newborn Flashcards
apgar score
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
assess intrapartum hypoxia/ischemia
best is presence of metabolic acidosis in umbilical artery blood at time of birth
Vit K bleeding
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
ophthalmia neonatorum
cause by neisseria gonorhoeae and chlamydia. Tx- erythromycin appliced to conjunctival sacs. Can use silver nitrate
dubowitz/ballard exam
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.
hypoglycemia
risk group: diabetic mother, SGA, LGA, birth asphyxia.
HIV pos M
bathed at birth. Zidovudine initiated by 12hr.
withdrawal
abstinence scoring system every 4hr ck vital sign.
LGA/posterm
> 90th percentile. skin cracked (wrist ankle), assess for trauma using Moro reflex and grasp symmetry, ID clavicular fractures, brachial plexus injury, facial n palsy.
dextrose/sterile water
avoid giving bc cause hyponatremia and other electrolyte disturbances
not breastfed
incr risk obesity, asthma, diabetes, childhood leukemia
reduce severe hyperbilirubinemia
promote breastfeeding, evaluate and ID, measure totoal serum bili or transQ bili for jaundiced bay in first 24hr. Under 38wk are at higher risk.
new born discharge
doesn’t happen until pass stool and urine, safe rear facing seat
vaccination
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.
Vit D
400IU per day after birth
risks for respiratory rdistress
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)
DD of respiratory distress
RDS, TTN, pxn, hypoglycemia, CHF, neonatal sepsis, congenital diaphramatic hernia, severe coarctation of aorta, mecoium aspiration, maternal drug exposure, hypothermia
RDS
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
Transient tachypnea of newborn (TTN)
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
Pneumothorax
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
hypoglycemia
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
CHF
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
neonatal sepsis
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
congenital diaphragmatic hernia
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
coarctation of aorta
if there is severe LV outflow tract obstruction
hypothermia
Premature newborns are more at risk to become hypothermic because of their small body size
small for gestation age
transition from intra to extrauterine life
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.
1st hr
elevated HR (160-180) and RR (60-80)
2nd hr of life
HR (120-160), RR (40-60)
persistent pulmonary HT of newborn (PPHN)
persistence of fetal circulation
sx of respiratory distress
tachypnea, retration of inter/subcostal = incr work of breathing due to decr lung compliance. grunting- end of expiration, = air expelled from partially closed glottis
cyanosis
due to respiraotry, congenital heart defects or CNS, infectious, other
respiratory causes of cyanosis
TTN, RDS.
Congenital heart defects-cyanosis
ToF. TGA
CNS cyanosis
hypoxic-ischemic encephalopathy, intraventricular hemorrhage, sepsis/meningitis
infectious cynosis
septic shock, meningitis
cynosis other
respiratory depression 2/2 maternal med, hypothermia, polycythemia/hyperviscosity syndrome
oxygen challenge test
dd cardiac and pulmonary etiology. O2 incr PaO2 of respiratory condition but not in cardiac lesion cases
insulin
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
hypoglycemia steps
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
sepsis in newborn
may be subtle clinical sx- temp instability, lethargy, poor feeding
developmental hip dysplasia
parital or complete disloation, instability of femoral head. RF- breech, gender (9:1-F), fx.
bf discharge
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
vernix caseosa
thick white creamy material in term infants. cover large areas of skin in preterm infants. absent in poster.
acrocynosis
blue extremities. common in first 48-72hr
cutis marmorata
mottling of the skin with venous prominence.
sings of vasomotor instability
acrocynosis and cutis marmorata
pallor
sign of neonatal asphyxia, shock, sepsis or anemia
pustular melanosis
benign transient rash. small dry superficial vesicles over dark macular base. more in AA. DD viral- herpes, bacterial-impetigo
erythema toxicum neonatorum
benign rash. 72hrerythematous macules, pustules, on trunk and extremeities, but not palms and soles. filled with eiosinophil. no tx. in 50%. less in preterm
nevus simplex
salmon patch. most common vascular lesion of infancy. in 30-40% mink, macular lesion on nape= stork bite, upper eyelid, global, nasolabial region. transient
nevus flammeus
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)
strawberry hemangiomas
benign prolif vascular tumor. in 10%. incr in size then resolve in 18-24mo. intervene if comprise airway or vision
neonatal acne
20% newborn, at 1-2wk. comedones, inflm pustules and papillose may be present. no tx
microcephaly dd
malformation syndrome, chromosome syndorm, FAS, CMV, toxo
caput succedaneum
diffuse edema or swelling of soft tissue of scalp that crosses sutures
craniosynotosis
premature fusion of cranial sutures, may result in ban shape and size of skull
craniotabes
soft area of skull with ping pong ball fee. may occur in parietal bone. not related to rickets. disappear in wks or mo.
choanal atresia
exclude by passing NG tube through nostril
micrognathia
small chin.
pierre robin syndrome
micrognathia, cleft palate, glossoptosis (downward dispalcement or retraction of tongue), obstruction of upper airway
macroglossia
suggest beck with -wiedemann syndrome, hypothyroidism, mucopolysaccharidosis
epstein pearls
small, white epidermoid mucoid cyst on hard palate. disappear in wks
neonatal torticollis
asym shortening of SCM M. may result from being in fixed position in utero or postnatal hematoma resulting from birth injury
turner syndrome
edema, webbing of neck
HR
94-180
femoral pulse
diminished- coarctation of aorta
incr- patent ductus arteriosis
diastasis recti
sep of L/R side of rectus abdomeinis at midline. no tx.
persistent urachus
failure of tracheal duct to close –> bladder to umbilical cord.
meconium plug/ ileus
may be first sign of CF
hydrometrocolpos
imperforate home with retention of vaginal secretion. small cyst btw labia or as lower midline and mass during childhood
hydrospadius
urethral meatus on ventral side of penis. not associated with urinary malformation
epispadius
urethral meatus on dorsal side of penis. associated with bladder extrophy-protrusion from abdominal wall with exposure of mucosa
hydrocele
fluid bubble in tunica vaginalis. associate with hernia. dissapear
cryptorchidism.
undescended testis. hernia, genitaluritay malformation, hydrospadius, genetic
absence or hypoplasia of radius
think TAR syndrome- thrombocytopenia absent radio, rancor anemia, oram syndrome
polydactylyl
isolated anomaly
extremity look for
absent or hypoplasia of radius, polydactyly, edema (turner, noonan), rocker bottom foot (trisomy 18), hips
causes of LGA
diabetes, beck with wiedemann, syndrome, prayer will.
5Ts of cyanotic congenital heart disease
Tof, transposition of great vessels, truncus arterioles, tricuspid atresia, total anomalous pulmonary venous cxn.
fetal lung maturity
lecithin to sphingomyelin raito >2:1. [jps[jatodu;g;ucerp; om amniocentisis
respiratory distress syndrome RF
low l:s ratio, prematurity, mother with previous preterm RDS
persistent pulmonary HTN of newborn
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
apnea of prematurity
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.
central apnea
complete cessation of chest wall mvt and no airflow
apnea secondary to airwya obsturciton
chest mvt + no air flow
indirect hyperbilirubinemia
conjugated component is
direct hyperbilirubinemia
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
esophageal atresia with tracheoesophageal fistula
most common- atresia of esophagus, distal TE fistula. associate with polyhydramnios, VACTERL.
eval- gastric tube
manage diagphragmatic hernia
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.
omphalocele
midline, true hernia sac through umbilical cord with peritoneal sac. associate with congenital anomalies,
gastroschisis
congenital issue of anterior and wall. in right paraumbilical area. no hernia sac. no association with congenital anomalies, but does incr bowel damage
soap bubble xray
air in meconium= meconium ileus
hirshsprung
sx-constipation, vomit, abd distension. dx- rectal bx- lack ganglion cells.
tx- resection or colostomy
Necrotizing enterocolitis
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.
hypoglycemia
serum gluc
plethoric/round facies
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
polycythemia
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,
lethargy + poor feeding in 2wk old DD
infection (sepsis, meningitis), intracranial path (hemorrhage, hydrocephalus, hydranencephaly), metbaolic, chromosomal anomaly, congenital hypothyroidism, shaken baby syndrome, down syndrome, congenital adrenal hyperplasia, polycythemia, hyperbilirubinemia
bulging fontanele
meningitis, hydrocephalus, subdural hematoma, lead poison
