newborn

Question 1

apgar score

Answer 1

1 and 5min. 5 components: HR(absent, 100), respiratory effort, M tone, reflex irritability, color. 5min score of 7-10= normal/ doesn’t predict outcome or dev of infant

Question 2

assess intrapartum hypoxia/ischemia

Answer 2

best is presence of metabolic acidosis in umbilical artery blood at time of birth

Question 3

Vit K bleeding

Answer 3

bc neonates have no gut flora to make K. so present at birth or wks later with skin bruising, mucosal bleeding, bleeding at umbilicus and circumcision site or fatal intracranial hemorrhage

Question 4

ophthalmia neonatorum

Answer 4

cause by neisseria gonorhoeae and chlamydia. Tx- erythromycin appliced to conjunctival sacs. Can use silver nitrate

Question 5

dubowitz/ballard exam

Answer 5

done at 12-24hr of life. used when gestational age or due date unclear. Assess infant neuroM and physical maturity. NM maturity is based on infant NM tone and reflexes. Physical M - anterior posterior progression of plantar creases and progression from transparency to cracking, lanugo, extent of dev of breast tissue, eye/ear dev, maturation of genitalia.

Question 6

hypoglycemia

Answer 6

risk group: diabetic mother, SGA, LGA, birth asphyxia.

Question 7

HIV pos M

Answer 7

bathed at birth. Zidovudine initiated by 12hr.

Question 8

withdrawal

Answer 8

abstinence scoring system every 4hr ck vital sign.

Question 9

LGA/posterm

Answer 9

> 90th percentile. skin cracked (wrist ankle), assess for trauma using Moro reflex and grasp symmetry, ID clavicular fractures, brachial plexus injury, facial n palsy.

Question 10

dextrose/sterile water

Answer 10

avoid giving bc cause hyponatremia and other electrolyte disturbances

Question 11

not breastfed

Answer 11

incr risk obesity, asthma, diabetes, childhood leukemia

Question 12

reduce severe hyperbilirubinemia

Answer 12

promote breastfeeding, evaluate and ID, measure totoal serum bili or transQ bili for jaundiced bay in first 24hr. Under 38wk are at higher risk.

Question 13

new born discharge

Answer 13

doesn’t happen until pass stool and urine, safe rear facing seat

Question 14

vaccination

Answer 14

hep B. w/in 12 hr if mother’s hep B status in unknown. Suggest- influenza, tetanus, reduced diphtheria toxoid, acellular pertusis, TdaP to postpartum mother.

Question 15

Vit D

Answer 15

400IU per day after birth

Question 16

risks for respiratory rdistress

Answer 16

maternal Diabetes, prematurity (lung immature), maternal GBS, c section (TTN), premature rupture of membrane (prolong PROM >18hr- RF for neonatal sepsis), meconium in amniotic fluid (meconium aspiration syndrome)

Question 17

DD of respiratory distress

Answer 17

RDS, TTN, pxn, hypoglycemia, CHF, neonatal sepsis, congenital diaphramatic hernia, severe coarctation of aorta, mecoium aspiration, maternal drug exposure, hypothermia

Question 18

RDS

Answer 18

Caused by a deficiency of lung surfactant and delayed lung maturation
Can occur as late as 37 weeks’ gestation
Most common cause of respiratory distress in premature infants
Remember that there may be surfactant deficiency and delayed lung maturation in infants of diabetic mothers
CXR- diffuse reticulograndular - ground glass appearance + air bronchograms

Question 19

Transient tachypnea of newborn (TTN)

Answer 19

Result of delayed clearance of fluid from the lungs following birth. Usually fluid cleared by squeezing during uterine contraction and absorption by pul lymphatics.
Much more common in infants born to diabetic mothers and in infants born by c-section
While generally considered a disorder of term infants, TTN does occur in premature infants
CXR- wet lungs, no consolidations/ air bronchograms

Question 20

Pneumothorax

Answer 20

Caused by a collection of gas in the pleural space with resultant collapse of lung tissue
Common risk factors are mechanical ventilation or underlying lung disease (especially meconium aspiration or severe infant respiratory distress syndrome).
While relatively uncommon, always an important consideration in an infant with respiratory distress
More likely in a premature infant with RDS

Question 21

hypoglycemia

Answer 21

May be seen in infants of diabetic mothers due to the chronic hyperinsulinemic state that occurred during gestation
Can be more pronounced in premature infants
Tachypnea is a non-specific response to this metabolic derangement. can be asx- but even then can affect brain dev. so always ck. at birth, sep of placenta cause decr in glu lvl over first 1-2hr then stabilize by 3-4hr- 65-71. intervene for asx at

Question 22

CHF

Answer 22

In an infant, most often caused by a congenital heart defect
May present with early cardiac failure and tachypnea
Increased risk of heart defects in IDM infants, and therefore an increased risk of CHF

Question 23

neonatal sepsis

Answer 23

Can present initially with tachypnea and progress to more severe illness rapidly
Often due to infection with Group B Streptococcus (GBS), usually transmitted from the mother during labor
Prolonged PROM is associated with an increased incidence of neonatal sepsis

Question 24

congenital diaphragmatic hernia

Answer 24

Occurs in 1 out of every 2,200 to 5,000 live births
Most common type (accounting for > 95% of cases) is the Bochdalek hernia, which is located posterolaterally
Absent breath sounds or presence of bowel sounds on one side of the chest are important diagnostic clues

Question 25

coarctation of aorta

Answer 25

if there is severe LV outflow tract obstruction

Question 26

hypothermia

Answer 26

Premature newborns are more at risk to become hypothermic because of their small body size

Question 27

small for gestation age

Question 28

transition from intra to extrauterine life

Answer 28

1) Removal of the low-resistance placental circulation by cutting the umbilical cord. 2) Initiation of air breathing by the newborn infant. 3) Reduction of the pulmonary arterial resistance. 4) Closure of the PFO and PDA.

Question 29

1st hr

Answer 29

elevated HR (160-180) and RR (60-80)

Question 30

2nd hr of life

Answer 30

HR (120-160), RR (40-60)

Question 31

persistent pulmonary HT of newborn (PPHN)

Answer 31

persistence of fetal circulation

Question 32

sx of respiratory distress

Answer 32

tachypnea, retration of inter/subcostal = incr work of breathing due to decr lung compliance. grunting- end of expiration, = air expelled from partially closed glottis

Question 33

cyanosis

Answer 33

due to respiraotry, congenital heart defects or CNS, infectious, other

Question 34

respiratory causes of cyanosis

Answer 34

TTN, RDS.

Question 35

Congenital heart defects-cyanosis

Answer 35

ToF. TGA

Question 36

CNS cyanosis

Answer 36

hypoxic-ischemic encephalopathy, intraventricular hemorrhage, sepsis/meningitis

Question 37

infectious cynosis

Answer 37

septic shock, meningitis

Question 38

cynosis other

Answer 38

respiratory depression 2/2 maternal med, hypothermia, polycythemia/hyperviscosity syndrome

Question 39

oxygen challenge test

Answer 39

dd cardiac and pulmonary etiology. O2 incr PaO2 of respiratory condition but not in cardiac lesion cases

Question 40

insulin

Answer 40

primary anabolic hormone for fetal growth especially in 3rd T- heart/liver/M are insulin sensitive. incr in fat sun and deposition. insulin insensitive organ- brain, kidney -normal size. therefore HbA1c control in T1 is predictor. >12--> 12x incr in major malformations

Question 41

hypoglycemia steps

Answer 41

1) glucometer test screen (10-15% lower than plasma) 2) serum or plasma glu to confirm 3)tx- feed milk, breast, bottle or NG. milk raises, flu maintain lvls and avoid rebound hypoglycemia if sx then IV dextrose started. 4) monitor: >40. 30-3hr ck dep on seveity

Question 42

sepsis in newborn

Answer 42

may be subtle clinical sx- temp instability, lethargy, poor feeding

Question 43

developmental hip dysplasia

Answer 43

parital or complete disloation, instability of femoral head. RF- breech, gender (9:1-F), fx.

Question 44

bf discharge

Answer 44

follow-up in 1wk. or if d/c bf 48hr then f/u in 48hr. feeding reg q2-4h voiding 6/d. min jaundice. it D prescription, car seat, cosleeping reviewed

Question 45

vernix caseosa

Answer 45

thick white creamy material in term infants. cover large areas of skin in preterm infants. absent in poster.

Question 46

acrocynosis

Answer 46

blue extremities. common in first 48-72hr

Question 47

cutis marmorata

Answer 47

mottling of the skin with venous prominence.

Question 48

sings of vasomotor instability

Answer 48

acrocynosis and cutis marmorata

Question 49

pallor

Answer 49

sign of neonatal asphyxia, shock, sepsis or anemia

Question 50

pustular melanosis

Answer 50

benign transient rash. small dry superficial vesicles over dark macular base. more in AA. DD viral- herpes, bacterial-impetigo

Question 51

erythema toxicum neonatorum

Answer 51

benign rash. 72hrerythematous macules, pustules, on trunk and extremeities, but not palms and soles. filled with eiosinophil. no tx. in 50%. less in preterm

Question 52

nevus simplex

Answer 52

salmon patch. most common vascular lesion of infancy. in 30-40% mink, macular lesion on nape= stork bite, upper eyelid, global, nasolabial region. transient

Question 53

nevus flammeus

Answer 53

port wine stain. congenital vascular malformation of dilated capillary like vessels. face or trunk. darker with age. if on area ophthalmic branch of trigeminal- may be associated with intracranial or spinal vascular malformation, seizure, intracranial calcification (sturge weber syndrome)

Question 54

strawberry hemangiomas

Answer 54

benign prolif vascular tumor. in 10%. incr in size then resolve in 18-24mo. intervene if comprise airway or vision

Question 55

neonatal acne

Answer 55

20% newborn, at 1-2wk. comedones, inflm pustules and papillose may be present. no tx

Question 56

microcephaly dd

Answer 56

malformation syndrome, chromosome syndorm, FAS, CMV, toxo

Question 57

caput succedaneum

Answer 57

diffuse edema or swelling of soft tissue of scalp that crosses sutures

Question 58

craniosynotosis

Answer 58

premature fusion of cranial sutures, may result in ban shape and size of skull

Question 59

craniotabes

Answer 59

soft area of skull with ping pong ball fee. may occur in parietal bone. not related to rickets. disappear in wks or mo.

Question 60

choanal atresia

Answer 60

exclude by passing NG tube through nostril

Question 61

micrognathia

Answer 61

small chin.

Question 62

pierre robin syndrome

Answer 62

micrognathia, cleft palate, glossoptosis (downward dispalcement or retraction of tongue), obstruction of upper airway

Question 63

macroglossia

Answer 63

suggest beck with -wiedemann syndrome, hypothyroidism, mucopolysaccharidosis

Question 64

epstein pearls

Answer 64

small, white epidermoid mucoid cyst on hard palate. disappear in wks

Question 65

neonatal torticollis

Answer 65

asym shortening of SCM M. may result from being in fixed position in utero or postnatal hematoma resulting from birth injury

Question 66

turner syndrome

Answer 66

edema, webbing of neck

Question 67

HR

Answer 67

94-180

Question 68

femoral pulse

Answer 68

diminished- coarctation of aorta | incr- patent ductus arteriosis

Question 69

diastasis recti

Answer 69

sep of L/R side of rectus abdomeinis at midline. no tx.

Question 70

persistent urachus

Answer 70

failure of tracheal duct to close --> bladder to umbilical cord.

Question 71

meconium plug/ ileus

Answer 71

may be first sign of CF

Question 72

hydrometrocolpos

Answer 72

imperforate home with retention of vaginal secretion. small cyst btw labia or as lower midline and mass during childhood

Question 73

hydrospadius

Answer 73

urethral meatus on ventral side of penis. not associated with urinary malformation

Question 74

epispadius

Answer 74

urethral meatus on dorsal side of penis. associated with bladder extrophy-protrusion from abdominal wall with exposure of mucosa

Question 75

hydrocele

Answer 75

fluid bubble in tunica vaginalis. associate with hernia. dissapear

Question 76

cryptorchidism.

Answer 76

undescended testis. hernia, genitaluritay malformation, hydrospadius, genetic

Question 77

absence or hypoplasia of radius

Answer 77

think TAR syndrome- thrombocytopenia absent radio, rancor anemia, oram syndrome

Question 78

polydactylyl

Answer 78

isolated anomaly

Question 79

extremity look for

Answer 79

absent or hypoplasia of radius, polydactyly, edema (turner, noonan), rocker bottom foot (trisomy 18), hips

Question 80

causes of LGA

Answer 80

diabetes, beck with wiedemann, syndrome, prayer will.

Question 81

5Ts of cyanotic congenital heart disease

Answer 81

Tof, transposition of great vessels, truncus arterioles, tricuspid atresia, total anomalous pulmonary venous cxn.

Question 82

fetal lung maturity

Answer 82

lecithin to sphingomyelin raito >2:1. [jps[jatodu;g;ucerp; om amniocentisis

Question 83

respiratory distress syndrome RF

Answer 83

low l:s ratio, prematurity, mother with previous preterm RDS

Question 84

persistent pulmonary HTN of newborn

Answer 84

low blood flow to lung. mostly late preterm or older, etio- prenatal asphyxia, MAS patho-incr pul vascular R- R to L shunt. do ECHO to r/o heart disease and assess degree of HTN and r to L shunt

Question 85

apnea of prematurity

Answer 85

respiratory pause without airflow lasting more than 15-20s. or any length + bradycardia/cynosis or o2 dessert. tx: maintane neutrl thermal enviro, respiratory stimulant med (caffeine, theophylline), ventilation as needed.

Question 86

central apnea

Answer 86

complete cessation of chest wall mvt and no airflow

Question 87

apnea secondary to airwya obsturciton

Answer 87

chest mvt + no air flow

Question 88

indirect hyperbilirubinemia

Answer 88

conjugated component is

Question 89

direct hyperbilirubinemia

Answer 89

conjugated component is >15%. always pathologic in neonates. obstructive J 2/2 choledochal cyst OJ 2/2 biliary atresia sepsis neonatal hepatitis -hep a/b/c, EBV, TORCH, Varicella, herpes, TB metabolic- galactosemia, hereditary fructose intol, tyrosinemia, a - antitrypsin def cholestatsis due to parenteral nutrition, CF

Question 90

esophageal atresia with tracheoesophageal fistula

Answer 90

most common- atresia of esophagus, distal TE fistula. associate with polyhydramnios, VACTERL. eval- gastric tube

Question 91

manage diagphragmatic hernia

Answer 91

no bag/mask vent bc incr air in GI--> compress lung. use mechanical vent with 100% O2, correct acidosis, hypoxemia, hypercarbia then surgery. prog deep on decree of defect.

Question 92

omphalocele

Answer 92

midline, true hernia sac through umbilical cord with peritoneal sac. associate with congenital anomalies,

Question 93

gastroschisis

Answer 93

congenital issue of anterior and wall. in right paraumbilical area. no hernia sac. no association with congenital anomalies, but does incr bowel damage

Question 94

soap bubble xray

Answer 94

air in meconium= meconium ileus

Question 95

hirshsprung

Answer 95

sx-constipation, vomit, abd distension. dx- rectal bx- lack ganglion cells. tx- resection or colostomy

Question 96

Necrotizing enterocolitis

Answer 96

ab distension, tenderness, residual gastric contents, bilious aspirate, bloody stool, ab erythema. can have thrombocytopenia, disseminated IV coag, death. dx- abd distension, a/f lvl, thick wall, pneumatosis intestinalis, venous portal gas. pneumoperitoneum tx- bowel rest, antibiotics, parenteral fluids/nutrition. ex lap for pneumatosis, fixed loop, or + parecentesis.

Question 97

hypoglycemia

Answer 97

serum gluc

Question 98

plethoric/round facies

Answer 98

IDM. usually LGA. SGA if placate insuf 2/2 vascular complication . 2-4x more congential heart disease. small left colon syndrome- specific, ab distention and can't pass meconium

Question 99

polycythemia

Answer 99

central venous hematocrit greater than 65% etio- incr EPO secretion 2/2 placental insufi, response to hypoxemia clinical- plethora, poor perfusion, cyanosis, poor feeding, respiratory distress, lethargy, jittery, seizure, renal vein thrombosis, metabolic acidosis, incr risk of NEC tx- parital exchange transfusion,

Question 100

lethargy + poor feeding in 2wk old DD

Answer 100

infection (sepsis, meningitis), intracranial path (hemorrhage, hydrocephalus, hydranencephaly), metbaolic, chromosomal anomaly, congenital hypothyroidism, shaken baby syndrome, down syndrome, congenital adrenal hyperplasia, polycythemia, hyperbilirubinemia

Question 101

bulging fontanele

Answer 101

meningitis, hydrocephalus, subdural hematoma, lead poison