Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is the most common long term complication of Necrotizing Enterocolitis?

A
  • Stricture formation

Others: short gut syndrome (following resection), bacterial overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why are anencephalic infants poor candidates for organ donations?

A
  • Do not satisfy the standard brain death criteria because of adequate brainstem function that maintains spontaneous respiration and heart rate after birth
  • By the time death has been declared, the organs will have undergone ischemic damage, making them unsuitable for transplantation
  • Use of life support does not improve the chance of successful organ donation from anencephalic infants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is apnea defined?

A

Absence of respiratory effort for >20 seconds, or of any duration with associated cyanosis or bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does apnea of prematurity usually resolve?

A

37 wks GA (but may persist for longer in those infants born <28 wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What medication should be given in the case of apnea of prematurity?

A

Caffeine (20 mg/kg loading, 5 mg/kg thereafter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to APGAR score?

A
  • Colour- cyanosis, acrocyanosis, pink
  • Tone - flat, weak, strong
  • Respiratory effort - absent, laboured, regular
  • Response to suction - none, grimace, cry
  • HR - absent, <100, >100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What virus is most likely to be responsible for Bronchiolitis?

A

RSV

followed by human metapneumovirus, rhinovirus, influenza, adenovirus, parainfluenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause for admission to hospital in the first year of life?

A

Bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for hospitalization in bronchiolitis

A
  • Signs of severe respiratory distress (eg, indrawing, grunting, RR >70/min)
  • Supplemental O2 required to keep saturations >90%
  • Dehydration or history of poor fluid intake
  • Cyanosis or history of apnea
  • Infant at high risk for severe disease
  • Family unable to cope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What treatments are recommended by the CPS for treatment of bronchiolitis?

A

Hydration and O2 (HHHFNC is not routinely recommended)

Equivocal evidence is seen for epinephrine, nasal suctioning, dexamethasone + epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition for Bronchopulmonary Dysplasia?

A

Disease process of respiratory insufficiency secondary to prematurity and arrested lung development rather than damage from prolonged ventilation

Mild: previously requiring oxygen for >28 days but now on RA at 36 wks PMA
Mod: <30% O2 at 36 weeks PMA
Severe: requiring >30% O2 at 36 wks PMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Should dexamethasone be used routinely in the treatment of infants with BPD?

A

No, as it has many side effects and may worsen neurodevelopment and the increase the risk of CP; only to be considered in the case of severe respiratory distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What treatments are routine used to prevent BPD in the case of premature infants?

A
  • Goal directed ventilation i.e. reduce barotrauma
  • Vitamin A
  • Nutritional support
  • Surfactant
  • Caffeine
  • Avoidance of PPHN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is medication metabolism different in neonates?

A
  • Slower gut motility results in longer half life
  • Thinner skin results in faster and greater dermal absorbtion
  • Rectal absorption is also increased in neonates
  • Decreased drug-protein binding capacity, resulting in more active circulating drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is adequate intrapartum antibiotic coverage?

A
  • Penicillin V
  • Ampicillin
  • Cefazolin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the risk factors for early onset sepsis?

A

1) Maternal GBS colonization
2) GBS bacteriuria
3) Previous infant with invasive GBS dx
4) PROM >18h
5) Maternal intrapartum fever (T >= 38.0C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the CPS suggest community paediatricians manage children based on GBS status?

A

If well: GBS unknown, GBS+ with 1 risk factor - d/c at 24 hours, if preterm, must monitor for at least 48 hours

If unwell: FSWU unless only respiratory symptoms, then 6 hours observation +/- investigations/BCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does transmission rate change based on maternal history of HSV?

A
  • First episode primary: 60%
  • First episode nonprimary: 30%
  • Recurrent episode: 2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How should children born to mothers with HSV at birth be managed?

A
  • Deliver first episode primary mothers by C/S if possible and swab MM and NP at 24 hours of life; may d/c home with close follow up if well
  • If first episode non-primary or recurrent and delivered SVD or by C/S, swab at 24 hours of life; d/c home with close follow up if well

If first episode primary and SVD, admit, swab and give IV acyclovir x 10 days

If HSV is detected, re-admit for Blood PCR, LP, transaminases and IV acyclovir
- If Blood PCR is positive, 21 days of acyclovir, otherwise, 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long should children with HSV be observed?

A

Up to 42 days of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How to prevent spread of HSV?

A
  • Good handwashing/gloves
  • Healthcare workers should take precautions when caring for high-risk patients such as newborns, immunocompromised individuals, and patients with chronic skin conditions
  • Patients and parents should be advised re: handwashing and avoiding contact with lesions and secretions, during active herpes outbreaks
  • Schools and daycare centers should clean shared toys and athletic equipment at least daily after use
  • Athletes with active herpes infections who participate in contact sports such as wrestling and rugby should be excluded from practice or games until the lesions are completely healed
  • Genital herpes can be prevented by avoiding genital-genital and oral-genital contact
  • Male circumcision is associated with a reduced risk of acquiring genital HSV infection
22
Q

What are known adverse effects of phototherapy?

A
  • Temp instability
  • Gut hypermotility/diarrhea
  • Interference/disruption of maternal-child bond
  • Bronze discolouration of skin (rare)
  • > parental anxiety/healthcare use
23
Q

What is the most common cause of hemolytic disease of the newborn?

A

ABO incompatibility

24
Q

What precautions can be taken to prevent future Rh incompatibility?

A
  • Rh- mom: 300μg IM RhoGAM (anti-D globulin) within 72h of delivery of a Rh+ infant, ectopic pregnancy, abdo trauma in pregnancy, amnio, abortion
  • All women who are Rh- and fetal blood type is unknown or known to be Rh+ should have Rhogam at 28 weeks and at 34 weeks
25
Q

What are the bilirubin thresholds for phototherapy and for exchange transfusion?

A

Phototherapy: 250, 300, 350

Exchange transfusion: 325, 375, 425

26
Q

What are the criteria to qualify for cooling?

A

Term and late preterm infants ≥36 weeks GA, ≤6 hours old and who:

A. Cord pH ≤7.0 or base deficit ≥−16

OR

B. pH 7.01 to 7.15 or base deficit −10 to −15.9 on cord gas or blood gas within 1 h AND

1) Hx of acute perinatal event (cord prolapse, placental abruption or uterine rupture)
2) Apgar score ≤5 at 10 mins or at least 10 mins of PPV

AND

C. Evidence of moderate-to-severe encephalopathy (seizures OR at least one sign in 3 or more of “SPLATR”)

Spontaneous activity
Posture
Level of consciousness
Autonomic dysfunction
Tone
Reflexes (primitive)
27
Q

Which infants should not qualify for cooling?

A

Exclusion criteria include:
• Moribund infants or infants with major congenital or genetic abnormalities for whom no further aggressive treatment is planned
• Infants with severe IUGR
• Infants with clinically significant coagulopathy
• Infants with evidence of severe head trauma or intracranial bleeding

28
Q

What areas of the brain are affected in HIE?

A

Cerebral arteries shunt blood flow from the anterior circulation to the posterior circulation to maintain adequate perfusion of the brainstem, cerebellum, and basal ganglia

As a result, damage is restricted to the cerebral cortex and watershed areas of the cerebral hemispheres

29
Q

What are the side effects of hypothermia/cooling?

A
  • Sinus bradycardia (HR 80 to 100 bpm)
  • Hypotension
  • Mild thrombocytopenia
  • PPHN with impaired oxygenation
  • Prolonged bleeding time
  • Subcutaneous fat necrosis, +/- hypercalcemia
30
Q

What is the optimal temperature of whole body cooling?

A

33.5 C

31
Q

What are the potential side effects of indomethicin?

A
  • Renal dysfunction i.e. oliguria
  • GI dysfunction i.e. bleeding, ulceration, reduction of blood flow, association with NEC
  • Abnormal platelet aggregation
  • Hyponatremia
  • Hyperkalemia
  • Hypoglycemia
32
Q

What are the teratogenic effects of poorly controlled diabetes during pregnancy?

A
  • Septal hypertrophy (ASD, VSD and other malformations)
  • Caudal regression syndrome
  • Small L colon syndrome
  • Hypoglycemia
  • Renal agenesis or malformation
  • LGA
  • Hyperinsulinism and associated hypoglycemia
  • Polycythemia as a result of extramedullary hematopoiesis
  • Holoprosencephaly
33
Q

When is acne concerning in a child/infant?

A

Between 3 months and 7 years

must look for abnormal source of androgens

34
Q

What is the greatest risk factor for development of NEC?

A

Prematurity
• Immature mucosal barrier
• Immature local host defenses i.e. low [ ] of IgA, mucosal enzymes (eg, pepsin and proteases), and other protective agents (eg, lactoferrin)
• Increased gastric pH (promotes bacterial overgrowth)
• Immature bowel motility

35
Q

What signs of NEC can be seen on AXR?

A
  • Portal venous gas
  • Pneumoperitoneum/free air
  • Dilated bowel loops (asymmetric)
  • Bowel wall edema (+/- thumbprinting)
36
Q

What is the underlying cause of neonatal thyrotoxicosis?

A

Transplacental movement of TRSAb (Neonatal Grave’s Disease)

37
Q

What is the treatment for neonatal thyrotoxicosis?

A
  • Propranolol 1-2 mg/kg/24 hrs PO divided TID
  • Methimazole 0.25-1 mg/kg/24hr PO divided q 12hr
  • Saturated KI (1 drop per day) may also be added
  • Other treatments
    • IV fluids and corticosteroids
    • Digitalis if heart failure is present

Basic principle: Antithyroid medications until euthyroid state is achieved (x3-4 months), as antibodies break down will remit spontaneously

If persistent consider genetic cause i.e. McCune-Albright syndrome

38
Q

What are the clinical manifestations of neonatal thyrotoxicosis?

A
  • Prematurity
  • Goiter
  • Exophthalmia
  • Extreme tachycardia and tachypnea
  • Hyperthermia
  • Weight loss despite ravenous appetite
  • Hepatosplenomegaly
  • Jaundice
  • Hypertension and cardiac decompensation
  • High T4 and T3, low TSH
  • Advanced bone age
  • Frontal bossing with triangular facies
  • Craniosynostosis
39
Q

What are 4 systems that are affected by Neonatal Lupus?

A
  • Cardiac - complete heart block
  • Dermatologic - annular, erythematous papulosquamous rash with fine scale and central clearing
  • Hematologic - thrombocytopenia
  • Hepatic - elevated liver enzymes, cholestatic hepatitis, hepatomegaly
  • Neurologic - macrocephaly, hydrocephalus, spastic paraparesis
40
Q

What are the treatment measures for Neonatal Lupus?

A
  • Fetal echo to assess heart block and endocardial fibroelastosis; may require treatment with dexamethasone / betamethasone +/- sympathomimetics
  • Pacemaker may be required soon after birth for neonates with complete heart block
  • Classic NLE rash does not require treatment; steroids may hasten healing but may increase risk of telangiectasias
  • Severe cytopenias may require treatment with IVIG
  • Future pregnancies require expectant management with FHR monitoring and mothers with autoantibodies may be treated with hydroxychloroquine (17% chance recurrence)
41
Q

What are some causes of PPHN that lie in the functional vasoconstriction category?

A
  • Hypoxia/asphyxia
  • Aspiration
  • Infection
  • RDS
42
Q

What are some causes of PPHN that lie in the functional obstruction category?

A
  • Polycythemia

* Hyperfibrinogenemia

43
Q

What are some maladaptive causes of PPHN?

A
  • IUGR
  • Placental insufficiency
  • Postdates
  • Premature closure of PDA
44
Q

What are some underdevelopment causes of PPHN?

A
  • CDH
  • Hypoplastic lung
  • Congenital lung malformation
45
Q

What is the gold diagnostic tool for PPHN?

A

ECHO

46
Q

Should sedation be used in PPHN?

A

Yes, to facilitate ease of ventilation, but no paralysis as this is associated with increased mortality

47
Q

What are the benefits and side effects of nitric oxide?

A

Benefits:
• Potent and selective pulmonary vasodilation without decreasing systemic vascular tone
• Combines with hemoglobin to form methemoglobin, which prevents systemic vasodilation (selective effect)
• Reduces V/Q mismatch by entering only ventilated alveoli and redirecting pulmonary blood by dilating adjacent pulmonary arterioles

Potential side effects: 
• Platelet dysfunction
• Pulmonary edema
• Methemoglobinemia
• Production of toxic byproducts such as nitrates
48
Q

What drugs can be used in the management of PPHN?

A
  • Surfactant
  • Corticosteroids
  • Bosentan
  • Sildenafil
  • Nitric Oxide
  • Milrinone
  • ECMO
49
Q

What are the clinical indications for using BLES?

A
  • Prophylactically to all infants < 26 weeks and to those 26-27 weeks who have not received antenatal steroids
  • Consider retreatment if persistent / recurrent O2 requirement of 30% or more and may be given as early as 2 hours after the initial dose (more commonly 4-6 hours after initial dose)
  • Intubated infants with RDS
  • Intubated infants with MAS requiring >50% oxygen should receive exogenous surfactant therapy
50
Q

What is the clinical definition of Respiratory Distress Syndrome (hyaline membrane disease)?

A

The presence of acute respiratory distress with disturbed gas exchange in a preterm infant with a typical clinical course or x-ray (ground glass appearance, air bronchograms and reduced lung volume)

51
Q

When does the CPS suggest resuscitative efforts in a newborn can be discontinued?

A

In infants with an Apgar score of 0 after 10 mins of resuscitation, if the HR remains undetectable, it may be reasonable to stop assisted ventilation; however, the decision to continue or discontinue resuscitative efforts must be individualized

Pediatrics (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions