Neonatology Flashcards
Preterm ADR
sulfisoxazole
Kernicterus
Preterm ADR
Chloramphenicol
gray baby syndrome, myelosuppression
Preterm ADR
NaHCO3
intraventricular hemorrhage
Preterm ADR
Amphotericin
anuric renal failure, hypokalemia, hypomagnesemia
Preterm ADR
Indomethacin
Oliguria, hyponatremia, intestinal perforation
Preterm ADR
Cisapride
prolonged QTc
Preterm ADR
Tolazoline
Hypotension, gastrointestinal bleeding
Preterm ADR
Calcium salts
subcutaneous necrosis
Preterm ADR
Aminoglycosides
Deafness, renal toxicity
Preterm ADR
Prostaglandins
seizures, diarrhea, apnea, hyperostosis, pyloric stenosis
Preterm ADR
furosemide
deafness, hyponatremia, hypokalemia, hypochloremia, nephrocalcinosis, biliary stones
Preterm ADR
erythromycin
pyloric stenosis
Indication of ROP screening
<27 wk AOG, or <1250 g
Asymptomatic subdural hemorrhages following labor should resolve by __
4 weeks
__ of infants <1500 g have IVH
30%
Single course of antenatal corticosteroids is recommended in pregnancies __ AOG that are at risk for preterm delivery
24-34 w
Therapeutic hypothermia
core temperature of __
duration __
33.5 C
Within first 6 hr after birth for 72 hours
Injury to the 5th and 6th cranial nerves
Characteristic position consists of adduction and internal rotation of the arm with pronation of the forearm
Erb-Duchenne paralysis
INjury to the 7th and 8th cervical nerves and 1st thoracic nerve
Paralyzed hand, possible Horner syndrome
Klumpe paralysis
Decision for surgical intervention for brachial palsy by __ if function has not yet improved
3 months
Drug and dose for respiratory depression caused by maternal sedation with narcotic drug within 4 hr prior to delivery
Naloxone hydrochloride 0.1 mg/kg
Apneic pauses of 5-10 sec followed by a burst of rapid respirations at a rate of 50-60 BPM for 10-15 sec
periodic breathing
Drug given for apnea of prematurity unresponsive to methylxanthines
doxapram
Acceptable blood gas values in RDS
PaO2 50-70
PaCO2 45-65
pH 7.2-7.35
PEEP 4-6
Contraindications to indomethacin
- PC <50,000
- bleeding disorders
- UO <1 mg/kg/hr
- NEC
- Intestinal perforation
- creatinine value > 1.8 mg/dL
Mild BPD in infants born <32 w
Treatment with >21% oxygen for ≥28 days
Breathing room air at 36 w postmenstrual age or at discharge, whichever comes first
Mild BPD in infants born ≥32 w
Treatment with >21% oxygen for ≥28 days
Breathing room air by 56 days or at discharge, whichever comes first
Moderate BPD in infants born <32 w
Need for <30% oxygen at 36 weeks postmenstrual age or at discharge, whichever comes first
Moderate BPD in infants born ≥32 w
Need for <30% oxygen at 56 days or at discharge, whichever comes first
Severe BPD in infants born <32 w
Need for ≥30% oxygen and/or positive pressure at 36 weeks postmenstrual age or at discharge whichever comes first
Severe BPD in infants born ≥32 w
Need for ≥30% oxygen and/or positive pressure at 56 days or at discharge whichever comes first
Minimum weight and age requirement for ECMO
≥2 kg, ≥34 w AOG
*ventilated for <10 days
___ (infection) has been associated with delayed onset of symptoms and a CDH
Group B streptococcal sepsis
Air can be demonstrated by radiographs in the jejenum by __
ileum __
colon __
Jejenum 15-60 min
Ileum 2-3 hr
Colon 3 hr after birth
Absence of rectal gas at 24 hr is abnormal
NEC triad
intestinal ischemia
enteral nutrition
bacterial translocation
Characteristic histologic finding in NEC
coagulation necrosis
Bilirubin level estimate
face
mid-abdomen
soles
face - 5 mg/dL
mid-abdomen - 15
soles - 20
Physiologic jaundice in term infant appears \_\_ disappears \_\_ peak concentration \_\_ at \_\_ rate \_\_
appears 2-3 days
disappears 4-5 days
peak 10-12 mg/dL at 2-3 days
rate <5
Physiologic jaundice in preterm infant appears \_\_ disappears \_\_ peak concentration \_\_ at \_\_ rate \_\_
appears 3-4 days
disappears 7-9days
peak 15 mg/dL at 6-8 days
rate <5
Clinical features of kernicterus acute form
Phase 1 (1st 1-2 days): poor suck, stupor, hypotonia, seizures Phase 2 (middle of 1st week): hypertonia of extensor muscles, opisthotonos, retrocollis, fever Phase 3 (after 1st week): hypertonia
Clinical features of kernicterus chronic form
1st year: hypotonia, active deep tendon reflexes, obligatory tonic neck reflexes, delayed motor skills
2nd year: movement disorders (choreoathetosis, ballismus, tremor), upward gaze, sensorineural hearing loss
Physiologic decrease in hemoglobin in term infants
8-12 weeks, hemoglobin 11 mg/dL
Physiologic decrease in hemoglobin in preterm infants
6 weeks or 1-3 months after birth, 7-10 mg/dL
Average weight of term newborn
3000 g
Normal range of head circumference of newborn
32-37 cm
Preterm infants must be scored (Ballard) within __. Term infant within __.
Preterm 12 hr
Term 72 hr
Pupillary reflex is present by?
> 32 weeks
The ff reflexes disappear by how old?
- Moro
- Grasp: palmar and plantar
- Rooting and sucking
- Tonic neck
- Moro - 5 mo
- Palmar - 6 mo; plantar - 9-10 mo
- Rooting and sucking - 3 mo
- Tonic neck - 5-6 mo
Diseases detected in Philippines NBS
CAH Congenital hypothyroidism Galactosemia G6PD deficiency PKU
When is NBS done?
24-72 hr after birth, after milk feeding for at least 24 hr
Samples taken <24 hr from birth require repeat screening at 2 wk of age
When is hearing screening done?
After 24 hr of life, not later than 6 mo
Ffup of patients with hearing loss
Bilateral - within 2 wk
Unilateral 3 mo
Umbilical cord normally falls off within
7-10 days
Most common benign murmur
Peripheral pulmonary stenosis
Average length of term newborn
50 cm
Birthweight doubles by? (Fundamentals)
Triples by?
Doubles by 5 mos
Triples by 1 yr
Infant’s length increases by 50% by __
1 yr
Increase in infant’s length in cm
1 yr
2 yr
3 yr
1 yr - 25 cm
2 yr - 10-15 cm
3 yr - 7-10 cm
By 2 yr, HC is __ of adult size
2/3
Skeletal growth continues until fusion of epiphysis of long bones at __ in females and __ in males
14 yr for females
17 yr for males
By the end of __ myelination of the cerebrum is completed
2 yr
Average weight of the brain at 40 wk is __, reaches __ by the end of first yr
400 g
1000 g
MUAC cutoff for severe acute malnutrition
<11.5 cm
Formula for weight in 0-6 mo
Age in mo x 600 + BW (in g)
Formula for weight in 6-12 mo
3600 + (age in mo x 500) + BW
Formula for weight in 1-6 yr
(Age in yr x 2) + 8
Formula for weight in 7-12 yr
[(age in yr x7)-5]/2
Formula for length in 0-3 mo
BL + 9 cm
Formula for length in 4-6 mo
BL+ 9 cm+ 8 cm
Formula for length in 7-9 mo
BL + 9+8+5
Formula for length in 10-12 mo
BL + 9+8+5+3
Formula for length/height in 2-12 yr
(Age in yr x 6) + 77
Midparental height in boys
[(paternal+maternal height)+13]/2
Mid-parental height for girls
[(paternal+maternal)-13]/2
1st among the senses to develop and is most developed at birth
Touch
External genitalia is distinguishable by
10 wk
Start of surfactant production
20 wk AOG
Infants roll over by
5-6 mo
Hands join together in the midline, allowing for transfers
5-6 mo
Index finger approach by
8 mo
Pincer grasp or thumb-finger grasp by
9-10 mo
Voluntary release of objects held is noted, allowing for throwing of objects
10-12 mo
Gurgling and cooing sounds by
6 w - 3 mo
Babbling by
5-6 mo
Nonspecific mama/papa by
9-10 mo
Alerting response to human voice by
3 mo
Turns head to source of sound by
5-6 mo
Infants recognize and respond to their names by
6-7 mo
Understands the concept of “no” by
9 mo
Infants follow a 1-step command aided by gestures by
1 yr
Single words with meaning by
12 mo
Can run, pivot, walk backwards by
15 mo
Can walk up the stairs with rails and throw a ball
18 mo
Can jump with both feet at once, kick a ball forward and walk downstairs by
2 yr
Spontaneous scribbling by
15 mo
Draws circles with a series of perseveration lines by
2-2.5 yr
By 2 yr, toddler may have acquired __ words. By 3 yr, vocabular booms to __ words
2 yr - 300 words
3 yr - 900 words
Able to follow commands without gesture by
15 mo
Follow 2-step commands by
18-24 mo
Able to convey hunger and exhaustion by
3 yr
Toddler is ready to be toilet trained by
2 yr
Able to feed self and put on clothes with supervision
3 yr
Able to jump forward and pedal a tricycle by
30 mo
Able to imitate stroke on paper by
18 mo
Able to imitate vertical lines by
24 mo
Can hop by
4 yr
Can skip by
5 yr
Can draw a circle or a person with 2 body parts
3 yr
Can draw a cross by
3.5-4 yr
Can draw a square by
4-4.5 yr
Can draw a triangle by
5 yr
Can speak in complete sentences and understand concept of size by
4 yr
Understands concept of time and follow 3-step commands by
5 yr
Can dress independently
4 yr
Can do simple errands and help in household chores by
5 yr
Able to state their name, age and sex and understands prepositions by
3 yr
Able to copy letters; still reverses some letters; draws a person with 12 parts by
6 yr
Knows right and left sides by
7 yr
Verbalizes emotions and follow 3-serial commands by
6 yr
Able to dress completely and tie shoe laces by
6 yr