Neonatology Flashcards
1
Q
associated with elevated AFP
A
RAIN Renal (nephrosis, renal agenesis, polycystic kidney) Abdominal wall defects Incorrect dating/multiple gestation Neuro (anencephaly, spina bifida)
2
Q
associated with low AFP
A
chromosomal abnormalities (trisomy 18 or 21)
3
Q
measures spontaneous fetal movement and heart rate activity
A
non stress test
4
Q
measures autonomic nervous system integrity
A
non stress test (by measuring spontaneous fetal movement and HR activity)
5
Q
measure uteroplacental insufficiency and tolerance of labor
A
contraction stress test (by measuring fetal HR in response to uterine contraction)
6
Q
positive contraction stress test
A
late decelerations after 50% of contractions - requires further work up
7
Q
biophysical profile
A
non stress test and US to evaluate: fetal movement, reactive HR, breathing, tone and volume of amniotic fluid
8
Q
apnea
A
no breathing >20 seconds
9
Q
apnea of prematurity treatment
A
caffeine and theophylline
10
Q
how to help reverse primary apnea
A
tactile stimulation and blow by oxygen
11
Q
how to help secondary apnea
A
PPV
12
Q
pressure needed to inflate lungs with first breath
A
60 mm Hg
13
Q
fluid in the interloper fissures and increased interstitial pulmonary markings in baby born by c-section
A
TTN
14
Q
TTN typically resolves in
A
72 hours
15
Q
hyaline membrane disease aka
A
RDS
16
Q
granular opacification’s and air bronchograms with a ground glass appearance obscuring heart and diaphragm borders on xray
A
RDS
17
Q
granular opacification’s and air bronchograms with a ground glass appearance obscuring heart and diaphragm borders on xray that is progressively worsening despite respiratory assistance
A
GBS pneumonia
18
Q
testing to indicate low risk of RDS
A
lethicin:sphingomyelin ratio >2
19
Q
mechanical ventilation indicated in RDS when pH and CO2 ___
A
pH <7.2 and pCO2>60
20
Q
clinical improvements expected with giving surfactant in RDS
A
decrease O2 requirement, increased lung compliance and decreased inspiratory pressure
21
Q
BPD treatment
A
diuretics
22
Q
babies with BPD are at risk for
A
hypocalcemia 2/2 diuretic use
23
Q
BPD is present in infants who
A
require oxygen past 28 days after birth and/or at 36 weeks corrected GA
24
Q
diffuse opacities with cystic areas and streaky infiltrates and ground glass appearance in infant on xray
A
BPD
25
sepsis treatment in neonates
ampicillin and gentamicin (enterobacter and serratia are resistant to cefotaxime)
26
placenta with white nodules think
listeria
27
early onset GBS presents when
first 7 days of life
28
late onset GBS presents when
usually first month of life but can be up to 90 days
29
late late onset GBS presents when
up to 6 months in preemies
30
when to screen for GBS
35 to 37 weeks
31
management of well appearing infant with inadequate treatment of GBS
monitor for 48 hours
32
management of infant born to mom suspected to have chorioamnionitis
CBC and blood culture with antibiotics pending culture results
33
management of clavicular fracture
observation, callus usually recedes by 2 years
34
erb's palsy location of injury
C5-C7
35
erb's palsy description
waiter's tip - adducted and internally rotated arm with wrist and fingers flexed
36
klumpke palsy location
C8, T1
37
klumpke palsy description
claw hand (affects muscles of the hand)
38
klumpke palsy can be associated with
Horner syndrome
39
umbilical cord should fall off by
2 week visit
40
umbilical cord that is attached after 1 month think
LAD or low WBC
41
test to perform if single umbilical artery
renal US
42
SGA definition
<10th%ile, <2500g
43
LGA definition
>90th%ile >3900g
44
SGA babies at higher risk for
temperature instability, polycythemia and fasting hypoglycemia
45
full term baby
38-42 weeks
46
newborn with dry skin that is peeling, long fingernails decreased lanugo on back and ears with strong recoil
post-term
47
normal arterial blood gas for newborn
pO2 60-90 and pCO2 35-45
48
normal scalp pH
>7.25
49
bilateral ankle clonus in newborn
normal
50
1 minute Apgar reflects
life in the uterus and endurance to delivery
51
5 minute Apgar reflects
transition and adjustment to the world
52
5 minute Apgar reflective of difficult adjustment
7
53
chest compressions at delivery if
HR<60 even with PPV
54
CPR in neonate
100 compressions/minute with one breath every 3 compressions
55
VLBW definition
<1500 grams
56
mean arterial pressure in preemies
should not be less than the corrected GA
57
thrombocytopenia in preemie without another known cause think
HSV
58
patchy areas of atelectasis alternating with areas of hyperinflation on xray
meconium aspiration
59
most likely complication of meconium aspiration
persistent pulmonary hypertension
60
pneumatosis intestinalis with air in the biliary tree
NEC
61
bloody stools, erythema of abdominal wall and thrombocytopenia
NEC
62
long term complication of NEC
intestinal strictures
63
NEC management
NG tube to intermittent suction, NPO with IV fluids and antibiotics
64
bilirubin up to what can be normal within first 24 hours of full term
12.4
65
what race has higher risk for hyperbilirubinemia
east asian
66
most common cause of unconjugated hyperbilirubinemia
breastfeeding jaundice (decreased caloric intake = increased enterohepatic circulation)
67
when does breastmilk jaundice occur
days 6 to 14 and may persist for 1 to 3 months
68
physiologic jaundice peaks
day 3
69
phototherapy is contraindicated in
direct hyperbilirubinemia or family history of light sensitive porphyria (causes bronze baby syndrome)
70
factors that can worsen neonatal jaundice
anything that competes for binding to albumin ex: sulfonamides. or sever acidosis
71
complications of exchange transfusion
high K+, low calcium, thrombocytopenia and hypovolemia
72
hypoglycemia in preemie
<25
73
hypoglycemia in full term
<35
74
hypoglycemia treatment
2-3 mL/kg D10 bolus
75
infants of diabetic mothers are at increased risk for
polycythemia (increased EPO), hypoplastic L colon, hypoglycemia, LGA 2/2 increased insulin levels
76
hypocalcemia defintion
Ical <4.5 and total calcium <8.5
77
EKG finding with hypocalcemia
prolonged QT interval
78
consider what if mom was on mag
hypocalcemia
79
hypocalcemia not responding to calcium
check magnesium
80
anemia in full term infant
<13
81
test to check fetal blood in mom
kleihauer betke test
82
polycythemia definition
central venous HCT >65
83
Hgb nadir in full term occurs when
2 to 3 months
84
Hgb nadir in preemies occurs when
1 to 2 months
85
polycythemia leads to
hypoglycemia, hyperbilirubinemia, thrombocytopenia
86
test of neonate's gastric aspirate to determine if it is maternal blood
apt test
87
prolonged PT in a bleeding infant think
vitamin K deficiency
88
prolonged PTT can be normal up until when
9 months
89
early onset hemorrhagic disease of the newborn
within 7 days - bleeding at circumcision or umbilical cord in breastfed infant not given IM vitamin K
90
diagnosis of vitamin K deficiency
bleeding and elevated PT that improves after giving vitamin K (levels aren't accurate)
91
seizure within 24 hours of delivery is most likely 2/2
birth asphyxia (most do not have long term sequelae)
92
treatment for seizures 2/2 HIE
phenobarbital
93
protrusion of bowel through the base of the umbilical cord
omphalocele
94
abdominal wall defect associated with syndromes
omphalocele (beckwith woodman and chromosomal abnormalities)
95
herniation of bowel through defect in abdominal musculature to the R of the umbilicus
gastroschisis
96
scaphoid abdomen with decreased breast sounds on the L side
diaphragmatic hernia
97
diaphragmatic hernia mangement
intubation and ventilation, NG to keep stomach decompressed and parenteral nutrition until surgical repair
98
IVH usually occurs when
within firs 96 hours
99
grade 1 IVH
germinal matrix
100
grade 2 IVH
IVH without dilation
101
grade 3 IVH
IVH with dilation
102
grade 4 IVH
IVH w. dilation and parenchymal involvement
103
soft boggy and crosses suture lines
caput succedaneum
104
beta adrenergic in mom
ex: terbutaline - can cause hyperinsulinism and then hypoglycemia
105
one time use of corticosteroids in mom
decreased risk of RDS, IVH and NEC
106
repeated corticosteroid use in mom
head growth impairment
107
signs of alcohol withdrawal in newborn
hyperactive, irritable, hypoglycemia
108
cocaine effects on newborn
at risk for anomalies due to vascular constriction (cerebral infarction, limb anomalies, urogenital defects) and increased risk of placental abruption
109
signs of barbiturate withdrawal in newborn
hyperactive, irritable, crying, poor suck/swallow corodination
110
signs of opioid withdrawal in newborn
hyperirritablity, tremors, jittery, hypertonia, loose stool, emesis, feeding difficulty, seizures
111
management of opioid withdrawal in newborn
methadone and/or oral morphine
112
time to discharge after c-section
72 hours
113
enlarged posterior fontanelle, umbilical hernia and jaundice
hypothyroidism
114
displaced PMI in posters newborn w/ history of mec-stained amniotic fluid
pneumothorax
115
congenital malformations associated with carbamazepine and phenytoin
spina bifida
116
DES associated with increased risk of what cancer
vaginal adenocarcinoma
117
ACE inhibitors increase risk of what congenital abnormality
renal dysgenesis, oligohydramnios and skull defects
118
most common effect of cigarette smoke on newborn
low birth weight
119
excessive hyperthermia from prolonged hot tube use associated with
neural tube defects
120
virus during pregnancy associated with risk of developing heart failure
parvovirus B19 (fifth disease)
121
frequent abnormality with single umbilical artery
trisomy 18
122
placenta of most identical twins
diamniotic, monochorionic
123
what scalp pH requires immediate delivery
<7.2
124
baseline fetal HR that defines fetal tachycardia
>160
125
baseline fetal HR that defines fetal bradycardia
<120
126
fall in fetal HR at the beginning of contraction peak that returns after the contraction ends
late deceleration (check fetal pH, potentially ominous)
127
change in mean pulmonary artery pressure at birth
decreases
128
change in pulmonary vascular resistance at birth
decreases
129
change in pulmonary blood flow at birth
increases
130
firm, fluctuant swelling that extends to the front of the ears and causes ears to push out laterally
subgaleal hemorrhage
131
location of surfactant production and storage
type 2 alveolar epithelial cells
132
tachypnea with differential cyanosis, tricuspid regurgitation and low narrowly split 2nd heart sound
persistent pulmonary hypertension
