetrical - body is proportionally small
Mother with HTN, vascular disease, congenital malformations, chromosomal abnormalities

Question 6

Late Onset IUGR

Answer 6

Type of small for gestational age (<10%ile)

Asymmetrical - normal head circum. with low weight/height

Question 7

Polyhydramnios

Answer 7

Greater than 2L amniotic fluid
Seen with gestational diabetes, abdominal wall defects, T18/21, anencephaly, meningomyelocele (fetus cannot swallow properly to regulate fluid volume)

Question 8

Oligohydramnios

Answer 8

Potter Sequence: Associated with IUGR, amniotic fluid leak, and congenital kidney problems
Kidneys don’t produce enough urine so there is less amniotic fluid
Uterine compression leads to immature lungs

Question 9

Neonatal RDS

Answer 9

AKA Hyaline Membrane Disease
Maternal diabetes, prematurity are risk
Poor surfactant production leads to alveolar collapse, diffuse atelectasis, shunting, hypoxemia, increased WOB, lecithin:sphingomyelin <2, reticulonodular/ground glass opacities on CXR
Low FiO2 (BPD, retinopathy of prematurity), artificial Surf, steroids

Question 10

Persistent Pulmonary Hypertension of the Newborn

Answer 10

Failure of the resistance of the pulmonary vasculature to fall after birth
Right to left shunting via PFO, PDA leading to hypoxemia
Meconium aspiration, RDS, T21, diaphragmatic hernia
Inhaled NO, supplemental O2

Question 11

Neonatal Hyperbilirubinemia

Answer 11

Increase indirect bili. from higher [Hb], decreased UDP glucuronylxferase activity, and increased enterohepatic circling

Indirect - physiologic or pathologic, risk of kernicterus (BG, Hip damage), phototherapy and exchange transfusion

Direct - always pathologic (concern for anatomic obstruction)

Question 12

NEC

Answer 12

CHD, prematurity, enteral feeding are risks
Vital sign instability, vomiting, bloody stools, pneumatosis intestinalis, pneumperitoneum, distended and tender abdomen are all s/sx
Bowel rest, support, Abx, +/- surgery

Question 13

Intraventricular Hemorrhage

Answer 13

Premature infants
Vessel fragility in the intraventricular germinal matrix
Lethargy, hypotonia, poor feeding, bulging fontanelles, aenmia, seizures, apnea, met acid
US through anterior fontanelle

Question 14

Hypoxic Ischemic Encephalopathy (HIE)

Answer 14

Ischemic reperfusion injury
Neonatal seizures, absent moro grasp and gag reflex, hypotonia, apnea
Normal neuro exam at 1 week is best prognostic factor