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Studying > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Steroids to prevent BPD

  • dex
  • hydrocort
  • inhaled corticosteroids
A

Dex:
- not in 1st week
- not routinely for evolving BPD
- consider low dose over 7-10 days for babies with worsening CLD, increasing O2 requirements
HC:
- consider low dose (physiologic replacement) within first week for those at highest risk
ICS: not routinely recommended

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2
Q

Infants of moms with covid-19

A

NPS if mother positive within 2hrs (but consider between 2-24hrs)
- repeat positive swabs at 24-48 hrs

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3
Q

Donor and recipient in monochorionic unbalanced flows

A

Donor: IUGR, oligohydramnios, no bladder seen, MCA doppler abnormal, anemia, ischemia, IUFD
Recipient: polyhydramnios, CHF, hydrops, CHD (valves/septum), polycythemia

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4
Q

Antenatal steroids in prematurity

A

< 34+6 weeks

- lung development, IVH, NEC, mortality

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5
Q

Antenatal magnesium sulphate

A

<33+6

- neuroprotection (CP)

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6
Q

Polyhydramnios associations

A
  • esophageal atresia

- TEF

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7
Q

Risk factors for prematurity

A
  • <20 or > 40 yrs
  • very low SES, low BMI
    Past gyne/OB (pyelo, uterine, cervical anomalies, multiple abortions)
    Lifestyle: >10 cigarettes/day, heavy work
    Pregnancies: multiple, previon prem delivery
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8
Q

Risk factors for IUGR

A

Maternal: hypertension, preeclampsia, renal disease, diabetes, antiphospholipid syndrome, nutritional deficiency, smoking and substances, maternal hypoxia
Fetal: multiple gestation, placental abnormalities, infection, congenital anomaly, chromosomes

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9
Q

Fetal circulation shunts

A
  1. Ductus venosus: UV –> IVC
  2. Foramen ovale: RA –> LA
  3. ductus arteriosus: PA –> Aorta
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10
Q

Contraindications to breastfeeding

A
  1. HIV
  2. localized HSV
  3. few drugs (street drugs, +++ alcohol, chemotherapy, immunosuppressants)
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11
Q

HC growth rate

A

0.5cm/week for 1st 2 months then 1cm/mont from 2-6 months

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12
Q

PPHN treatment

A

Goal = decrease pulmonary vascular restance and increase systemic vascular pressure

  • Pulm vasodilators: oxygen, nitric oxide
  • avoid pulm vasoconstrictors: acidosis, hypercarbia, cold/stress
  • Systemic pressure: volume ++, inotropes
  • other: prostaglandins keeping duct open can sometimes be helpful
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13
Q

BPD definition

A
  • oxygen dependence beyond 28 days or at 36 weeks post-gestational age
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14
Q

BWT definitions

  • LBW
  • VLBW
  • ELBW
A

LBW < 2500
VLBW<1500
ELBW <1000

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15
Q

Apnea DDX in term baby

A 
Never normal in term infant 
- mat drug
- sepsis/meningitis
- ICH
- seizure
- GERD
- metabolic
- polycythemia
- PDA
- central hypoventilation
- hypoxia/acidosis
(note 20% of VLBW still have apnea at term corrected)
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16
Q

Risk factors for ROP

A
  • hypotension
  • prolonged ventialtion
  • oxygen therapy
  • slow postanatal growth
  • prematurity
17
Q

NEC risk factors

A
  • prematurity
  • ischemia (asphyxia, CHD, PDA, severe IUGR, exchange transfusions)
  • complication of Hirschprungs
  • infection
  • feeding (breast milk protective)
18
Q

Early onset sepsis risk factors

A

GBS (swab or bacteriuria)
Previous infant with GBS disease
PROM>18hrs
maternal temp

19
Q

Floppy baby

  • brain
  • spinal cord
  • anterior horn cell
  • neuromuscualr junction
  • muscle
  • genetic syndrome
A

Brain: perinatal depression/HIE
Spinal cord: trauma, stenosis
Ant horn cell: SMA (face sparing)
Neuromuscular jxn: Myasthenia gravis (transient)
Muscle: congenital muscular dystrophy (AR), congenital myotonic dystrophy (mother affected)
Genetic: T21, Prader Willi

20
Q

Perinatal brachial plexus palsy

C5,C6,C7

A
  • Upper/Middle = Erbs = C5/6/7 = waiter’s tip
  • Lower Klumpke = C8-T1 , klaw hand (rare)
  • C5 to T1 = often associated with Horner’s = less favorable
21
Q

Hypoglycemia

  • decreased substrate
  • increased utilization
  • inability to use glucose
A

Decreased substrate: SGA, prem, discordant twin
Increased utilization: (hyperinsulinism: IDM, B-W, SGA), polycythemia
Inability to use: GSD-1, galactosemia, fructose intolerance, IEM
Other: birth asphyxia, CAH, hypopit

22
Q

Features suggestive of IEM (labs)

A
  • hypoglycemia
  • acidosis
  • hyperammonemia
  • hyperbilirubinemia
23
Q

IEM - normal gas and high ammonia

A

Urea cycle defect

24
Q

IEM: acidosis +/- high ammonia

A

Organic acidemia

25
Q

IEM: hypoglycemia, normal gas, normal ammonia

A

Galactosemia

26
Q

Kleihauer test

A

check maternal blood for fetal hemoglobin

27
Q

Polycythemia

A
  • measure central Hct (venous/arteria)
  • HCT> 75% repeated or symptomatic: partial exchange transfusion (controversial as rarely done)
  • volume

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