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Pediatrics > Newborn > Flashcards

Newborn Flashcards

1
Q

Harlequin color change

A

dramatic confluent red color change of dependent part of body, the other half is pale. Lasts for 30s-to 20minutes and resolves with increased activity. Up to 10% of infants undergo this color change that occurs between day 2-5 of life. 2/2 autonomic dysregulation. Seen more commonly in LBW infants

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2
Q

What is considered the neonatal period?

A

1st month of life

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3
Q

When does myelination of the cortex begin?

A

starts at 8 months gestation, complete by 2 years.

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4
Q

What should rate of growth be during first month?

A

30g/day. This is the period of fastest postnatal growth

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5
Q

By when does birthweight double?

A

4 months

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6
Q

What should 2-4 mo old sleep pattern be?

A

Needs 14-16 hours of sleep per day, with 9-10 concntrated at night and 2 naps through day.

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7
Q

When do babies start to “sleep through night”

A

70% sleep for 6-8 hours straight by 6 months

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8
Q

By when does birthweight triple?

A

1 year

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9
Q

At what age are they expected to sleep through night

A

Add 2 hours to age in month - expected amount of hours sleep through night.

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10
Q

When can start using OTC cold meds

A

at earliest age 6

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11
Q

How much should newborns be eating in the first week

A

1-2 oz q1-2 hours

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12
Q

How much should newborns be eating in first month

A

3-4oz q2-3 hours

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13
Q

Signs of a successful latch

A

Audible swallowing noises without clicking noises from the infant’s mouth (may not be audible in the very early days, but should be visible)
Infant nose aligned to nipple with head tilted backwards
Full rounded cheeks, no dimpling cheeks
Rhythmic jaw movements

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14
Q

Treatment of sore nipples?

A

An over-the-counter product, lanolin, can also be applied to the affected area and does not need to removed before nursing. This product is 100% natural and comes from the raw wool grease of sheep’s wool.

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15
Q

How much should babies gain in first 2-3mos of life

A

she/he should gain somewhere between 4 to 7 ounces a week

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16
Q

When do newborn stooling patterns change?

A

At around 6 weeks of life, the stools may become less frequent, even as infrequent as every 3 days for breastfed infants.

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17
Q

Signs of adequate milk intake?

A

Bowel movements: 3-4 or more every 24 hrs.
Urination: 6 or more times every 24 hrs.
Baby is content between feedings
Average weight gain: 5-7 ounces/week (100 -
200 gms per week

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18
Q

When should nipple shields be used

A

temporarily if woman has inverted nipple or very sore nipples

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19
Q

up to what age is thrush ok in normal baby?

A

6 months after 6-12 months , raised concern for immunodeficiency. Ask if mom has rash, contaminated vitamin dropper, etc?

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20
Q

Similac special care

A

Premature infant formula (<34 weeks)

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21
Q

Enfamil Premature

A

Premature infant formula (<34 weeks)

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22
Q

Good Start Premature

A

Premature infant formula (<34 weeks) partially hydrolyzed whey

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23
Q

Neosure

A

Transition NICU Discharge; intact proteins

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24
Q

Enfacare

A

Transition NICU Discharge; intact proteins

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25
Q

Good Start Nourish

A

Transitional NICU Discharge formula; partially hydrolyzed whey.

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26
Q

Similac Advance

A

Standard formula whey 18: casein 82

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27
Q

Enfamil Premium

A

Healthy Term Infant whey 100: casein 0

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28
Q

Enfamil Gentlease

A

For mild GI discomfort; partially hydrolyzed proteins

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29
Q

Good start Protect

A

partially hydrolyzed proteins for mild GI discomfort. Has probiotics

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30
Q

Good start Gentle

A

partially hydrolyzed proteins for mild GI discomfort. Has Prebiotics

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31
Q

Good Start soothe

A

partially hydrolyzed proteins for mild GI discomfort. Has probiotics and less lactose.

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32
Q

Complete elemental formulas

A

Neocate Infant, Elecare Infant, Nutramigen AA

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33
Q

Nutramigen Enflora

A

Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.

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34
Q

Pregestimil

A

Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.

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35
Q

Alimentum Advance

A

Entensive hydrolyzed proteins (casein), lactose free. For family history of food allergies or sensitive to casein and soy.

36
Q

What is included in the biophysical profile?

A

Non-stress test, fetal movement, reactive HR, Breathing, Tone, AFI - get either 0 or 2 for each. total score of 8-10 is normal.

37
Q

What can cause false negative in newborn screen?

A

Drawn

38
Q

What can cause false positives in newborn screen?

A

TPN, antibiotics, hemoglobinopathies

39
Q

Placental Accreta

A

the uterus lacks normal decidua because of previous trauma ( curettage, myomectomy, or c section

40
Q

Placental percreta

A

develops when the placenta penetras the scars in placental accreta, resulting in serious hemorrhage

41
Q

Placental abruption

A

develops when a firm blood clot forms after a retroplacental hemorrhage

42
Q

What is the difference between primary and secondary apnea?

A

Primary apnea can be reversed with tactile stim, for secondary apnea, oxygen and stim will not work. PPV is needed. Both types can occur in utero and it is difficult to tell the difference, thus when a baby is born and is apneic, you are quick to start PPV in case this is secondary apnea.

43
Q

Causes of increased AFP

A

Renal (renal agenesis, nephrosis, polycystic kidney disease), abd wall defects, NTD, incorrect dates, multiple gestation

44
Q

When is the quad screen done?

A

15-20 weeks

45
Q

Causes of decreased AFP

A

TRisomy 13, 18, 21, incorrect fetal age, IUGR, fetal demise

46
Q

Increased AFP, normal hcg, uE3

A

NTD

47
Q

Low AFP, increased hcg, low uE3

A

trisomy 21

48
Q

Low AFP, low hcg, low uE3

A

trisomy 18

49
Q

What is a non stress test

A

done in 3rd trimester, 20 minutes of continuous monitoring for fetal HR and movement. Measures autonomic system integrity

50
Q

Contraction stress test

A

Done at >34 weeks. Mom given oxytocin to cause contractions. Look for decels. Measures uteroplacental insufficiency and tolerance of labor

51
Q

What test is used to test lung maturity?

A

lecithin:sphingomyelin ratio. If greater that 2, low risk for RDS. This helps decide about giving antenatal steroids. MAternal diabetes can mess up this ratio

52
Q

How does hypermagnesemia present in the newborn?

A

respiratory depression, failure to pass meconium, lethargy, flaccidity, hyporeflexive, poor feeding. IV Ca and mag will reduce levels

53
Q

How can you remember blood pressure parameters in preemies?

A

MAP should equal GA

54
Q

What is unique about preemie formula

A

24kcal/oz, higher ca and phos, more MCT, whey:casein 60:40

55
Q

aplasia cutis

A

ulcerated, noninflammatory, well demarcated congenital absence of skin that is usually limited to a small area. Associated with Trisomy 13. Self resolves with epithilization and atrophic, hairless scar over a few weeks

56
Q

What are congenital cataracts associated with?

A

rubella, toxo, CMV congenital infections

57
Q

What percent of hemoglobin is fetal at birth?

A

50%

58
Q

When do you trewat plycythemia in a newborn

A

when >70%. Partial exchange transfusion

59
Q

When is the nadir of Hgb in full term vs preemie infants?

A

Full tern 2-3 months, preemie 1-2 months. Also preemies start with a low hgb

60
Q

What is the Apt test?

A

tests newborns gastric secretions to determine if it in actual swallowed maternal blood

61
Q

What is a neoanatal side effect of turbutaline?

A

leads to hyperinsulinism and hypoglycemia

62
Q

Widely spaced nipples with shield chest - associated with which conditions

A

Turners and noonan

63
Q

Why do infants of diabetic mothers have higher risk of RDS?

A

bc insulin seems to block the development of enzymes necessary for the synthesis of lecithin, a precursor of surfactant

64
Q

Which heart abnormalities occurs in infants of diabetic mothers (type 1)

A

hypertrophic CM (however this serlf resolves by 3-6 months. Septal defects, TOGA, Truncus arteriosus, coarctation

65
Q

Who gets prophylactic surfactant at birth

A

infants 50% FiO@ for PaO2>50mmHg

66
Q

Describe lithium in pregnancy and breastfeeding

A

Lithium use in pregnancy poses some risks but is not completely contraindicated during pregnancy. It is associated with an increased risk for a few birth defects as well as other problems that may develop in the second trimester, and may also cause transient feeding and respiratory problems at birth. Mothers who require lithium to address a serious psychiatric disorder should not breastfeed while taking this medication

67
Q

Which signs and symptoms suggest persistent pulmonary hypertension of the newborn

A

tachypnea with cyanosis, hypoxia more severe than imaging suggests, greater O2 sats in upper body (due to R to L ductus shunting), prominant precordial pulse, tricuspid regurg murmur, loud, narrowly split P2

68
Q

What is Wilson-Mikity Syndrome?

A

Interstitial pulmonary fibrosis syndrome. Seen in infants

69
Q

What workup does a well appearing infant, of any GA who mother had chorio need?

A

limited eval (CBC and blood cultlure with diff) and need empiric antibiotics until cultures are 48 hours neg

70
Q

Management of a GBS positive mother, well appearing infant, adequate GBS prophy

A

> 48 hours of observation (or 24 if there is experienced observer or prompt access to medical care)

71
Q

If well appearing, > or =37 weeks, inadequate prophy and ROM

A

needs 48hours obs

72
Q

If infant is well appearing, inadequate prophy, 18 hours,

A

should undergo limited eval and observe for 48 hours

73
Q

What is postive end pressure ventilation helpful in infants with PDA?

A

it helps to decrease the amoutn of left to right shunting through the PDA, leading to increased systemic blood flow

74
Q

What are contraindications to indomethacin therapy for closing PDA

A

Nec, serum Cr>1.6, UOP

75
Q

Whats the highest APGAR a VLBW infant can get

A

6 (2 for HR, 1 breathing, 1 color, 1 flexion, 1 grimace)

76
Q

How do you define direct hyperbilirubinemia?

A

direct hyperbilirubinemia, which is defined by a serum direct bilirubin concentration of more than 1.0 mg/dL (17.1 µmol/L) with total bilirubin values of less than 5.0 mg/dL (85.5 µmol/L) or greater than 20% of the total bilirubin for values greater than 5.0 mg/dL (85.5 µmol/L).

77
Q

What is the abnormal enzyme in galactosemia?

A

galactose-1-phosphate uridyltransferase level

78
Q

What do intraabdominal calcifications suggest

A

meconium peritonitis

79
Q

which parts of the bowel are most often affected by NEC

A

distal ileum and proximal colon

80
Q

What are reasonable antibiotic regimens for treating NEC

A

vancomycin, gentamicin and clinda OR metronidazole OR zosyn

81
Q

What score on a biophysical profile suggests need for urgent delivery

A

4 or less

82
Q

What conditions is hirschsprungs associated with?

A

Waardenbergs, Downs, Bardet-Biedl syndrome, multiple endocrine neoplasia type 2, Smith-Lemli-Opitz

83
Q

What is used as the CF newborn screening test?

A

immunoreactive trypsinogen levels

84
Q

how is hemoglobin nadir different in preterm than term infants?

A

Preterm start with lower hct, reach nadir sooner and recover slower

85
Q

What is molded baby syndrome?

A

When have too little amniotic fluid and results in torticollis, metatarsus adductus, and DDH. may include head molding, postural torticollis, congenital scoliosis, pelvic obliquity with altered hip movement, and malposition of the knees and feet.

86
Q

Below what age do most cases of IVH occur?

A

Pediatrics (25 decks)

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