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Peds > newborn > Flashcards

newborn Flashcards

1
Q

apgar score

A

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

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2
Q

assess intrapartum hypoxia/ischemia

A

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

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3
Q

Vit K bleeding

A

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

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4
Q

ophthalmia neonatorum

A

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

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5
Q

dubowitz/ballard exam

A

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.

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6
Q

hypoglycemia

A

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

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7
Q

HIV pos M

A

bathed at birth. Zidovudine initiated by 12hr.

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8
Q

withdrawal

A

abstinence scoring system every 4hr ck vital sign.

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9
Q

LGA/posterm

A

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

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10
Q

dextrose/sterile water

A

avoid giving bc cause hyponatremia and other electrolyte disturbances

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11
Q

not breastfed

A

incr risk obesity, asthma, diabetes, childhood leukemia

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12
Q

reduce severe hyperbilirubinemia

A

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

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13
Q

new born discharge

A

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

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14
Q

vaccination

A

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.

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15
Q

Vit D

A

400IU per day after birth

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16
Q

risks for respiratory rdistress

A

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)

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17
Q

DD of respiratory distress

A

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

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18
Q

RDS

A

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

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19
Q

Transient tachypnea of newborn (TTN)

A

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

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20
Q

Pneumothorax

A

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

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21
Q

hypoglycemia

A

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

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22
Q

CHF

A

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

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23
Q

neonatal sepsis

A

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

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24
Q

congenital diaphragmatic hernia

A

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

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25
Q

coarctation of aorta

A

if there is severe LV outflow tract obstruction

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26
Q

hypothermia

A

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

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27
Q

small for gestation age

A
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28
Q

transition from intra to extrauterine life

A

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.

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29
Q

1st hr

A

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

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30
Q

2nd hr of life

A

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

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31
Q

persistent pulmonary HT of newborn (PPHN)

A

persistence of fetal circulation

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32
Q

sx of respiratory distress

A

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

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33
Q

cyanosis

A

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

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34
Q

respiratory causes of cyanosis

A

TTN, RDS.

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35
Q

Congenital heart defects-cyanosis

A

ToF. TGA

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36
Q

CNS cyanosis

A

hypoxic-ischemic encephalopathy, intraventricular hemorrhage, sepsis/meningitis

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37
Q

infectious cynosis

A

septic shock, meningitis

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38
Q

cynosis other

A

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

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39
Q

oxygen challenge test

A

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

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40
Q

insulin

A

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

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41
Q

hypoglycemia steps

A

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

42
Q

sepsis in newborn

A

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

43
Q

developmental hip dysplasia

A

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

44
Q

bf discharge

A

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

45
Q

vernix caseosa

A

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

46
Q

acrocynosis

A

blue extremities. common in first 48-72hr

47
Q

cutis marmorata

A

mottling of the skin with venous prominence.

48
Q

sings of vasomotor instability

A

acrocynosis and cutis marmorata

49
Q

pallor

A

sign of neonatal asphyxia, shock, sepsis or anemia

50
Q

pustular melanosis

A

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

51
Q

erythema toxicum neonatorum

A

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

52
Q

nevus simplex

A

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

53
Q

nevus flammeus

A

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)

54
Q

strawberry hemangiomas

A

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

55
Q

neonatal acne

A

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

56
Q

microcephaly dd

A

malformation syndrome, chromosome syndorm, FAS, CMV, toxo

57
Q

caput succedaneum

A

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

58
Q

craniosynotosis

A

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

59
Q

craniotabes

A

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

60
Q

choanal atresia

A

exclude by passing NG tube through nostril

61
Q

micrognathia

A

small chin.

62
Q

pierre robin syndrome

A

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

63
Q

macroglossia

A

suggest beck with -wiedemann syndrome, hypothyroidism, mucopolysaccharidosis

64
Q

epstein pearls

A

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

65
Q

neonatal torticollis

A

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

66
Q

turner syndrome

A

edema, webbing of neck

67
Q

HR

A

94-180

68
Q

femoral pulse

A

diminished- coarctation of aorta

incr- patent ductus arteriosis

69
Q

diastasis recti

A

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

70
Q

persistent urachus

A

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

71
Q

meconium plug/ ileus

A

may be first sign of CF

72
Q

hydrometrocolpos

A

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

73
Q

hydrospadius

A

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

74
Q

epispadius

A

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

75
Q

hydrocele

A

fluid bubble in tunica vaginalis. associate with hernia. dissapear

76
Q

cryptorchidism.

A

undescended testis. hernia, genitaluritay malformation, hydrospadius, genetic

77
Q

absence or hypoplasia of radius

A

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

78
Q

polydactylyl

A

isolated anomaly

79
Q

extremity look for

A

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

80
Q

causes of LGA

A

diabetes, beck with wiedemann, syndrome, prayer will.

81
Q

5Ts of cyanotic congenital heart disease

A

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

82
Q

fetal lung maturity

A

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

83
Q

respiratory distress syndrome RF

A

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

84
Q

persistent pulmonary HTN of newborn

A

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

85
Q

apnea of prematurity

A

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.

86
Q

central apnea

A

complete cessation of chest wall mvt and no airflow

87
Q

apnea secondary to airwya obsturciton

A

chest mvt + no air flow

88
Q

indirect hyperbilirubinemia

A

conjugated component is

89
Q

direct hyperbilirubinemia

A

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

90
Q

esophageal atresia with tracheoesophageal fistula

A

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

91
Q

manage diagphragmatic hernia

A

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.

92
Q

omphalocele

A

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

93
Q

gastroschisis

A

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

94
Q

soap bubble xray

A

air in meconium= meconium ileus

95
Q

hirshsprung

A

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

96
Q

Necrotizing enterocolitis

A

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.

97
Q

hypoglycemia

A

serum gluc

98
Q

plethoric/round facies

A

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

99
Q

polycythemia

A

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,

100
Q

lethargy + poor feeding in 2wk old DD

A

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

101
Q

bulging fontanele

A

meningitis, hydrocephalus, subdural hematoma, lead poison

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