Newborn Flashcards by Lindsay Hammons

APGAR

Activity (muscle tone), Pulse, Grimace, Appearance (Color), Respirations; 2pts each

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What does APGAR tell you at (A) 1 minute, (B) 5 minutes

(A) how tolerated labor (B) response to resuscitation

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APGAR is NOT a therapy ____ or ____ factor

guide; prognostic

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Erb-Duchenne; tx

C5-C6; arm extended and medially rotated; refer if not better by 3-6 months

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Klumpke

C7-C8 + T1

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Clinical signs for clavicular fracture of newborn; tx

crepitus and discontinuity of clavicle (will form callus in 1 wk); no tx but can use fig-8 splint

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Caput succedaneum

“edema crosses suture lines”

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Cephalohematoma

“fluctuance doesn’t cross suture lines” (dent in head)

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Mongolian spot

Asians; congenital dermal melanocytosis, will go away

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Nevus simplex (salmon patch)

vascular birthmark that occurs in 33 percent of newborns; blanch when compressed; bilateral/symmetric

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Milia

pearly white bumps on a baby’s nose, chin or cheeks

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Erythema toxicum neonatorum (ETN)

in at least half of all infants; self-limited; lesions surrounded by blotchy, erythematous halo

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Strawberry hemangioma

most common on the face, scalp, back, or chest; ABSENT AT BIRTH

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Neonatal acne

often on nose/cheeks; peaks at around 2mo; no tx

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Nevus sebaceous; tx

“an area of alopecia with orange colored nodular skin”; remove before adolescence (can become malignant)

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Seborrhetic dermatitis; tx

thick, yellow/white oily scale on inflammatory base; clean gently w/ mild shampoo

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____ and ____ are two disorders screening in every state.

phenylketonuria; galactosemia

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Phenylketonuria

def phe hydrolxalase; sxs- MR, athetosis, seizures, vomiting, dev delay over 1st few months

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Phenylketonuria signs; tx

fair hair/eyes/skin, musty smell; low phe diet

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Galactosemia

def G1P-uridyltransferase–G1P accum to damage kidney/liver/brain

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Galactosemia sxs; tx

MR direct hyperbili & jaundice, ↓glc, cataracts, seizures; predisposed to E. coli sepsis; tx-no lactose

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Ddx Yellow Baby (4)

Jaundice = phys, breast feeding, breast milk, pathologic

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3 days old, bili @ 10, direct is 0.5. Eating & pooping well

Phys jaundice–gone by 5th DOL; b/c liver conjugation not yet mature

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7 days old, bili @ 12, direct is 0.5. dry mucous membranes, not gaining weight

Breast feeding Jaundice–↓feeding = dehydration = retain meconium & re-absorb deconjugated bili

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14 days old, bili @ 12, direct is 0.5. Baby regained birth weight, otherwise healthy

Breast milk Jaundice--Breast milk has glucuronidase and de-conj bili

Pathologic Jaundice --on 1st DOL, bili >___, d-bili >____, rate of rise >____ EX: 1 day old, bili @ 14, direct is 0.5

>12; >2; >5/day

Pathologic jaundice--next steps

Coombs test; if (+) -- Rh/ABO incompatibility; if (-) --twin/twin or mom/fetus transfusion, spherocytosis, G6PDH def, etc.

7 days old. Dark urine, pale stool. Bili @ 12, dbili is 8. LFTs also elevated

Biliary atresia -- Bile ducts cannot drain bile; causes liver failure. Need surgery!!

Ddx hyperbilirubinemia

ALWAYS R/O SEPSIS!!!, biliary atresia, galactosemia, hypothyroid, choledochal cyst, CF

Inherited causes of indirect hyperbili (2)

(1) Gilbert-- ↓glucoronyl transferase level; (2) Crigler-Najjar -- (type1) total deficiency

Inherited causes of direct hyperbili (2)

Dubin Johnson = black liver; Rotor = No black liver

Indirect bili can cross _____ and deposit into BG/brainstem nuclei and cause _____ (esp if bili >20)

BBB; kernicterus

Kernicterus tx

1st = Phototherapy--ionizes the uncoj bili so it can be excreted; 2nd = Double volume exchange transfusion if that doesn’t work

Baby born w/ respiratory distress, scaphoid abdomen & bowel in thoracic cavity-- MC? Can't miss?

Diaphragmatic hernia; pulmonary hypoplasia

Pulm hypoplasia tx

if dx prenatally, plan delivery at @ place w/ ECMO--Let lungs mature 3-4 days then do surg

Baby is born w/ respiratory distress w/ excess drooling. MCC?

TE-fistula

TE-fistula diag test; other clinical signs to look for?

test--place feeding tube, take xray, see it coiled in thorax; VACTER

1 week old baby becomes cyanotic when feeding but pinks up when crying. dx?

choanal atresia [congenital, back of the nasal passage (choana) is blocked by abnormal bony or soft tissue due to failed recanalization]

Choanal atresia--what else to look for?

CHARGE [coloboma, heart defects, retarded growth, GU, ear anomalies, deafness]

32 wk premie has dyspnea, RR of 80 w/ nasal flaring

RDS

Respiratory distress syndrome--prenatal dx; tx

L/S

38 wk LGA infant born by C/S to an A2GDM has dyspnea/grunting

transient tachypnea of newborn (TTN)

Transient tachypnea of newborn (TTN)--pathophys; tx

lung fluid not squeezed out; minimal O2 needed and self-resolves in hrs-days

41 wk AGA infant was born after ROM yielded greenish- brown fluid

Meconium aspiration syndrome

Meconium aspiration syndrome--next steps; complications

intubate/suction BEFORE stimulation; pulmonary artery HTN, pneumonitis

Gastroschisis: will see high maternal ___ in preg; [is/is not] associated w/ other disorders

AFP; IS NOT

Gastroischisis: complications

atretic or necrotic [req removal], short gut syndrome

Omphalocele [w/ sac] associated w/ ____ and ____ birth defects; also w/ Beckwith Wiedemann

Edwards; Patau

Beckwith Wiedemann Syndrome clinical

big baby w/ big tongue, ↓glc, ear pits, omphalocele; [inc risk childhood cancer]

Umbilical hernia assoc w/ ______; tx

congenital hypothyroidism (also big tongue); NONE unless there past age 2-3yo

4wk old infant w/ non- bileous vomiting and palpable “olive”

pyloric stenosis

Pyloric stenosis--metabolic complications; tx

hypochloremic met alkalosis; immediate surg

2wk old infant w/ bileous vomiting. The pregnancy was complicated by polyhydramnios

Intestinal atresia or Annular pancreas

Intestinal atresia [duodenal esp] and Annular pancreas assoc w/ ____

Down syndrome

1 wk old baby w/ bileous vomiting, draws up his legs, has abd distension

Malrotation and volvulus; Ladd’s bands [cecum to abd wall] can also kink the duodenum

MC pathophys malrotation

no rotating 270˚ ccw around SMA

3 day old newborn has still not passed meconium (name 2)

(1) Hirschprung's (2) Meconium ileus

Meconium ileus--dx, tx

[consider CF if +FH] gastrograffin enema is dx & tx

Hirschprung's--dx

DRE-->exposion of poo; bx showing no ganglia is gold standard

5 day old former 33 weeker develops bloody diarrhea

Necrotizing enterocolitis

Necrotizing enterocolitis--RF; tx

Premature gut, introduction of feeds, formula; NPO, TPN (if nec), antibiotics and resection of necrotic bowel

On xray, necrotizing enterocolitis shows _____.

pneumocystis intestinalis (air in wall)

2mo old baby has colicky abd pain and current jelly stool w/ a sausage shapend mass in the RUQ

Intussusception

Intussusception--dx, tx

barium enema is dx/tx

Newborn male with no palpable testes; what is this associated with?

cryptorchidism; assoc w/ prune belly syndrome

Cryptorchidism--MC location of testes; dx; tx

inguinal canal; US if not palpable; sx if not descended by 1yo [avoid sterility/cancer]

Newborn male with urethral opening on the ventral surface; what do you NOT DO?

hypospadias; circumcise (foreskin used in repair)

Newborn w/ ambiguous genitalia and 1mo later has vomiting, dec Na and inc K acidosis

Congenital adrenal hyperplasia

Congenital adrenal hyperplasia--MCC; dx; tx

21 Hydroxylase def (auto recessive); 17-OH progesterone before ACTH bolus; hydrocortisone + fludrocortisone

IDM--tx of moms w/ preexisting diabetes (esp type 1)

Control glc in the 1st trimester & take 4mg folate/day

IDM--moms w/ preexisting diabetes (esp type 1) fetal complications (5)

Placental insufficiency/IUGR, Congenital heart dz, NTD, Caudal regression syndrome, Small left colon syndrome

IDM--moms w/ gestational DM--complications of large gest. age

inc risk birth trauma (clavicle, Erbs), c/s and transient tachypnea of newborn (TTN)

IDM--moms w/ gestational DM--hypoglycemic baby complications/tx

neonatal seizure; feed frequently if glc

IDM--moms w/ gestational DM--hypocalcemic baby complications

neonatal seizure

IDM--moms w/ gestational DM--reason for polycythemic baby

big babies need more O2 and hypoxia inc EPO

IDM--moms w/ gestational DM--polycythemic baby complications

renal/splenic vein thrombosis

IDM--moms w/ gestational DM--reason for jaundice baby

more RBCs to break down (risk for kernicterus)

IDM--moms w/ gestational DM--reason for respiratory distress syndrome

inc insulin interferes w/ cortisol surge prior to birth that normally stimulates lung maturation [CHECK L/S ratio >2]

Neonatal fever work-up for baby

fever >100.4 = sepsis until proven otherwise; urine, blood, CSF, CXR

Gestational RF neonatal sepsis (6)

Prematurity, chorioamnionitis, intrapartum fever, maternal leukocytosis, prolonged rupture of membranes (>18hrs), GBS+ mom

Neonatal sepsis--MC bugs

Group B Strep, E. Coli, Lysteria monocytogenes

Neonatal sepsis--empiric tx

Amp + gent until 48hr cx are negative; Cefotaxime + Amp if meningitis suspected

Maculopapular rash on palms and soles, snuffles, periostitis--diagnosis, tx

Syphilis; PCN

Hydrocephalus, intracranial calcifications and chorioretinitis--diagnosis, tx

toxoplasmosis; sulfadiazine + leucovorin

Cataracts, deafness and heart defects (esp PDA, VSD), extramedullary hematopoeisis--diagnosis, tx

Rubella; no tx

Microcephaly, periventricular calcifications, deafness, thrombocytopenia and petechiae--diagnosis, tx

CMV; ganciclovir, but won't prevent MR

Limb hypoplasia, cutaneous scars, cataracts, chorioretinits, cortical atrophy--diagnosis, tx

Cong Varicella if mom infected 1st or 2nd trimester; If mom exposed 5 days before – 2 days after delivery, baby gets VZIG

DOL 1-3, red conjunctiva and tearing--diagnosis

chemical conjunctivitis caused by silver nitrate drops; not common b/c we use erythromycin

DOL 3-5, bilateral purulent conjunctivitis can cause corneal ulceration--diagnosis, tx

Gonococcal conjunctivitis; topical erythromycin + IV 3rd gen ceph

DOL 7-14, red conjunctiva w/ mucoid discharge & lid swelling--diagnosis, tx

Chlamydia conjunctivitis; oral erythromycin

Chlamydia conjunctivitis complication

chlamydial pneumonia [cough, nasal drainage, scattered crackles + bilat infiltrates on CXR]