Neonatology Flashcards
APGAR Scoring system
Activity Pulse Grimace Appearance Respirations
0-3: severely depressed
4-6: Moderately depressed
7-10: excellent condition
EINC Core Steps
Immediate and thorough drying
Early skin-to-skin contact
Properly Timed cord clamping
Non-separation of mother and baby
Drying should be the first action, IMMEDIATELY for 30 seconds unless
The infant is BOTH floppy/limp and apneic
Benefits of early skin to skin contact
BLEST
Breastfeeding success Lymphoid tissue system stimulation Exposure of o maternal skin flora Sugar (protection from hypoglycemia) Thermoregulation
How long should you delay cord clamping?
2-3 min after birth or until the cord has stopped pulsating
Clamp the cord without milking it __cm from the base and put the 2nd clamp __cm from the base and cut the cord
2cm and 5cm
Consequence of failure to give Vit K injection after birth
Vitamin K Hemorrhagic Disease of the newborn
Bathing of the baby should be delayed until ___ of life because this removes the vernix, thus exposing the child to hypothermia
6hrs
The umbilical stump usually falls after how many days?
10-14 days
What vaccines are given to a newborn with HepB + mothers?
BCG
Hep B Vaccine
HBIG within 12hrs of life
Newborn screening act
RA 9288
For term and healthy newborns, NBS is usually done
24-48 hours old
If blood was collected less than 24hrs
Repeat at 2 weeks old
For preterms ideal time for NBS should be at
5-7 days old
*Can be done until 1 month old for sick babies
NBS includes the following conditions:
Congenital hypothyroidism Congenital Adrenal hyperplasia Galactosemia G6PD deficiency PKU MSUD
Presents with hypothermia, sluggish, feeding diff with edema of the scrotum/genitals; prolonged physiologic jaundice (earliest possible physical sign)
Congenital hypothyroidism
21-hydroxylase enzyme deficiency
CAH
Galactose-1-phosphate uridyltransferase deficiency
Galactosemia
Patients with galactosemia are at increased risk for
E.coli neonatal sepsis
Symptoms develop 1-2 days after exposure to a substance with oxidant properties
G6PD deficiency
Musty odor
PKU
Enzyme deficient in MSUD and what AA are to be avoided
A-ketoacid dehydrogenase
Valine, leucine, isoleucine (branched chain AA)
Skin lesion characterized as flat, blue gray with well defined margins usually on the sacral area
Mongolian spots
Small Papules or pustules on an erythematous base filled with eosinophils
Erythema toxicum
Benign, disappears in 2wks
Small inclusion cyst, pearly white usually on the face
Milia
Lacy pattern on the skin similar to cobblestones
Cutis marmorata
Vasomotor response to cold stress
When is capillary (strawberry) hemangiomas considered alarming?
When it bleeds
Subperiosteal bleed which does not cross the suture lines
Cephalhematoma
Resolves in a few weeks
Swelling of the scalp which crosses the suture lines
Caput succedaneum
Resolves in a few days
Birth injury usually associated with vacuum assisted delivery which cause collection of blood beneath the apomeurosis and occipitofrontalis muscle
Subgaleal hematoma
Primitive reflexes usually disappears until
4-6 months of life
Most commonly fractured bone during delivery Causing crepitus over the shoulder and asymmetric Moro reflex
Clavicle
Tearing, photophobia and cornea more than 1cm diameter
Congenital glaucoma
Webbing of the neck
Turner’s syndrome
Head is turned toward and face turns away from the affected side
Congenital torticollis
Early signs of respiratory distress with scaphoid abdomen and in read chest wall diameter
Diaphragmatic hernia
Most common form of diaphragmatic hernia in NB where the usual affectation is the posterolateral portion of the diaphragm
Bochdalek form
Urethral opening on the dorsal penis
Epispadia
Urethral opening on the ventral surface of the penile shaft
Hypospadia
Accumulation of fluid in the tunica vaginalis and usually resolves within 12 months
Hydrocele
If more than 12months - elective surgery
Common form of inguinal hernia in children
Indirect inguinal hernia
If the testes has not descended by ____ it will remain undescended
4months
Undescended testes is treated surgically not later than ____
9-15 months
Due to deficiency or immaturity of surfactant
RDS
CXR: ground glass pattern, air bronchogram
RDS
“Bubbly lungs” or cystic lucencies, irregularly aerated lungs
Bronchopulmonary dysplasia
Complication of RDS
Usually seen in term infants delivered by CS
CXR: overaeration and flat diaphragm
Transient Tachypnea of the newborn
Resolves in 4-5 days
Most common cause of Persistent pulmonary hypertension of the NB
Meconium Aspiration Syndrome
Coarse streaking granular pattern on both lungs, irregularly aerated lungs, flattened diaphragm, increased AP diameter
Meconium aspiration syndrome
Black lung
Idiopathic PPH of NB
Peumatosis intestinalis
NEC
Physiologic neonatal jaundice
After 48 hrs
Resolves within 1wk (term) or 2wks (preterm)
TB peaks at 14-15 mg/dL
Pathologic neonatal jaundice
1st 24hrs
Persists beyond 1wk (term) or 2wks (preterm)
TB >15 mg/L
Used to detect antibodies that are bound to the surface of RBCs
Direct Coomb’s test
Detects antibodies against RBCs that are unbound to patient’s serum
Indirect Coomb’s test
Coomb’s test positive
Rh/ABO incompatibility
Given to a mother immediately after delivery of the each Rh+ infant reduces Rh hemolytic disease
Anti-D gamma globulin (RhoGAM)
Sepsis which occurs from birth to 7th day of life
Early neonatal sepsis
Risk factors for neonatal sepsis
Maternal infection during pregnancy
PROM (18hrs)
Prematurity
Transplantal infections
TORCH Toxoplasmosis Others (Varicella, Parvo B19, syphilis) Rubella CMV HSV
Handling cat feces, presents with hydrocephalus
Toxoplasmosis
Blueberry muffin rash
Rubella
Most common congenital infection
Microcephaly
CMV
Hutchinson teeth, saddle nose
syphilis late stage (>2 yrs old)
Maculopapular rash where predilection is palms and soles
Syphilis early stage
