neonatology Flashcards
What is primary vs secondary apnea?
Primary is reversed with tactile stimulation but secondary requires positive pressure ventilation
What is the diagnosis in a healthy newborn with respirations>60, retractions and grunting but normal CXR?
Transient tachypnea of the newborn
Newborn had increased anion gap metabolic acidosis, thrombocytopenia, high serum ammonia and elevated urine ketones, what is the likely diagnosis?
Organic acidemias
Newborn with high ammonia, high PT/PTT and serum glutamic oxaloacetic transaminase who presents with respiratory alkalosis?
Citrullinemia
What could be the cause of elevated AFP?
RAIN= renal disease, abdominal wall defects, incorrect dates /multiple pregnancy and neuro defects (anencephaly or spina bifida)
Low AFP is associated with what?
Trisomy 21 and 18
What is a measure of fetal autonomic nervous system integrity?
Non stress test
What measures uteroplacental insufficiency and tolerance of labor?
Stress test
What is included in the biophysical profile?
Non stress test + ultrasound for fetal movement, HR, breathing, tone and amniotic fluid
What is the result of deficient surfactant in alveolar lining?
Rds
What is the diagnosis and what should you do of the fetus has HR>240?
Svt- Give anti arrhythmic to mother to avoid congestive Heart failure and hydrops
What condition causes X-ray findings of granular lung opacification and air bronchograms? What is the classic description on chest xray
Rds - ground glass appearance
What are symptoms or rds?
Respiratory distress in the newborn. Cyanosis is possible
How can you distinguish RDS from pneumonia in a newborn ?
Calculate ratio of bands to neutrophils. If >0.2, think sepsis !
What 6 coexisting conditions can worsen RDS?
PDA Hypoglycemia Hypocalcemia Anemia Acidosis Hyperbili
What can occur in a patient with RDS and hyperbilirubinemia?
Threshold for kernicterus is lower
What 3 factors increase the risk for RDS?
Diabetes, c sections, birth asphyxia
What 2 factors decrease the risk for RDS?
Prolonged rupture of membranes, prenatal steroids
What test can predict the risk of RDS?
L:S ratio > 2 suggests a low risk for RDS
When is mechanical ventilation indicated in a patient with RDS?
Ph <7.2 and pCo2 > 60
What 3 things does administration of surfactant cause in the lungs?
Decreased oxygen requirements, reduces inspiratory pressure and improved lung compliance
What is pulmonary interstitial emphysema ?
Air leak into the interstitium due to mechanical ventilation – leads to PTX
What is the goal po2 in an infant with RDS?
50-70
Patients on prolonged ventilator support are at risk for what and why?
Bronchopulmonary dysplasia due to prolonged oxygen exposure and barotrauma
What are the indications for ECMO?
Infant with reversible lung disease for less than 14 days and failure of other methods. Pt can not have intracranial bleed or congenital heart disease
What is the treatment of BPD and what is a side effect of this treatment?
Diuretics - can increase risk of hypocalcemia
What is found on X-ray in a newborn with BPD?
Diffuse opacities, cystic areas with streaky infiltrates and ground glass appearance
What is the name of a chronic lung disease of the newborn that is not associated with prolonged ventilator use?
Wilson Mikity syndrome
What is the difference between BPD and Wilson Mikity syndrome ?
BPD has inflammatory changes in lung tissues but MKS does not
What is the empiric treatment of neonatal sepsis?
Ampicillin and gentamicin
What bacteria should you be concerned about if infants mother had flu like illness during pregnancy?
Listeria
When toxoplasmosis infection occurs early in pregnancy, what is the risk and severity of infant infection?
Lower chance of infection but more severe disease
What are some symptoms of toxoplasmosis in a newborn?
Microcephaly, hydrocephaly, chorioretinitis, cerebral calcifications, jaundice and hepatosplenomegaly
How is diagnosis of toxoplasmosis made?
Immunofluorescence
What is the best imaging study for toxoplasmosis?
MRI to diagnose encephalitis if ring enhancing lesions
What is the difference between cmv and toxo when looking at MRI?
Cmv calcifications are peri ventricular but with toxoplasmosis are diffuse
If asymptomatic at birth, what later signs can toxoplasmosis cause?
Deafness, blindness, seizures, MR
What is the treatment for toxoplasmosis?
Pyrimethamine, sulfadiazine and folinic acid
What two palsied are associated with clavicle fracture in the newborn?
Erbs and phrenic nerve
What is the injury associated with the arm internally rotated and addicted with flexed wrist?
Erbs palsy, c5-7 Injury
What should you be concerned about if clavicle fracture leads to respiratory distress?
Phrenic nerve palsy
What is the injury associated with claw hand?
Klumpke palsy at C8 T1
What is the difference between klumpke and Erb palsy in relation to reflexes?
In Erb palsy the grasp reflex is intact but is lost in klumpke
Which palsy can be associated with Horner syndrome?
Klumpke
What two maternal conditions can cause neonatal heart block?
Lupus and sjogren
What do you do if you find a newborn with a single umbilical artery?
Renal ultrasound
What are the common complications of umbilical artery and vein catheter placement?
NEO CATH = Necrosis , embolize ruin (liver), omphalitis, compromised femoral pulse, accidental hemorrhage, traumatic perforation thrombosis and hepatic (dysfunction)
When should the umbilical cord fall of and what is the concern if it does not?
Should fall off by 2 weeks ; if attached past 1 month, consider leukocyte adhesion deficiency
When is a baby considered SGA?
In the lower 10th percentile for gestational age
When is a baby considered LGA?
In the upper 10th percentile for weight for gestational age
What is considered a full term baby?
38-42 weeks
What is seen in a post term newborn?
Dry peeling skin, long fingernails, decreased lanugo, ears with strong recoil
What is the most common cause of fetal demise?
Chromosomal abnormalities and congenital malformations
What is a normal scalp pH?
7.25 or higher
What are some causes of delayed passage of meconium?
Meconium plug syndrome
Hirschsprung
Imperforate anus
For the purpose of boards, when do you intubate a meconium baby?
If baby is floppy, suction and intubate
What is the presentation and How do you diagnose Hirschsprung’s disease?
No meconium passage after 48 hours or abdominal distention with diarrhea may be present - diagnosis with biopsy
What condition is Hirschsprung’s disease associated with?
Down’s syndrome