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Neonatology Flashcards

1
Q

What does APGAR stand for? What is the scale?

A 
Appearance
Pulse
Grimace
Activity/muscle tone
Respirations
graded from 0-2. 10 is possible, but usu only get 9 b/c acrocyanosis is common.
7 & over is normal
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2
Q

What is a O, 1, 2 for: appearance?

A

0: blue all over
1: acrocyanosis
2: pink all over

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3
Q

What is 0, 1, 2 for pulse?

A

0: pulseless
1: HR100

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4
Q

What is 0, 1, 2 for grimace?

A

0: nothing
1: grimace
2: cough, sneeze, cry

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5
Q

What is 0, 1, 2 for activity/muscle tone?

A

0: absent
1: some flexion
2: spontaneous movement

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6
Q

What is 0, 1, 2 for respirations?

A

0: absent
1: irregular or slow
2: regular

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7
Q

When do neonates need to be put on positive pressure ventilation?

A

HR

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8
Q

When might you need to start chest compressions on a neonate?

A

when their HR

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9
Q

What are some risk factors for respiratory distress syndrome in neonates?

A

prematurity: decreased surfactant

gestational diabetes: also don’t produce a whole lot of surfactant for some reason.

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10
Q

What is a quick rule of thumb for pathologic jaundice?

A

first day of life: Bili>12
direct bili>2
rise of >5/d

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11
Q

What are some possible causes of direct hyperbilirubinemia?

A

hypothyroidism
galactosemia
choledochal cyst
cystic fibrosis

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12
Q

What is the definition of neonatal polycythemia?

A

term infants

Hct>65%

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13
Q

What are some possible causes of polycythemia in neonates?

A 
increased EPO from intrauterine hypoxia
**maternal diabetes
*maternal HTN
*smoking
*IUGR
Erythrocyte transfusion
*delayed cord clamping
*twin twin transfusion
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14
Q

What is the clinical presentation of neonatal polycythemia?

A 
ruddy skin
hypoglycemia
respiratory distress
cyanosis
apnea, irritability, jitteriness
abdominal distention
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15
Q

What is the treatment for neonatal polycythemia?

A

partial exchange transfusion

remove blood, infuse normal saline

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16
Q

What’s the deal with persistent pulmonary HTN after birth?

A

pulmonary vascular resistance remains high after birth

vasoconstriction worsened by hypoxia, hypercapnia, acidosis

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17
Q

What is the clinical presentation of persistent pulmonary HTN in a neonate?

A 
tachypnea 
nasal flaring
grunting
tachycardia
cyanosis
tricuspid regurg (systolic murmur)
signs of RV failure: hepatomegaly, decreased peripheral pulses.
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18
Q

What is the workup and treatment for persistent pulmonary HTN?

A

echo
CXR (poorly perfused lungs)
oxygen, nitric oxide
ECMO (extra corporeal membrane oxygenation)

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19
Q

Respiratory distress syndrome aka _____
seen in premature infants age ________
from decreased ________

A

hyaline membrane disease
premies age 24-37 wks
decreased surfactant (L:S

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20
Q

What is the presentation, workup, and treatment of respiratory distress syndrome?

A

tachypnea, nasal flaring, bad sats, grunting
make sure you evaluate for sepsis
give surfactant, CPAP, maybe intubation if it is really bad.

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21
Q

What is transient tachypnea of the newborn?

A

kind of RDS for term infants
caused by pulmonary edema from decreased clearance of fetal lung fluid (will see fluid on CXR)
biggest risk factor: C-sections

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22
Q

What is the presentation of transient tachypnea of newborn?

A

unlike, RDS, grunting is uncommon.
RR 60-80
hypoxia must be correctable by

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23
Q

What is the workup and treatment of transient tachypnea of the newborn?

A

workup: sepsis r/o, CXR
treatment: supportive care, CPAP

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24
Q

What is the presentation of congenital diaphragmatic hernia?

A

resp distress
scaphoid abdomen
heart sounds may be shifted
cyanosis

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25
What is the workup for congenital diaphragmatic hernia?
CXR ABG karyotyping (why) also well visualized on newborn U/s
26
What is the treatment for congenital diaphragmatic hernia?
``` intubation replogle tube (used to drain saliva--nose and esophagus) try to avoid bag and mask repair defect days later in case of pneumothorax-chest tube. ```
27
What is Fryn's syndrome?
``` abnormal facies small thorax wide-spaced nipples distal limb and nail hypoplasia diaphragmatic hernia with pulmonary hypoplasia ```
28
What is bronchopulmonary sequestration?
a mass of lung tissue that receives its blood supply from the aorta doesn't communicate with tracheobronchial tree has atelectasis all the time and gets cysts CXR: oval base lung mass on one side of the chest.
29
What's a weird thing that can happen to your voice during delivery?
recurrent laryngeal nerve damage | soft, hoarse cry with stridor.
30
What is apnea of prematurity?
cessation of breathing >20 s OR cessation of breathing w/ bradycardia, oxygen desat. this is only a possible diagnosis >24 hours old
31
Apneic spells in the first 24 hours of life is considered what?
neurology abnormality | OR infection
32
What is the treatment for apnea of prematurity?
oxygen nasal cannula methylxanthines (PDE inhibitors) CPAP if necessary
33
What is the definition of neonatal hypoglycemia?
34
What is the presentation of neonatal hypoglycemia?
hypotonia jitteriness apnea or tachypnea seizures
35
What are some causes of neonatal hypoglycemia?
``` maternal diabetes prematurity growth failure perinatal asphyxia (anaerobic metabolism depletes glucose) cold stress sepsis Beckwith Wiedemann nesidioblastosis galactosemia/hypopituitarism ```
36
What is the treatment for neonatal hypoglycemia?
``` breast/bottle feeds single bolus D10W or IV glucose infusion If due to hyperinsulinemia: corticosteroids diazoxide ```
37
What are the features of Beckwith-Wiedemann syndrome?
hypoglycemia (from too much insulin islet cell hyperplasia) visceromegaly macroglossia omphalocele
38
What is nesidioblastosis?
pancreatic islet cell hyperplasia
39
What is retinopathy of prematurity?
extraretinal fibrovascular proliferation can cause retinal detachment and blind screen
40
What is periventricular leukomalacia?
associated with cerebral palsy damage to white matter around ventricles from hypoxia, ischemia, inflammation
41
What do you use to treat Group B strep infections?
ampicillin and gentamicin
42
What is antenatal hydronephrosis?
presents with uti, dehydration, ftt, sepsis, rds | ddx: cystic kidney disease, kidney stones
43
What are the most common causes of newborn hydronephrosis?
``` #1: posterior urethral valves #2: ureteropelvic junction obstruction #3: ureterovesicle junction obstruction #4: ureterocele ```
44
What is the workup for newborn hydronephrosis?
Always renal ultrasound first if enlarged-antibiotic prophylaxis voiding cystourethrogram: detects vesicoureteral reflux if reflux is found-->antibiotic prophylaxis.
45
What's the deal with intraventricular hemorrhage in newborns?
more common in infants
46
What is the presentation of intraventricular hemorrhage?
``` bulging anterior fontanels seizures hyperglycemia acidosis drop in H&H looks like meningitis w/o nuchal rigidity or fevers ```
47
What is the workup for intraventricular hemorrhage?
head U/S. serial. also can do CT/MRI may need therapeutic lumbar taps to remove fluid or VP shunt even
48
What is neonatal alloimmune thrombocytopenia?
ITP in neonates
49
What are some causes of cyanosis in a newborn?
heart: Transposition of the great vessels coarctation of the aorta total anomalous pulmonary venous return lungs: primary pulm disease, pulmonary htn neuromuscular conditions (spinal muscular atrophy type I-decreases resp drive)
50
When should you think about a cyanotic congenital heart defect? WHat is the first thing you should do when you think that?
cyanosis w/o resp distress!! | give PGE1 to keep PDA open.
51
How can you determine pulm HTN in newborn?
has something to do with putting pulse ox on R hand and puls ox on feet. 15%?
52
What is the workup of a cyanotic newborn?
100% O2-no improvement if heart neuromusc-order CPK CSF and serum pyruvate/lactate ratio genetic tests
53
What are some causes of hypotonia in a newborn?
``` down's prader willi tay sachs botulism benign neonatal hypotonia zellweger syndrome hypothryoidism galactosemia ```
54
What are some causes of floppy baby?
tay sachs | botulism
55
What is necrotizing enterocolitis?
premature infants that are first fed, esp on formula get feeding intolerance and abdominal distention platelets drop b/c they are septic
56
What is the treatment for necrotizing enterocolitis?
stop feeding IVF antibiotics monitor via Dx abd if there are surgical indications
57
What are some surgical indications for necrotizing enterocolitis?
pneumoperitoneum intestinal pneumatosis (gas in bowel wall) air in portal vein abdominal wall erythema
58
What are 2 bad conditions that you can get neonatal constipation from? suspect if you don't pass meconium in the first 24-48 hours...
hirschsprung's | cystic fibrosis
59
What is the cause of Hirschsprung dx?
failure of migration of ganglionic cells | usu at about the rectosigmoid colon--chronically contracted!!
60
What is the presentation of Hirschsprung dx?
``` failure to pass meconium within 48 hours obstruction with feeding vomiting abdominal distention feel stool on abdominal exam, no stool on digit rectal exam ```
61
What are some possible complications in Hirschsprung dx?
enterocolitis bowel perforation bloody diarrhea shock
62
What is the workup for Hirschsprung dx?
obstruction series manometry of anus (balloon inflated in rectum and failure of internal sphincter to relax) colonoscopy with full thickness biopsy to see if the ganglionic cells are there.
63
What is the treatment for Hirschsprung dx?
2 part surgery diverting colostomy get rid of aganglionic colon, reconnect the pieces.
64
What is meconium ileus?
seen in babies with cystic fibrosis | feeding intolerance, bilious vomiting
65
What is the workup and treatment for meconium ileus?
xray: multiple dilated small loops of bowel ground glass look in lower avdomen tx: gastrograffin enema (softens pellets-diagnostic and therapeutic)
66
T/F Direct hyperbilirubinemia is sometimes physiologic.
False. always pathologic. watch for DB>2.
67
What are the most common causes of neonatal direct hyperbilirubinemia?
1. biliary atresia 2. idiopathic neonatal hepatitis A1AT Alagille choledochal cyst
68
What is the workup for direct hyperbilirubinemia?
``` GGT CBC infectious disease titers U/S sweat test percutaneous liver biopsy--only way to distinguish idiopathic neonatal hepatitis and biliary atresia. ```
69
What is the presentation of biliary atresia?
``` jaundice past 2 weeks pale stool dark urine hepatomegaly increased direct bilirubin ```
70
What would the imaging show for biliary atresia?
HIDA hepatobiliary scintography | following 1 wk phenobarbital-->uptake in liver w/o excretion.
71
What is the treatment for biliary atresia?
extrahepatic bile duct excision jejunum-->fibrotic porta hepatis (Kasai procedure) if that fails: liver transplant
72
What is the etiology of choledochal cysts?
congenital malformation pancreatic bile duct is messed up-->so you get reflux into biliary system obstruction of distal common bile duct.
73
What is the presentation of choledochal cysts?
increased direct bilirubin | intermittent abdominal pain w/ or w/o intermittent jaundice
74
What is the workup and treatment of choledochal cysts?
U/s in younger children MRCP and ERCP in older children tx: complete excision possible reconnection of the bile duct to the jejunum?
75
What is biliary hypoplasia associated with? What is it due to? What is its presentation?
associated w/ alagille's syndrome not enough intrahepatic bile ducts can be asymptomatic!
76
What is the treatment of biliary hypoplasia?
medical management | portoenterostomy if severe
77
What is inspissated bile syndrome?
mechanical obstruction of bile duct (thick sludge)
78
What are causes of inspissated bile syndrome?
things that can cause thick sludge... hemolysis 2/2 blood group incompatibility cystic fibrosis (not enough pancreatic secretions) parenteral nutrition
79
alpha 1 at can be associated with what biliary thing?
cholestasis
80
What are 2 important ways that cystic fibrosis may present in infant age children?
meconium ileus | cholestasis
81
What is the timeframe of breastfeeding failure jaundice and breast milk jaundice?
breast milk jaundice: starts at 3-5 days, peaks at 2 weeks breast feeding failure jaundice: first week of life. will also see signs of dehydration. may see brick red urate crystals in the diaper **seems like feeding failure comes first!

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