Newborn Flashcards
- The 1-minute score gives an idea of ______
* The 5-minute score gives an idea of _______
what was going on during labor and delivery.
response to therapy (resuscitation).
T or F
the Apgar score is not predictive of outcome
T
Part of the Newborn Care
Vitamin K IM • Prophylactic eye erythromycin • Umbilical cord care • Hearing test • Newborn screening tests
MC skull Fx in NB
Linear
_______ C5–C6; cannot abduct shoulder; externally rotate and supinate forearm;
_____ C7–C8 ± T1; paralyzed hand ± Horner syndrome
Erb-Duchenne:
Klumpke:
Prognosis of Brachial Nerve Palsy
Most with full recovery (months); depends on
whether nerve was injured or lacerated; Rx
Position of birth prone to clavicular fx
Especially with shoulder dystocia in vertex
position and arm extension in breech
What is needed if no improvement after 3-6 mos in facial/brachial nerve injury
neuroplasty if no improvement (torn fibers)
Diffuse edematous swelling of soft tissues of
scalp; crosses suture lines
Caput succedaneum
Caput succedaneum may lead to?
may lead to molding for week
Subperiosteal hemorrhage: does not cross
suture lines
Cephalohematoma
COurse of Cephalohematoma
May have underlying linear fracture; resolve in 2
wk to 3 mo; may calcify; jaundice
Lacy, reticulated vascular pattern over most of body when baby is cooled; improves over first month; abnormal if persists
Cutis marmorata
Blue to slate-gray macules; seen on presacral, back, posterior thighs; > in nonwhite infants; arrested melanocytes; usually fade over first few years; differential: child abuse
Mongolian spots
Pale, pink vascular macules; found in nuchal area, glabella, eyelids; usually disappears
Salmon patch (nevus simplex)
Firm, yellow-white papules/pustules with erythematous base; peaks on second day of life; contain
eosinophils; benign
Erythema toxicum, neonatorum
CHaracteristics of superficial hemangioma
Superficial: bright red, protuberant, sharply demarcated; most often appear in first 2 months; most on face, scalp, back, anterior chest; rapid expansion, then stationary, then involution (most by 5–9 years of age);
CHaracteristics of deeper hemangioma
bluish hue, firm, cystic, less likely to regress; Rx: (steroids, pulsed laser) only if large and interfering with function
What to do if with Preauricular tags/pits
Look for hearing loss and genitourinary anomalies
Association of Coloboma of iris
CHARGE association
Hypoplasia of iris; defect may go through to retina; association with Wilms tumor
Aniridia
Enzyme deficiency of PKU
Phenylalanine hydroxylase; accumulation of PHE in body
fluids and CNS
Asscn of PKU
Fair hair, fair skin, blue eyes, tooth abnormalities,
microcephaly
Gal-1-P uridylyltransferase deficiency; accumulation of gal-1-P with injury to kidney, liver, and brain.
What condition?
Classic Galactosemia
SSx of Classic Galactosemia
Jaundice (often direct), hepatomegaly, vomiting,
hypoglycemia, cataracts, seizures, poor feeding, poor weight gain, mental retardation
Classic Galactosemia Association
Predisposition to E. coli sepsis; developmental delay, speech disorders, learning disabilities
T or F
May begin prenatally—
transplacental galactose from mother
T
Types of IUGR
symmetric and asymmetric
etiology of symmetric IUGR
Genetic syndromes, chromosomal abnormalities, congenital infections, teratogens, toxins
What is the reason for asymmetric IUGR
Relatively late onset after fetal organ development;
abnormal delivery of nutritional substances and
oxygen to the fetus
Etiology of asymmetric IUGR
Uteroplacental insufficiency secondary to maternal diseases (malnutrition, cardiac, renal, anemia) and/or
placental dysfunction (hypertension, autoimmune disease,
abruption
- Birth weight >4,500 grams at term
- Predisposing factors: obesity, diabetes
- Higher incidence of birth injuries and congenital anomalies
Large for Gestational Age (LGA)—Fetal Macrosomia
Post term is delivery after_____
42 weeks
Characteristics of post term babies
− Increased birth weight − Absence of lanugo − Decreased/absent vernix − Desquamating, pale, loose skin − Abundant hair, long nails − If placental insufficiency, may be meconium staining
• Maternal hyperglycemia (types I and II DM) → fetal ________
hyperinsulinemia
______ is the major fetal growth hormone → increase in size of all organs except the brain
Insulin
Infants of DM mothers are_____
large for gestational age and plethoric (ruddy).
Hypocalcemia in infants of DM mothers from?
(felt to be a result
of delayed action of parathyroid hormone)
Cadiomegaly from infants of DM mothers?
asymmetric septal hypertrophy (insulin effect, reversible)
infants of DM mothers
___________ (flank mass, hematuria, and thrombocytopenia) from polycythemia
Renal vein thrombosis
Increased incidence of congenital anomalies:
° Cardiac—especially ________
° _________ (transient delay in development of left side of colon; presents with abdominal distention)
° _________: spectrum of structural neurologic defects of the caudal region of spinal cord which may result in neurologic impairment
(hypo, aplasia of pelvis & LE)
VSD, ASD, transposition
Small left colon syndrome
Caudal regression syndrome
What is the problem with surfactant deficiency?
Inability to maintain alveolar volume at end expiration → decreased FRC (functional residual capacity) and atelectasis
Xrays of Respiratory distress syndrome (RDS) from surfactant deficiency
ground-glass appearance, atelectasis, air bronchograms
Most accurate diagnostic test—Respiratory distress syndrome (RDS) from surfactant deficiency
L/S ratio (part of complete lung profile; lecithin-to sphingomyelin ratio)
°° Done on amniotic fluid prior to birth
Most accurate diagnostic test—Respiratory distress syndrome (RDS) from surfactant deficiency
–– Best initial treatment—________
–– Most effective treatment—_______
oxygen
intubation and exogenous surfactant administration
Slow absorption of fetal lung fluid → decreased pulmonary compliance and tidal volume with increased dead space
TTN
TTN association
Common in term infant delivered by Cesarean section or rapid second stage of labor
Chest x-ray (best test) for TTN—
air-trapping, fluid in fissures, perihilar streaking
Chest x-ray (best test) for MAS—
patchy infiltrates, increased AP diameter, flattening of diaphragm
Cx of MAS
air leak (pneumothorax, pneumomediastinum)
TX of MAS
Treatment—positive pressure ventilation and other complex NICU therapies
Failure of the diaphragm to close → abdominal contents enter into chest, causing pulmonary hypoplasia
CDH
PE of CDH
Born with respiratory distress and scaphoid abdomen
• Bowel sounds may be heard in chest
Tx of CDH
immediate intubation in delivery room for known or suspected
CDH, followed by surgical correction when stable (usually days
Umbilical hernia
Most are small and resolve in _______years without any treatment
1-2
- Failure of intestines to return to abdominal cavity with gut through umbilicus
- Covered in a sac (protection
Omphalocele
Genetic abn asstd with Omphalocele
Trisomy
Mx of Omphalocele
Large defects need a staged reduction (use of a surgical Silo), otherwise respiratory failure and ischemia
- Defect in abdominal wall lateral to umbilicus (vascular accident)
- Any part of the GI tract may protrude
- Not covered by a sa
Gastroschisis
Asstd problems with Gastroschisis
tresia, stenosis, ischemia, short gut
Mx of Gastroschisis
Surgery based on condition of gut; if no ischemia, large lesions need a staged reduction
as with omphalocele
What condition?
- Transmural intestinal necrosis
- Greatest risk factor is prematurity; rare in term infants
- Symptoms usually related to introduction of feeds:
NEC
Abdominal Xray for NEC
Pneumatosis intestinalis on plain abdominal film is pathognomonic (air in bowel wall)
(unconjugated bilirubin in the basal ganglia and brain stem nuclei) hypotonia, seizures, opisthotonos, delayed motor skills, choreoathetosis, and sensorineural hearing loss
kernicterus
Work up for pathologic hyperbilirubinemia when:
- It appears on the first day of life
- Bilirubin rises >5 mg/dL/day
- Bilirubin >13 mg/dL in term infant
- Direct bilirubin >2 mg/dL at any time
Causes of hyperbilirubinemia from Increased RBC production:
Chronic hypoxia, IUGR, post-mature; IODM,
Beckwith-Wiedemann syndrome (insulin effect); maternal Graves’ disease (transplacental antibodies); trisomies (? mechanism)
Causes of hyperbilirubinemia from Extra RBCs entering the circulation:
delayed cord clamping, twin-twin transfusion,maternal-fetal transfusion
Treatmentof jaundice form PV:
partial exchange transfusion with normal saline (dilutional)
What test:
Jaundice + immune related hemolysis
labs: high unconjugated bilirubin, may be anemia, increased reticulocyte count, positive direct Coombs test)
Causes of immune related hemolysis
i. Rh negative mother/Rh positive baby: ______
ii. _________: most common reason for hemolysis in the newborn
iii. Minor blood group incompatibility (Kell is very antigenic; Kell negative mother), uncommon
classic hemolytic disease of the newborn (erythroblastosis fetalis)
ABO incompatibility (almost all are type O mother and either type A or B baby)
Smear of Non-immune mediated hemolysis
Smear shows characteristic-looking RBCs: membrane defect (most are either spherocytosis or elliptocytosis
Smear of Non-immune mediated hemolysis,
normal looking RBC
DDx
(most are G6PD deficiency then pyruvate kinase deficiency)
Bilirubin is then bound to albumin and carried in the blood; bilirubin may be uncoupled from albumin in the blood stream to yield free bilirubin in what conditions?
e.g. neonatal sepsis, certain drugs (ceftriaxone), hypoxia, acidosis
Bilirubin is transported to the hepatocytes: within the hepatocytes is the conversion of unconjugated (laboratory indirect-acting) fat-soluble bilirubin to conjugated (glucuronide) water-soluble bilirubin (laboratory direct-acting) by the action of ______
hepatic glucuronyl transferase (GT).
Conditions that may decrease activity of hepatic glucuronyl transferase (GT).
°° Normal newborn first week of life
°° Primary liver disease of systemic disease affecting the liver (sepsis, TORCH, metabolic
diseases)
°° No GT activity: Crigler-Najjar syndrome (type I)
Transport through the intrahepatic biliary system to the porta hepatis for excretion into the duodenum; abnormalities of transport and excretion cause a_____________
conjugated (direct) hyperbilirubinemia (>2 mg/dL direct-acting bilirubin in the blood in the newborn
(progressive obliterative cholangiopathy): obstruction at birth due to fibrosis and atresia of the extrahepatic ducts (and so no gall bladder); then variable severity and speed of inflammation and fibrosis of the intrahepatic system which ultimately leads to cirrhosis
Biliary atresia
MC sx of Biliary atresia
Most present in first 2 weeks of life with jaundice (conjugated hyperbilirubinemia), poor feeding, vomiting, lethargy, hepatosplenomegaly, persistent acholic stools and dark urine
Best initial test for Biliary Atresia:
U/S (triangular fibrotic cord at porta hepatis; no evidence of normal ductal anatomy; no gallbladder
Most accurate test for biliary atresia (next step):
percutaneous liver biopsy (is pathognomonic for this
process)
Best initial Tx for Biliary Atresia:
hepatic portojejunostomy (Kasai procedure
Best long term Tx for Biliary Atresia:
liver transplant
Intestinal transport and excretion: most bilirubin is eliminated in the stool with final
products synthesized with help of colonic bacteria; some bilirubin is eliminated in the
urine, some is reprocessed in the liver due to _____
enterohepatic circulation (along with bile acids)
______ hydrolyzes glucuronide-bilirubin bonds to yield
some unconjugated bilirubin, which is absorbed into the portal circulation and transported back to the liver to be acted upon by hepatic glucuronyl transferase
intestinal beta-glucuronidase
means a baby is not nursing well and so not getting many calories.
This is common in first-time breast-feeding mothers. The infant may become dehydrated; however, it is lack of
calories that causes the jaundice.
Treatment is to obtain a lactation consultation and rehydrate the baby. The jaundice occurs in the first days of life
Breast-feeding jaundice
________occurs due to a glucoronidase present in some breast milk. Infants become jaundiced
in week 2 of life. Treatment is phototherapy if needed.
Breast-milk jaundice
Cx of hyperbilirubinemia
loose stools, erythematous macular rash, overheating leading to dehydration, and bronze baby syndrome
(occurs with direct hyperbilirubinemia; dark, grayish-brown discoloration of the skin [photo-induced change in porphyrins, which are present in cholestatic jaundice])
bronze baby syndrome
Tx of hyperbilirubinemia
________—if bilirubin continues to rise despite
intensive phototherapy and/or kernicterus is a concern
Double volume exchange transfusion
RF for neonatal sepsis
– Prematurity
– Chorioamnionitis
– Intrapartum fever
– Prolonged rupture of membranes
Most common organisms for neonatal sepsis:
group B Streptococcus, E. coli, and Listeria monocytogenes
Tx of sepsis If no evidence of meningitis
ampicillin and aminoglycoside until 48–72-hour cultures are negative
Tx of sepsis If meningitis or diagnosis is possible:
ampicillin and third-generation cephalosporin (not ceftriaxone)
Outcomes of Toxoplasmosis
– Psychomotor retardation
– Seizure disorder
– Visual impairments
Tx of Toxo
maternal treatment during pregnancy reduces the likelihood of transmission significantly (spiramycin)
Tx of Toxo in childrne
Infants are treated with pyrimethamine, sulfadiazide, and leucovorin
Congenital rubella
• Classic findings when maternal infection occurs in _________
first 8 weeks’ gestation
Findings in Congenital Rubella
– Blueberry muffin spots (extramedullary hematopoiesis), thrombocytopenia
– Cardiac—PDA, peripheral pulmonary artery stenosis
– Eye—cataracts
– Congenital hearing loss
– Thrombocytopenia
– Hepatosplenomegaly
Manifestations of HSV
• Keratojunctivitis, skin (5–14 days), CNS (3–4 weeks), disseminated (5–7 days)
Prevention of HSV
Prevention is elective Cesarean section when active disease or visible lesions
are identified; however, this is not 100% effective
Early manifestations of Congenital Syphilis
snuffles, maculopapular rash (including palms of soles,
desquamates), jaundice, periostitis, osteochondritis, chorioretinitis, congenital nephrosis
Late manifestations of Congenital Syphilis
Hutchinson teeth, Clutton joints, saber shins, saddle
nose, osteochondritis, rhagades (thickening and fissures of corners of mouth)
Neonatal Varicella happens when?
delivery occurs <1 week before/after maternal infection
Neonatal Varicella is associated with?
Associated with limb malformations and deformations, cutaneous scars, microcephaly, chorioretinitis, cataracts, and cortical atrophy
