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Pediatrics Module > Newborn and Neonatal Medicine > Flashcards

Newborn and Neonatal Medicine Flashcards

1
Q

Differentiate term newborn, prematurity, and post mature

A

Newborn (37-42 wks gestation)
Prematurity (< 37 wks)
Post mature (+42 wks)

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2
Q

What is gestational age and how is it determined?

A

= Number of weeks after mother’s last menstrual period

Estimated via last 1st trimester U/S (Obstetric dating) or by physical exam (Ballard Scoring)

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3
Q

_____ weeks gestation considered compatible with life.

A

24

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4
Q

Complications of prematurity

A
  • Intraventricular hemorrhages
  • ARDS = surfactant deficiency = Hyaline Membrane disease
  • Retinopathy
  • Necrotizing Enterocolitis
  • Fluid and lyte imbalances
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5
Q

What are the birth weight ranges of normal vs preterm infants?

A

Normal: 2500 to 4500 grams (5lbs 8oz to 9lbs 4oz)

Low birth weight (LBW): < 2500 grams (5lbs 8oz)

Very low birth weight (VLBW): < 1500 grams (3lbs 5oz)

Extremely low birth weight (ELBW), “micro-premies”: < 1000 grams (2lbs 4oz)

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6
Q

Causes of prematurity

A

Maternal: premature rupture, trauma, cervical incompetence, vaginal infection, multiple birth, smoking/drugs, eclampsia

Fetal: fetal growth restriction/ fetal distress, macrosomia/LGA, polyhydramnios

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7
Q

Complications of post maturity

A

growth failure, meconium aspiration, neonatal hypoglycemia

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8
Q

Percentile of gestational weights of SGA, AGA, and LGA

A

SGA: Birth weight < 10th percentile for gestational age

AGA: Appropriate for gestational age, between 10th and 90th percentile

LGA: > 90th percentile for gestational age; infant of diabetic mother (IDM)

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9
Q

APGAR Score

A

Score measured at 1 and 5 mins that indicates newborn current status and response to resuscitation efforts

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10
Q

effects of oligohydramnios and polyhydramnios

A

too little or too much amniotic fluid around fetus

Oligohydraminos think renal or pulmonary defect
Polyhydramnios think abdominal defect

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11
Q

mild symptoms of Fetal Alcohol Syndrome or “fetal alcohol effects”

A

ADHD, learning delays, behavioral problems, conduct d/o, increased risk of criminal activity

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12
Q

Signs of Fetal Alcohol Syndrome

A 
THIN UPPER LIP WITH SMOOTH PHILTRUM (FAS until disproven)
Microcephaly
Growth retardation
Short nose
Cardiac Defects 
Micropthalmia - small eyes
Small distal phalanges
Cleft lip/palate
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13
Q

Causes of increased and decreased AFP (alpha-fetoprotein)

A

increased: Neural Tube Defects, Abdominal wall defects
decreased: Trisomies; primarily Down’s syndrome

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14
Q

What maternal serum samples make up the quad screen for Down syndrome?

A

aFP
hCG
Unconjugated estriol
Inhibin A

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15
Q

Group of congenitally acquired infections which may cause significant morbidity and mortality in neonates

A

TORCH infections

  • Toxoplasmosis
  • Other (Syphilis, Parvovirus, VZV, Hep B, HIV)
  • Rubella
  • CMV
  • HSV
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16
Q

How are infants positive for Toxoplasmosis treated?

A

IV PCN G and undergo spinal tap

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17
Q

If mother positive for Hep B or unknown at delivery ________ given to infant at birth.

A

Hep B vaccine and immunoglobins

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18
Q

What happens if pregnant women gets Varicella Zoster virus?

A

before 20 wks: in utero death

after 20 wks: high mortality; variable presentation - CNS infections, limb anomalies, blindness, pneumonias, cutaneous lesions/scarring

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19
Q

tx of Varicella Zoster virus

A

ZV Ig and Acyclovir for mother and infant

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20
Q

Which vaccines are live and can’t be given to pregnant women?

A

MMR, Varicella, and live attenuated influenza

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21
Q

What does parvovirus cause?

A

Erythema infectiosum (Fifth Disease, Slapped Cheek)

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22
Q

Treatment for parvovirus infection (erythema infectiosum)

A

supportive; can’t do much for this

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23
Q

Per AAP and CDC, all pregnant women HIV+ will start on _________. Her child will also be treated similarly until confirmation at _____ old.

A

antiretroviral therapy

6 weeks

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24
Q

Which viruses are contraindicated for nursing?

A

HIV, Hep B

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25
Q

Signs of Rubella in 1st trimester and after?

A

1st trimester: microcephaly, blueberry muffin spots

After: congenital rubella triad- carditis, ophthalmitis, sensorineural hearing loss

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26
Q

dx and tx of infant rubella infection

A

dx: infant rubella IgM titers

Tx: supportive

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27
Q

types of scalp hematomas

A

Caput Succadaneum: edema of scalp secondary to birth trauma

Cephalohematoma: blood along periosteum contained w/i suture lines

Subgaleal bleed: beneath epicranial aponeurosis; uncommon but can cause hemorrhagic shock

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28
Q

epicanthal folds indicate ________.

A

Down syndrome

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29
Q

No Red reflex on newborn eye exam could indicate _______.

A

retinal blastoma

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30
Q

Things to look for on newborn neuro exam

A

Tone
Primitive reflexes
Nerve Palsies

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31
Q

Primitive reflexes that appear at birth? When do they usually disappear?

A

Moro, hand/toe grasp, Galant reflex
* ATNR at 2 wks

Usually disappear about 6 months

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32
Q

Why is erythromycin ophthalmic ointment AAP required for all newborns?

A

Prevents gonococcal ophthalmia neonatorium which can cause ocular perforation and blindness

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33
Q

Vit K required for what?

A

synthesis of coag factors II, VII, IX, and X

conversion of inactive precursors into active clotting factors

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34
Q

Why is there a Vit K decrease after birth?

A
  • Poor placental transfer of maternal Vit K
  • Immature liver function
  • Delayed synthesis of Vit K in colon
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35
Q

Signs of Vit K deficiency in neonates

A

sites of bleeding; oozing from injection sites, umbilical stump, circumcision, vaginal/rectal, intracranial

elevated PT/INR, PTT

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36
Q

What does Vit K protect against?

A

hemorrhagic disease of newborn

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37
Q

Which bilirubin levels can be measured directly?

A

total and conjugated

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38
Q

Pathophysiology behind neonatal jaundice

A
  • Increased breakdown of fetal erythrocytes which have shorter lifespan than non-fetal RBCs
  • Low excretory capacity of immature liver
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39
Q

unconjugated vs conjugated bilirubin

A

unconjugated/indirect: before liver; RBC breakdown in blood

conjugated/direct: after liver; secreted to bile and small intestines

40
Q

Kernicterus

A

aka Bilirubin encephalopathy

bilirubin mostly deposits in basal ganglia, so first sign is movement disorder

sx: hypotonia, lethargy, vomiting, seizures, death

caused by elevated unconjugated bilirubin that can cross BBB

41
Q

Hyperbilirubinemia treatment

A

Phototherapy:

  • Follow nomogram
  • Converts indirect bilirubin into a water soluble form
  • Encourage increased hydration

Exchange Transfusion if phototherapy doesn’t work (rarely used)

42
Q

DDX of hyperbilirubinemia

A

Indirect:

  • Physio, breast feeding, or breast milk jaundice
  • Increased RBC breakdown
  • RBC hemolysis (ABO or Rh incompatibility)

Direct:

  • Liver/biliary system
  • Biliary atresia (r/o with U/S)
  • Hypothyroid
43
Q

Breast feeding vs. Breast milk Jaundice

A

Breast feeding due to inadequate intake or production that causes bilirubin concentration (“dehydration”); day 2-4
tx: increase feeds

Breast milk due to enzyme in milk which inhibits conjugation; week 1-3
tx: self-limiting

44
Q

AAP recommendations for when to get total bilirubin levels

A
  • every infant who is jaundiced in the first 24 hours after birth
  • excessive jaundice for age
  • Before discharge, every newborn should be assessed for risk of developing severe hyperbilirubinemia with a nursery protocol
45
Q

Bilirubin discharge planning

A

Ensure f/u within first few days for total bilirubin

< 24 hrs old: within 3 days (may require 2 visits)
24-48 hrs: within 4 days
48-72 hrs: within 5 days

46
Q

Standard of care management prior to hospital discharge

A

erythromycin eye ointment, Vitamin K, bilirubin screen, hearing screen, newborn screen, Hep B vaccine

47
Q

Newborn/Infant anticipatory Guidance for parents

A 
Infant Care
Injury prevention
Nutrition
Parental/infant bonding
Vaccinations
48
Q

omphalitis

A

nosocomial or acquired infection of umbilical cord and skin

Most common bacteria: G+ staph

Medical emergency! need IV abx

49
Q

umbilical hernia tx

A

as long as soft then don’t do anything

should naturally regress by 4-5 yo

50
Q

gastroschisis

A

Defect in abdominal wall allowing extrusion of abdominal contents

increased risk of infection and sepsis

Tx: Broad spectrum abx and surgery

51
Q

omphalocele

A

Results in protrusion of abdominal contents covered by an amniotic sac

Associated with chromosomal anomalies and cardiac, diaphragmatic, and bladder anomalies

52
Q

Normal crying characteristics

A

birth to 6 weeks: 2-3 hr/day

can be soothed by swaddling, feeding, changing diaper

53
Q

Colic crying characteristics

A

Lasting > 3 hours in a day, > 3 episodes in a week

Unable to sooth

May be gassy, otherwise normal exam and hx

54
Q

colic crying treatment

A

Parental reassurance
Soothing Techniques
Empirical changing of formula
Simethicone (gas drops)

55
Q

When is spitting up a concern?

A

forceful, larger than couple teaspoons (5mL), poor weight gain, projectile vomit

56
Q

DDX if parent comes in complaining that newborn is spitting up

A 
Normal
Overfeeding (most common)
GER
GERD
Formula intolerance or allergy
Hiatal Hernia
GI obstruction
57
Q

erythema toxicum neonatorum

A

Affects 60% of newborns 2-3 days old
Diffuse rash with small, erythematous papules/vesciles
Self resolves within 48-72 hours

58
Q

seborrhea dermatitis

A

“cradle cap”
greasy, crusty flakes of skin
tx: diluted sells blue, self resolves

59
Q

Common newborn rashes that are self-limiting

A

erythema toxicum neonatorum
seborrhea dermatitis
neonatal acne
milia/miliaria

60
Q

milia/miliaria causes

A

Milia: 1-2 mm pearly white or yellow papules caused by retention of keratin within the dermis

Miliaria: sweat retention from partial closure of eccrine structures; heat rash from over bundling

61
Q

Most likely DDX of diaper rashes

A

Irritant/contact dermatitis
Yeast/Candida dermatitis
Seborrhea dermatitis
Impetigo/Staph infection

62
Q

contact dermatitis tx

A

topical zinc or Vit E creams

63
Q

difference between contact and Candidal diaper dermatitis

A

Candidal and seborrhea occur in creases while contact spares the creases

Candidas is more beefy red and may have associated oral thrush

64
Q

Which diaper rash may involve body and scalp

A

seborrhea dermatitis

65
Q

seborrhea dermatitis tx

A

anti-fungal cream (Nystatin)

66
Q

Parental co-sleeping allowed?

A

controversial

AAP doesn’t recommend; supports having crib in same room

67
Q

Proper sleeping position of newborns to reduce SID

A

always place sleep face up on back with pacifier

68
Q

SIDS vs SUIDS

A

SID = sudden death of infant under age 1 that cannot be explained

SUDI = sudden unexpected death in infancy, whether explained or unexplained

50% of cases of SUIDS can be attributed to SIDS

The remainder of SUIDs attributed to suffocation, asphyxia, entrapment, infection, ingestions, metabolic dz, and trauma

69
Q

Pathophysiology of SIDS

A

poorly understood

Immature brain with immature arousal centers converging with “stressors” –> progressive asphyxia, bradycardia, hypotension, metabolic acidosis, and ineffectual gasping, leading to death

70
Q

Risk factors of SIDS

A 
Prematurity
SGA / IUGR
Smoke exposure
Male Infant
African American or Native American
Time of year (winter season)
Age (2-4 months)
Lower socioeconomic status
Young maternal age
Co-Sleeping, Prone sleeping
71
Q

How to prevent SIDS?

A

supine sleep, safety-approved cribs, awake tummy time, no bed sharing, no wedges or bumper pads, no excessive pillows or comforters in crib

72
Q

causes of plagiocephaly

A

supine sleeping position without varied sleep position, decreased tummy time

73
Q

Tobacco exposure in newborns increases risk of what?

A

URI, reactive airway disease, otitis media, pneumonia, SIDs

74
Q

car seat guidelines

A
  • 0-2 yo = face rear
  • 2-5 yo = forward facing with harness, five point restraints
  • Up to 4’ 9” = Sit inclined (booster seat)
  • All children younger than 13 in back seat with lap and shoulder seat belts
75
Q

Daily caloric intake for term normal newborn and premature/LBW infant?

A

term normal newborn = 100 kcal/kg/day

premature/LBW infant = 120-140 kcal/kg/day

76
Q

Infants should double birth weight by _______, triple by ______.

A

6 months

1 year

77
Q

Beneficial contents of breastmilk

A
  • IgA immunoglobins and macrophages
  • Reduces adherence of viruses and bacteria to intestinal wall
  • Reduces URIs
  • Inhibits growth of E. coli
78
Q

Breast feeding recommendations

A

Exclusive breastfeeding for first 6 months and continued for at least 12 months and thereafter as long as it is mutually desired

79
Q

Breast feeding advantages for mother and baby

A

Mother: decreased bleeding, delayed ovulation, decreased risk of ovarian/breast cancer, increased bonding with baby, promotes weight loss, inexpensive

Baby: controls needs, increased immunologic factors, decreased infections, decreased chronic disease, higher IQ, better vision, decreased SIDS, less fussy eaters

80
Q

Contraindications for breast feeding

A 
Infant with galactosemia
Mother with HIV
Mother with untreated, active TB
Mother using illicit drugs
Mother on chemo agents or undergoing radiation
81
Q

Infant infections with intracranial calcifications

A

CMV (periventricular)

Toxoplasmosis (diffuse)

82
Q

Infant infections with blueberry muffin spots

A

CMV and Rubella

83
Q

What is vertical transmission of infection?

A

transmitted during labor

instead of transplacental

84
Q

How is CMV dx’d?

A

viral shedding in bodily fluids by viral culture

85
Q

CMV treatment

A

Gancyclovir (off-label)

86
Q

Dx of Herpes Simplex

A

HSV titers, viral culture, or PCR of CSF

87
Q

Tx of HSV

A

prevention: C-section

suppressive therapy for mother (Acyclovir, Valtrex at 36 wks)

Acyclovir IV for infant

88
Q

When is it ok if mother with HSV delivers baby vaginally?

A

if no active lesions and if she is on suppressive tx

89
Q

How does congenital syphilis present in infant?

A

asx at birth
rash at 2 months
if untreated after 2 yrs begin seeing deformities (periositis, Hutchinson teeth, saddle nose, perforated hard palate)

90
Q

Which reflexes are present at 4-9 months and persist with age?

A

Head righting
Protective equilibrium
Parachute

91
Q

What if infants born to mother with known gonorrhea infection?

A

infant requires IV or IM antibiotics, as topical prophylaxis alone is inadequate

92
Q

Standard of Care management prior to newborn hospital discharge

A 
erythromycin ointment
Vit K
Total bilirubin
Hearing Screen
Newborn Screen
Hep B vaccine
93
Q

Most common cause of hemolytic anemia in neonates

A

ABO incompatibility -> jaundice

94
Q

Regular infant formula yields ______ kcal/oz

A

20

95
Q

Infants should gain at least what weight per day?

A

20 grams/day

Pediatrics Module (15 decks)

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