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Pediatrics Clerkship > Neonatology > Flashcards

Neonatology Flashcards

1
Q

classification by GA

A

■ preterm: <37 wk
■ near-term: 35-37 wk
■ term: 37-42 wk
■ post-term: >42 wk

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2
Q

Pre-terms infants problems

A

RDS,
apnea of prematurity, chronic lung disease, bronchopulmonary dysplasia
Feeding difficulties, NEC
Hypocalcemia, hypoglycemia, hypothermia Anemia, jaundice
Retinopathy of prematurity
ICH/IVH
PDA

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3
Q

Routine Neonatal Care

A
  1. erythromycin ointment: applied to both eyes for prophylaxis of ophthalmia neonatorum
  2. vitamin K IM: prophylaxis against HDNB
  3. newborn screening tests
    ■ metabolic disorders (amino acid disorders, organic acid disorders, fatty acid oxidation defects,
    biotinidase deficiency, galactosemia)
    ■ blood disorders (SCD, other hemoglobinopathies)
    ■ endocrine disorders (CAH, congenital hypothyroidism)
    ■ others (CF, severe combined immunodeficiency) ■ congenital hearing loss
  4. if mother Rh negative: send cord blood for blood group and direct antiglobulin test
  5. if mother hepatitis B surface antigen positive: HBIg and start hepatitis B vaccine series
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4
Q

Apgar Score

A 
0,1,2 score/10
Appearance (colour)
Pulse (heart rate)
Grimace (irritability)
Activity (tone)
Respiration (respiratory effort)
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5
Q

steps to takefor all infants resuscitation

A

Warm and dry
Position and clear airway (if needed)
stimulate infant: rub back and fleet EXCEPT if meconium present (in which tracheal suction first)
assess breathing and heart rate

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6
Q

Caput seccedaneum

A
  • diffuse swelling of sof tissues
  • can CROSS suture
  • from pressure of uterus or vaginal wall
  • resolves within days
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7
Q

Cephalohematoma

A

subperiostal hemorrhage

  • NEVER CROSS
  • traumatic, forceps
  • monitor bilirubin + hematocrit level as can lead to blood take up and then break down
  • resolves 2-3 weeks
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8
Q

Fontanelles

A

Posterior closes approx. 2 months

Anterior 18-24 months

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9
Q

Subgaleal hematoma

A
  • below epicranial aponeurosis
  • CROSS midline + into neck or ear
  • baby can exsanguinate; may need transfusion
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10
Q

ATNR reflex

A

Fencing position
Ipsilateral extension of the limbs on the side where head is turn and contralateral flexion
*primitive reflex present at birth and disappear by 4-6 months

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11
Q

Newborn screening

A

ARE NOT diagnostic

  • if positive = follow up
  • if negative but has symptoms = should undergo further testing
  • phenylketonuria, galactosemia, congenital hypothyroidism, congenital adrenal hyperplasia, cystic fibrosis, sickle cell disease, thalassemia
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12
Q

Erythema toxium

A
  • Etiology unknown (Smears = esoinophils)
  • onset: 2-3 days of life
  • then wax + wane for 3-6 days
  • present: small erythematous papule / postule/ vesicule
  • no treatment, self-limiting
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13
Q

Hip: DDH exam

A

Bartlow
-adduction + lateral pressure exerted by thumb + downward pressure (out = +ve)

Ortolani -Abduction with medial pressure by middle finger (in = +ve)
i

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14
Q

CPS feeding recommendations:

A

1/ Breast feed exclusively for first 6 months
2/ 400 IU daily vit-D supplement for breastfed infants
3/ First foods = iron rich (meat, meat alternative, iron-fortified cereals)
4/ Baby does not need additional water

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15
Q

Contraindications to breast feeding

A 
1/ HIV + (in developed countries)
2/ HTLV-1 (T cell lymphoma virus)
3/ Herpes on breasts (both)
4/ Child with Galactosemia (metabolic disorder)
5/ Medications (some)
6/ Disease: TB, Varicella, Measles
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16
Q

Milk: 9-12 months

A

Homogenized milk (3.25% M.F.) Cows milk until 2 years of age

  • Max 3/day
  • Partly skimmed or low fat NOT recommended in the first 2 years
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17
Q

Newborn weight gain

A

NORMAL

20-30g/day

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18
Q

Long term complications of preterm

A
  • Cerebral palsy from ABN brain development
  • mental retardation
  • speech and language problems
  • blindness
  • hearing problems
  • behavioural + learning disabilities
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19
Q

NEC

*breast milk protective

A

intestinal inflammation with ulceration and necrosis

  • terminal illeum + colon
  • xray shows intramural air
  • tx: NPO, IV, NG decompression, supportive therapy, TPN, abx
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20
Q

Apnea of prematurity

A

> 20 sec or less if bradycardia <70-80 or desaturation <80-85%

  • inversely proportional to gestational age: Immature ventilatory drive in infants = lack of response to increased CO2 in blood along with hypoxia –> central apnea
  • usually resolve by 35-37w
  • tx: caffeine
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21
Q

Respiratory Distress Syndrome (RDS)

A
  • Etiology: Surfactant deficiency (Surfactant = from type 2 pneumocytes) ** sufficient amount by ~36 weeks of GA**
  • Only found in pre-term babies

Prevention

  • Prenatal Corticosteroids (CELESTONE 12mg q24h x2) if risk pre-term <34w
  • Lecithin:Sphingomyelin on Amnio (L:S >2:1) = lung maturity

Treatment

  • Resuscitation - O2 + Ventilation
  • Surfactant
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22
Q

Intra-Ventricular Hemorrhage:

A

Brain hemorrhage in the periventricular Subependymal Germinal Matrix

Subependymal GM = right next to lateral ventricles

Risk factos

a. ↑With ↓Gestational age (< 32 weeks)
b. Low birth weight < 1500g
c. Vigorous resuscitation at birth
d. pneumothroax
e. instability
f. RDS
g. coagulopathy

Routine US

i. <1500 g OR
ii. 32 weeks

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23
Q

Most serious complication of hyperbilirubinemia in the newborn

A

Encephalopathy

24
Q

Jaundice within 24 hours in a first born child

Most likely etiology?

A

ABO incompatibility

25
Q

Jaundice within 24 hours in a second born child

Most likely etiology?

A

Rh incompatibility

26
Q

Jaundice within 24 hours
History of prolonged second stage of labor
No prenatal check-up

Most likely etiology?

A

Sepsis

27
Q

Jaundice within 24 hours
History of maternal infection during pregnancy

Most likely etiology?

A

TORCH
[Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infection]

28
Q

______________ Jaundice

- attributed to the presence of _______________ in some breast milk

A

Breast Milk Jaundice

- attributed to the presence of glucuronidase in some breast milk

29
Q

Breastfeeding jaundice or breast milk jaundice?

Onset at 3rd to 4th DOL

A

BFJ

30
Q

Breastfeeding jaundice or breast milk jaundice?

Onset at 7th day of life

A

BMJ

31
Q

Breastfeeding jaundice or breast milk jaundice?

Duration is a few days

A

BFJ

32
Q

Breastfeeding jaundice or breast milk jaundice?

Duration is 3 weeks to 3 months

A

BMJ

33
Q

Physiologic Neonatal Jaundice

  • most common cause of jaundice in neonates
  • presents after the ___th hour of life
  • resolves in ___ week (term), ___ weeks (preterm)
A

Physiologic Neonatal Jaundice

  • presents after the 48th hour of life
  • resolves in 1 week (term), 2 weeks (preterm)
34
Q

Physiologic Neonatal Jaundice Physiology

A
  • increased production of bilirubin and decreased elimination of bilirubin
  • increased production due to increased hematocrit and decreased RBC lifespan in newborns
  • decreased elimination due to slow conjugation of bilirubin by immature glucuronyl transferase enzyme in newborn
35
Q

Pathologic neonatal jaundice

TB increases by greater than ____ umol/L/day

A

Pathologic neonatal jaundice

TB increases by greater than 85 umol/L/day

36
Q

______________ Jaundice

  • early-onset and accentuated, caused by decreased milk intake with dehydration and/or reduced caloric intake
  • One way to reduce incidence: frequent breastfeeding (>___ in 24 hours)
A

Breastfeeding Jaundice

  • early-onset and accentuated, caused by decreased milk intake with dehydration and/or reduced caloric intake
  • One way to reduce incidence: frequent breastfeeding (>10 in 24 hours)
37
Q

Kernicterus

  • results form the deposition of ________________ bilirubin in the ____________ and _____________
  • Phase 1: seizure, poor sucking, stupor, hypotonia
  • Phase 2: hypertonia, opisthotonus, Fever
  • Phase 3: hypertonia
A

Kernicterus

  • results form the deposition of unconjugated bilirubin in the basal ganglia and brainstem (the brain)
  • Phase 1: seizure, poor sucking, stupor, hypotonia
  • Phase 2: hypertonia, opisthotonus, Fever
  • Phase 3: hypertonia
38
Q

_________ Coombs Test
- used to detect antibodies that are bound to the surface of RBCs
_________ Coombs Test
- detects antibodies against RBCs that are present unbound to the patient’s serum

A

DIRECT Coombs Test
- used to detect antibodies that are bound to the surface of RBCs
INDIRECT Coombs Test
- detects antibodies against RBCs that are present unbound to the patient’s serum

39
Q

Direct Hyperbilirubinemia - caused by

_____________ cholestasis

  • sepsis / TORCH infection
  • prolonged TPN
  • hypothyroidism
  • galactosemia
  • cystic fibrosis
  • alpha-1 antitrypsin deficiency

______________ cholestasis

  • choledochal cyst
  • biliary atresia (paucity of bile ducts)
A

Direct Hyperbilirubinemia - caused by

HEPATIC cholestasis

  • sepsis / TORCH infection
  • prolonged TPN
  • hypothyroidism
  • galactosemia
  • cystic fibrosis
  • alpha-1 antitrypsin deficiency

POST-HEPATIC cholestasis

  • choledochal cyst
  • biliary atresia (paucity of bile ducts)
40
Q

in which type of hyperbilirubinemia would you have a weird stool color

A

conjugated hyperbilirubinemia ==> hepatic / excretory cause

== pale stools b/c not being colored with bili

41
Q

What are the 4 physiological competencies preterm babies must achieve before being eligible for discharge home?

A
  1. Thermoregulation: maintain normal body temperature when fully clothed in an open cot
  2. Control of breathing: apnea free period of at least 5-7 days
  3. Respiratory stability: maintenance of SaO2 > 90-95% in RA
  4. Feeding skills/weight gain
42
Q

What is the commonly used definition of chronic lung disease/bronchopulmonary displasia?

A

Need for O2 at CGA of 36 weeks + respiratory symptoms + compatible changes on CXR

43
Q

How do bilirubin levels differ in late prem infants compared to term infants? (4)

A
  1. Peaks later (at 7 days as opposed to 5 days)
  2. Reaches higher peak
  3. Stays elevated for longer
  4. Risk of kernicterus at lower levels of bilirubin
44
Q

What are the risk factors for early GBS sepsis? (6)

A
  1. Intrapartum fever
  2. ROM > 18 hrs
  3. GBS bacteruria
  4. Previous child with invasive GBS disease
  5. Maternal chorioamnionitis
  6. Prematurity
45
Q

Pathological jaundice

A

CONJUGATED + if jaundice <24h

*<24h: Hemolytic (ABO, Rh), Sepsis (GBS, TORCH)

46
Q

SGA symmetric

A 
<10th percentile
<2500g
Symmetric= reduction in both weigh, length and head
- causes
1st trimester infection TORCH
Chromosomal abnormality
*PDA usually only in SYMMETRIC
47
Q

SGA asymmetrical

A 
weight manly affected with HEAD GROWTH PRESERVED
-causes
placental insufficiency
poor nutrition
HTN
multiple pregnancies
drugs/smoking/alcohol
48
Q

Screening hypoglycaemia in newborn

A

a. Any symptoms = test baby
b. Any Asymptomatic with risk factors (premature, SGA, LGA, IDM)–> blood sugar checked 2 hrs after birth + eery 3-6 hrs before feeds until feeds are established and blood glucose > 2.6
c. Hypoglycemia diagnosed based on blood glucose <2.6

49
Q

Clinical presentation hypoglycemia

A

a. Apathy + irritability
b. Weak or high pitched cry
c. Low tone / limpless
d. Lethargy
e. Tremor or seizure
f. Poor feeding
g. Apnea or tachypnea
h. cyanosis

50
Q

Albumin can be saturated and bili can be displaced with medications

A
  1. Ceftriaxone
  2. Streptomycin
  3. NSAIDS
  4. Warfarin
51
Q

**Babies can have an increased enterohepatic circulation = more Unconjugated Bilirubin (UCB) resorption

A

Cause:

  1. Meconium
  2. Dehydration
  3. Decreased GI motility
52
Q

Jaundice (Hyperbilirubinemia): yellowing of skin from bilirubin

A

Visible at levels of 85-120umol/L

53
Q

Notable Risk Factors for Severe Hyperbili:

A
  1. <38 weeks GA
  2. Previous siblings with severe hyperbili
  3. Visible burising
  4. Cephalhematoma
  5. Male
  6. Maternal age > 25 years old
  7. Asian or European background
  8. Dehydration
54
Q

Breast milk jaundice

A

1 in 200 breast fed infants
- B-glycuronidases in breast milk –> unconjugates –> causes increase enterohepatic uptake of UCB
- Onset 4-7 days of life –> Peak 2-3 weeks of life –> resolve by 6w
- Levels reached are NOT concerning
iv.

55
Q

Indications for work up of jaundice

A

a. <24 hrs
b. Conjugated bili (>35umol/L)
c. Unconjugated that rises rapidly or excess of age or weight
d. Persistent jaundice >1-2 weeks age

Pediatrics Clerkship (9 decks)

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