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Pediatric Boards > Newborn > Flashcards

Newborn Flashcards

1
Q

10 weeks - _
10 weeks - _
15 weeks - _
15 weeks - _

A

10 weeks - cell free DNA
10 weeks - chorionic villus sampling
15 weeks - amniocentesis
15 weeks - quad screen

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2
Q

Reasons for high AFP: RAIN

  • R
  • A
  • I
  • N
A

Reasons for high AFP: RAIN

  • Renal anomalies/dysgenesis/nephrosis
  • Abdominal wall defects
  • Incorrect dating (most common reason)
  • Neural tube defects
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3
Q

Early decels:

Late decals:

Variable decals:

A

Early decels: Head compression. Not associated with adverse outcomes

Late decals: Uteroplacental insufficiency. Considered ominous.

Variable decals: Compression of umbilical cord. May indicate fetal hypoxia

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4
Q

Endotracheal intubation for neonates

  • Depth:____
  • Size
    • <1.5kg: __mm tube
    • 1.5-2.5kg = __mm tube
    • > 2.5kg = __mm tube
  • Epinephrine: _ mg/kg (_ml/kg) of 1:__ concentration
A

Endotracheal intubation for neonates

  • Depth: Weight in kg + 6
  • Size
    • <1.5kg: 2.5mm tube
    • 1.5-2.5kg = 3mm tube
    • > 2.5kg = 3.5mm tube
  • Epinephrine: 0.01-0.03 mg/kg (0.1-0.3ml/kg) of 1:10,000 concentration
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5
Q

Primitive reflexes

  • Palmar grasp absent by __ mo
  • Rooting, stepping, sucking, hand grasp, and Moro all disappear by __ months
  • Tonic neck or fencing reflex- appears by 2 weeks and disappears by 6mo
  • Parachute present by __ months, persists indefinitely
  • Crossed adductor disappears by 7 mo
  • Toe grasp disappears by 8-15 mo
  • Babinski disappears by __ months
A

Primitive reflexes

  • Palmar grasp absent by 2-3 mo
  • Rooting, stepping, sucking, hand grasp, and Moro all disappear by 3-4 months
  • Tonic neck or fencing reflex- appears by 2 weeks and disappears by 6mo
  • Parachute present by 6-9 months, persists indefinitely
  • Crossed adductor disappears by 7 mo
  • Toe grasp disappears by 8-15 mo
  • Babinski disappears by 9-12 months
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6
Q

Erb-Duchenne Palsy

  • Involves nerves -
  • “Waiter’s tip” Adducted and internally rotated. Biceps tendon reflex is _, but triceps reflex is _. Grasp is _.
  • Risk of associated __ nerve involvement, leading to __ paralysis
  • Tx: PT weekly. >90% have full recovery within 3 mo
A

Erb-Duchenne Palsy

  • Involves nerves C5-C7
  • “Waiter’s tip” Adducted and internally rotated. Biceps tendon reflex is absent, but triceps reflex is present. Grasp is intact.
  • Risk of associated phrenic nerve involvement, leading to diaphragmatic paralysis
  • Tx: PT weekly. >90% have full recovery within 3 mo
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7
Q

Klumpke-Dejerine Palsy

  • Involves ,,_
  • Pt: __ posturing of hand. Grasp is not intact.
  • Injury to sympathetic fibers of T1 causes __ syndrome , in addition to delayed pigmentation of the iris.
  • Tx: Splint forearm and wrist. Most recover in 3-6mo but not as well as Erb palsy
A

Klumpke-Dejerine Palsy

  • Involves C7,8, T1
  • Pt: Clawlike posturing of hand. Grasp is not intact.
  • Injury to sympathetic fibers of T1 causes Horner syndrome - ptosis, mitosis, anhidrosis, in addition to delayed pigmentation of the iris.
  • Tx: Splint forearm and wrist. Most recover in 3-6mo but not as well as Erb palsy
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8
Q

Single umbilical artery

- __ is one of the more frequent abnormalities

A

Single umbilical artery

- Trisomy 18 is one of the more frequent abnormalities

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9
Q

Delayed umbilical cord separation

- Separation of cord beyond __ weeks is significantly delayed

A

Delayed umbilical cord separation

- Separation of cord beyond 3 weeks is significantly delayed

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10
Q

Clitoromegaly

- >0.__cm in length (base to tip, not including hood), >0.__cm width

A

Clitoromegaly

- >0.9cm in length (base to tip, not including hood), >0.6cm width

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11
Q

Micropenis

- Stretched penile length less than ___cm is abnormal and requires endocrine evaluation

A

Micropenis

- Stretched penile length <2.5cm is abnormal and requires endocrine evaluation

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12
Q

SMR1

- Testes less than ___mL or long-axis length less than ___cm

A

SMR1

- Testes <4mL or long-axis length <2.5cm

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13
Q

Anterior fontanelle less than ___cm. Usually closes at ____mo.

A

Anterior fontanelle <3.5cm. Usually closes at 9-18 mo.

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14
Q

Posterior fontanelle is a fingertip in size. Closes by _ mo.

A

Posterior fontanelle is a fingertip in size. Closes by 4 mo.

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15
Q

A large fontanelle can result from _, _, or _.

The combination of a persistent posterior fontanelle, umbilical hernia, and prolonged jaundice indicates _.

A

A large fontanelle can result from hydrocephalus, hypothyroidism, or rickets.

The combination of a persistent posterior fontanelle, umbilical hernia, and prolonged jaundice indicates hypothyroidism.

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16
Q

Macrocephaly

- Benign causes: _, _

A

Macrocephaly
- Benign causes: Enlargement of the subarachnoid space, familial macrocephaly

Enlargement of the subarachnoid space

  • Head is large (but within normal range) at birth, but subsequently exceeds or parallels the 98%ile
  • A common cause of a progressively enlarging head in an otherwise normally developing infant.
  • If imaging is performed, a pronounced subarachnoid space is appreciated with slight enlargement; often have increased ventricular size, widening of sulci and sylvian fissure
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17
Q

Torticollis

  • Normal:
    • Normal passive rotational ROM of the neck for children age 0-3yo: __ degrees on each side
    • Normal lateral flexion of the neck for children age 0-3yo: __ degrees on each side
  • Path:
    • Uncertain. May be abnormal uterine position or direct trauma to SCM.
  • Tx: Early tx with PT. Passive stretching.
A

Torticollis

  • Normal:
    • Normal passive rotational ROM of the neck for children age 0-3yo: 110 degrees on each side
    • Normal lateral flexion of the neck for children age 0-3yo: 70 degrees on each side
  • Path:
    • Uncertain. May be abnormal uterine position or direct trauma to SCM.
  • Tx: Early tx with PT. Passive stretching.
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18
Q

Plagiocephaly

  • Pt: Flattened posterior skull on one side with forehead prominence on the same side
  • Tx: Tummy time. Helmet molding most beneficial when __mo
A

Plagiocephaly

  • Pt: Flattened posterior skull on one side with forehead prominence on the same side
  • Tx: Tummy time. Helmet molding most beneficial when 4-6mo
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19
Q

Craniosynostosis

  • Premature fusion of >1 skull bone sutures
  • If multiple sutures are involved, then likely associated with a syndrome.
  • __ (50%, most common)) > __ > ___ > __
  • Most common type: ___ (dolichocephaly) - premature fusion of the midline __ suture
  • 2nd most common - anterior plagiocephaly - premature closure of a __ suture.
  • 3rd most common type - ___ - result of premature closure of ___ suture.
  • Posterior plagiocephaly - Premature closure of unilateral ___ suture. Uncommon, easily confused with positional plagiocephaly
    • Unilateral ___ synostosis causes trapezoid-shaped head with ipsilateral occipitoparietal flattening, posterior displacement of the ipsilateral ear, and contralateral frontal bossing
      • In contrast to positional plagiocephaly…
        • Posterior/inferior displacement of the ipsilateral ear
        • Absent frontal prominence
        • Present contralateral occipital parietal prominence
        • Present lambdoid ridge or submastoid prominence
        • Continues to progress after 7 months
  • Dx: The earliest sign is increased bone density along the suture.
A

Craniosynostosis

  • Premature fusion of >1 skull bone sutures
  • If multiple sutures are involved, then likely associated with a syndrome.
  • Sagittal (50%, most common)) > coronal > metopic > lambdoid
  • Most common type: Scaphocephaly (dolichocephaly) - premature fusion of the midline sagittal suture
  • 2nd most common - anterior plagiocephaly - premature closure of a coronal suture.
  • 3rd most common type - trigonocephaly - result of premature closure of metopic suture.
  • Posterior plagiocephaly - Premature closure of unilateral lambdoid suture. Uncommon, easily confused with positional plagiocephaly
    • Unilateral lambdoid synostosis causes trapezoid-shaped head with ipsilateral occipitoparietal flattening, posterior displacement of the ipsilateral ear, and contralateral frontal bossing
      • In contrast to positional plagiocephaly…
        • Posterior/inferior displacement of the ipsilateral ear
        • Absent frontal prominence
        • Present contralateral occipital parietal prominence
        • Present lambdoid ridge or submastoid prominence
        • Continues to progress after 7 months
  • Dx: The earliest sign is increased bone density along the suture.
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20
Q
  • Crouzon syndrome
    • inheritance?. 100% __ mutation
    • Premature closure of __ sutures
    • Pt:
      • Exophthalmos
      • ___ hands and feet
      • ___ IQ
A
  • Crouzon syndrome
    • AD. 100% FGFR2 mutation
    • Premature closure of coronal sutures
    • Pt:
      • Exophthalmos
      • Normal hands and feet
      • Normal IQ
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21
Q
  • Apert syndrome
    • Inheritance__?. 100% __ mutation
    • Pt:
      • ___ (__ hands)
      • __ IQ
A
  • Apert syndrome
    • AD. 100% FGFR2 mutation
    • Pt:
      • Syndactyly (mitten hands)
      • Low IQ
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22
Q

Hypoglycemia

  • less than __ in 1st 4 HOL, then less than __. After 24 HOL, less than __. After 48 HOL, less than __
  • Tx: __ml/kg (200mg/kg) of IV D10W
A

Hypoglycemia

  • <40 in 1st 4 HOL, then <45. After 24 HOL, <50. After 48 HOL, <60
  • Tx: 2ml/kg (200mg/kg) of IV D10W
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23
Q

CCHD

  • Pass: Pre/postductal saturations >/=__%. Pre/post difference =__%
  • Retest: Pre-/postductal sats >__% but 3% difference
  • Failed: Pre/postductal saturations
A

CCHD

  • Pass: Pre/postductal saturations >/=95%. Pre/post difference =3%
  • Retest: Pre-/postductal sats >90% but <95% OR with >3% difference
  • Failed: Pre/postductal saturations <90%
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24
Q

Causes of infant death

  1. _
  2. _
  3. Pregnancy complications
  4. SIDS
  5. Unintentional injury

1-4yo

  1. __
  2. __
  3. Homicide

Causes of death in adolescence

  1. __
  2. __
  3. Homicides
A

Causes of infant death

  1. Congenital defects
  2. Prematurity
  3. Pregnancy complications
  4. SIDS
  5. Unintentional injury

1-4yo

  1. Unintentional injury
  2. Congenital defects
  3. Homicide

Causes of death in adolescence

  1. Unintentional injuries
  2. Suicides
  3. Homicides
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25
Q

Infant of Diabetic Mother

  • Neonatal findings:
    • Hypoglycemia
    • Macrosomia/LGA
    • SGA/IUGR
    • Prematurity
    • Electrolyte abnormalities
      • Hypo___
      • Hypo___
    • Unconjugated hyperbilirubinemia
    • Polycythemia/plethora
    • Hypertrophic cardiomyopathy - ______ or one/both ventricular walls. Rarely, will lead to heart failure. Some will need tx with Beta blocker
    • RDS. Insulin blocks precursor of surfactant.
    • Small ___ syndrome. Resolves spontaneously after a few days.
  • The increased risk of congenital anomalies in IDMs is likely due to poor diabetes control BEFORE conception and during early pregnancy, when fetal organogenesis is occurring. Therefore it is highly recommended that diabetes be well-controlled PRIOR TO and throughout pregnancy.
  • Findings for infants of mothers with pregestational diabetes (onset before pregnancy)
    • Congenital anomalies occurs 2-4x more frequently in IDM with preconception glucose
      • Cleft palate, vertebral, intestinal, anencephaly, spina bifida, GI atresia, situs inversus, and urinary tract anomalies
      • _____
      • Increased risk of _____
A

Infant of Diabetic Mother

  • Neonatal findings:
    • Hypoglycemia
    • Macrosomia/LGA
    • SGA/IUGR
    • Prematurity
    • Electrolyte abnormalities
      • Hypocalcemia
      • Hypomagnesemia
    • Unconjugated hyperbilirubinemia
    • Polycythemia/plethora
    • Hypertrophic cardiomyopathy - inter ventricular septum or one/both ventricular walls. Rarely, will lead to heart failure. Some will need tx with Beta blocker
    • RDS. Insulin blocks precursor of surfactant.
    • Small left colon syndrome. Resolves spontaneously after a few days.
  • Infant of mothers with gestational diabetes only are at increase risk for morbidities except for congenital anomalies and future obesity/diabetes.
  • The increased risk of congenital anomalies in IDMs is likely due to poor diabetes control BEFORE conception and during early pregnancy, when fetal organogenesis is occurring. Therefore it is highly recommended that diabetes be well-controlled PRIOR TO and throughout pregnancy.
  • Findings for infants of mothers with pregestational diabetes (onset before pregnancy)
    • Congenital anomalies occurs 2-4x more frequently in IDM with preconception glucose
      • Cleft palate, vertebral, intestinal, anencephaly, spina bifida, GI atresia, situs inversus, and urinary tract anomalies
      • Caudal regression syndrome / Lumbosacral dysgenesis
      • Increased risk of obesity and diabetes later in life
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26
Q

GBS Prophylaxis

  • Indications for intrapartum antibiotic prophylaxis:
    • 1).
    • 2)
    • 3)
    • Unknown GBS status PLUS any of the following
      • __
      • __
      • __
      • __
A

GBS Prophylaxis

  • Indications for intrapartum antibiotic prophylaxis:
    • Prior infant with neonatal GBS infection.
    • GBS bacteriuria or GBS UTI during current pregnancy (regardless of tx)
    • GBS-positive rectal or vaginal culture during the current pregnancy
    • Unknown GBS status PLUS any of the following
      • <37 weeks gestation
      • Intrapartum fever
      • ROM for >18 hours
      • Intrapartum NAAT positive for GBS
27
Q

Management of infants born to mothers requiring GBS pix:
- Symptomatic for signs of sepsis: Work-up (CBC, blood culture, CXR, lumbar puncture) and start antibiotic therapy

Asymptomatic

1) <37 weeks gestation or ROM >18 hours:
- Adequate abx: Observe for __ hours
- Inadequate abx: ___

2) Full term >37 weeks AND ROM <18 hrs
- Adequate intrapartum antibiotic tx for GBS (ampicillin, penicillin, or cefazolin):___
- Inadequate antibiotics: ___

A

Management of infants born to mothers requiring GBS pix:
- Symptomatic for signs of sepsis: Work-up (CBC, blood culture, CXR, lumbar puncture) and start antibiotic therapy

Asymptomatic

1) <37 weeks gestation or ROM >18 hours:
- Adequate abx: Observe for 48 hours
- Inadequate abx: Blood culture, CBC, observe for 48 hours and do full sepsis workup if indicated

2) Full term >37 weeks AND ROM <18 hrs
- Adequate intrapartum antibiotic tx for GBS (ampicillin, penicillin, or cefazolin): Meet early discharge criteria at 24 hours with follow-up in 48h
- Inadequate antibiotics: Observation for 48 hrs and do full sepsis workup if indicated

28
Q

Polycythemia

  • Hematocrit >__% from free flowing venous sample
  • Polycythemia can lead to hyper viscosity which can lead to decreased oxygenation or organs
  • Pt: >70% are asymptomatic. Plethora, irritability, jitteriness, apnea, seizures
  • The most common lab abnormality is ____.
  • Tx:
    • Asymptomatic with Hct 65-70%: ____
    • Symptomatic or Hct >70%: ____
A

Polycythemia

  • Hematocrit >65% from free flowing venous sample
  • Polycythemia can lead to hyper viscosity which can lead to decreased oxygenation or organs
  • Pt: >70% are asymptomatic. Plethora, irritability, jitteriness, apnea, seizures
  • The most common lab abnormality is hypoglycemia.
  • Tx:
    • Asymptomatic with Hct 65-70%: Close monitoring for hydration, hypoglycemia, and hyperbilirubinemia
    • Symptomatic or Hct >70%: IVF or partial exchange transfusion
29
Q

Diaphragmatic hernia

  • Dx: Typically prenatal US. CXR will demonstrate abdominal viscera in chest cavity and elevation of hemidiaphragm
  • Management: 1) Intubation for resp distress, ventilation (AVOID ___), and NG suction. 2) Surgical repair. ECMO may be needed.
  • Prognosis is dependent on severity of _____
  • For repaired congenital diaphragmatic hernia, the most likely complication is ____
A

Diaphragmatic hernia

  • Dx: Typically prenatal US. CXR will demonstrate abdominal viscera in chest cavity and elevation of hemidiaphragm
  • Management: 1) Intubation for resp distress, ventilation (AVOID bag mask ventilation), and NG suction. 2) Surgical repair. ECMO may be needed.
  • Prognosis is dependent on severity of pulmonary hypoplasia
  • For repaired congenital diaphragmatic hernia, the most likely complication is recurrent herniation
30
Q

Transient Tachypnea of Newborn

  • RF: C-section
  • CXR: Prominent pulmonary/perihilar markings, fluid in the fissures
  • Tx: Resolve within 12-24 hours
A

Transient Tachypnea of Newborn

  • RF: C-section
  • CXR: Prominent pulmonary/perihilar markings, fluid in the fissures
  • Tx: Resolve within 12-24 hours
31
Q

Respiratory Distress Syndrome

  • RF:
    • Incidence increases with decreasing gestational age
      • Surfactant production begins 32-34 weeks gestation and usually reaches sufficient quantities by 36 weeks.
      • As gestational age increases, more surfactant is synthesized and stored in type 2 alveolar cells. Mature levels of pulmonary surfactant are usually present at >____ weeks.
      • Infants born at <28 weeks of gestation whose mothers have not received glucocorticoid tx are at high risk of RDS.
    • Infant of diabetic mother, male sex, caucasian race
  • Predict which infant will develop RDS by measuring the lecithin/sphingomyelin (L/R) ratio in amniotic fluid. L/S >2 predicts mature surfactant function.
  • RDS causes a mixed metabolic acidosis and respiratory acidosis
  • CXR shows 1) poor lung expansion 2) fine ground glass haziness 3) air bronchograms (atelectasis)
    • Appears identical to CXR for pneumonia caused by GBS. For this reason, newborns with RDS with RF for infection should be tx with antimicrobial therapy
  • Tx: Oxygen support
    • Intratracheal surfactant within 30-60 mins after delivery
      • Criteria for surfactant therapy: Clinical and radiographic diagnosis of RDS in an infant who requires >30% FiO2 to maintain a PaO2 >80mmHg.
  • Ppx: Maternal steroids within 7 days of delivery reduces risk of RDS. Recommended at 23-34 weeks
A

Respiratory Distress Syndrome

  • RF:
    • Incidence increases with decreasing gestational age
      • Surfactant production begins 32-34 weeks gestation and usually reaches sufficient quantities by 36 weeks.
      • As gestational age increases, more surfactant is synthesized and stored in type 2 alveolar cells. Mature levels of pulmonary surfactant are usually present at >35 weeks.
      • Infants born at <28 weeks of gestation whose mothers have not received glucocorticoid tx are at high risk of RDS.
    • Infant of diabetic mother, male sex, caucasian race
  • Predict which infant will develop RDS by measuring the lecithin/sphingomyelin (L/R) ratio in amniotic fluid. L/S >2 predicts mature surfactant function.
  • RDS causes a mixed metabolic acidosis and respiratory acidosis
  • CXR shows 1) poor lung expansion 2) fine ground glass haziness 3) air bronchograms (atelectasis)
    • Appears identical to CXR for pneumonia caused by GBS. For this reason, newborns with RDS with RF for infection should be tx with antimicrobial therapy
  • Tx: Oxygen support
    • Intratracheal surfactant within 30-60 mins after delivery
      • Criteria for surfactant therapy: Clinical and radiographic diagnosis of RDS in an infant who requires >30% FiO2 to maintain a PaO2 >80mmHg.
  • Ppx: Maternal steroids within 7 days of delivery reduces risk of RDS. Recommended at 23-34 weeks
32
Q

Persistent pulmonary hypertension of newborn
- Hypoxemia refractory to oxygen administration

  • Pt:
    • Tachypnea with cyanosis is the most common feature
    • Greater oxygen saturation in the upper body compared to the lower body is classic.
    • Typical cardiac findings:
      • Prominent precordial pulse
      • Tricuspid regurgitation murmur (harsh systolic murmur at the L lower sternal border)
      • Loud narrowly split 2nd heart sound (P2)
    • In some infants, oxygen requirements vary widely bc resistance oscillates
  • Tx: Treat underlying etiology
    • Correct hypoxia, acidosis, and hypotension until pulmonary vascular resistance falls
    • Inhaled NO reduces the need for ECMO. However, NO has rare complication of methemoglobinemia. Therefore, periodically track methemoglobin levels during NO therapy.
A

Persistent pulmonary hypertension of newborn
- Hypoxemia refractory to oxygen administration

  • Pt:
    • Tachypnea with cyanosis is the most common feature
    • Greater oxygen saturation in the upper body compared to the lower body is classic.
    • Typical cardiac findings:
      • Prominent precordial pulse
      • Tricuspid regurgitation murmur (harsh systolic murmur at the L lower sternal border)
      • Loud narrowly split 2nd heart sound (P2)
    • In some infants, oxygen requirements vary widely bc resistance oscillates
  • Tx: Treat underlying etiology
    • Correct hypoxia, acidosis, and hypotension until pulmonary vascular resistance falls
    • Inhaled NO reduces the need for ECMO. However, NO has rare complication of methemoglobinemia. Therefore, periodically track methemoglobin levels during NO therapy.
33
Q

Bronchopulmonary Dysplasia - long term consequence of RDS

  • Generally develops in infants <30 weeks
  • Definitions: Respiratory support needed at either ___ weeks gestation (if born before ___ WGA) or at __ days gestational age (if born after ___ WGA).
    • Infants requiring oxygen >21% for at least first ___ DOL PLUS one of the following

A) - Gestational age <32 weeks

    - Mild: Breathing room air at 36 weeks PMA or discharge, whichever comes first
    - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first
    - Severe: Need for >30% and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first

B) - Gestational age >32 weeks

    - Mild: Breathing room air by 56 days postnatal age or discharge, whichever comes first
    - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first
    - Severe: Need for >30% and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first
  • Labs: Compensated respiratory acidosis
  • Tx: Oxygen
    • Surfactant
    • For moderate-severe, chronic use of thiazide diuretics in combination with spironolactone
    • Bronchodilatory therapy
    • RSV ppx
A

Bronchopulmonary Dysplasia - long term consequence of RDS

  • Generally develops in infants <30 weeks
  • Definitions: Respiratory support needed at either 36 weeks gestation (if born before 32 WGA) or at 56 days gestational age (if born after 32 WGA).
    • Infants requiring oxygen >21% for at least first 28 DOL PLUS one of the following

A) - Gestational age <32 weeks

    - Mild: Breathing room air at 36 weeks PMA or discharge, whichever comes first
    - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first
    - Severe: Need for >30% and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first

B) - Gestational age >32 weeks

    - Mild: Breathing room air by 56 days postnatal age or discharge, whichever comes first
    - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first
    - Severe: Need for >30% and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first
  • Labs: Compensated respiratory acidosis
  • Tx: Oxygen
    • Surfactant
    • For moderate-severe, chronic use of thiazide diuretics in combination with spironolactone
    • Bronchodilatory therapy
    • RSV ppx
34
Q

Retinopathy of Prematurity

  • Screening:
    • All infants with BW less than ___g or a gestational age less than __ weeks
    • Infants with complicated clinical course
  • Screening
    • Infants 22 - ___+6 weeks are initially screened at ___ weeks. All other infants (>___ weeks) should be screened at __ chronological weeks (DOL __) after birth
A

Retinopathy of Prematurity

  • Screening:
    • All infants with BW <1500g or a gestational age <30 weeks
    • Infants with complicated clinical course
  • Screening
    • Infants 22 - 26+6 weeks are initially screened at 31 weeks. All other infants (>27 weeks) should be screened at 4 chronological weeks (DOL 28) after birth
35
Q

IVH

  • Head US indications: less than __ weeks OR less than ___g OR clinically indicated. Perform at ___ days postnatally. May need HUS at 1mo as clinically indicated.
  • Intraventricular hemorrhage is characterized by the extent of the hemorrhage
    • Grade 1: Involves only the germinal matrix only
    • Grade 2: Involves the lateral ventricles without ventricular dilation
    • Grade 3: Involves at least 50% of the lateral ventricles with associated ventricular dilation
    • Grade 4: Involves periventricular brain parenchyma
  • IVH of any grade is a RF closely associated with neurodevelopment impairment
A

IVH

  • Head US indications: <32 weeks OR <1500g OR clinically indicated. Perform at 7 days postnatally. May need HUS at 1mo as clinically indicated.
  • Intraventricular hemorrhage is characterized by the extent of the hemorrhage
    • Grade 1: Involves only the germinal matrix only
    • Grade 2: Involves the lateral ventricles without ventricular dilation
    • Grade 3: Involves at least 50% of the lateral ventricles with associated ventricular dilation
    • Grade 4: Involves periventricular brain parenchyma
  • IVH of any grade is a RF closely associated with neurodevelopment impairment
36
Q

NEC

  • Pt: Abdominal distention appears first
  • Stages:
    • Stage IA (suspected NEC): Nonspecific systemic signs and mild abdominal signs
    • Stage IIA (proven NEC, mildly ill): Worsening abdominal, systemic, and ______
    • Stage IIIA (advanced NEC, severely ill with intact bowel): Advancement to signs of sepsis, acute abdomen
  • XR shows
    • ______ - Classic and pathognomonic finding on films
    • Air in the ____ is also pathognomonic for NEC. May show portal venous gas
    • Pneumoperitoneum/free air secondary to bowel perforation.
    • “Football sign” on supine radiograph- large radiolucent area in the central abdomen with demarcation of the falciform ligament
    • Sentinel loops (loops of bowel that remain in a fixed position) are suggestive of necrotic bowel and/or peritonitis.
  • Tx:
    • NPO, bowel rest, NG tube decompression, TPN, blood cultures
    • IV abx
      • ___, ___, ___ OR
      • ___, ___, and ___
    • Isolate from others in NICU
    • Surgery consult
A

NEC

  • Pt: Abdominal distention appears first
  • Stages:
    • Stage IA (suspected NEC): Nonspecific systemic signs and mild abdominal signs
    • Stage IIA (proven NEC, mildly ill): Worsening abdominal, systemic, and radiographic findings
    • Stage IIIA (advanced NEC, severely ill with intact bowel): Advancement to signs of sepsis, acute abdomen
  • XR shows
    • Pneumatosis intestinalis (air in submucosa wall of bowel. “Double line” or “train track”) - Classic and pathognomonic finding on films
    • Air in the hepatic portal system is also pathognomonic for NEC. May show portal venous gas
    • Pneumoperitoneum/free air secondary to bowel perforation.
    • “Football sign” on supine radiograph- large radiolucent area in the central abdomen with demarcation of the falciform ligament
    • Sentinel loops (loops of bowel that remain in a fixed position) are suggestive of necrotic bowel and/or peritonitis.
  • Tx:
    • NPO, bowel rest, NG tube decompression, TPN, blood cultures
    • IV abx
      • Vancomycin, gentamicin, metronidazole OR
      • Vancomycin, gentamicin, and piperacillin-tazobactam
    • Isolate from others in NICU
    • Surgery consult
37
Q

Toxoplasmosis

  • Pt:
    • Triad of __, __, and____
    • Isolated ocular toxoplasmosis: Characteristic retinal lesions (white focal retinitis with overlying vitreous inflammation)
  • Dx: Anti-toxoplasma IgM and IgA are most reliable markers
  • Tx of the mother can begin during if the diagnosis is made.
    • If the infection occurs in weeks 7-34 of gestation, you can give _____ 1g q8h (not licensed in US, available through CDC).
      • If fetal infection is excluded, continue spiramycin until term.
      • If you confirm infection of the fetus, switch therapy to ____, ___, and ___ (which is folinic acid, not folic acid). The congenitally infected child must receive 12 mo of therapy.
    • If the maternal infection occurs after 34 weeks of gestation, the 3-drug regimen can be used.
    • After delivery, continue treating the infant even if there are no clinical signs/symptoms.
      • Continue combination of ___, ___, and ____
A

Toxoplasmosis

  • Pt:
    • Triad of hydrocephalus, chorioretinitis, and cerebral calcifications (throughout corteX or CircuMVent)
    • Isolated ocular toxoplasmosis: Characteristic retinal lesions (white focal retinitis with overlying vitreous inflammation)
  • Dx: Anti-toxoplasma IgM and IgA are most reliable markers
  • Tx of the mother can begin during if the diagnosis is made.
    • If the infection occurs in weeks 7-34 of gestation, you can give spiramycin 1g q8h (not licensed in US, available through CDC).
      • If fetal infection is excluded, continue spiramycin until term.
      • If you confirm infection of the fetus, switch therapy to pyrimethamine, sulfadiazine, and leucovorin (which is folinic acid, not folic acid). The congenitally infected child must receive 12 mo of therapy.
    • If the maternal infection occurs after 34 weeks of gestation, the 3-drug regimen can be used.
    • After delivery, continue treating the infant even if there are no clinical signs/symptoms.
      • Continue combination of pyrimethamine, sulfadiazine, and folinic acid (leucovorin).
38
Q

Congenital Rubella

  • Path: Togavirus
  • ____ of infection has important prognostic predictors.
    • Triad: __, ____, ____
    • Thrombocytopenic purpura aka blueberry muffin (also seen in cmv)
    • Radiolucencies in the long bone metaphysis
    • Higher risk of __
    • Rare complication of progressive ____, which is a severe progressive neurologic deterioration that begins in the 2nd decade of life.
  • Tx: ____
A

Congenital Rubella

  • Path: Togavirus
  • Trimester of infection has important prognostic predictors:
    • 1st trimester: 90% fetal infection risk
  • Pt:
    • Triad: Cataracts (or glaucoma), congenital heart defects (PDA), sensorineural loss (deafness, damage to organ of Corti)
    • Thrombocytopenic purpura aka blueberry muffin (also seen in cmv)
    • Radiolucencies in the long bone metaphysis
    • Higher risk of DM1
    • Rare complication of progressive rubella panencephalitis, which is a severe progressive neurologic deterioration that begins in the 2nd decade of life.
  • Tx: Supportive
39
Q

Cytomegalovirus

  • Pt:
    • MOST COMMON cause of _____; most common long-term sequela of CMV
    • Blueberry muffin rash (as in rubella)
    • Microcephaly
    • Chorioretinitis
    • _____intracerebral calcifications
  • Tx:
    • Treatment with antiviral agents is NOT recommended for ____ congenital CMV infection.
    • For ____ infants, start tx with ____ or ____ in the 1st month of life.
      - Adverse effects of therapy include significant __ (in 20% of infants) and ___.
A

Cytomegalovirus

  • Pt:
    • MOST COMMON cause of congenital sensorineural hearing loss; most common long-term sequela of CMV
    • Blueberry muffin rash (as in rubella)
    • Microcephaly
    • Chorioretinitis
    • Periventricular intracerebral calcifications (CMV will “CircuMVent” the ventricles)
  • Tx:
    • Treatment with antiviral agents is NOT recommended for neonates with ASYMPTOMATIC congenital CMV infection.
    • For symptomatic infants, start tx with ganciclovir or valganciclovir in the 1st month of life.
      • Oral valganciclovir (16mg/kg/dose administered twice daily) for 6 months is recommended for term neonates with symptomatic congenital CMV infection with and without CNS disease; therapy must be started by 4 weeks of age.
        • Adverse effects of valganciclovir therapy include significant neutropenia (in 20% of infants) and hepatoxicity.
      • IV ganciclovir may be considered in neonates with symptomatic congenital CMV infection who have necrotizing enterocolitis or other intestinal problems limiting their ability to absorb oral medication.
        • Studies have shown that 6mg/kg dose IV for 6 weeks in newborns with severe CMV and neurologic improvement showed protection against hearing loss and head circumference growth in the first 6-12mo of life
        • Significant myelosuppression (in 66% of infants) is a major concern with IV ganciclovir therapy
40
Q

Parvovirus B19

- Pt: __, ___

A

Parvovirus B19

- Pt: Hydrops fetalis, aplastic crisis

41
Q

Varicella

  • Varicella infection during the 1st trimester (8-20 weeks gestation) results in a risk of fetal abnormalities in about 1-2% of births. Short ___, small ____.
    • Limb reduction defects can occur if the infection occurs prior to, or during, limb bud formation.
    • Microphthalmia, cataracts
  • Infants born to mothers who develop varicella from __ days before delivery to ___ days after delivery are at risk of severe neonatal varicella
  • Tx: IV _____
A

Varicella

  • Varicella infection during the 1st trimester (8-20 weeks gestation) results in a risk of fetal abnormalities in about 1-2% of births. Short limbs, small eyes.
    • Limb reduction defects can occur if the infection occurs prior to, or during, limb bud formation.
    • Microphthalmia, cataracts
  • Infants born to mothers who develop varicella from 5 days before delivery to 2 days after delivery are at risk of severe neonatal varicella
  • Tx: IV acyclovir
42
Q

Neonatal HSV
- Risk of transmission is far greater with ___ HSV infection as compared with reactivation of previous infection.

  • Pt:
    • SEM: Skin, eye, and mouth disease (45% of cases)
    • Localized CNS disease with or without skin lesions (30% of cases): Seizures, lethargy, mouth
    • Disseminated disease (25% of cases): Multiple organ systems
      • Sepsis, hepatitis, coagulopathy, DIC, encephalitis/CNS
  • Dx:
    • Surface swabs by culture/PCR
    • LP
  • Tx:
    • Suspected or confirmed HSV must receive IV ____ (60mg/kg/d in 3 divided doses)
      • For 14 days for SEM disease
      • For 21 days for CNS or disseminated disease
      • (Nephropathy as a result of tubular precipitation of acyclovir can occur with IV administration, not oral. It is more common with rapid infusion and in patients with dehydration.)
    • Following completion of IV tx, all infants with neonatal HSV infection must receive oral ____ suppression therapy for 6 months.
      • Infants must be closely monitored with serial blood cell counts for ____ while receiving suppressive therapy.
        • Should have absolute neutrophil counts assessed at 2 and 4 weeks after starting treatment and then monthly since at risk for neutropenia/myelosuppression
A

Neonatal HSV

  • Risk of transmission is far greater with primary HSV infection as compared with reactivation of previous infection.
  • Pt:
    • SEM: Skin, eye, and mouth disease (45% of cases)
    • Localized CNS disease with or without skin lesions (30% of cases): Seizures, lethargy, mouth
    • Disseminated disease (25% of cases): Multiple organ systems
      • Sepsis, hepatitis, coagulopathy, DIC, encephalitis/CNS
  • Dx:
    • Surface swabs by culture/PCR
    • LP
  • Tx:
    • Suspected or confirmed HSV must receive IV acyclovir (60mg/kg/d in 3 divided doses)
      • For 14 days for SEM disease
      • For 21 days for CNS or disseminated disease
      • (Nephropathy as a result of tubular precipitation of acyclovir can occur with IV administration, not oral. It is more common with rapid infusion and in patients with dehydration.)
    • Following completion of IV acyclovir, all infants with neonatal HSV infection must receive oral acyclovir suppression therapy for 6 months.
      • Infants must be closely monitored with serial blood cell counts for neutropenia while receiving acyclovir suppressive therapy.
        • Should have absolute neutrophil counts assessed at 2 and 4 weeks after starting treatment and then monthly since at risk for neutropenia/myelosuppression
43
Q

Congenital Syphilis

  • Pt:
    • Early congenital syphilis (<2yo)
      • S__
      • Pseudoparalysis of extremity secondary to osteochondritis or periostitis
      • S__
    • Late congenital syphilis (>2yo)
      • Hutchinson triad:
        • _
        • _
        • _
      • M__ m__
      • _ nose (destruction of septum)
      • _ shins (anterior bowing of tibia)
      • Eyes (interstitial keratitis), clutter joints (painless arthritis of knees)
  • Dx:
    • Non-treponemal testing: RPR, VDRL
    • Treponemal testing: FTA-ABS
  • Tx: ___
A

Congenital Syphilis

  • Pt:
    • Early congenital syphilis (<2yo)
      • Snuffles / copious purulent rhinorrhea
      • Pseudoparalysis of extremity secondary to osteochondritis or periostitis
      • Skin rash of vesicular/desquamation of hands/feet
    • Late congenital syphilis (>2yo)
      • Hutchinson triad:
        • Hutchinson teeth (peg/barrel incisors)
        • Sensorineural hearing loss
        • Interstitial keratitis
      • Mulberry molars
      • Saddle nose (destruction of septum)
      • Saber shins (anterior bowing of tibia)
      • Eyes (interstitial keratitis), clutter joints (painless arthritis of knees)
  • Dx:
    • Non-treponemal testing: RPR, VDRL
    • Treponemal testing: FTA-ABS
  • Tx: Penicillin G
44
Q

Hyperthermia

- Increases risk of ___

A

Hyperthermia

- Increases risk of neural tube defects

45
Q

Valproic acid

A

Valproic acid

- Neural tube defects. Craniofacial and digital complications

46
Q

Phenytoin

- P: 
- H: 
- N:
A

Phenytoin
- Fetal hydantoin syndrome: growth deficiency, craniofacial defects, abnormal/retarded growth and development, and hypo plastic phalanges/nails

- P: cleft Palate
- H: small Head, Hypoplastic face, Heart defects
- N: hypoplastic Nails/digits, Neurologic defects
47
Q

Carbamazepine

A

Carbamazepine

- Risk of spina bifida

48
Q

Lithium

A

Lithium

- Ebstein’s anomaly - atrialization of RV. Can develop into WPW

49
Q

Thalidomide

A

Thalidomide

- Originally antinausea drug. Limb defects

50
Q

Methotrexate

A

Methotrexate

- Craniosynostosis, craniofacial abnormalities, limb defects

51
Q

ACE Inhibitors

A

ACE Inhibitors

- Renal dysgenesis, oligohydramnios, skull ossification defects

52
Q

DES

A

DES

- Vaginal adenocarcinoma

53
Q

Retinoids

A

Retinoids
- Malformations: Microcephalic, facial palsies, microbial, external auditory canal anomalies, cardiovascular defects, thymic hypoplasia, GU anomalies

54
Q

Streptomycin

A

Streptomycin

- Hearing loss

55
Q

Tetracycline

A

Tetracycline

- Discoloration of fetal teeth

56
Q

Warfarin

A

Warfarin

- Fetal warfarin syndrome: Nasal hypoplasia, stippled epiphyses

57
Q

SSRIs

  • Can present with __
  • Increase the risk __
A

SSRIs

  • Can present with NAS
  • Increase the risk persistent pulmonary HTN
58
Q

Cocaine

A

Cocaine

  • Increase risk of miscarriage, stillbirth, premature delivery, placental abruptions, intracranial hemorrhage
  • Infant: jitteriness, excessive sucking, hyperactive Moro reflex, irritable, muscle rigidity
59
Q

Tobacco

A

Tobacco

  • Low birth weight, SGA
  • Miscarriage, prematurity, stillbirth
60
Q

Neonatal Abstinence Syndrome

A

Neonatal Abstinence Syndrome
- Tachypnea, diarrhea, hypertonia, high pitched cry, tremors/jitteriness, irritability, sleep problems/restlessness, fever, nasal flaring, vomiting, poor feeding, seizures, autonomic symptoms

61
Q

Fetal Alcohol Syndrome

  • Most common cause of intellectual disability
  • Dx: 3 cardinal features along with substantiated maternal alcohol use:
    • 1) ___
    • 2) ___
    • 3) ____
A

Fetal Alcohol Syndrome

  • Most common cause of intellectual disability
  • Dx: 3 cardinal features along with substantiated maternal alcohol use:
    • 1) Abnormal facial features. Must have 2 of the following
      • Hypoplastic nasal root
      • Short upturned nose
      • Hypoplastic or absent philtrum
      • Thin upper lip
      • Midface hypoplasia
    • 2) Pre of postnatal growth deficiency. Must have 1 of the following
      • Weight <10%ile
      • Microcephalic
      • Length/Height ratio <10%ile
    • 3) Cognitive abnormalities: must have 1 developmental or learning problem
62
Q

Endotracheal intubation for pediatrics

  • Size (mm)
    • Uncuffed: tube = ____
    • Cuffed: tube = _____
  • Depth:
    • Child <1 year: Depth of intubation cm = _____
    • Child >1 year: Depth of intubation cm = _____
A

Endotracheal intubation for pediatrics

  • Size (mm)
    • Uncuffed: tube = (age/4) + 4
    • Cuffed: tube = (age/4) + 3.5
  • Depth:
    • Child <1 year: Depth of intubation cm = weight/2 + 8
    • Child >1 year: Depth of intubation cm = age/2 + 13
63
Q

Monozygotic “identical” twins

  • Most commonly monochorionic/diamniotic
  • Monoamniotic/monochorionic (single placenta) - share same amniotic sac/cavity; highest risk of cord entanglement

Dizygotic “fraternal” twins

  • Diamniotic and dichorionic (separate placentas)
  • Dizygotic twins are no more similar than nontwin siblings
A

Monozygotic “identical” twins

  • Most commonly monochorionic/diamniotic
  • Monoamniotic/monochorionic (single placenta) - share same amniotic sac/cavity; highest risk of cord entanglement

Dizygotic “fraternal” twins

  • Diamniotic and dichorionic (separate placentas)
  • Dizygotic twins are no more similar than nontwin siblings

Pediatric Boards (24 decks)

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