Newborn Flashcards
1
Q
routine management of the newborn involves … (only names)
A
- phyisical exam
- Apgar
- eye care
- routine disease prevention + screening
2
Q
normal delivery - after? (steps) (after apgar)
A
- suction of mouth and nose
- clamping + cutting of the umbilical cord
- newborn is then dried, wrapped in clean towels, and place under a warmer (it was in a warm environment in uterus)
- gentle rubbing or stimulating the heels to stimulate crying and breathing
- Vit K + opthalmic oitments
3
Q
after delivery - when incubation and ABG analysis
A
if the newborn is not breathing or is in respiratory distress
4
Q
after delivery - when NG tube
A
GI decompression is needed
5
Q
pre-term
A
25-37 weeks
6
Q
term
A
early: 37-38,6
full: 39-40,6
late: 41-41,6
7
Q
normal vital signs of newborn
A
always HIGHER
RR: 40-60
HR: 120-160
8
Q
APGAR score - evalutes …
A
1 min: evaluates conditions during labor and delivery
5 min: response to resusciatative efforts
DOES NOT PREDICT MORTALITY
9
Q
Apgar score is based on
A
Appearance Pulse Grimace Activity Respiration
10
Q
Apgar score - score for appearance
A
pink –> 2
extremities blue –> 1
pale or blue –> 0
11
Q
Apgar score - score for Pulse
A
more than 100 –> 2
less than 100 –> 1
no pulse –> 0
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
13
Q
Apgar score - score for Activity
A
active movement –> 2
arms, legs flexed –> 1
no movement –> 0
14
Q
Apgar score - score for Respiration
A
strong cry –> 2
slow irregular –> 1
no breathing –> 0
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
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
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:
- Erythomocycin or tetracycline oitment (effective against N. gonor)
- silver nitrate solution
18
Q
Hepres infection neonatal conjuctivitis - when and treatment
A
3 weeks or more
systemic acyclovir and topical vidarabine
19
Q
newborn have low vit K - why / results in / prevention
A
- no adequate colon flora
- low levels in breast milk
- 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 )
20
Q
ALL neonates must be screened before discharge for
A
- PKU 2. CAH 3. Cystic fibrosis
- beta thalassemia
- Hypothyroidism
- Homocysteinuria
- Biotinidase
- PKU
21
Q
screening that i do not know
A
Biotinidase
22
Q
newborn - hearing test
A
exclude congenital sensory neural hearng loss
23
Q
cystic fibrosis - Best initial test and most accurate test
A
best initial: sweat chloride
most accurate: Genetic analysis of the CFTR gene
24
Q
galactosemia treatment
A
cut out all lactose-containing products
25
PKU treatment
special diet low in phenylalanine or at least 16 years of the patient's life
26
neonatal screening tests that are more reliable id done after 48 hours
1. PKU
2. Galactosemia
3. Hypothyroidism
27
Hepatits B vaccination
- vaccine in HBsAG negative moters
| - vaccine and immunoglobin in HBsAG (+) mothers
28
transient conditions of the newborn
1. transient polycythemia of the newborn
2. transient tachypnea of the newborn
3. transient hyperbilirubinemmia
29
transient polycythemia of the newborn
hypoxia during delivery --> EPO --> increase RBCs --> first breath increase O2 --> drop EPO
SPENOMEGALY is normal finding
30
transient tachypnea of the newborn
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
31
transient tachypnea of the newborn for more than 4 hours
considered sepsis --> blood + urine cultures
| LP with CSF analysis + culture when neurological signs (irritabiity lethargy, feeding problems, Q irregularity)
32
transient hyperbilirubinemmia
over 60% of all newborns are jaundiced - due to spleen removing excess RBC with HBF
33
delivery associated subconjunctical hemorrhage
minute hemorrhage in the yes due to rise intrathoracic P as the chest is comporessed
- no treatment needed
34
delivery associated skull fructires - types
1. Linear (MC)
2. Depressed: can cause cortical damage without surgical intervention
3. Basilar (most fatal)
35
delivery associated scalp injuries - types
1. capute succedaneum: swelling of soft tissues, CROSS sutures lines
2. Cephalohematoma: subperiosteal hemorrhage DOES NOT cross suture lines
36
delivery associated scalp injuries - diagnosis and treatment
diagnosis: clinically
| improvement occurs gradually without treatment over a few weeks to months
37
delivery associated Branchial Palsy - mechanism
2ry to births with traction in the event of shoulder dystocia (MC in macrosomic infants)
38
delivery associated Branchial Palsy - forms
1. Duchenne - Erb Paralysis: C5-C6
| 2. Klumpke Paralysis: C7,C8 +/- T1
39
Duchenne - Erb Paralysis
- C5-C6
- Waiter's tip appearance: unable to abduct the shoulder or extternally rotate and supinate the arm
treatment: immobilization
40
Klumpke Paralysis
- 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
the most common newborn fracture as a result of shoulder dystocia
Clavicular fracture
42
amniotic fluid prodaction by
80% is a filtrate of mothers plasma
| 20% is produced by the baby by swallowing, absorbing, filtering and urinating
43
causes of Polyhydramnions
1. Neurological Werdnig Hoffman (SMA)+ unable to swallow
| 2. intestinal atresia
44
causes of oligohydramnios
1. prune belly: lack of abd muscles -> unable to bear down and urinate
2. Renal agenesis (potter)
45
Potter sequence (syndrome) - mnemonic
```
POTTER
Pulmonary hypoplasia
Oligohydramnios (trigger)
Twisted face
Twisted skin
Extremitiy defects
Renal failure (in utero)
```
46
prune belly syndrome treatmnet
foley catheter --> risk for UTI
47
diaphragmatic hernia - findings
1. bowel sound in the chest
| 2. air fluid level on chest x-ray
48
diaphragmatic hernia - types
1. Morgagni: defect in retrosternal or parasternal
| 2. Bochdalek: defect in posterolateral (MC, usually left)
49
omphalocele - mechanism
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
omphalocele - screening / treatment
maternal AFP and U/S
| treatment: surgical reintroduction of contents
51
ophalocele is highly associated with ...
Edwards (18)
52
elevated AFP indicate
1. neural tube defects
2. abdominal wall defects
3. incorrect dating (MC)
53
umbilical hernia
congenital weakness of the rectus abd muscle --> protrusion of vessels and bowel
54
umbilical hernia - associated with
congenital hypothyroidism
55
umbilical hernia - natural history
90% close spontaneously by age 3
| after 4, surgical intervention is indicated to prevent strangulation + necrosis
56
Gastroschisis?
wall defect LATERAL to midline with intestines + ogans WITHOUT SAC
multiple intestinal atresias occur
57
Gastroschisis - treatment
immediate surgical intervention with GRADUAL introduction with of bowel and silo formation
- aggressive surgical reintroduction of the bowel --> 3rd spacing + bowel infraction
58
MC abdominal mass in children / diagnosis / treatment
Wilms tumor
US is best initial
CT with contrast is the most accurate
total nephrectomy +/- with chemo and radiation
59
Wilms tumor
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
WAGR syndrome (manifestation and chromosome)
```
Wilms
Aniridia
Genitourinary malformation
Mental retardation
deletion in chromosome 11
```
61
MC cancer in infancy
Neuroblastoma
| and MC extracranial solid malignancy
62
Neuroblastoma - how often is metastasis
50-60% presents with metastasis
63
Neuroblastoma - 2 higly tested fingings
1. Hypsarrhythmia (EEG) and osomyiclonus: eye movements + myoclonic jerks + cerebellar ataxia
2. Increased VMA and metanephrines in urine collection are diagnostic
64
neurolastoma vs wilms in clinical examination
neuroblastoma may cross the midline and is fixed and immobile
65
Hydrocele - clinical manifestation
PAINLESS swoellen fluid filled sac along the speramtic cord within that scrotum that tranilluminates upon inspection
66
Hydrocele - remant of
tunic vaginalis
67
Hydrocele - management
observation + reassuring --> most of them resolve by age 1
68
Hydrocele - must differentiate from
inguinal hernia
69
MC complaint in Varicocele
dull ache and heaviness in the scrotum
(does NOT transilluminate)
it can cause infertility
70
Varicocele - Best initial test, Most accurate test
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
Varicocele - treatment
it is indicated for delayed growth of the testes or in those with evidence of testicular atrophy
72
Cryptorchidism - clinical
90% it can be felt in the inguinal canal
73
Cryptorchidism - treatment
orchioexy to bring the testicle down into the scrotum after the age of 1 to avoid sterility (IF TO RESOLVE UNTIL 6 MONTHS)
74
Cryptorchidism - complications
- increased risk of malignancy, regardless of surgical intervention (but orchiopexy decreases the risk, but not all the risk)
- test torsion
- subfertility
- inguinal hernia
75
hyposadias vs epispadias in definition
hypo: opening in the ventral surface of penis in urethra
epi: dorsal surface
76
hyposadias vs epispadias in treatment
both need surgical correction
77
hyposadias vs epispadias regarding association
hypo: cryptorchidism + inguinal hernias
epi: urinary incontinence, bladder exstrophy
78
hyposadias - what is contraindicated
circumcision, due to dificulties in surgical correction of the hypospadias
79
Mongolian spots
blue/gray macules on presacral back + posterior thighs
- usually fade in the 1st year
- rule out child abuse
80
Erythema toxicum
firm, yellow-white papules, postules with erythematous base, which peak on 2nd day of life
- self limited
81
hemangioma - natural history
appears in first 2 months,, rapidly expandig then ivoluting by age 5-9 years
82
preauricular tags/pits - association
hearing loss
| genitourinary abnormalities
83
Charge syndrome
```
Cologoma or iris,
heart defects
Atresia of nasal choanae
Growth retardation
Genitourinary abnormalities
Ear abnormalities
```
84
communicating vs non-communicating hydrocele
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
Risk factros for cryptorchidism
1. prematurity
2. small for gestational age
3. low birth weight
4. genetic disorders
5. hypospadias
86
infants are labeled small for gestational age when
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
small gestational age - complications
hypoxia, perinatal asohyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, polycythemia
88
Neonatal displaced clavicular fracture - RF
1. macrosomia (DM, post-term)
2. instrumental delivery
3. shoulder dysplasia
89
Neonatal displaced clavicular - clinical features
1. crying/pain with passive motion
2. crepitus
3. asymmetric Moro rexles
90
Neonatal displaced clavicular - diagnosis
x-ray
91
Neonatal displaced clavicular - treatment
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
splenomegaly on newborn
normal
93
jaundice is consider pathologic when
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
