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Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Major pathophysiology of cause of physiologic nadir of infancy

A

Fetus’ EPO levels rise, with the highest levels in the final trimester. Erythropoiesis is directly driven by EPO, and as a consequence, a significant portion of the red blood cell mass is produced in the final trimester of pregnancy.

At birth, blood oxygen levels suddenly increase. Renal oxygen tension sensors detect this sudden rise in oxygen levels, and in response, downregulate hypoxia-inducible factors, which in turn, downregulate the production of EPO, resulting in a slowly decreasing hemoglobin for several weeks after birth

  • Other causes: shorter lifespan of HbF, iron depletion
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2
Q

When does physiologic nadir of infancy happen and what is the normal Hgb in full term neonates

A

8-12 weeks
11.0 g/dL

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3
Q

Amniotic Band Syndrome cause and management

A

Cause: interruption of the normal sequence of development during the third trimester, affects the arms or legs.
Tx: refer to a plastic surgeon for reconstructive surgery.

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4
Q

Contraindications to breastfeeding (maternal infection (5), medication (3) and infant condition (1) )

A

Untreated Active TB
HIV (in developed countries)
Human T-cell lymphotropic virus tipe I or II
Untreated brucellosis
Ebola

Illicit drug use
Chemotherapy
Radioactive medications

Galactosemia

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5
Q

If neonate has left humeral fracture, what’s the management?

A

immobilization with elbow in 90 degrees

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6
Q

Management of delivery-related femur fracture

A

Pavlik harness (optional)

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7
Q

Management of Erb’s palsy

A

physical therapy

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8
Q

Complications for neonates born to mothers with phenylketonuria

A

IUGR
microcephaly
Structural cardiac anomalies
Developmental delay

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9
Q

If mother does not have PKU but fetus does, would they have IUGR or other growth restrictions?

A

NO

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10
Q

Direct hyperbillirubinemia definition in neonate

A

> 20% of total bilirubin

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11
Q

Direct hyperbillirubinemia and microcephaly

A

think CMV

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12
Q

Direct hyperbillirubinemia and microcephaly

A

think CMV

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13
Q

Pathophysiology of physiologic jaundice and when does it happen?

A

Increased RBC turnover and decreased BUGT activity
Starts 2-4 days after birth, peaks between 4-5 days

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14
Q

If infant has indirect hyperbillirubinemia, is stooling and wetting diapers, mother has A/B or AB blood type, what’s the likely cause?

A

G6PD

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15
Q

What is hemolytic disease of fetus and newborn?

A

Maternal Ab against neonate RBC
Usually when neonate have blood type A or B, mother with type O blood
It’s the IgG that crosses placenta and cause hemolysis
usually severe

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16
Q

When does breast milk jaundice occur and what’s the pathophys

A

7days to 10 weeks
BUGT inhibition

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17
Q

workup of Ischemis perinatal stroke and what artery does it most commonly effect

A

L MCA

MRI/ head US, echo (congenital heart disease and thrombus in heart)
Coagulation studies:
Protein C activity/ag
Free and total protein S
Fasting homocysteine
Fibrinogen
Plasminogen
Lipoprotein A
Factor VIII
lupus anticoagulant/antiphospholipid Ab
Factor V
Prothrombin
EEG

18
Q

Mechanism of brachial plexus injury

A

stretching of nerves

19
Q

How does transient tachypnea of the newborn happen? (pathophys)

A

Labor activates Na-K ATPase channels –> clears fluid from alveoli
If infant is born via c- section, this doesnt happen.

20
Q

Risks for early onset sepsis

A

Premature birth between 34-36 wks
Post-term >41 weeks
Maternal fever >38
PROM >18h
GBS status
Incidence in hospital EOS

21
Q

What is a must for newborn discharge?

A

Newborn Screen
CHD screen (pulse ox)
hearing test
vitals
voided and stooled, nursing

f/u in 48h

22
Q

Who should not be early discharged (<48h)?

A

Neonates born to mothers with chronic medical conditions
excessive maternal bleeding
complications from delivery including need for instrument assistance or C-S

23
Q

CCHD criteria to pass

A

95%
3 or less difference in RH and foot

24
Q

Preterm infant born to a febrile mother vaginally through green/brown-stained amniotic fluid, grunting and tachypnic. Likely pathogen?

A

Listeria
Causes preterm delivery AND green-brown amniotic fluid

Not likely meconium because infant is premature.

25
Q

Normal vaginal delivery followed by maternal hemorrhage and neonatal pettechiae, low platelet for both <20. Management and cause?

A

IVIG

Maternal ITP (maternal alloantibodies to both neonate and maternal platelets)

26
Q

Difference between maternal ITP and neonatal alloimune thrombocytopenia (NAIT)

A

Maternal ITP: both maternal and neonate PLT are low
NAIT: only infant’s is low (passive transplacental transmission of maternally derived alloantibody to Ag found on paternal and neonatal platelets.

27
Q

When do you give maternal platelets?

A

NAIT

28
Q

How do you workup congenital neonatal syphilis

A

Neonatal RPR or VDRL (nontreponemal)

FTA-Abs could be falsely positive since mother’s could still be found in infants’

29
Q

Umbilical granuloma management

A

Ligate with absorbable sutures
If persistent, get US to rule out urachal anomalies (umbilical polyp, urachal cyst, patent urachal sinus)

30
Q

Umbilical hernia should spontaneously close by ___

A

6 years old

31
Q

Infant with white forelock and delayed passage of meconium. What is the syndrome?

A

Waardenburg type 4 aka Waardenburg-Shah
Associated with Hirschsprung

32
Q

Causes of cyanosis

A

polycythemia (because of 30g/L deoxygenated hb though there is enough oxygen)

benign if peripheral (acrocyanosis), after feeding, after bathing

Neuro, resp, cardiac also ddx

33
Q

Neonates born to mothers with poorly controlled DM are at risk of ___

A

cardiomegaly
Heart failure
asymmetric hypertrophy of intraventricular septum (dynamic outlet obstruction like HOCM)–> propranolol if tachycardic, resolves overtime

Pathophys: decreased cardiac output

34
Q

Malformation sequence
Disruption sequence
Deformation sequence
Association

A

Malformation sequence: intrinsic to fetus, abnormal tissue development
Disruption sequence: developing fetus experiences event or exposure that alters normal course of development (amniotic band)
Deformation sequence: abnormal mechanical/structural external forces
Association: part of anomalies like VACTERL

35
Q

Normal prenatal tests and what they do

A

Nonstress test (NST): normal = 2 episodes of HR >150bpm in 20-min test (normal variation of HR)

Biophysical profile (BPP): 5 items: HR, fetal breathing, movement, tone, amniotic fluid volume (8-10 is normal)

35
Q

Normal prenatal tests and what they do

A

Nonstress test (NST): normal = 2 episodes of HR >150bpm in 20-min test (normal variation of HR)

Biophysical profile (BPP): 5 items: HR, fetal breathing, movement, tone, amniotic fluid volume (8-10 is normal)

36
Q

Appropriate MAP for infant

A

~GA in first week of birth

37
Q

What is the biggest factor that influences neonate hematocrit?

A

gestational age
(Preterm neonates have lower Hct, decreased sensitivity of hepatic sensors to hypoxia and reduced iron stores)

38
Q

Sx of neonatal abstinence sd

A

low-grade fever
mild tremor
facial excoriation

39
Q

Infant not feeding well, no tone, otherwise normal pulm, CV exam. What should be on the differential?

A

seizure
Inherited disease of metabolism

40
Q

some characteristics of preterm vs. term infants (breast, movement, respiration, cartilage)

A

30-34wk: areola flat, no palpable breast bud. Jerky, nonpurposeful movements of extremities, apnea of prematurity, ear cartilage soft with delayed recoil

34-36 weeks: stippled areola with 1-2mm breast bud, jerky movements of arms, periodic breathing, ear cartilage soft with instant recoil

Post term (42wk): cracked skin that’s peeling, hard ear cartilage

41
Q

Barium enema for hirschsprung

A

narrowed distal bowel

Pediatrics (26 decks)

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