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PEDS > Neonatology > Flashcards

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
Q

What is the workup for congenital diaphragmatic hernia?

A

CXR
ABG
karyotyping (why)
also well visualized on newborn U/s

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26
Q

What is the treatment for congenital diaphragmatic hernia?

A 
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.
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27
Q

What is Fryn’s syndrome?

A 
abnormal facies
small thorax
wide-spaced nipples
distal limb and nail hypoplasia
diaphragmatic hernia with pulmonary hypoplasia
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28
Q

What is bronchopulmonary sequestration?

A

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.

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29
Q

What’s a weird thing that can happen to your voice during delivery?

A

recurrent laryngeal nerve damage

soft, hoarse cry with stridor.

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30
Q

What is apnea of prematurity?

A

cessation of breathing >20 s
OR cessation of breathing w/ bradycardia, oxygen desat.
this is only a possible diagnosis >24 hours old

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31
Q

Apneic spells in the first 24 hours of life is considered what?

A

neurology abnormality

OR infection

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32
Q

What is the treatment for apnea of prematurity?

A

oxygen nasal cannula
methylxanthines (PDE inhibitors)
CPAP if necessary

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33
Q

What is the definition of neonatal hypoglycemia?

A
34
Q

What is the presentation of neonatal hypoglycemia?

A

hypotonia
jitteriness
apnea or tachypnea
seizures

35
Q

What are some causes of neonatal hypoglycemia?

A 
maternal diabetes
prematurity
growth failure
perinatal asphyxia (anaerobic metabolism depletes glucose)
cold stress
sepsis
Beckwith Wiedemann
nesidioblastosis
galactosemia/hypopituitarism
36
Q

What is the treatment for neonatal hypoglycemia?

A 
breast/bottle feeds
single bolus D10W
or IV glucose infusion
If due to hyperinsulinemia:
corticosteroids
diazoxide
37
Q

What are the features of Beckwith-Wiedemann syndrome?

A

hypoglycemia (from too much insulin islet cell hyperplasia)
visceromegaly
macroglossia
omphalocele

38
Q

What is nesidioblastosis?

A

pancreatic islet cell hyperplasia

39
Q

What is retinopathy of prematurity?

A

extraretinal fibrovascular proliferation
can cause retinal detachment and blind
screen

40
Q

What is periventricular leukomalacia?

A

associated with cerebral palsy
damage to white matter around ventricles
from hypoxia, ischemia, inflammation

41
Q

What do you use to treat Group B strep infections?

A

ampicillin and gentamicin

42
Q

What is antenatal hydronephrosis?

A

presents with uti, dehydration, ftt, sepsis, rds

ddx: cystic kidney disease, kidney stones

43
Q

What are the most common causes of newborn hydronephrosis?

A 
#1: posterior urethral valves
#2: ureteropelvic junction obstruction
#3: ureterovesicle junction obstruction
#4: ureterocele
44
Q

What is the workup for newborn hydronephrosis?

A

Always renal ultrasound first
if enlarged-antibiotic prophylaxis
voiding cystourethrogram: detects vesicoureteral reflux
if reflux is found–>antibiotic prophylaxis.

45
Q

What’s the deal with intraventricular hemorrhage in newborns?

A

more common in infants

46
Q

What is the presentation of intraventricular hemorrhage?

A 
bulging anterior fontanels
seizures
hyperglycemia
acidosis
drop in H&H
looks like meningitis w/o nuchal rigidity or fevers
47
Q

What is the workup for intraventricular hemorrhage?

A

head U/S. serial.
also can do CT/MRI
may need therapeutic lumbar taps to remove fluid or VP shunt even

48
Q

What is neonatal alloimmune thrombocytopenia?

A

ITP in neonates

49
Q

What are some causes of cyanosis in a newborn?

A

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
Q

When should you think about a cyanotic congenital heart defect? WHat is the first thing you should do when you think that?

A

cyanosis w/o resp distress!!

give PGE1 to keep PDA open.

51
Q

How can you determine pulm HTN in newborn?

A

has something to do with putting pulse ox on R hand and puls ox on feet.
15%?

52
Q

What is the workup of a cyanotic newborn?

A

100% O2-no improvement if heart
neuromusc-order CPK
CSF and serum pyruvate/lactate ratio
genetic tests

53
Q

What are some causes of hypotonia in a newborn?

A 
down's
prader willi
tay sachs
botulism
benign neonatal hypotonia
zellweger syndrome
hypothryoidism
galactosemia
54
Q

What are some causes of floppy baby?

A

tay sachs

botulism

55
Q

What is necrotizing enterocolitis?

A

premature infants that are first fed, esp on formula
get feeding intolerance and abdominal distention
platelets drop b/c they are septic

56
Q

What is the treatment for necrotizing enterocolitis?

A

stop feeding
IVF
antibiotics
monitor via Dx abd if there are surgical indications

57
Q

What are some surgical indications for necrotizing enterocolitis?

A

pneumoperitoneum
intestinal pneumatosis (gas in bowel wall)
air in portal vein
abdominal wall erythema

58
Q

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…

A

hirschsprung’s

cystic fibrosis

59
Q

What is the cause of Hirschsprung dx?

A

failure of migration of ganglionic cells

usu at about the rectosigmoid colon–chronically contracted!!

60
Q

What is the presentation of Hirschsprung dx?

A 
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
Q

What are some possible complications in Hirschsprung dx?

A

enterocolitis
bowel perforation
bloody diarrhea
shock

62
Q

What is the workup for Hirschsprung dx?

A

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
Q

What is the treatment for Hirschsprung dx?

A

2 part surgery
diverting colostomy
get rid of aganglionic colon, reconnect the pieces.

64
Q

What is meconium ileus?

A

seen in babies with cystic fibrosis

feeding intolerance, bilious vomiting

65
Q

What is the workup and treatment for meconium ileus?

A

xray: multiple dilated small loops of bowel
ground glass look in lower avdomen

tx: gastrograffin enema (softens pellets-diagnostic and therapeutic)

66
Q

T/F Direct hyperbilirubinemia is sometimes physiologic.

A

False. always pathologic. watch for DB>2.

67
Q

What are the most common causes of neonatal direct hyperbilirubinemia?

A
  1. biliary atresia
  2. idiopathic neonatal hepatitis
    A1AT
    Alagille
    choledochal cyst
68
Q

What is the workup for direct hyperbilirubinemia?

A 
GGT
CBC
infectious disease titers
U/S
sweat test
percutaneous liver biopsy--only way to distinguish idiopathic neonatal hepatitis and biliary atresia.
69
Q

What is the presentation of biliary atresia?

A 
jaundice past 2 weeks
pale stool
dark urine
hepatomegaly
increased direct bilirubin
70
Q

What would the imaging show for biliary atresia?

A

HIDA hepatobiliary scintography

following 1 wk phenobarbital–>uptake in liver w/o excretion.

71
Q

What is the treatment for biliary atresia?

A

extrahepatic bile duct excision
jejunum–>fibrotic porta hepatis (Kasai procedure)
if that fails: liver transplant

72
Q

What is the etiology of choledochal cysts?

A

congenital malformation
pancreatic bile duct is messed up–>so you get reflux into biliary system
obstruction of distal common bile duct.

73
Q

What is the presentation of choledochal cysts?

A

increased direct bilirubin

intermittent abdominal pain w/ or w/o intermittent jaundice

74
Q

What is the workup and treatment of choledochal cysts?

A

U/s in younger children
MRCP and ERCP in older children
tx: complete excision
possible reconnection of the bile duct to the jejunum?

75
Q

What is biliary hypoplasia associated with? What is it due to? What is its presentation?

A

associated w/ alagille’s syndrome
not enough intrahepatic bile ducts
can be asymptomatic!

76
Q

What is the treatment of biliary hypoplasia?

A

medical management

portoenterostomy if severe

77
Q

What is inspissated bile syndrome?

A

mechanical obstruction of bile duct (thick sludge)

78
Q

What are causes of inspissated bile syndrome?

A

things that can cause thick sludge…
hemolysis 2/2 blood group incompatibility
cystic fibrosis (not enough pancreatic secretions)
parenteral nutrition

79
Q

alpha 1 at can be associated with what biliary thing?

A

cholestasis

80
Q

What are 2 important ways that cystic fibrosis may present in infant age children?

A

meconium ileus

cholestasis

81
Q

What is the timeframe of breastfeeding failure jaundice and breast milk jaundice?

A

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!

PEDS (14 decks)

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