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Neonatology Flashcards

1
Q

Describe routine care for a newborn

A

APGAR: Appearence, Pulse, Grimace, Activity, Respiratory

  • Weight, height, head circumference
  • warmed and patted dry
  • topical erythromycin eye drops within 2 hours
  • vitamin K1 injection within 1 hour
  • skin to skin contact
  • Heel prick between 48-72hrs of life: phenylketonuria, galactosemia, congenital hypothyroidism, congenital adrenal hyperplasia, cystic fibrosis, sickle cell, thalassemia
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2
Q

Discuss the presentation and management of erythema toxicum

A
  • is a benign self-limited asymptomatic skin condition occurring after birth and lasting for 2 weeks
  • small erythematous papules, vesicles with surrounding erythematous halo that are transient
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3
Q

List some contraindications to breast feeding

A
  • HIV positive mother
  • HTLV-1 positive mother
  • Herpes lesion of breast
  • Child with galactosemia
  • Mother taking penicillin, anti-metabolite or recreational drugs
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4
Q

Discuss the benefits of breastmilk

A
  • contains many calories, hydration, antimicrobial and immunologic properties
    Colostrum
  • high level of antibodies, low fat and high protein
  • IgA that protects GI tract and increase GI motility
    Mature milk (2-5 days)
  • change according to child needs
  • do not require supplement as long as output is normal for baby
  • recommended for 6 months
  • decreased change of constipation or diarrhea
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5
Q

What are the normal inputs and outputs for a newborn

A
  • Feed every 2-3hrs
  • 6-8 wet diapers
  • Stool every 1-3 days
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6
Q

When should you begin to initiate solid foods

A
  • > 6 months with better head control, can sit up, ability to tell caregiver when full, pick up food and place in mouth
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7
Q

Discuss order of introducing foods

A
  • iron rich foods first
  • add common allergen foods at this time
  • avoid juice, honey and sugary drinks
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8
Q

What are the caloric, vitamin and mineral needs in <1 year old

A

Caloric: 100 kcal/kg/day for first 6 months
Vitamin: 400IU of vitamin D
Minerals:
- Na 3mEq/kg, K 2mEq/kg, Cl 5mEq/kg
- Ca: 210 from 0-6 and then increases as get older
- Iron 1mg/kg

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9
Q

List preventive risk factors of breast feeding for baby and for mom

A 
Baby have lower risk of:
- asthma
- allergy
- diabetes
- obesity
- sudden infant death syndrome
Mother have lower risk of:
- breast cancer
- hypertension
- diabetes
- cardiovascular diseae
- uterine and ovarian cancer
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10
Q

Discuss the differences between a food intolerance and food allergy

A

Food Allergy:
- caused by IgE mediated event to even small amount of food
- diagnosed with skin prick test or history of anaphylaxis
Food Intolerance:
- caused by GI mediated response
- symptoms dependent on frequency and amount of intake
- diagnosed with trial elimination

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11
Q

What qualifies as pre-term?

A

<37 weeks gestation

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12
Q

Discuss pre-term intraventicular hemorrhage

A

Risk:
- vigourous resuscitatin
- pneumothorax
- hypotensive and hypertensive with fluctuating cerebral blood flow
- coagulopathy
Presentation
- begin 8 hours to 3 days of life and majority are asymptomatic
- routine head ultrasound in all infants <32 weeks to diagnose if do not have any neurologic, cardioresp, or metabolic signs
Management
- supportive and follow up

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13
Q

Discuss retinopathy of prematurity

A

Risk: high oxygen exposure at birth
Pathophysiology:
- interruption of growth in developing retinal blood vessels -> early vasoconstriction and obliteration of capillary bed -> neovascularization -> macular edema, tear and retinal detachment
Management:
- crytherapy, laser photocoagulation, anti-VEGF
- surgical vitrectomy or scleral buckle

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14
Q

Discuss apnea of prematurity

A
  • is the cessation of breathing for >20 seconds or shorter respiratory pause with hypoxia and/or bradycardia
    Management:
  • usually resolves on its own
  • environmental temperature control, proper neck positioning
  • oxygenation via nasal prong, CPAP
  • Caffeine to increase ventilatory drive by inhibiting adenosine receptor
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15
Q

Discuss respiratory distress syndrome in a preterm

A 
Risk Factors:
- low birth weight
- maternal diabetes
- C-section without labour
- meconium aspiration
- acidosis, sepsis
Pathophysiology:
- surfactant deficiency -> high alveolar surface tension -> poor lung compliance -> atelectasis -> hypoxia
Presentation:
- respiratory distress that onsets within first few hours and worsens
Investigation
- x-ray: decreased aeration and lung volumes, reticulonodular pattern, atelectasis
Management:
- steroids for prevention
- prophylactic surfactant in <28 week old
- supportive O2
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16
Q

Discuss bronchopulmonary dysplasia for preterm

A
  • is an oxygen requirement for >28days at 30 weeks with abnormal chest x-ray
    Risks
  • prolonged intubation and ventilation with high pressure and oxygen
    Presentation:
  • respiratory distress
  • rales
  • improvement over 2-4 months
    X-ray: lung opacification with hyperinflation
    Treatment:
  • reduce risk factors
  • furosemide, bronchodilators, corticosteroids
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17
Q

Discuss patent ductus arteriosus

A
  • normally closes within first 15 hours of life due to decreased prostoglandins and then anatomically closes within 2-3 weeks of age
    Presentation:
  • poor feeding with increased fatiguability
  • failure to thrive
  • machine like murmur at LUSB
    Investigations:
  • left atrial and ventricular hypertrophy on ECG
  • increased pulmonary vasculature on CXR
    Treatment:
  • PDE2 antagonist in premature (indomethacin)
  • surgical ligation in term or older infants
18
Q

Discuss necrotizing enterocolitis

A 
Risks:
- poor bowel perfusion
- hyperosmolar feeds or formula feeds
- sepsis 
Pathophysiology:
- bowel ischemia -> mucosal damage -> further enteral feeding lead to bacterial proliferation -> bacterial invasion into bowel wall leading to necrosis and perforation 
Presentation:
- feeding intolerance
- increased gastric aspirate or bile 
- blood in stool
- respiratory failure
- temperature instability
Investigations:
- X-ray: pneumatosis intestinalis (intraluminal air), free air, dilated bowel loops
Treatment:
- NPO minimum one week with TPN
- NG tube decompression
- IV fluids
- IV Amp and Gentamycin for 7-10 days
- peritoneal drain if perforation
19
Q

What is small for gestation age

A

Infant weight <10th percentile
Symmetric SGA:
- weight, height and HC <10th percentile
- due to 1st trimester congenital infection, chromosomal abnormality, or severe placental insufficiency
Asymmetric SGA:
- weight is only thing affected
- due to 2nd and 3rd trimester from maternal factors or placental insufficiency

20
Q

Discuss how to differentiate causes of SGA

A 
Maternal Factors:
- malnutrition
- smoking, drug use, alcohol
- vasculopathy
- TORCH
Placental Factors:
- insufficiency
- abruption
Neonatal:
- chromosomal
- multiple gestations
21
Q

List some complications of SGA

A
  • peri-natal: asyphyxiation, meconium aspiration

- metabolic: hypoglycemia, hypothermia, hypocalcemia

22
Q

What is the management of SGA

A
  • antenetal corticosteroids between 24-34 weeks in week before delivery
  • peri-natal: prevent asphyxia by clearing airway
  • prevent hypothermia by drying and warming
  • serial glucose and calcium checks
  • begin feeding
23
Q

What is large for gestational age

A

Weight >90th percentile

  • genetic causes
  • maternal factors: obesity, excessive gestational weight gain, diabetes
  • prolonged gestation
24
Q

List some of the complications of LGA

A
  • increases risk of morbidity and mortality
  • increased birth injury risk
  • respiratory: respiratory distress syndrome, transient tachypnea of the newborn
  • metabolic: hypoglycemia, polycythemia and increased viscosity
  • obesity and diabetes later in life
  • neurodevelopmental disorder
25
Discuss the metabolism of bilirubin
Heme oxygenase breaks down RBC into iron, CO, an biliverdin -> biliverdin converted to bilirubin -> bilirubin binds to albumin which transports it to the liver -> conjugated to glucuronic acid by glucuronosyltransferase -> conjugated bilirubin can then be secreted into the bile -> can have enterohepatic circulation as beta-glucuronidase can deconjugate the bilirubin
26
Discuss the causes of hyperbilirubinemia
Increased production: - isoimune-mediated hemolysis: ABO or Rh incompatibility - RBC membrane defects: herediatroy spherocytosis or elliptocytosis - Erythrocyte enzymatic defects: G6PD deficiency, pyruvate kinase deficiency - Sepsis - Polycythemia - Cephalohematoma or bruising Decreased clearance: - Crigler-Najjar - Gilbert - Congenital hypothyroidism or galactosemia Increased enterohepatic circulation: - intestinal obstruction - breast feeding failure - breast milk jaundice
27
Discuss the presentation of hyperbilirubinemia
``` Jaundice: progresses cephalocaudal Acute bilirubin encephalopathy: - Phase 1: fatigue, mild hypotonia - Phase 2: febrile and lethargic with poor suck - Phase 3: apnea, inability to feed, fever, seizures, hypertonicity Kernicterus: after first year - cerebral palsy - hearing loss ```
28
Discuss the management of hyperbilirubinemia
- Both plotted based on gestational age, risk factors (asphyxia, resp distress, acidosis, sepsis, temperature instability, isoimmune, G6PD) and post-natal age Phototherapy: - first line and require complete exposure - if severe will not take out to feed Exchange transfusion:
29
Discuss the transition of the neonatal blood circulation
labour increases catelcholmines which stop pulmonary secretion and increase resorption -> mechanical pressure from birth pushes fluid out -> first breath air displaces fluid and air entry dilate pulmonary blood vessels decreasing resistance -> umbilical vein clamp increases systemic vascular resistance closing right to left shunts
30
Discuss neonatal resuscitation algorithm
Good APGAR score can move onto routine care (warmth, clear airway, dry, ongoing evaluation) - If not breathing or poor tone in first 30 seconds begin to warm, dry and stimulate with rubbing and toe flicking - if no response, if HR below 100, gasping or apnea present begin PPV and Sp02 monitoring - if HR below 100 take ventilation steps by intubation, CPAP and high FiO2 - if HR below 60 than chest compressions with 3 every 2 seconds and 2 breaths with 100% FiO2 - continue for 15-20 minutes or until resuscitation successful
31
Discuss the causes of neonatal respiratory distress
- CNS (asphyxia encephalopathy) - Respiratory (ARDS, TTN, pneumothorax) - infection - cardiac
32
List the causes of hypoxic ischemic encephalopathy
``` Maternal Factors: - impaired oxygenation - inadequate perfusion: shock, pre-eclampsia, chronic vascular disease Placental Causes: - placental abruption - tight nuchal cord - cord prolapse - uterine rupture Fetal causes: - hemorrhage, bradycardia or thrombus preventing oxygenation ```
33
Discuss presentation of neonatal encephalopathy
- poor tone with abnormal posturing and diminished spontaneous movements - abnormal level of consciousness - absent primitive reflexes - low APGAR scores
34
List the common causes of neonatal seizures
- Hypoxic-ischemic encephalopathy - intracranial hemorrhage - CNS infection (TORCH, meningitis) - Metabolic: hypoglycemia, hypocalcemia, hypomagnesemia
35
Discuss the investigations and management for neonatal hypoglycemia
- those with risk factors should have glucose examined from 1 hr of life ever 3-6 hours before feeds for 12 hours Treatment: - symptomatic hypoglycemia (<2.6): IV dextrose - asymptomatic severe (<1.8 at 2hrs or <2 anytime): IV dextrose - asymptomatic, mild (1.8-2 at 2 hours or 2-2.5) then re-feed and check in 1 hour
36
Discuss the presentation and red flags for poor feeding in neonates
- lack of interest in feeding or problem with receiving proper amount of nutrition Red flags: - fever - respiratory distress - inconsolable crying, irritability, lethargy, decreased LOC - failure to thrive
37
Discuss the differential for poor feeding in neonates
``` Behavioural: - inappropriate feeding technique - insufficient lactation - maternal/infant dysfunction Interference with Physical Eating - CP, neuromuscular disorder, hypotonia - upper airway: nasal obstruction, cleft palate, adenoid hypertrophy - GERD - esophageal dysmotility syndrome Systemic: - infection - metabolic - congenital heart disease - vomiting or constipation ```
38
What is lethargy in neonates?
Reduced alertness and awareness due to generalized brain dysfunction
39
Discuss the presentation of cow's milk protein allergy
- subacute or delayed colitis - vomiting - diarrhea - bloody stool - failure to thrive
40
Discuss the three types of non-pathological jaundice and when they most likely appear
Physiologic Jaundice: - Occurs >1 day to 1 week - Pathophysiology: decreased bilirubin excretion from immature liver and increased enterohepatic circulation. - also have increased bilirubin production due to increased RBC volume and shorter RBC lifespan Breastfeeding Jaundice: - occurs 3-4 days to 10 days - due to poor milk supply or insufficient feeding resulting in increased enterohepatic circulation and dehydration resulting in greater jaundice Breastmilk Jaundice - occurs 1-2 weeks to 1-3 months - human milk may inhibit enzymes of conjugation

Pediatrics (18 decks)

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