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PEDIATRICS - PLE TOPNOTCH 2020 > NEONATOLOGY > Flashcards

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

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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.

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3
Q

The target temperature for newborns is?

A

36.5 - 37.5°C

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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

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5
Q

Optimal method for maintaining temperature in a stable neonate?

A

Skin-skin contact

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6
Q

Low birth weight

A

<2,500 grams

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7
Q

Very low birth weight

A

<1,500 grams

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8
Q

Extremely low birth weight

A

<1,000 grams

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9
Q

Late preterm birth

A

Equal/>34 and <37 weeks

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10
Q

Very preterm birth

A

<32 weeks

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11
Q

Extremely preterm birth

A

<28 weeks

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12
Q

also known as intra-uterine growth retardation (IUGR)

A

SMALL FOR GESTATIONAL AGE

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13
Q

BW is < 3 rd percentile for calculated gestational age

A

SMALL FOR GESTATIONAL AGE

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14
Q

differentiate Symmetric from Asymmetric IUGR

A
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15
Q

LARGE FOR GESTATIONAL AGE

A

Birth weight of >90 th percentile for gestational age

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16
Q

The most important component of the APGAR score is the:

A

Respiration

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17
Q

The best description of the APGAR score is that it

A

. Assesses neonates in need of resuscitation

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18
Q

EINC TIME-BOUND INTERVENTIONS

A
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19
Q

IMMEDIATE NEWBORN CARE

A
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20
Q

APGAR scoring system

A

Remember when given the word “grimace” the score for that is 1

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21
Q

Expanded NBS covers how many diseases?

A

28 diseases

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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)
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23
Q

NEWBORN SCREENING TEST RA #

A

RA #9288

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24
Q

enzyme defect in MAPLE SYRUP URINE DISEASE

A

defective activity of the enzyme branched chain alpha-keto acid dehydrogenase complex

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25
Q

has a potent mineralocorticoticoid activity

A

11-Deoxycorticosterone

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26
Q

enzyme deficient in classic galactosemia

A

Galactose-1-phosphate uridyltransferase (GALT) deficiency

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27
Q

CNS + more abrupt presentation + maple syrup odor

A

MSUD

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28
Q

Galactosemia that presents with cataracts

A

Galactokinase deficiency (GALK)

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29
Q

What is the enzyme that is deficient in phenylketonuria?

A

Phenylalanine hydroxylase

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30
Q

present with unpleasant musty odor

A

PHENYLKETONURIA

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31
Q

Slate blue, well demarcated areas of pigmentation over the buttocks and back

A

Mongolian Spots

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32
Q

CNS + kidney + liver affected

A

Galactosemia

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33
Q

CNS + delayed presentation + musty odor

A

PKU

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34
Q

Cysts appearing on the hard palate which is composed of accumulations of epithelial cells.

A
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35
Q

The cheese-like material that covers the normal term infant in varying amounts:

A

. Vernix caseosa

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36
Q

The purplish reticulated pattern noted on the skin of a neonate when exposed to cold:

A

Cutis marmorata

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37
Q

Small, white occasionally vesiculopustular papules on an erythematous base develop after 1-3 days. Contains eosinophils.

A

Erythema toxicum

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38
Q

Vesiculopustular eruption over a dark macular base around the chin, neck, back, and soles. Contains neutrophils.

A

Pustular melanosis

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39
Q

Pearly white papules seen mostly on the chins and around the cheeks

A

Milia

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40
Q

Open and closed comedones or inflammatory pustules and papules on the cheeks of the baby usually after a week from delivery

A

Neonatal acne

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41
Q

Pink macular lesions on the nape, glabella, upper eyelids, or nasolabial region

A

Nevus simplex

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42
Q

Hair that covers the skin of preterm infants. Seen on term infants around the shoulders.

A

Lanugo

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43
Q

Thick, white creamy material usually absent in post term infants

A

Vernix caseosa

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44
Q

Mottling of the skin with venous prominence. Cobblestone, lacy appearance

A

Cutis marmorata

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45
Q

ABSENT MORO REFLEX

  • Abnormal crepitus palpated around the clavicle
  • Clavicle not clearly delineated in the skin
A

Clavicular fracture

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46
Q

ABSENT MORO REFLEX

  • Arm abducted
  • Pronated
  • Internally rotated
  • History of excessive traction on the head
  • Intact hand grasp reflex
A

Brachial plexopathy

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47
Q

Differentiate Capput Succedaneum vs cephalhematoma vs subgaleal hemorrhage

48
Q

Cross the midline and suture lines

A

Caput succedaneum

49
Q

Subperiosteal hemorrhage

A

Cephalohematoma

50
Q

Limited to the surface of one cranial bone

A

Cephalohematoma

51
Q

No discoloration of overlying scalp

A

Cephalohematoma

52
Q

Edema, ecchymosis, and swelling apparent right after birth

A

Caput succedaneum

53
Q

May cause jaundice

A

Cephalohematoma

54
Q
  • 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
A

Tracheoesophageal Atresia

55
Q

the most common type of TEF

A

Type C (esophagus ends in blind pouch + distal TEF)

56
Q

A term infant with severe respiratory disease. Scaphoid abdomen on PE.

A

Diagnosis: Congenital Diaphragmatic Hernia

57
Q

most common type of Congenital Diaphragmatic Hernia

A

Bochdalek hernia

58
Q

Gastroschisis is more common on left side or right side of umbilicus?

59
Q

OMPHALOCELE VS GASTROSCHISIS

60
Q

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?

61
Q

histologic finding of NEC

A

Coagulation necrosis

62
Q

Thickened bowel walls and air in the bowel wall:

A

PNEUMATOSIS INTESTINALIS

63
Q

Management for NEC.

A

Supportive

If the baby developed pneumoperitonium, Surgery

64
Q

triad of the pathophysiology of NEC

A

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
Q

Surfactant is present in high concentrations in fetal lung homogenates by what AOG?

A

20 wk of gestation

66
Q

Surgactant appears in amniotic fluid between what AOG?

A

28 and 32 wks AOG

67
Q

Mature levels of pulmonary surfactant are present usually after what AOG?

A

35 wk of gestation

68
Q

APNEA defined as cessation of breathing for longer than how many seconds?

A

20 seconds or for any duration if accompanied by cyanosis and bradycardia

69
Q

MCC of apnea

A

idiopathic apnea of prematurity

71
Q

Apnea Management

A
  • 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
Q

What is the expected chest x-ray finding of RDS?

A

Fine reticular granularity of the parenchyma and air bronchograms

73
Q

CXR findings of Transient tachypnea of the newborn

A

Prominent pulmonary vascular markings, fluid in the intralobar fissures, overaeration, flat diaphragms

74
Q

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?

A

Persistent pulmonary HTN

75
Q

What is the primary cause of Persistent pulmonary HTN ?

A

Persistence of the fetal circulatory pattern of right-to-left shunting through the PDA and foramen ovale after birth

76
Q

Expected CXR findings of Persistent pulmonary HTN.

A

Normal findings

77
Q

Which of the following is very useful in evaluating a patient with PPTN?

A

Real-time echocardiography with Doppler flow

78
Q

CXR findings of Bronchopulmonary Dysplasia

A

“bubbly lungs” (cystic lucencies)

79
Q

Meconium Aspiration Syndrome

A

Coarse streaking granular pattern of both lungs fields

80
Q

CXR findings of Neonatal Pneumonia

A

Perihilar streaking

81
Q

usually develops in neonates being treated with oxygen and PPV for respi failure

A

Bronchopulmonary dysplasia

82
Q

Definition of BPD: DIagnostic Criteria

83
Q

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

A

PERSISTENT PULMONARY HYPERTENSION

84
Q

PaO2 or oxygen saturation gradient between a preductal (right radial artery) and a post-ductal (umbilical artery) site of blood sampling suggests

A

right-to-left shunting through the ductus arteriosus

85
Q

Ground Glass opacities, Under-aerated, atelectasis

86
Q

Chart for plotting the total bilirubin

A

Bhutani Chart

87
Q

The most serious complication of hyperbilirubinemia in the newborn is:

A

D. Encephalopathy

88
Q

Jaundice appearing between the second and third day after birth in full-terms infants is likely due to:

A

. Normal changes

89
Q

most common cause of jaundice in neonates is:

A

Physiologic

90
Q

JAUNDICE RISK FACTORS IN NEONATAL HYPERBILIRUBINEMIA

A
  • 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
Q

differentiate physiologic from pathologic jaundice

92
Q

JAUNDICE WITHIN 24H

First born child

A

ABO-incompatibility

93
Q

JAUNDICE WITHIN 24 H

Second born child

A

Rh-incompatibility

94
Q

JAUNDICE WITHIN 24 H

History of prolonged second stage of labor

No prenatal check up

A

Sepsis Neonatorum

95
Q

JAUNDICE WITHIN 24 H

History of maternal infection during pregnancy

A

TORCH infection

96
Q

JAUNDICE AFTER 24 H

Mother supplements feeding with sugar water.

Onset: 3-4 days

A

Breastfeeding Jaundice

97
Q

JAUNDICE AFTER 24 H

Baby is purely breastfed

Onset: >1 week

A

Breast Milk jaundice

98
Q

COMPARISON OF JAUNDICE RELATED TO BREASTFEEDING

99
Q

Substance that causes breastmilk jaundice

A

Glucuronidase

100
Q

Results from deposition of unconjugated bilirubin in the basal ganglia and brainstem

A

KERNICTERUS

101
Q

Examples of Intrahepatic Cholestasis

A

§ sepsis / TORCHeS

§ prolonged TPN

§ hypothyroidism

§ galactosemia

§ cystic fibrosis

§ alpha-1-antitrypsin deficiency

102
Q

Examples of Extrahepatic Cholestasis

A
  • choledochal cyst
  • biliary atresia

o paucity of bile ducts

103
Q

used to detect antibodies that are bound to the surface of RBCs

A

Direct Coombs test

104
Q

detects antibodies against RBCs that are present unbound to the patient’s serum

A

Indirect Coombs test

105
Q

Most common cause of hemolytic disease of the newborn

A

ABO INCOMPATIBILITY

106
Q

ABO incompatibility lab test results:

A
  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
Q

Conditions when Rh incompatibility occurs:

A
  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
Q

Rh incompatibility lab test results:

A
  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
Q

A baby with IUGR born to a mother with a history of infection during pregnancy

+

Chorioretinitis Imaging: Periventricular calcifications

110
Q

A baby with IUGR born to a mother with a history of infection during pregnancy

+

Maculopapular rash. Imaging: Periostitis of the bone

111
Q

A baby with IUGR born to a mother with a history of infection during pregnancy

+

Chorioretinitis Microcephaly Hepatosplenomegaly

Imaging: Intracerebral calcifications

A

Toxoplasmosis

112
Q

A baby with IUGR born to a mother with a history of infection during pregnancy

+

Cutaneous scars Imaging: Cortical atrophy

113
Q

Undescended testes may observe up to_____

A

3-4months of age

114
Q

Hydrocoele – may observe up to _____

A

1 year of age

115
Q

If the testes has not descended by _____months, it will remain undescended.

116
Q

Undescended testes is treated surgically not later than ____

A

9-15 months old

PEDIATRICS - PLE TOPNOTCH 2020 (15 decks)

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