Neonatology Flashcards
The significance of having delayed cord clamping is to
Decrease incidence of anemia
This intervention in the EINC is to prevent neonatal hypothermia and to increase colonization with protective family bacteria
Uninterrupted skin to skin contact
Breastfeeding must be done within hour many hours of life?
1 hour
Mechanism of heat loss from the cooler surrounding air
Convection
Mechanism of heat loss from the colder materials touching the newborn
Conduction
Mechanism of heat loss from the infant to other nearby cooler objects
Radiation
Optimal method for maintaining temperature in a stable neonate?
Skin to skin contact
Also known as IUGR
BW is <3rd percentile for calculated gestational gestational age
Small for gestational age
LGA babies are at risk for
Hypoglycemia
Polycythemia
This type of IUGR is associated with genetic and metabolic conditions and seen early in gestation
Symmetric
This type of IUGR is associated with poor maternal nutrition
Weight is more affected
Fetus affected in late gestation
Asymmetric
Most important component of the APGAR score
Respiration
Diseases Included in the basic newborn screening
Congenital hypothyroidism Congenital adrenal hyperplasia Galactosemia Phenylketonuria G6PD Maple Syrup Urine
When is NBS screening done
24-48 hours after feeding
If NBS is done <24 hours, it must be repeated after
2 weeks
What is the ideal time to do NBS in preterms?
5-7 years old
1st physical sign of a suspected congenital hypothyroidism baby
Prolonged jaundice
Most common cause of congenital hypothyroidism
Thyroid dysgenesis
Autosomal recessive disorders of cortisol biosynthesis
Congenital adrenal hyperplasia
Most common enzyme deficiency in congenital adrenal hyperplasia
21-hydroxylase
Newborns with CAH are normal at birth but exhibit sexual and somatic precocity within
The 1st 6 months of life
Elevation in 17- hydroxyprogesterone is seen in how many days of life
2-3 days of life
Dexamethasone given prenatally can supress androgens and prevents virilization in females if given by
6 weeks AOG
Sodium and potassium levels in CAH are
Decreased- Na
Increased-K
This disease detected in newborn screening is an absolute contraindication to breastfeeding
Galactosemia
Classic form of galactosemia
Galactose 1 phosphate uridyltransferase deficiency (GALT)
This enzyme deficiency in galactosemia presents with cataracts
Galactokinase deficiency
Without the enzyme in galactosemia, galactose will accumulate in these organs
Brain
Kidney
Liver
Patients with galactosemia are at increased risk for this bacterial sepsis
E.coli neonatal sepsis
What product of the pentose phosphate pathway counteracts oxidative stress that is lacking in G6PD deficiency?
Reduced glutathione
Enzyme deficiency in phenylketonuria
Phenylalanine hydroxylase
Cheese like material that covers normal term infant in varying amounts
Vernix caseosa
Purplish reticulated pattern noted on the skin of a neonate when exposed to cold
Lacy cobblestone appearance
Cutis marmorata
Slate blue well demaracated areas of pigmentation over the buttocks and back
Mongolian spots
Red, sharply demarcated area 1/2 of body, due to imbalance of cutaneous blood vessel tone, premature hypothalamus
Harlequin color change
Small, white occasionally vesiculopustular papules on an erythematous base that contains eosinophils and develop after 1-3 days
Erythema toxicum
Vesiculopustular eruption over a dark macular base around the chin, neck, back and soles. Contains neutrophils
Pustular melanosis
Cysts appearing on the hard palate which is composed of accumulations of epithelial cells
Epstein pearl
Pearly white papules seen mostly on the chin and around the cheeks
Milia
Open and closed comedones or inflammatory pustules and papules on the cheeks of the baby usually after a week from delivery
Neonatal acne
Pink macular lesions on the nape, glabella, upper eyelids or nasolabial region
Nevus simplex
Common cause of neonatal acne
Maternal estrogen transfer
Hair that covers the skin of preterm infants; seen on term infants around the shoulders
Lanugo
Cephalhematoma or caput succedaneum?
Crosses suture lines
Caput
Cephalhematoma or caput succedaneum?
Subperiosteal hemorrhage
Cephalhematoma
Cephalhematoma or caput succedaneum?
Limited to the surface of one cranial bone
Cephalhematoma
Cephalhematoma or caput succedaneum?
With discoloration of overlying scalp
Caput
Cephalhematoma or caput succedaneum?
Edema, ecchymosis and swelling apparent right after birth
Caput
Cephalhematoma or caput succedaneum?
May cause jaundice
Cephalhematoma
Suggestive of tracheoesophageal fistula
Inability to pass an NGT
Term infant with severe respiratory distress and scaphoid abdomen on PE
Congenital diaphragmatic hernia
Most common type of congenital diaphragmatic hernia
Bochdalek
Immediate intervention for omphalocele/gastroschisis
Decompression and wrapping
Omphalocele or gastroschisis?
Associated with other congenital abnormality
Omphalocele
OEIS complex in omphalocele
Imperforate anus
Spinal
Gastroschisis is more common on what side of the umbilicus?
Right
Histologic finding in Necrotizing enterocolitis
Coagulation necrosis
Thickened bowel walls and air in the bowel is highly suggestive of
Pneumatosis intestinalis
Greenish yellow vomitus
Nondistended non tender abdomen
Double bubble sign on xray
Duodenal atresia
Donut ring sign
Intussuception
Normal amniotic fluid L/S ratio
> 2
Surfactant appears in amniotic fluid between ____ weeks AOG
28-32
Mature levels of surfactant usually present at what AOG
35 weeks AOG
Greatest risk factor of necrotizing enterocolitis
Prematurity
CXR findings:
Finely granular lungs
Ground glass appearance
Hyaline membrane disease
CXR findings:
Prominent pulmonary vascular markings
Fluid lines in fissure
Transient tachypnea
CXR findings:
Bubbly lungs - cystic lucencies
Bronchopulmonary dysplasia
CXR findings:
Coarse streaking granular pattern of both lung fields
Meconium aspiration
CXR findings:
Perihilar streaking
Pneumonia
The most serious complication of hyperbilirubinemia in the newborn is
Encephalopathy
Jaundice appearing between the 2nd and 3rd day after birth in full terms infants is likely due to
Normal changes
Most common cause of jaundice in neonates
Physiologic
Physiologic or pathologic jaundice?
Direct hyperbilirubinemia at any time
Pathologic
Physiologic or pathologic jaundice?
Peaks at 5-6mg/dl on the 2nd-4th day
Physiologic
Physiologic or pathologic jaundice?
Jaundice persistent after 10-14 days
Pathologic
Physiologic or pathologic jaundice?
Appears on the 1st 24-36 hours of life
Pathologic
Most likely etiology of jaundice in the 1st 24 hours in the first born child
ABO incompatibility
Most likely etiology of jaundice in the 1st 24 hours in the second born child
RH incompatibility
Most likely etiology of jaundice in the 1st 24 hours with a history of prolonged 2nd stage of labor
No prenatal check up
Sepsis
Most likely etiology of jaundice in the 1st 24 hours with a history of maternal infection during pregnancy
TORCH
Most likely etiology of jaundice with an onset of 3-4 days and mother supplements breastfeeding with sugar water
Breastfeeding jaundice
Most likely etiology of jaundice with an onset of 1 week and mother exclusively breastfeeds
Breastmilk jaundice
Treatment for breasfeeding jaundice
Continue breastfeeding
Treatment for breastmilk jaundice
Stop for 2 days
Substance in breastmilk that causes breastmilk jaundice
Glucuronidase
This results from deposition of unconjugated bilirubin in the basal ganglia and brainstem
Kernicterus
Kernicterus may manifest if the serum bilirubin level is more than
25mg/dl
This type of Coombs test is used to detect antibodies that are bound to the surface of RBC
Direct Coombs
This conditions may be implicated if the direct coombs test is positive
RH
ABO
Most common cause of hemolytic disease of the newborn
ABO incompatibility
Positive direct coombs Spherocytes in blood smear Hemoglobin may be normal Increased retic count Increased B1
ABO incompatibility
RH incompatibility is due to this antigen
D antigen
Treatment for RH incompatibility for subsequent pregnancies
Anti D gamma globulin injection
RhoGAM
Most important risk factor that predisposes a neonate to sepsis is
Prematurity
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Vesicular lesions on the face and mouth
Heroes simplex 2
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Purpuric hemorrhagic lesions all over the body
Rubella
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Maculopapular rash
Imaging: periostitis of the bone
Syphilis
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Chorioretinitis
Imaging: peri ventricular calcifications
CMV
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Chorioretinitis, microcephaly, hepatosplenomegaly
Imaging: intracerebral calcifications
Toxoplasmosis
An IUGR baby born to a mother with a history of infection during pregnancy presents with
Cutaneous scars
Imaging: cortical atrophy
Varicella
Genitourinary abnormality that is an accumulation of fluid in the tunica vaginalis
Hydrocele
Hydrocele usually resolves by this age
12 months
Genitourinary anomaly that usually present as reducible scrotal swelling
Hernia
Direct hernia is ___ to the epigastric vessels and projects to the abdominal wall
Medial
Direct hernia is lateral to the epigastric vessels and projects to the
Inguinal ring
If the testes remains undescended by this age, it will remain undescended
4 months
Undescended testes is treated at what age
9-15 months old
Majority of undescended testes descend at what age
1st 3 months of life
