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Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What should you do if you notice jaundice in the first 24hrs of life?

A

requires evaluation of serum bilirubin

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2
Q

Why are we concerned of high levels of unconjugated bilirubin?

A

High levels of unconjugated bilirubin and an immature blood-brain barrier raise risk of bilirubin-related CNS damage
Acute bilirubin encephalopathy
Kernicterus

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3
Q

Acute bilirubin encephalopathy Sx

A

lethargy or irritability, hypo- or hypertonia, poor suck, high-pitched cry, fever, opisthotonus, stupor, coma

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4
Q

What is Kernicterus?

A

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

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5
Q

Neurotoxicity Risk Factors

A

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.

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6
Q

Hyperbilirubinemia Tx

A

Phototherapy, IVIG, Exchange Transfusion

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7
Q

Bilirubin < 20 mg/dL without risk factors, Tx

A

supplemented feeding, office follow-up, sometimes home phototherapy

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8
Q

Bilirubin > 20 mg/dL and/or with risk factors, Tx

A

inpatient phototherapy +/- supplemented feeding

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9
Q

Bilirubin > 25 mg/dL

A

inpatient phototherapy
IV hydration and supplemented feedings
preparations for exchange transfusion

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10
Q

Bilirubin > ~28 mg/dL

A

critical care monitoring and phototherapy

exchange transfusion

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11
Q

Signs of breast feeding jaundice

A

weight loss, decreased urine output, problems with breast feeding.

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12
Q

If there is breast milk jaundice and baby is feeding and growing well, what do you do?

A

bili levels can be monitored.

If they start to increase or there is a direct component then more investigation is needed.

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13
Q

Breast Feeding Jaundice vs. Breast Milk Jaundice?

A

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.

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14
Q

Biliary Artesia Clinical Presentation

A

jaundice, conjugated hyperbilirubinemia, hepatomegaly, and acholic stools.

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15
Q

When is surgery indicated for umbilical hernia?

A

if umbilical hernia persists beyond 2 years of age and/or becomes progressively larger

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16
Q

Omphalitis

A

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

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17
Q

Omphalitis Tx

A

Broad antibiotic coverage for coverage of gram negatives, E. Coli and Staphylococcus Aureus (Vancomycin and Cefotaxime)
Surgical Consult if spread to surrounding tissue

18
Q

Persistent PDA clinical findings?

A 
continuous, to-and-fro murmur
bounding pulses (acts as aortic pressure shunt)
S2 paradoxically split
19
Q

PDA Dx

A

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

20
Q

PDA Tx

A

surgical closure for large PDAs, emergent or persistent cases caught late

medical closure using indomethacin
inhibitor of prostaglandin synthesis
carries risk of gut perforation

21
Q

Transient tachypnea characteristics

A

-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

22
Q

Severe cases of meconium aspiration can cause what?

A

ventilation defects

pulmonary htn

23
Q

Meconium aspiration Tx

A

ventilatory support, often mechanical

antibiotics

fluids/pressor support as needed.

24
Q

TORCH infections

A

toxoplasmosis

other- syphillis, varicella, parovirus b19

rubella - blueberry rash and cataracts

CMV

HSV 1 &2

HIV

25
Q

Common serious postpartum bacterial infections

A

Sepsis, meningitis, pneumonia, UTI, omphalitis

26
Q

Hypoxic-Ischemic Encephalopathy (HIE)

A

Term given to brain injury from asphyxia suffered by the neonate during the birth process. Can lead to permanent neurologic damage (ex. cerebral palsy, developmental delay) and death.

27
Q

When to consider HIE

A

Significant perinatal event
Apgars <5
Metabolic acidosis as seen on blood gas
Clinical signs of encephalopathy: hypotonia, lethargy, poor reflexes, seizures. (Sarnat exam can assist with this)

28
Q

HIE Tx

A

Patients who meet criteria can undergo cooling to help mitigate damage from HIE.

29
Q

Neonatal Abstinence Syndrome (NAS)

A

Describes a constellation of symptoms that are displayed by babies who have had in utero exposure to substances such as opiates.

30
Q

Neonatal Abstinence Syndrome (NAS) Sx

A

irritability, sleep problems, sneezing, diaphoresis, GI disturbances.

31
Q

Neonatal Abstinence Syndrome (NAS) Tx

A

Treatment includes giving morphine to help withdrawal. Other medications can also be used to help manage symptoms.

32
Q

Prematurity Common Problems

A

temperature regulation

feeding insufficiency

anemia

intraventricular hemorrhage

33
Q

Respiratory Distress Syndrome (Hyaline Membrane Disease) Pathophysiology

A

Premature infants often have insufficient surfactant leading to…
Atelectasis
Decreased Functional Residual Capacity
Arterial Hypoxemia

34
Q

Respiratory Distress Syndrome (Hyaline Membrane Disease) Dx

A

High Index of Suspicion in premature infants

CXR- “ground glass” haze, air bronchograms, white-out

35
Q

Respiratory Distress Syndrome (Hyaline Membrane Disease) Tx

A

Prevent premature birth (tocolytics, bed rest, cerclage, tocolytics)
Stimulate surfactant fetal lung production of surfactant (steroids)
Assisted Ventilation
Replace Surfactant (Exogenous Surfactant administration)

36
Q

Bronchopulmonary Dysplasia (BPD)

A

Oxygen mediated lung injury due to chronic superoxides

Oxygen dependence beyond 36 weeks postconceptual age accompanied by lung abnormalities, Ex:
Interstitial edema
Atelectasis, mucosal metaplasia
Interstitial fibrosis

37
Q

Retinopathy of Prematurity Causes

A

Acute and Chronic effects of oxygen toxicity on the developing blood vessels of the premature infant’s retina

38
Q

Retinopathy of Prematurity Tx

A

Prevent risk factors- reduce oxygen toxicity, reduce time on ventilator
Laser therapy
Surgery for retinal detachment
Follow up

39
Q

Necrotizing enterocolitis clinical signs

A

Abdominal Distention, Feeding Intolerance, increased gastric residuals, emesis, rectal bleeding, diarrhea

Radiographic Imaging:
Pneumotosis Intestinalis
Intestinal Ileus

40
Q

Necrotizing enterocolitis Tx

A

Discontinue Enteral Feedings, GI decompression
Fluid and Electrolyte correction, parenteral nutrition
Broad spectrum antibiotics
Surgical Intervention right away- resection of bowel needed in 25-50% of cases

Pediatrics (8 decks)

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