Neonatology Flashcards
What should you do if you notice jaundice in the first 24hrs of life?
requires evaluation of serum bilirubin
Why are we concerned of high levels of unconjugated bilirubin?
High levels of unconjugated bilirubin and an immature blood-brain barrier raise risk of bilirubin-related CNS damage
Acute bilirubin encephalopathy
Kernicterus
Acute bilirubin encephalopathy Sx
lethargy or irritability, hypo- or hypertonia, poor suck, high-pitched cry, fever, opisthotonus, stupor, coma
What is Kernicterus?
Chronic irreversible brain damage.
Associated with yellow staining of basal ganglia and brainstem nuclei
visual and auditory abnormalities
movement disorders - chorea, tremor
cognitive deficits, athetoid cerebral palsy
Neurotoxicity Risk Factors
lethargy, presence of isoimmune hemolysis (positive direct Coombs’ test), asphyxia or other cause of hemolysis, low serum albumin (if checked)
*Presence of neurotoxicity risk factors would directly affect your decision to treat.
Hyperbilirubinemia Tx
Phototherapy, IVIG, Exchange Transfusion
Bilirubin < 20 mg/dL without risk factors, Tx
supplemented feeding, office follow-up, sometimes home phototherapy
Bilirubin > 20 mg/dL and/or with risk factors, Tx
inpatient phototherapy +/- supplemented feeding
Bilirubin > 25 mg/dL
inpatient phototherapy
IV hydration and supplemented feedings
preparations for exchange transfusion
Bilirubin > ~28 mg/dL
critical care monitoring and phototherapy
exchange transfusion
Signs of breast feeding jaundice
weight loss, decreased urine output, problems with breast feeding.
If there is breast milk jaundice and baby is feeding and growing well, what do you do?
bili levels can be monitored.
If they start to increase or there is a direct component then more investigation is needed.
Breast Feeding Jaundice vs. Breast Milk Jaundice?
Breast Feeding Jaundice: From inadequate milk supply in breast fed babies.
Breast Milk Jaundice
Unconjugated: hyperbilirubinemia that persists beyond the first week of life in breast fed infants. Thought to be a substance in the breast milk leading to increased re-absorption of bili in infants intestine.
Biliary Artesia Clinical Presentation
jaundice, conjugated hyperbilirubinemia, hepatomegaly, and acholic stools.
When is surgery indicated for umbilical hernia?
if umbilical hernia persists beyond 2 years of age and/or becomes progressively larger
Omphalitis
Infection of the area involving the umbilicus and the surrounding tissue
Life-threatening infection due to position of umbilicus that allows infection to spread to peritoneum, umbilical or portal vessel, bacteremia, skin (cellulitis), necrotizing fasciitis
Omphalitis Tx
Broad antibiotic coverage for coverage of gram negatives, E. Coli and Staphylococcus Aureus (Vancomycin and Cefotaxime)
Surgical Consult if spread to surrounding tissue
Persistent PDA clinical findings?
continuous, to-and-fro murmur bounding pulses (acts as aortic pressure shunt) S2 paradoxically split
PDA Dx
clinical suspicion - murmur, postductal hypoxemia, abnormal S2
EKG - may show ventricular hypertrophy
CXR - may show cardiomegaly
echocardiogram- DEFINITIVE TEST:
direct visualization of flow in the ductus arteriosus
flow demonstrated across the pulmonary and aortic arteries
PDA Tx
surgical closure for large PDAs, emergent or persistent cases caught late
medical closure using indomethacin
inhibitor of prostaglandin synthesis
carries risk of gut perforation
Transient tachypnea characteristics
-presumably related to retained fetal alveolar fluid
-mild oxygen requirement
-resolves with supportive care in 3 days or fewer
-associated with labor of brief duration
-CXR:
prominent pulmonary vessels
fluid in interlobar fissures
hyperinflation
Severe cases of meconium aspiration can cause what?
ventilation defects
pulmonary htn
Meconium aspiration Tx
ventilatory support, often mechanical
antibiotics
fluids/pressor support as needed.
TORCH infections
toxoplasmosis
other- syphillis, varicella, parovirus b19
rubella - blueberry rash and cataracts
CMV
HSV 1 &2
HIV
