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Special Pops- Peds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Assessment of Fetal Maturation

A

New Ballard Score→ takes into account Physical Maturity Signs such as→ skin, lanugo (fine, soft hair on newborn), plantar surface, breast, eye/ear, genitals→ added up, total score should correlate to weeks of age.

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2
Q

Major Reason for Large Neonatal size (Infants large for gestational Age-IGA

A

infant of DM mother. Mother’s blood sugar is high and crosses placenta, baby releases insulin as a result→ insulin is a growth hormone= large baby

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3
Q

Reasons for Small gestational age (SGA)

A
  • Asymmetrical→ placental insufficiency (maternal vascular dz—HTN), poor weight gain during pregnancy, multiple gestations
  • Symmetrical→ protoplasm was effected→ drugs, alcohol, chromosomal abnormalities, infections
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4
Q

Apgar Score

A

asses condition of new born at birth, has best predictability for neurologic injury at 10 min
activity, pulse, grimace, appearance, resp

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5
Q

Newborn Reflexes

A

check to see that reflex is present and if it is asymmetrical→ sucking, rooting (head turns to focal stimulus), traction, palmar grasp, DTR, moro/startle, tonic neck

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6
Q

Contraindications for early newborn discharge

A

jaundice@ 24 hr, risk of infection, reason to believe child will withdraw, cleft lips, less than 38 wks, less than 6lb, not feeding, multiple births

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7
Q

Acute Bilirubin Encephalopathy

A

• SX→ lethargy, poor feeding, irritability, arching neck, apnea, seizures

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8
Q

Chronic Bilirubin Encephalopathy

A

• Extrapyramidal movement disorder, gaze problems, hearing probs, dysplasia of enamel

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9
Q

Hypoglycemia

A

<45mg/dl→ stressed infants at risk
• SX→ lethargy, poor feeding, irritability, seizures
• Mother is DM, baby’s BS rises, insulin is released→ birth, insulin still being released→ BS crashes
• Reduced fetal hyperinsulemia
• TX→ feed if 20-45 w/no sx
o If under 45 w/sx= give D10W (bolus then infusion)
o If under 20 → give D10W (bolus then infusion)

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10
Q

Respiratory Distress

A

tachypnea over 60, retractions, cyanosis
• Can be pulmonary, sepsis, cardio.
• Should get CXR, ABG/CBG

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11
Q

Neonatal Murmurs

A

if present at birth= valvular.
• Turbulent blood flow, change in vascularity, change in how fast blood goes across a valve, neonates are changing so rapidly
• After 24 hrs if murmur present→ BP in R arm and LE (looking for coarctation of aorta)
• D/C new born with F/U
• If NB isn’t feeding well and/or cyanotic→ could be CHF

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12
Q

Birth Trauma

A

difficult delivery
• Often larger birth weight, abnormal presenting position
• Soft tissue, bruising, fractures, cervical plexus palsies, intracranial hemorrhage, subglial hemorrhage, caput, cephalohematoma, subgleal

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13
Q

Infants of mothers who abuse drugs

A
  • Coke & meth→IUGR, premature delivery, withdrawal (irritability)
  • Opiods→hyperactivity, hypertonicity, tremors, seizures, GI probs, nasal stuffiness, sneezing, IUGR
  • Tobacco→ IUGR
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14
Q

Birth Asphyxia

A

become hypoxic, become bradycardic

• D/T→ acute interruption of umbilical blood flow, maternal hypotension/hypoxia, chronic placental insufficiency

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15
Q

Monochorial Twins

A

monozygous, same sex, diamniotic/monoamniotic→ risk of twin-twin transfusion= congential abnormalities, CP. One could steal all the food and hemoglobin from the other

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16
Q

Dichorial Twins

A

can be same sacks or different sacks, same or different sex, not at risk for transfusions syndrome

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17
Q

Complications of multiple births

A

IUGR, twin-twin transfusion, CP, birth weights that are significantly different, preterm delivery, extra amniotic fluid (polyhydramnios), premature rupture of membranes, abnormal fetal presentations, prolapsed umbilical cord

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18
Q

Apnea of Prematurity

A

no breath for 20 seconds
• Could be temp related (heat, cold), vagal response to feeding tube, GERD, pulm dz, PDA, hypoglycemia, infection, intracranial hemorrhage (scan head if you can’t figure out why they are apneic), seizures, drugs

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19
Q

RSD Type 1

A

surfactant deficiency in alveoli (either didn’t produce or inactivated d/t protein leak)
• CXR→ reticulogranular pattern (ground glass)
• TX→ antenatal corticosteroids, early intubation and surfactant→ proph in infants less than 27 weeks

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20
Q

Transient Tachypnea of Newborn (RDS type 2)

A
  • Often associated with c section, TX w/02 support

* On CXR will see interstitial edema, pleural effusions

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21
Q

Patent Ductus Arteriosus

A

presents on 3-7 days
• SX→ respiratory distress
• Tx→ medical ligation→ indomethacin
o Surgical

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22
Q

Bronchopulmonary Dysplasia

A

common in premies that required mechanical ventilation
• Pathology→ inflammation→hypercellularity→fibrosis
• Change in lung tissue from injury that occurs→ the damaged tissue is often replaced by new lung that does not have fibrosis→ as they get older so they tend to outgrow it
• On CXR→ see large cysts, not homogenous ground glass
• Tx→ surfactant use (early) glucocorticoid can help wean from ventilator, diuretics

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23
Q

Necrotizing Enterocolitis (NEC)

A

often premies w/sepsis getting gastric feeds presenting w/bloody stool, distension, penumatosis intestinalis (air developing in the gut wall).
• Often in premies under 4 lbs, and full term babies w/polycythemia
• Etiology→ can be d/t infection, immunological immaturity

24
Q

Necrotizing Enterocolitis (NEC) treatment

A

• Treatment→ NG tube, maintain ventilation/oxygenation, IV fluids (to replace third spaced fluids). Often need TPN.
o Surgery if perf, fixed dilated loop of bowel, abd wall cellulitis
o ABX→ broad spectrum

25
Q

Anemia in Preterm Infants

A

Sx→ poor feeding, lethargy, increased HR, poor weight gain, periodic breathing
• Sx present when hct is <20%
• Tx→ erythropoietin

26
Q

Intraventricular Hemorrhage

A

bleeding MC occurs in subependymal germinal matrix right along lateral ventricles. Hemonculus→ legs close to ventricles, so when ventricles dilate there is problem with the legs
MC in infants w/low gestational age (<26 wks)

27
Q

Intraventricular Hemorrhage Sx and Dx

A
  • Sx→ hypostension, metabolic acidosis, altered neurologic status,
  • Dx→ routine ultrasound if born before 32 weeks (US of anterior fontanelle)
28
Q

Retinopathy of Prematurity (ROP)

A

happens when pre mature retinal is not completely vascularized, triggered by insulin like growth factors
• abnormal vascularization can occur→ fibrovascular tissue in vitreous is associated w/inflammation, scarring, retinal folds/detachment

29
Q

Acyanotic Congenital Heart Lesions

A 
Most are left-sided outflow obstruction
•	Cant deliver enough flow to tissue, large heart, pulm edema, L→ shunting (sx don’t occur until pulm resistance goes up and you’re shunting more back over)
•	Clinical sx start @ 3-4 weeks
•	CXR= large heart
•	EKG= Diagnostic
30
Q

Treatment of Cyanotic & Acyanotic Lesions

A

Supportive (IV glucose, O2, vent)
• Prostaglandin E1 (maintain ductal patency) and improves systemic perfusion for left sided outflow tract obstruction
• Surgery & cardiac cath
• Prognosis depends on lesions, and complications from surgery

31
Q

Persistent Pulmonary HTN (Fetal circulation)

A

• TX→1st line: O2 and Vent. 2nd line: pressors (dopamine, dobutamine), correct metabolioc academia
o Nitric oxide, ECMO if still poorly oxygenated on vent
o Prognosis→ 10-15% of those that survive have neurologic deficits.

32
Q

bradyarrhythmias

A

congenital heart block
• Heart= structurally normal
• If its not fetal hydrops, then its well tolerated→ if CO is not enough may need pacing

33
Q

tachyarrhythmias

A

wide complex/V-Tach, narrow complex SVT is MC and can be d/t structural heart dz, myocarditis, left atrial enlargement, aberrant conduction pathway.
• TX→ acute: ice to face, IV adenosine

34
Q

2 types of intestinal obstruction

A
  • Duodenal Atresia→

* Malrotation & Volvulus→

35
Q

Malrotation & Volvulus

A

bilious vomiting in 1st week. Dilated stomach on x-ray, UGI shows displaced duodenojejunal jxn (twisted bowel)

36
Q

Duodenal atresia

A

downs (30-50%), early vomiting (sometimes bilious). Can see 2 bubbles (gastric and duodenal) on x-ray

37
Q

Tracheoesophageal Fistula

A

amniotic fluid is the baby’s pee, they swallow and digest it and the cycle continues/stay constant→ if they can’t swallow you have too much amniotic fluid (its not being digested by baby) if you have too little amniotic fluid the baby has a kidney prob (its not making urine)

38
Q

Tracheoesophageal Fistula Sx and Tx

A
  • Sx→ drooling, chocking on secretions/feedings, can pass orogastric tube
  • It’s a pouch with or w/out fistula connection between proximal and distal esophagus and airway
  • Tx→ surgery
39
Q

Intestinal Atresia & Stenosis

A

often Dx’d prenatally
• See dbl bubble on x-ray w/e bilious vomiting and distension
• Often has other congenital probs like cardiac & renal, downs syndrome
• Tx→ duodenoduodenotomy—bypasses the stenosis/atresia

40
Q

Intestinal Malrotation

A

presents in 1st 3 wks w/bilious vomiting, can have ascites, meconium
Will corckscrew in, the blood supply will be blocked and the child will get an ischemic bowel and could die
• Later presentation= obstruction, malabsorption, diarrhea
• Dx→ UGI is gold standard
• Tx→ surgical- ladd procedure

41
Q

Cystic Fibrosis

A 
autosomal recessive 
•	Causes defects in water and salt movement across cell membranes= thick secretions
o	Lung (mucus plug), GI (meconium ileus, pancreatic insufficiency) male infertility
42
Q

Presentation of CF

A

• Presentation→ FTT (failure to thrive) common. GI problem common 1st presenting sx
o Cough, wheezing, recurrent PNA, chronic airway infections in 1st yr
o On x-ray→ long, cylindrical filling in descending & sigmoid colon (large stool impaction)

43
Q

Ompalocele

A

membrane covered herniation of abd contents into umbilical cord
• Tx→ @ birth the cord is covered w/sterile dress, NG decrompression, IV fluids, ABX then surgery (primary closure)

44
Q

Gastroschisis

A

vascular: right side of umbilicus doesn’t form properly, bad because it has now been exposed to amniotic fluid
• Intestine extrudes through abd wall, evisecretion from abnormal involution of right umbilical vein or vacular accident
• Cause: environmental factors, use of drugs during pregnancy.
• Tx→ exposed bowel placed in bag, surgical of bowel back into the abd cavity.

45
Q

Perinatal infections

A
  • Blood-borne transplacental infection: CMV, rubella, syphilis
  • Ascending infection w/disruption of amniotic membrane: bacterial
  • Infection on passage through an infected birth canal: herpes, Hep B, HIV,
  • Some immunity is passed through placenta
46
Q

Neonatal meningitis

A

CSF protein >150mg/dl, glucose 25, grams stain confirmed by culture
• Patho→ MC is GBS and gram neg enteric bacteria
• Prognosis→ of the survivors: 33% have significant neurologic probs

47
Q

Neonatal PNA

A

can occur in utero or when coming through birth canal
• Presentation→ tachypnea, retractions, cyanosis= may need increased O2 or vent
• Patho→ bacteria (chlamydia) and viruses (CMV, respiratory syncytial virus, adenovirus, influenza, HSV, Para influenza)

48
Q

Neonatal UTI

A

uncommon, could suggest Gu abnormalities
• Patho→ enterococcus, gram neg enteric
• Tx→ IV abx

49
Q

Neonatal Omphalitis

A

cord colonized w/strep/staph/gram neg organisms
• Presentation→ edema/erythema
• Tx→ IV Abx (naficillin) or vanco and a 3rd gen ceph

50
Q

Neonatal Conjunctivitis

A
  • Patho→ Neisseria gonorrhea, chlamydia (from passage through birth canal)
  • Presentation→ 3-7 days post birth, purulent conjunctivitis
  • Tx→ IV or IM ceftriazone (gonorrhea) erythromycin (chlamydia)
51
Q

Vitamin K Deficiency→ Hemolytic Dz of Newborn

A
  • Presentation→ bleeding from mucous membrane, gi tract, skin, intracranial
  • Can be prevented w/prenatal vit K
52
Q

Neonatal Thrombocytopenia

A
  • Presentation→ petechiae, ozzing at cord. Platelets<10,000-20,000 (this is when sx occur)
  • Tx→ transfusion of platelets
53
Q

Neonatal Anemia Acute/Chronic/hemolytic presentations

A

hematocrit <40% @ birth
• Presentation
o Acute Blood Loss→tachycardia, poor perfusion, hypotension (sx of hypovolemia), reticulo count is normal
o Chronic Blood Loss→ pallor w/out hypovolemia (low hct and elevated reticulosis)
o Hemolytic Anemia→ accompanied by excessive hyperbilirubinemia

54
Q

Neonatal stroke

A
  • Focal Cerebral ischemic injury→ intraventricular hemorrhage, hypoxic ischemic encephalopathy
  • Associated with: maternal drug use, hx of infertility, preeclampsia, chorioamnionitis, prolonged membrane rupture
  • Presentation→ seizure
55
Q

Neonatal Renal Vein Thrombosis Presentation

A

o Presentation→IDM (insulin dependent mother), polycythemia, dehydration w/renal mass, oliguria/hematuria

56
Q

Neonatal Renal Failure Presentation and Dx

A

o Presentation→ birth depression, hypovolemia, hypotension, shock, rising SCr, hypokalemia, metabolic acidosis, fluid overload
• Dx→prenatal unltrasoundography

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