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pediatrics > Newborn > Flashcards

Newborn Flashcards

1
Q

routine management of the newborn involves … (only names)

A
  1. phyisical exam
  2. Apgar
  3. eye care
  4. routine disease prevention + screening
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2
Q

normal delivery - after? (steps) (after apgar)

A
  1. suction of mouth and nose
  2. clamping + cutting of the umbilical cord
  3. newborn is then dried, wrapped in clean towels, and place under a warmer (it was in a warm environment in uterus)
  4. gentle rubbing or stimulating the heels to stimulate crying and breathing
  5. Vit K + opthalmic oitments
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3
Q

after delivery - when incubation and ABG analysis

A

if the newborn is not breathing or is in respiratory distress

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4
Q

after delivery - when NG tube

A

GI decompression is needed

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5
Q

pre-term

A

25-37 weeks

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6
Q

term

A

early: 37-38,6
full: 39-40,6
late: 41-41,6

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7
Q

normal vital signs of newborn

A

always HIGHER
RR: 40-60
HR: 120-160

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8
Q

APGAR score - evalutes …

A

1 min: evaluates conditions during labor and delivery
5 min: response to resusciatative efforts
DOES NOT PREDICT MORTALITY

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9
Q

Apgar score is based on

A 
Appearance
Pulse
Grimace 
Activity 
Respiration
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10
Q

Apgar score - score for appearance

A

pink –> 2
extremities blue –> 1
pale or blue –> 0

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11
Q

Apgar score - score for Pulse

A

more than 100 –> 2
less than 100 –> 1
no pulse –> 0

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12
Q

Apgar score - score for Grimace

A

reflex irritability
cries and pulls away or sneeze/cough –> 2
Grimaces or weak cry –> 1
no response to stimulation –> 0

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13
Q

Apgar score - score for Activity

A

active movement –> 2
arms, legs flexed –> 1
no movement –> 0

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14
Q

Apgar score - score for Respiration

A

strong cry –> 2
slow irregular –> 1
no breathing –> 0

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15
Q

Apgar score - management/evaluation/meaning

A

if less than 7 –> further evaluation
if remains low at later time points –> increased risk to develop long-term neurological damage
LOW SCORE IS NOT ASSOCIATED WITH FUTURE CEREBRAL PARALYSIS
- most neonates have 9 because blue extremities

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16
Q

neonatal conjuctivitis - types and age of onset

A
  • chemical irritation due to silver nitrate (it is not allergy, esp in developing countries: day 1: eye lubricant
  • gonococcal: day 2-5: single IM dose of 3rd gener ceph
  • chlamydial: 5-14: macrolide PO
  • 3 weeks or more: Hepres infection: systemic acyclovir and topical vidarabine
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17
Q

eye care in newborns

A

all newborns must be given 2 types of antibiotics drops in each eye to prevent ophthalmia neonatorum (N. gon or Chlam trachomatis:

  1. Erythomocycin or tetracycline oitment (effective against N. gonor)
  2. silver nitrate solution
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18
Q

Hepres infection neonatal conjuctivitis - when and treatment

A

3 weeks or more

systemic acyclovir and topical vidarabine

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19
Q

newborn have low vit K - why / results in / prevention

A
  1. no adequate colon flora
  2. low levels in breast milk
  3. doesn’t cross placenta
    bleeding from GI, belly button (αφαλός), Urinary tract (also may be brain)
    –> SINGLE IM dose is recommedned –> decrease incidence of VKDB (Vitamin K deficiency bleeding )
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20
Q

ALL neonates must be screened before discharge for

A
  1. PKU 2. CAH 3. Cystic fibrosis
  2. beta thalassemia
  3. Hypothyroidism
  4. Homocysteinuria
  5. Biotinidase
  6. PKU
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21
Q

screening that i do not know

A

Biotinidase

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22
Q

newborn - hearing test

A

exclude congenital sensory neural hearng loss

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23
Q

cystic fibrosis - Best initial test and most accurate test

A

best initial: sweat chloride

most accurate: Genetic analysis of the CFTR gene

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24
Q

galactosemia treatment

A

cut out all lactose-containing products

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25
Q

PKU treatment

A

special diet low in phenylalanine or at least 16 years of the patient’s life

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26
Q

neonatal screening tests that are more reliable id done after 48 hours

A
  1. PKU
  2. Galactosemia
  3. Hypothyroidism
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27
Q

Hepatits B vaccination

A
  • vaccine in HBsAG negative moters

- vaccine and immunoglobin in HBsAG (+) mothers

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28
Q

transient conditions of the newborn

A
  1. transient polycythemia of the newborn
  2. transient tachypnea of the newborn
  3. transient hyperbilirubinemmia
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29
Q

transient polycythemia of the newborn

A

hypoxia during delivery –> EPO –> increase RBCs –> first breath increase O2 –> drop EPO
SPENOMEGALY is normal finding

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30
Q

transient tachypnea of the newborn

A

compression of rib cage through vaginal canal –> helps to remove fluid from lungs
if C-cection –> excess lung fluid –> hypoxic –> transient for LESS THAN 4 HOURS
RF: C-section, prematurity, DM
FLUID IN INTERLOBULAR FISSURES

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31
Q

transient tachypnea of the newborn for more than 4 hours

A

considered sepsis –> blood + urine cultures

LP with CSF analysis + culture when neurological signs (irritabiity lethargy, feeding problems, Q irregularity)

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32
Q

transient hyperbilirubinemmia

A

over 60% of all newborns are jaundiced - due to spleen removing excess RBC with HBF

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33
Q

delivery associated subconjunctical hemorrhage

A

minute hemorrhage in the yes due to rise intrathoracic P as the chest is comporessed
- no treatment needed

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34
Q

delivery associated skull fructires - types

A
  1. Linear (MC)
  2. Depressed: can cause cortical damage without surgical intervention
  3. Basilar (most fatal)
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35
Q

delivery associated scalp injuries - types

A
  1. capute succedaneum: swelling of soft tissues, CROSS sutures lines
  2. Cephalohematoma: subperiosteal hemorrhage DOES NOT cross suture lines
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36
Q

delivery associated scalp injuries - diagnosis and treatment

A

diagnosis: clinically

improvement occurs gradually without treatment over a few weeks to months

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37
Q

delivery associated Branchial Palsy - mechanism

A

2ry to births with traction in the event of shoulder dystocia (MC in macrosomic infants)

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38
Q

delivery associated Branchial Palsy - forms

A
  1. Duchenne - Erb Paralysis: C5-C6

2. Klumpke Paralysis: C7,C8 +/- T1

39
Q

Duchenne - Erb Paralysis

A
  • C5-C6
  • Waiter’s tip appearance: unable to abduct the shoulder or extternally rotate and supinate the arm
    treatment: immobilization
40
Q

Klumpke Paralysis

A
  • C7,C8 +/- T1 (the same as grabing a tree branch)
  • Claw hand due to lack of grasp reflex: flex MCP and extent DIP + PIP joints
  • Horner
    treatment: immobilization
41
Q

the most common newborn fracture as a result of shoulder dystocia

A

Clavicular fracture

42
Q

amniotic fluid prodaction by

A

80% is a filtrate of mothers plasma

20% is produced by the baby by swallowing, absorbing, filtering and urinating

43
Q

causes of Polyhydramnions

A
  1. Neurological Werdnig Hoffman (SMA)+ unable to swallow

2. intestinal atresia

44
Q

causes of oligohydramnios

A
  1. prune belly: lack of abd muscles -> unable to bear down and urinate
  2. Renal agenesis (potter)
45
Q

Potter sequence (syndrome) - mnemonic

A 
POTTER 
Pulmonary hypoplasia
Oligohydramnios (trigger)
Twisted face 
Twisted skin
Extremitiy defects 
Renal failure (in utero)
46
Q

prune belly syndrome treatmnet

A

foley catheter –> risk for UTI

47
Q

diaphragmatic hernia - findings

A
  1. bowel sound in the chest

2. air fluid level on chest x-ray

48
Q

diaphragmatic hernia - types

A
  1. Morgagni: defect in retrosternal or parasternal

2. Bochdalek: defect in posterolateral (MC, usually left)

49
Q

omphalocele - mechanism

A

defect in which intestines and organs form beyond the abdominal wall WITH SAC COVERING. from failure of the GI sac to retract at 10-12 wks

50
Q

omphalocele - screening / treatment

A

maternal AFP and U/S

treatment: surgical reintroduction of contents

51
Q

ophalocele is highly associated with …

A

Edwards (18)

52
Q

elevated AFP indicate

A
  1. neural tube defects
  2. abdominal wall defects
  3. incorrect dating (MC)
53
Q

umbilical hernia

A

congenital weakness of the rectus abd muscle –> protrusion of vessels and bowel

54
Q

umbilical hernia - associated with

A

congenital hypothyroidism

55
Q

umbilical hernia - natural history

A

90% close spontaneously by age 3

after 4, surgical intervention is indicated to prevent strangulation + necrosis

56
Q

Gastroschisis?

A

wall defect LATERAL to midline with intestines + ogans WITHOUT SAC
multiple intestinal atresias occur

57
Q

Gastroschisis - treatment

A

immediate surgical intervention with GRADUAL introduction with of bowel and silo formation
- aggressive surgical reintroduction of the bowel –> 3rd spacing + bowel infraction

58
Q

MC abdominal mass in children / diagnosis / treatment

A

Wilms tumor
US is best initial
CT with contrast is the most accurate
total nephrectomy +/- with chemo and radiation

59
Q

Wilms tumor

A

caused by hemihypertrophy of 1 kidney due ot its increased vascular demands
Aniridia is highly associated (the most valuable clue)
- signs of constipation, abd pain, nause, vomiting

60
Q

WAGR syndrome (manifestation and chromosome)

A 
Wilms
Aniridia
Genitourinary malformation
Mental retardation 
deletion in chromosome 11
61
Q

MC cancer in infancy

A

Neuroblastoma

and MC extracranial solid malignancy

62
Q

Neuroblastoma - how often is metastasis

A

50-60% presents with metastasis

63
Q

Neuroblastoma - 2 higly tested fingings

A
  1. Hypsarrhythmia (EEG) and osomyiclonus: eye movements + myoclonic jerks + cerebellar ataxia
  2. Increased VMA and metanephrines in urine collection are diagnostic
64
Q

neurolastoma vs wilms in clinical examination

A

neuroblastoma may cross the midline and is fixed and immobile

65
Q

Hydrocele - clinical manifestation

A

PAINLESS swoellen fluid filled sac along the speramtic cord within that scrotum that tranilluminates upon inspection

66
Q

Hydrocele - remant of

A

tunic vaginalis

67
Q

Hydrocele - management

A

observation + reassuring –> most of them resolve by age 1

68
Q

Hydrocele - must differentiate from

A

inguinal hernia

69
Q

MC complaint in Varicocele

A

dull ache and heaviness in the scrotum
(does NOT transilluminate)
it can cause infertility

70
Q

Varicocele - Best initial test, Most accurate test

A

Best initial: physical exam with gag of warms
Accurate: U/S of the scrotal sac: dilation of the pampiniform plexus more than 2mm (always check the other testicle as well)

71
Q

Varicocele - treatment

A

it is indicated for delayed growth of the testes or in those with evidence of testicular atrophy

72
Q

Cryptorchidism - clinical

A

90% it can be felt in the inguinal canal

73
Q

Cryptorchidism - treatment

A

orchioexy to bring the testicle down into the scrotum after the age of 1 to avoid sterility (IF TO RESOLVE UNTIL 6 MONTHS)

74
Q

Cryptorchidism - complications

A
  • increased risk of malignancy, regardless of surgical intervention (but orchiopexy decreases the risk, but not all the risk)
  • test torsion
  • subfertility
  • inguinal hernia
75
Q

hyposadias vs epispadias in definition

A

hypo: opening in the ventral surface of penis in urethra
epi: dorsal surface

76
Q

hyposadias vs epispadias in treatment

A

both need surgical correction

77
Q

hyposadias vs epispadias regarding association

A

hypo: cryptorchidism + inguinal hernias
epi: urinary incontinence, bladder exstrophy

78
Q

hyposadias - what is contraindicated

A

circumcision, due to dificulties in surgical correction of the hypospadias

79
Q

Mongolian spots

A

blue/gray macules on presacral back + posterior thighs

  • usually fade in the 1st year
  • rule out child abuse
80
Q

Erythema toxicum

A

firm, yellow-white papules, postules with erythematous base, which peak on 2nd day of life
- self limited

81
Q

hemangioma - natural history

A

appears in first 2 months,, rapidly expandig then ivoluting by age 5-9 years

82
Q

preauricular tags/pits - association

A

hearing loss

genitourinary abnormalities

83
Q

Charge syndrome

A 
Cologoma or iris, 
heart defects
Atresia of nasal choanae
Growth retardation
Genitourinary abnormalities
Ear abnormalities
84
Q

communicating vs non-communicating hydrocele

A

communi: open processus vaginals –> preiotneal fluid accumulate –> increased size with crying
non-commmunic: close of processus, but fluid collected does not reaborb –> unchanged with crying

85
Q

Risk factros for cryptorchidism

A
  1. prematurity
  2. small for gestational age
  3. low birth weight
  4. genetic disorders
  5. hypospadias
86
Q

infants are labeled small for gestational age when

A

their weight is below the 10th percentile for gestational age
it can be symmetrical (weight, head, and height are equal) or assymetrical (weight is more affected)

87
Q

small gestational age - complications

A

hypoxia, perinatal asohyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, polycythemia

88
Q

Neonatal displaced clavicular fracture - RF

A
  1. macrosomia (DM, post-term)
  2. instrumental delivery
  3. shoulder dysplasia
89
Q

Neonatal displaced clavicular - clinical features

A
  1. crying/pain with passive motion
  2. crepitus
  3. asymmetric Moro rexles
90
Q

Neonatal displaced clavicular - diagnosis

A

x-ray

91
Q

Neonatal displaced clavicular - treatment

A
  1. reassurance
  2. gentle handling
  3. analgesics
  4. place affected arm in a long-sleeved garment + pin sleeve to chest with elbow flexed at 9- degrees
92
Q

splenomegaly on newborn

A

normal

93
Q

jaundice is consider pathologic when

A
  1. appears 1st day
  2. rises more than 5 / day
  3. above 19.5 in term child
  4. Direct bilir rises aboe 2 at any time
  5. present after the 2nd week

pediatrics (16 decks)

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