Neonatology Flashcards by Clyde Silverio

[EINC]

What are the steps in EINC?

Immediate drying
Uninterrupted skin-to-skin contact
Delayed cord clamping after 1-3 minutes
Breastfeeding

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[EINC]

What are the mechanism of heat loss in a newborn?

Convection
Conduction
Heat radiation
Evaporation

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[Birth weight]

Low birth weight

<2500g

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[Birth weight]

Very low birth weight

<1500g

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[Birth weight]

Extremely low birth weight

<1000g

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[Gestational Age]

Late preterm

> / 34 but < 37 weeks

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[Gestational Age]

Very preterm birth

<32

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[Gestational Age]

Extremely preterm birth

<28

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____ BW is less than 3rd percentile for calculated age

SGA

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____ BW is > 90th percentile for gestational age

LGA

associated with maternal DM and obesity, risk for hypoglycemia, polycythemia

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[EINC]

What is the objective of thorough drying?

To stimulate breathing, provide warmth

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[EINC]

What is the objective of early skin to skin contact?

To provide warmth, bonding, prevent infection, and hypoglycemia

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[EINC]

What is the objective of delayed cord clamping

Reduce anemia in term and preterm

2. Reduce IVH and transfusions in preterm

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What are the components of APGAR?

Activity - active
Pulse - >100bpm
Grimace - Active motion
Appearance - body pink, extremities blue
Respiration - vigorous cry

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RA ____

Newborn Screening test

RA 9288

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In normal infants, NBS is done at __ hours

24 to 48 hours

If blood was collected <24hrs, repeat at 2 weeks old

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For preterm infants, NBS should be done _____ day old

5-7 days old

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How many diseases does Expanded NBS covers?

28 diseases

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[Diagnosis]

Normal birth weight and length
Delayed physical, mental and sexual development;

Sluggish, deeding difficulties

Edema of scrotum and genitals, prolonged jaundice

Congenital Hypothyroidism

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What is the most common cause of congenital hypothyroidism?

Thyroid Dysgenesis

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[Diagnosis]

Normal at birth but with signs of sexual and somatic precocity within 1st 6 months of life

Hyponatremia, hyperkalemia, hypoglycemia

Congenital Adrenal Hyperplasia

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Marked elevation of 17-OHprogesteron is normally elevated in the first ____ DOL in sick pre-term infants

2-3 DOL

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Most common enzyme deficiency associated with CAH?

21-hydroxylase enzyme

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What is the treatment for CAH

Glucocorticoid replacement 15 to 20mg/m2/24 hours administered orally in 3 divided doses

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What is the DOC for salt-wasting type of CAH

Fludrocortisone

What are the enzyme deficiency in Galactosemia?

1. Galactose-1-phosphate uridyltansferase (classic) 2. Galactokinase (cataract) 3. Galactose-4-epimerase

What is the enzyme deficient in phenylketonuria?

Phenylalanine hydroxylase | Increased Phe

What is the damaging by product of phenylalanine that disrupts normal metabolism and causes brain damage?

Phenylethylamine unpleasant musty odor

What is the most common manifestation of phenyketonuria?

developmental delay Infant: severe vomiting, hypertonic, hyperactive DTRs Older: hyperactive with purposeless movements, rhythmic rocking and athetosis, unpleasant musty odor

What is the enzyme deficiency in MSUD?

Branched chain alpha-keto acid dehydrogenase complex L, I, V

[PE findings at birth] slate blue, well demarcated areas of pigmentation over the buttocks and back

Mongolian spots

[PE findings at birth] small, white, vesiculopustular papules on an erythematous base after 1-3 days, with eosinophils

Erythema toxicum

[PE findings at birth] Vesiculopustular eruption over a dark macular base around the chin, neck, back and soles. contains neutrophils

Pustular melanosis

[PE findings at birth] Cysts appearing on the hard palate which is composed on accumulations of epithelial cells

Epstein pearls

[PE findings at birth] pearly white papule seen mostly on the chins and around the cheeks

Milia

[PE findings at birth] open and closed comedones or inflammatory pustules after a weeks from delivery

Neonatal acne

[PE findings at birth] pink macular lesions on the nape, glabella, upper eyelids, nasolabial region

Nevus simplex

[PE findings at birth] hair that covers the skin of preterm infants

Lanugo

[PE findings at birth] thick, white creamy material usually absent in post term infants

vernix caseosa

[PE findings at birth] mottling of the skin with venous prominence. Cobblestone, lacy appearance

cutis marmorata

What are the possible causes of absent moro reflex?

1. Clavicular fracture | 2. Brachial plexopathy

[Birth injury] At point of contact, can extend across sutures; shifts with gravity

Caput succedaneum

[Birth injury] Usually over parietal bones, does not cross sutures; more fluctuant after 48 hours, distinct margins, initially firm

Cephalhematoma

[Birth injury] beneath epicranial aponeurosis; may extend to orbits, nape of neck can have crepitus or fluid wave; progressive, may be massive

Subgaleal hemorrhage

[Diagnosis] 12hours DOL, frothing at the mouth of secretions. Regurgitated when given milk 155bom, RR 68, harsh breath sounds, good cardiac tone, soft abdomen, cyanotic lips and nailbeds

EA with TEF Dx: inability to pass an NGT or OGT in the newborn Manage: maintain patent airway, prone position, esophageal suctioning, surgery

What is the most common type of EA?

Type C

[Diagnosis] Newborn, tachypnea, grunting, use of accessory muscles with cyanosis at the 2nd hour of life, scaphoid abdomen, PMI shifted near the sternal side

Congenital Diaphragmatic hernia

What is the most common type of diaphragmatic hernia?

Bochdalek hernia

[Omphalocele vs Gastroschisis] Extrusion of abdominal viscera, present sac, below the umbilicus, umbilicus is at the center of the membrane, normal bowel and alimentation

Omphalocele more commonly associated with congenital anomalies

[Omphalocele vs Gastroschisis] Extrusion of abdominal viscera, no sac, lateral to the umbilicus, the umbilical cord is left of the defect, bowel is inflamed, delayed alimentation

Gastroschisis

[Diagnosis] Newborn. Abdominal distention with abdominal erythema ; baby cries more when touched

NEC

What is the histologic finding in Necrotizing enterocolitis?

Coagulation necrosis

___ refers to a thickened bowel walls and air in bowel wall

pneumatosis intestinalis

What are the triad of the pathophysiology of NEC?

1. Intestinal ischemia 2. Enteral nutrition 3. Pathologic organism

[Respiratory condition] AOG at which surfactant is present in fetal lung

20 weeks AOG

[Respiratory condition] AOG at which the surfactant is present in the amniotic fluid

28 and 32 weeks

[Respiratory condition] mature levels of pulmonary surfactant are present in ____

35 weeks AOG

What is the major component of surfactant

Phosphatidylcholine

Apnea is the cessation of breathing for more than ____

20 seconds or any duration if accompanied by cyanosis and bradycardia

What is the most common cause of apnea?

Idiopathic apnea of prematurity

In neonates, what is the HR to initiate CPR

<60 bpm

This drug is given to neonates presenting with apnea which acts a by lowering the threshold of response to hypercapnia and enhance the contractility of the diaphragm

Methyxanthine (Caffeine or theophylline)

What is the CXR finding of RDS

Fine reticular granularity of the parenchyma and air bronchograms

What is the CXR finding of TTH?

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

[Diagnose: CXR] Finely granular lungs; ground glass appearance

Hyaline membrane disease

[Diagnose: CXR] prominent pulmonary vascular markings, fine lines in fissures

TTN

[Diagnose: CXR] bubbly lungs

Bronchopulmonary dysplasi

[Diagnose: CXR] Coarse streaking granular pattern of both lung fields

MAS

[Diagnose: CXR] Perihilar streaking

Neonatal pneumonia

[Jaundice: Physiologic/Pathologic] visible only on the 2nd - 3rd day

Physiologic

[Jaundice: Physiologic/Pathologic] decline to adult level by 10-14 days of life

Physiologic

[Jaundice: Physiologic/Pathologic] appears in the first 24 to 36 hours

pathologic

[Jaundice: Physiologic/Pathologic] serum bilirubin rising >5mg/dL/24 hours

pathologic

[Jaundice: Physiologic/Pathologic] TB increases >0.5mg/dL/hour

Pathologic

What substance in milk that contributes to breastfeeding jaundice?

Glucurinidase

Kernicterus results from deposition of unconjugated bilirubin in what part of the brain

ganglia and brainstem

[Coomb's Test] ____ detect antibodies that are bound to the surface of RBCs

Direct Coombs

[Coomb's Test] detects antibodies agains RBCs that are unbound

indirect coombs

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

ABO incompatibility

What are the lab test results in ABO incompatibility?

1. (+) coombs test 2. Spherocytes in blood smear 3. Hemoglobin is usually normal but maybe as low as 10-12g/dL 4. Increased reticulocyte count 5. Increased B1

What is injected to the mother to reduce the Rh hemolytic disease?

Anti-D gamma globulin immediately after the delivery of each Rh + infant

What are the Rh incompatibility lab results?

1. (+) Direct Coombs test 2. Anemia 3. Increased reticulocyte count 4. B1 rises rapidly 5. B2 may also be elevated

What are the conditions that are coombs test negative with high hemoglobin and increased B1?

1. Polycythemia 2. Infant of diabetic mother 3. SGA 4. Delayed cord clamping 5. Twin transfusion / maternal-fetal transfusion

What are the conditions that are Coombs test negative with normal / low hemoglobin and normal reticulocyte count

1. Enclosed hemorrhage 2. Increased enterohepatic circulation 3. Decreased calories 4. Disorders of conjugation

What are the conditions that are coombs test negative with normal / low hemoglobin and increased reticulocyte count

1. Spherocytosis 2. Elliptocytosis 3. G6PD 4. Pyruvate kinase deficiency

What are the conditions that can cause coomb's test positive?

1. ABO incompatibility | 2. RH incompatibility

[Congenital infection] vesicular lesions on the face and mouth

HSV

[Congenital infection] purpuric hemorrhagic lesions all over the body

Rubella

[Congenital infection] maculpapular rash; periostitis of the bone

syphilis

[Congenital infection] chorioretinitis CT: Periventricular calcifications

CMV

[Congenital infection] Chorioretinitis, microcephaly, hepatosplenomegaly CT: Intracerebral calcifications

Toxoplasmosis

[Congenital infection] Cutaneous scars CT: Cortical atrophy

Varicella

Accumulation of fluid in the tunica vaginalis; majority are non-communicating; resolves by 12 months

Hydrocele may be observe up to 1 year of age

Undescended testes may be observed up to ____ months of age

3-4 months