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Peds clerkship > Neonatology > Flashcards

Neonatology Flashcards

1
Q

important part of neonatal Hx

A
  1. maternal age
  2. GTPAL - grav, term, partity, abort, live
  3. planned/unplanned
  4. PMx
  5. blood type
  6. antenatal serology
  7. est. date
  8. screenings done
  9. infections
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2
Q

important part of L&D

A
  • labour type
  • rupture of membranes
  • vag. vs assisst vs CS
  • head or breech
  • date and time, BW, GA
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3
Q

parts of neonatal Hx

A
  • meconium, urine
  • feeding
  • issues - jaundice, poor feeds
  • disharge weight
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4
Q

neonate Phx

A

see p 175

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5
Q

important resp issues

A
  • lungs dev. surfactant at 24 weeks
  • dev. for 8 weeks after
  • need to overcome fluid for first breaths
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6
Q

fetal circ. pathway

A

placenta>umb vein>ductus venosus>IVC>RA>FO>LA>LV>aorta>brain>SVC>RA>RV>PA>10/5 lungs and rest to descending aorta

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7
Q

diff. in fetal circ and normal

A 
fetal
- high pulm R
- low systemic R
- placenta is resp
normal
- low pulm R
- high systemic R
- lung for resp
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8
Q

neonatal resus

A

P 178

  • stim for 30 seconds before assessing HR and RR
  • chest compression and epi for persistent brady
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9
Q

term age

A

37

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10
Q

3 etiology of prematurity and subtypes

A
  1. maternal
    - preeclampsia
    - infection
    - substances
    - trauma
    - illness
  2. placental
    - previa
    - abruption
    - 1st trimester bleed
  3. fetal
    - multi gestation
    - macrosomia
    - RBC isoimmunization
    - infeciton
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11
Q

causes of acute premature morbidity

A
  • asphyxia
  • hemmorage
  • RDS
  • patent DA
  • feed intolerance, NEC
  • sepsis
  • temp instability
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12
Q

def and mgmt of late preterm

A

34-36weeks

  • not necc. in NICU
  • observe carefully
  • at risk for readmission
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13
Q

2 most important outcomes of jaundice

A
  1. acute bili encephalopathy (ABE) - CLINICAL neuro state following jaundice
  2. kernicterus - NEUROPATH finding of staining of neruons in basal gang
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14
Q

2 main types of bili

A
  1. uncong

2. cong

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15
Q

2 types of uncong

A
  1. non-path
    - breastfeeding - dehydration from low intake
    - breast milk
  2. patho
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16
Q

2 main types of patho uncong

A
  1. hemolytic
    - intrinsic to RBC - defect, Hbopathies
    - etrinsic - ABO, frags
  2. non-hemolytic
    - sepsis
    - crigler najjar
    - cephalohematoma
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17
Q

4 main types of congugated

A
  1. anatomic
    - bilary atresia
    - cysts
  2. infecitons
    - sepsis, viral
  3. metabolic/endo
    - galactosemia
    - A1 anti-trypsin
  4. misc
    - long term TPN
    - hepatitis
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18
Q

features that indicate patho jaundice

A
  • at
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19
Q

risk factors for hyperbili

A
  • predischarge levels in high risk zone
  • first 24 hours
  • blood incompatible
  • GA
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20
Q

invest for jaundice

A
  • bb and mom ABO
  • DAT
  • CBC and diff
  • cong and uncong bili
  • G6PD
  • blood Cx if concerned about sepsis
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21
Q

mgmt of jaundice

A
  • phototherapy - use guildine nomogram for intensive (181)

- IVIG

22
Q

def. neotnatal sepsis

A

SIRS to infection

  • early - DOL 0-7
  • late 7-90
23
Q

neonate bugs especially

A
  • GBS
  • listeria
  • ecoli
  • GAS
  • Staph
24
Q

risk factors for sepsis (any 2 will increase)

A
  • > 18hr ROM
  • intrapartum temp >38
  • chorioamnionitis
  • maternal GBS
  • premature
  • perinatal asphyxia
  • male
25
Q

presentation of neonatal sepsis

A
  • often non-specific
  • poor feeds
  • low tone
  • fever
  • vomiting abdo dist
  • resp distress
  • tachy
26
Q

def. full septic W/U

A
  • blood Cx
  • urine Cx
  • LP
    possible
  • CXR, stool
27
Q

empiric Abx for sepsis

A
  • amp and cefotaxime - esp for meningitis
  • amp and genta if no FSWU performed
  • add vanco if suspect meningitis of lines in place
28
Q

what is hypoxic ischemic encephalopathy (HIE)

A
  • brian injury caused by reduction in blood supply to brain compounded by low blood flow to organs, in neonatal period
  • a leading cause of death and severe impariments
29
Q

3 main etiologies of HIE and subtypes

A
  1. maternal
    - cardiac arrest
    - asphyxiation
    - anaphylaxis
    - status epil
    - hypovolemic shock
  2. utreroplacental
    - abruption
    - cord prolapse
    - uterine rupture
    - hyperstim with oxytocic agents
  3. fetal
    - hemmorage
    - twin to twin transfusion
    - immune hemolytic disease
    - arrhytmias
30
Q

clincal manifestaions

A
  • low APGAR at delivery
  • met acidosis in cord
  • presence of neuro dysfunction (tone, power, reflexes)
  • injury to other organs
31
Q

invest for HIE

A
  • lytes, trops, renal, LFTs
  • brain MRI
  • EEG
32
Q

mgmt of HIE

A
  • initial resus
  • supportive measures
  • hypothermia - 33 degrees for 3 days
33
Q

clinical presentation of resp. distress

A
  • tachypnea
  • pachy
  • duskiness
  • all the usual
34
Q

3 most common cause of resp. distress and 3 less common

A
  1. transient tachypnea of newborn
  2. RDS
  3. meconium aspiration
    less common
  4. infection
  5. non-pulm
  6. persistent pulm hypertension
35
Q

investigations for resp .distress

A
  1. labs - CBC lytes, RBG, blood gas
  2. LP
  3. CXR echo
  4. ECG
36
Q

chars of common causes

A

p 188

37
Q

def. neonatal hypoglycemia

A

BG

38
Q

2 main causes

A
  1. endocrine
    - persistent hyperinsulinemic hypoglycemia
    - diabetic mom
    - large bb
    - gerneallt rare
  2. non-edno
    - stress
    - sepsis/shock
    - small bb
    - persistent pulm hypertension
39
Q

presentation of hypoglycemia

A
  • irritable
  • jittery
  • feeding probs
  • lethargy
  • tremor
40
Q

mgmt of hypoglycemia

A
  • ID an monitor at risk BBs
  • monitor BG q3-4h befoer feeds
  • if under 1.8 despite 1 feed should get dextrose
  • repeated
41
Q

def. SIDS

A

sudden unexpected death of infant

42
Q

epi of SIDS

A
  • more males
  • 2-4 months highest
  • higher in RSV season
  • most deaths midnight to 8am
  • high increase of siblings
43
Q

risk factors for SIDS

A
  • male
  • african origiin
  • premature
  • smoking
  • alcohol
  • SES
  • soft bedding
  • bed sharing
  • side or prone sleeping
  • mild infections
44
Q

prevention of SIDS

A

back to sleep

  • change risk factors
  • pacifier
  • no evidence for alarms or monitors
45
Q

def. dev. dysplasia of hip DDH

A 
spectrum of disorders where relationship between femoral head and acetabulum is off
- dislocated
- dislocatable
- subluxed
-
46
Q

risk for DDH

A
  • breech

- fam Hx

47
Q

exam for DDH

A

galeazzi sign - knee appears lower on side
barlow - dislocates
ortolani - see if will go back in
- gluteal creases assymetry

48
Q

mgmt of DDH

A

definite - ortho

  • unsure - US
  • usually start with pavlik harness
49
Q

what is use of vit K

A

humans have a small amount in milk

- give IM injection at birth

50
Q

what is use of erythromycin

A
  • ointment placed in eyes at brith
  • prevents gonoccocal opthalmia neonatorum
  • no longer reccomended
51
Q

what are universal screening tests

A
  1. newborn hearing
    - automated machine before DC
    - if failed, get a brain stem test
  2. genetic and metabolic screen
    - heel prick sample 1-7 days
    - pos. screen not Dx, but needs F/U
    - meatbolic disorders
    - SCD and hemoglobinopathies
    - endocrine - hypothyroid and CAH
    - CF
    - SCID

Peds clerkship (22 decks)

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