NEONATOLOGY Flashcards
1
Q
The rationale of this intervention in the Essential Newborn Care is to prevent neonatal hypothermia and to increase colonization with protective family bacteria
A
Uninterrupted skin-to-skin contact
2
Q
ESSENTIAL NEWBORN CARE
A
• Immediate drying → prevents hypothermia
standard
• Uninterrupted skin-to-skin contact → 60 - 90 mins; prevents hypothermia, increases colonization with protective family bacteria and improves breastfeeding initiation and exclusivity.
• Delayed cord clamping after 1 to 3 minutes → decreases anemia in 1 out of 3 premature babies and prevents brain hemorrhage in 1 out of 2; prevents anemia in 1 out of 7 term babies.
• Breastfeeding within first hour of life prevents 19.1% of all neonatal deaths.
3
Q
The target temperature for newborns is?
A
36.5 - 37.5°C
4
Q
Mechanisms of heat loss in a newborn
A
(1) Convection of heat energy to the cooler surrounding air
(2) Conduction of heat to the colder materials touching the infant
(3) Heat radiation from the infant to other nearby cooler objects
(4) Evaporation from skin and lungs
5
Q
Optimal method for maintaining temperature in a stable neonate?
A
Skin-skin contact
6
Q
Low birth weight
A
<2,500 grams
7
Q
Very low birth weight
A
<1,500 grams
8
Q
Extremely low birth weight
A
<1,000 grams
9
Q
Late preterm birth
A
Equal/>34 and <37 weeks
10
Q
Very preterm birth
A
<32 weeks
11
Q
Extremely preterm birth
A
<28 weeks
12
Q
also known as intra-uterine growth retardation (IUGR)
A
SMALL FOR GESTATIONAL AGE
13
Q
BW is < 3 rd percentile for calculated gestational age
A
SMALL FOR GESTATIONAL AGE
14
Q
differentiate Symmetric from Asymmetric IUGR
A
15
Q
LARGE FOR GESTATIONAL AGE
A
Birth weight of >90 th percentile for gestational age
16
Q
The most important component of the APGAR score is the:
A
Respiration
17
Q
The best description of the APGAR score is that it
A
. Assesses neonates in need of resuscitation
18
Q
EINC TIME-BOUND INTERVENTIONS
A
19
Q
IMMEDIATE NEWBORN CARE
A
20
Q
APGAR scoring system
A
Remember when given the word “grimace” the score for that is 1
21
Q
Expanded NBS covers how many diseases?
A
28 diseases
22
Q
On what day of life is NBS done?
A
24 - 48 hrs of life
- Ideally done at 48 hours of life
- If blood was collected <24 hours old, repeat at 2 weeks old.
- For preterm: ideal time for NBS should be at 5-7 days old
- Can be done until 1 month old (for sick babies)
23
Q
NEWBORN SCREENING TEST RA #
A
RA #9288
24
Q
enzyme defect in MAPLE SYRUP URINE DISEASE
A
defective activity of the enzyme branched chain alpha-keto acid dehydrogenase complex
25
has a potent mineralocorticoticoid activity
11-Deoxycorticosterone
26
enzyme deficient in classic galactosemia
**Galactose-1-phosphate uridyltransferase (GALT)** **deficiency**
27
CNS + more abrupt presentation + maple syrup odor
MSUD
28
Galactosemia that presents with cataracts
Galactokinase deficiency (GALK)
29
What is the enzyme that is deficient in phenylketonuria?
Phenylalanine hydroxylase
30
present with unpleasant musty odor
PHENYLKETONURIA
31
Slate blue, well demarcated areas of pigmentation over the buttocks and back
Mongolian Spots
32
CNS + kidney + liver affected
Galactosemia
33
CNS + delayed presentation + musty odor
PKU
34
Cysts appearing on the hard palate which is composed of accumulations of epithelial cells.
35
The cheese-like material that covers the normal term infant in varying amounts:
. Vernix caseosa
36
The purplish reticulated pattern noted on the skin of a neonate when exposed to cold:
Cutis marmorata
37
Small, white occasionally vesiculopustular papules on an erythematous base develop after 1-3 days. Contains **eosinophils.**
Erythema toxicum
38
Vesiculopustular eruption over a dark macular base around the chin, neck, back, and soles. Contains **neutrophils**.
Pustular melanosis
39
Pearly white papules seen mostly on the chins and around the cheeks
Milia
40
Open and closed comedones or inflammatory pustules and papules on the cheeks of the baby usually after a week from delivery
Neonatal acne
41
Pink macular lesions on the nape, glabella, upper eyelids, or nasolabial region
Nevus simplex
42
Hair that covers the skin of preterm infants. Seen on term infants around the shoulders.
Lanugo
43
Thick, white creamy material usually absent in post term infants
Vernix caseosa
44
Mottling of the skin with venous prominence. Cobblestone, lacy appearance
Cutis marmorata
45
ABSENT MORO REFLEX
## Footnote
* Abnormal **crepitus** palpated around the clavicle
* Clavicle not clearly delineated in the skin
Clavicular fracture
46
ABSENT MORO REFLEX
## Footnote
* Arm abducted
* Pronated
* Internally rotated
* History of excessive traction on the head
* Intact hand grasp reflex
Brachial plexopathy
47
Differentiate Capput Succedaneum vs cephalhematoma vs subgaleal hemorrhage
48
Cross the midline and suture lines
Caput succedaneum
49
Subperiosteal hemorrhage
Cephalohematoma
50
Limited to the surface of one cranial bone
Cephalohematoma
51
No discoloration of overlying scalp
Cephalohematoma
52
Edema, ecchymosis, and swelling apparent right after birth
Caput succedaneum
53
May cause jaundice
Cephalohematoma
54
* Frothing & bubbling at the mouth & nose, cough, cyanosis, respiratory distress
* Feeding exacerbates the symptoms, causes regurgitation & precipitate aspiration
* Diagnosis**: inability to pass an NGT or OGT in the newborn is suggestive**
Tracheoesophageal Atresia
55
the most common type of TEF
Type **C** (esophagus ends in blind pouch + distal TEF)
56
A term infant with severe respiratory disease. Scaphoid abdomen on PE.
Diagnosis: **Congenital Diaphragmatic Hernia**
57
most common type of Congenital Diaphragmatic Hernia
Bochdalek hernia
58
Gastroschisis is more common on left side or right side of umbilicus?
Right
59
OMPHALOCELE VS GASTROSCHISIS
60
A preterm baby won’t stop crying. He then developed **abdominal distention with abdominal erythema**. The baby cries more when touched. What is your diagnosis?
NEC
61
histologic finding of NEC
Coagulation necrosis
62
Thickened bowel walls and air in the bowel wall:
PNEUMATOSIS INTESTINALIS
63
Management for NEC.
**Supportive**
If the baby developed pneumoperitonium, **Surgery**
64
triad of the pathophysiology of NEC
**1. Intestinal ischemia** (GI tract of toxic neonates are ischemic)
**2. Enteral nutrition** (serves as substrate for organism)
**3. Pathologic organisms** (colonic bacteria like Clostridium, E. coli, Klebsiella)
65
Surfactant is present in high concentrations in fetal lung homogenates by what AOG?
20 wk of gestation
66
Surgactant appears in amniotic fluid between what AOG?
28 and 32 wks AOG
67
Mature levels of pulmonary surfactant are present usually after what AOG?
35 wk of gestation
68
APNEA defined as cessation of breathing for longer than how many seconds?
**20 seconds** or for any duration if accompanied by **cyanosis and bradycardia**
69
MCC of apnea
idiopathic apnea of prematurity
70
71
Apnea Management
* immediate management
* Stimulation + O 2for 30 seconds, if it does not work à
* PPV for 30 seconds, if it does not work à
* Intubate
* CPR anytime if heart rate falls \<60bpm
* Identify and correct causes
* Methylxanthines (Caffeine or theophylline)
* increase central respiratory drive by lowering the threshold of response to hypercapnia
* enhances contractility of the diaphragm and preventing diaphragmatic fatigue
72
What is the expected chest x-ray finding of RDS?
Fine reticular granularity of the parenchyma and air bronchograms
73
CXR findings of Transient tachypnea of the newborn
Prominent pulmonary vascular markings, fluid in the intralobar fissures, overaeration, flat diaphragms
74
A 32 y/o G4P3 gave birth to a 42wk male neonate via SVD after 18 hours of labor. The neonate was noted to have **aspirated meconium.** Twelve hours after birth, the neonate was noted to have **grunting, nasal flaring, and intercostal retractions.** He was also tachycardic and was hypoxemic at 80% O 2 sats. After drawing blood from the right radial artery and umbilical artery, a PaO 2 gradient was noted. Which of the following is the initial diagnosis?
Persistent pulmonary HTN
75
What is the primary cause of Persistent pulmonary HTN ?
Persistence of the fetal circulatory pattern of right-to-left shunting through the PDA and foramen ovale after birth
76
Expected CXR findings of Persistent pulmonary HTN.
Normal findings
77
Which of the following is very useful in evaluating a patient with PPTN?
Real-time echocardiography with Doppler flow
78
CXR findings of Bronchopulmonary Dysplasia
“bubbly lungs” (cystic lucencies)
79
Meconium Aspiration Syndrome
Coarse streaking granular pattern of both lungs fields
80
CXR findings of Neonatal Pneumonia
Perihilar streaking
81
usually develops in neonates being treated with oxygen and PPV for respi failure
Bronchopulmonary dysplasia
82
Definition of BPD: DIagnostic Criteria
83
Persistence of the fetal circulatory pattern of right-to-left shunting through the PDA and foramen ovale after birth is a result of excessively high PVR
PERSISTENT PULMONARY HYPERTENSION
84
PaO2 or oxygen saturation gradient between a preductal (right radial artery) and a post-ductal (umbilical artery) site of blood sampling suggests
right-to-left shunting through the ductus arteriosus
85
Ground Glass opacities, **Under-aerated,** atelectasis
RDS
86
Chart for plotting the total bilirubin
Bhutani Chart
87
The most serious complication of hyperbilirubinemia in the newborn is:
D. Encephalopathy
88
Jaundice appearing between the second and third day after birth in full-terms infants is likely due to:
. Normal changes
89
most common cause of jaundice in neonates is:
Physiologic
90
JAUNDICE RISK FACTORS IN NEONATAL HYPERBILIRUBINEMIA
* Jaundice visible on the 1st day of life
* A sibling with neonatal jaundice or anemia
* Unrecognized hemolysis (ABO, Rh, other blood group, incompatibility); UDP-glucuronyl transferase deficiency (Crigler-Najjar, Gilbert disease)
* Non-optimal feeding (formula or breast-feeding)
* Deficiency of glucose-6-phosphate dehydrogenase
* Infection (viral, bacterial). Infant of diabetic mother. Immaturity (prematurity)
* Cephalohematoma or bruising. Central hematocrit \>65% (polycythemia)
* East Asian, Mediterranean, Native American heritage
91
differentiate physiologic from pathologic jaundice
92
JAUNDICE WITHIN 24H
First born child
ABO-incompatibility
93
JAUNDICE WITHIN 24 H
Second born child
Rh-incompatibility
94
JAUNDICE WITHIN 24 H
## Footnote
**History of prolonged second stage of labor**
**No prenatal check up**
Sepsis Neonatorum
95
JAUNDICE WITHIN 24 H
History of maternal infection during pregnancy
TORCH infection
96
JAUNDICE AFTER 24 H
Mother supplements feeding with sugar water.
Onset: 3-4 days
Breastfeeding Jaundice
97
JAUNDICE AFTER 24 H
Baby is purely breastfed
Onset: \>1 week
Breast Milk jaundice
98
COMPARISON OF JAUNDICE RELATED TO BREASTFEEDING
99
Substance that causes breastmilk jaundice
Glucuronidase
100
Results from deposition of unconjugated bilirubin in the basal ganglia and brainstem
KERNICTERUS
101
Examples of Intrahepatic Cholestasis
§ sepsis / TORCHeS
§ prolonged TPN
§ hypothyroidism
§ galactosemia
§ cystic fibrosis
§ alpha-1-antitrypsin deficiency
102
Examples of Extrahepatic Cholestasis
* choledochal cyst
* biliary atresia
o paucity of bile ducts
103
used to detect antibodies that are **bound** to the surface of RBCs
Direct Coombs test
104
detects antibodies against RBCs that are present **unbound** to the patient’s serum
Indirect Coombs test
105
Most common cause of hemolytic disease of the newborn
ABO INCOMPATIBILITY
106
ABO incompatibility lab test results:
1. Weakly to moderately (+) direct Coombs test
2. Spherocytes in blood smear
3. Hemoglobin is usually normal but maybe as low as 10-12 g/dL
4. Increased reticulocyte count in 10-15%
5. Increased B1 (may reach 20 mg/dL in 10-20%)
107
Conditions when Rh incompatibility occurs:
1. When Rh+ blood is infused into a Rh- woman by error, or;
2. When Rh+ fetal blood with D Ag inherited from a Rh+ father enter the maternal circulation during pregnancy, with spontaneous or induced abortion, at delivery
108
Rh incompatibility lab test results:
1. Direct Coombs test is +
2. Anemia
3. Increased reticulocyte count
4. B1 rises rapidly in the 1 st 6 hours of life
5. B2 may also be elevated
109
A baby with IUGR born to a mother with a history of infection during pregnancy
+
Chorioretinitis Imaging: Periventricular calcifications
CMV
110
A baby with IUGR born to a mother with a history of infection during pregnancy
+
Maculopapular rash. Imaging: Periostitis of the bone
Syphilis
111
A baby with IUGR born to a mother with a history of infection during pregnancy
+
Chorioretinitis Microcephaly Hepatosplenomegaly
Imaging: Intracerebral calcifications
Toxoplasmosis
112
A baby with IUGR born to a mother with a history of infection during pregnancy
+
Cutaneous scars Imaging: Cortical atrophy
Varicella
113
Undescended testes may observe up to\_\_\_\_\_
3-4months of age
114
Hydrocoele – may observe up to \_\_\_\_\_
1 year of age
115
If the testes has not descended by \_\_\_\_\_months, it will remain undescended.
4
116
Undescended testes is treated surgically not later than \_\_\_\_
**9-15 months old**
