Neonatology Flashcards
important part of neonatal Hx
- maternal age
- GTPAL - grav, term, partity, abort, live
- planned/unplanned
- PMx
- blood type
- antenatal serology
- est. date
- screenings done
- infections
important part of L&D
- labour type
- rupture of membranes
- vag. vs assisst vs CS
- head or breech
- date and time, BW, GA
parts of neonatal Hx
- meconium, urine
- feeding
- issues - jaundice, poor feeds
- disharge weight
neonate Phx
see p 175
important resp issues
- lungs dev. surfactant at 24 weeks
- dev. for 8 weeks after
- need to overcome fluid for first breaths
fetal circ. pathway
placenta>umb vein>ductus venosus>IVC>RA>FO>LA>LV>aorta>brain>SVC>RA>RV>PA>10/5 lungs and rest to descending aorta
diff. in fetal circ and normal
fetal - high pulm R - low systemic R - placenta is resp normal - low pulm R - high systemic R - lung for resp
neonatal resus
P 178
- stim for 30 seconds before assessing HR and RR
- chest compression and epi for persistent brady
term age
37
3 etiology of prematurity and subtypes
- maternal
- preeclampsia
- infection
- substances
- trauma
- illness - placental
- previa
- abruption
- 1st trimester bleed - fetal
- multi gestation
- macrosomia
- RBC isoimmunization
- infeciton
causes of acute premature morbidity
- asphyxia
- hemmorage
- RDS
- patent DA
- feed intolerance, NEC
- sepsis
- temp instability
def and mgmt of late preterm
34-36weeks
- not necc. in NICU
- observe carefully
- at risk for readmission
2 most important outcomes of jaundice
- acute bili encephalopathy (ABE) - CLINICAL neuro state following jaundice
- kernicterus - NEUROPATH finding of staining of neruons in basal gang
2 main types of bili
- uncong
2. cong
2 types of uncong
- non-path
- breastfeeding - dehydration from low intake
- breast milk - patho
2 main types of patho uncong
- hemolytic
- intrinsic to RBC - defect, Hbopathies
- etrinsic - ABO, frags - non-hemolytic
- sepsis
- crigler najjar
- cephalohematoma
4 main types of congugated
- anatomic
- bilary atresia
- cysts - infecitons
- sepsis, viral - metabolic/endo
- galactosemia
- A1 anti-trypsin - misc
- long term TPN
- hepatitis
features that indicate patho jaundice
- at
risk factors for hyperbili
- predischarge levels in high risk zone
- first 24 hours
- blood incompatible
- GA
invest for jaundice
- bb and mom ABO
- DAT
- CBC and diff
- cong and uncong bili
- G6PD
- blood Cx if concerned about sepsis
mgmt of jaundice
- phototherapy - use guildine nomogram for intensive (181)
- IVIG
def. neotnatal sepsis
SIRS to infection
- early - DOL 0-7
- late 7-90
neonate bugs especially
- GBS
- listeria
- ecoli
- GAS
- Staph
risk factors for sepsis (any 2 will increase)
- > 18hr ROM
- intrapartum temp >38
- chorioamnionitis
- maternal GBS
- premature
- perinatal asphyxia
- male
presentation of neonatal sepsis
- often non-specific
- poor feeds
- low tone
- fever
- vomiting abdo dist
- resp distress
- tachy
def. full septic W/U
- blood Cx
- urine Cx
- LP
possible - CXR, stool
empiric Abx for sepsis
- amp and cefotaxime - esp for meningitis
- amp and genta if no FSWU performed
- add vanco if suspect meningitis of lines in place
what is hypoxic ischemic encephalopathy (HIE)
- 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
3 main etiologies of HIE and subtypes
- maternal
- cardiac arrest
- asphyxiation
- anaphylaxis
- status epil
- hypovolemic shock - utreroplacental
- abruption
- cord prolapse
- uterine rupture
- hyperstim with oxytocic agents - fetal
- hemmorage
- twin to twin transfusion
- immune hemolytic disease
- arrhytmias
clincal manifestaions
- low APGAR at delivery
- met acidosis in cord
- presence of neuro dysfunction (tone, power, reflexes)
- injury to other organs
invest for HIE
- lytes, trops, renal, LFTs
- brain MRI
- EEG
mgmt of HIE
- initial resus
- supportive measures
- hypothermia - 33 degrees for 3 days
clinical presentation of resp. distress
- tachypnea
- pachy
- duskiness
- all the usual
3 most common cause of resp. distress and 3 less common
- transient tachypnea of newborn
- RDS
- meconium aspiration
less common - infection
- non-pulm
- persistent pulm hypertension
investigations for resp .distress
- labs - CBC lytes, RBG, blood gas
- LP
- CXR echo
- ECG
chars of common causes
p 188
def. neonatal hypoglycemia
BG
2 main causes
- endocrine
- persistent hyperinsulinemic hypoglycemia
- diabetic mom
- large bb
- gerneallt rare - non-edno
- stress
- sepsis/shock
- small bb
- persistent pulm hypertension
presentation of hypoglycemia
- irritable
- jittery
- feeding probs
- lethargy
- tremor
mgmt of hypoglycemia
- ID an monitor at risk BBs
- monitor BG q3-4h befoer feeds
- if under 1.8 despite 1 feed should get dextrose
- repeated
def. SIDS
sudden unexpected death of infant
epi of SIDS
- more males
- 2-4 months highest
- higher in RSV season
- most deaths midnight to 8am
- high increase of siblings
risk factors for SIDS
- male
- african origiin
- premature
- smoking
- alcohol
- SES
- soft bedding
- bed sharing
- side or prone sleeping
- mild infections
prevention of SIDS
back to sleep
- change risk factors
- pacifier
- no evidence for alarms or monitors
def. dev. dysplasia of hip DDH
spectrum of disorders where relationship between femoral head and acetabulum is off - dislocated - dislocatable - subluxed -
risk for DDH
- breech
- fam Hx
exam for DDH
galeazzi sign - knee appears lower on side
barlow - dislocates
ortolani - see if will go back in
- gluteal creases assymetry
mgmt of DDH
definite - ortho
- unsure - US
- usually start with pavlik harness
what is use of vit K
humans have a small amount in milk
- give IM injection at birth
what is use of erythromycin
- ointment placed in eyes at brith
- prevents gonoccocal opthalmia neonatorum
- no longer reccomended
what are universal screening tests
- newborn hearing
- automated machine before DC
- if failed, get a brain stem test - 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
