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CPS statements > NEWBORN/FETUS > Flashcards

NEWBORN/FETUS Flashcards

1
Q

Brachial plexus palsy definition

A

Flaccid paralysis of the arm at birth affecting different nerves of the brachial plexus C5-T1

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2
Q

Brachial plexus palsy MCC, associations

A

MCC: Birth trauma

Associations:

  • Shoulder dystocia
  • LGA
  • Maternal diabetes
  • Instrumental delivery
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3
Q

Brachial plexus palsy counselling

A
  • Not always preventable
  • 75% recover completely by 1 month
  • 25% experience permanent impairment and disability
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4
Q

Brachial plexus palsy - when to refer?

A

If not improved by 1 month

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5
Q

Brachial plexus palsy - treatment

A

Decide surgical vs nonsurgical based on: History, electrodiagnostic procedures, imaging, physical exam

No RCT evidence that primary surgical exploration > conservative management for outcomes, but nonrandomized studies suggest better results with surgical repair

Secondary surgical reconstructions are inferior to primary intervention but can improve function in kids w serious impairment

Secondary soft tissue and bone reconstructive surgery may help improve function if significant impairment but < primary intervention

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6
Q

Hemorrhagic disease of the newborn - presentation

A

Unexpected bleeding (often GI, ecchymosis, or ICH) due to low vit K from insufficient prenatal storage and insufficient vit K in BM

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7
Q

Types of vitK deficient bleeding

A

Early <24h - maternal meds (AEDs)
Classic - day 2-7, low vitK intake
Late - 2-12 weeks and up to 6m (50% ICH) 2/2 chronic malabsorption and low intake

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8
Q

Vitamin K deficiency bleeding - prevention?

A

IM vit K (0.5 if BW <1500 and 1.0 if BW > 1500) within 6h post delivery prevents early and classic

NO evidence for oral vit K supplement in women on AEDs to prevent early

IM > PO (storage, slow release)
PO only for parents who decline IM at birth

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9
Q

Rate of late vitK deficiency bleeding

Risk factor?

A

1/140,000 - 1/170,000

Breastfeeding

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10
Q

Vitamin K deficiency bleeding and prematurity

A

Higher risk (hepatic immaturity, delayed gut colonization with bacteria)

routine IV vitK not recommended

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11
Q

What to do if parents decline vitK injection

A

Counsel on health risks of VDKB:

  • PO less effective than IM for prevention
  • Making sure infant receives all follow up doses
  • Infant remains at risk for VKDB despite use of parenteral form for PO admin

If still decline, give 2.0 mg PO at time of first feed, repeat at 2-4 and 6-8 weeks of age

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12
Q

Circumcision - definition and epidemiology

A

Partial or complete removal of the foreskin
Rate 32% nationally
Majority by medical practitioners/skilled traditional providers

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13
Q

Circumcision - potential benefits

A
  • Phimosis (scarring/thickening of foreskin that prevents retraction) treatment - medical treatment (topical steroids BID with gentle traction) usually effective, 0.8-1.6% of boys will need circ pre-puberty
  • UTI reduction - decreased by 90% in circumcised infants (risk overestimating as contaminated?)
  • STI reduction - HIV 50-60% reduction in African subcontinent (unclear in NA as HIV transmitted mainly via IVDU), decreased HSV, HPV, no impact on chlamydia/gon, for female partners lower trich, BV, genital ulcers
  • Cancer reduction - reduces female cervical ca risk, squamous cell carcinoma of the penis
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14
Q

Circumcision - risks

A 
Pain
Minor bleeding
Local infection
Unsatisfactory cosmetic result
Partial amputation of penis
Sepsis/hemorrhage - death very rare
Meatal stenosis (2-10%) requires surgical dilation, prevent by applying vaseline for 6m post circ

NO evidence for decreased sexual function/satisfaction

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15
Q

Circumcision - contraindications

A

Hypospadias

Bleeding diathesis

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16
Q

Normal foreskin retraction

A

50% by age 6, 95% by age 17

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17
Q

Neonatal ophthalmia - definition

A

Conjunctivitis occurring within first 4 weeks of life

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18
Q

N. gonorrhea neonatal ophthalmia

  • frequency w/o prevention in positive mums
  • Complications
A

30-50%

quickly progresses to corneal ulceration, performation of globe, and permanent visual impairment

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19
Q

C. trachomatis - risks with untreated positive mom, prevention, how to test?

A

50% will get an infection

  • 30-50% risk conjunctivitis
  • 10-20% risk of chlamydial pna
  • ocular proph does NOT prevent transmission from mum to bb, does NOT prevent conjunctivitis or pna
  • routine prenatal screening and treatment during pregnancy preferred
  • close clinical follow up and swab infant if suspicion (NP + conjunctival)
20
Q

Neonatal ophthalmia - frequency of common bugs?

A

C. trachomatis: 2-40%
N. gonorrhea: <1%
Other (staph, strep, hemophilus, other GNBs): 30-50%
Viral (HSV, adeno, entero)

21
Q

Ocular prophylaxis with erythromycin?

A

not routinely recommended

22
Q

Best prevention strategy for neonatal ophthalmia

A

Screen all pregnant women for gon/chlamydia,

  • Those infected should be treated during pregnancy, tested for cure, and tested again in 3T, partners should also be treated
  • Those not infected but high risk should be screened again in 3T
  • Rescreening with other STIs should be considered in 3T for women not in a stable monogamous relationship
  • Pregnant women not screened during preg should be screened at delivery
23
Q

How to manage NB exposed to N gonorrhea

A
  • If results not available at dc, ensure ability to contact mother promptly, to monitor for eye discharge, and who to contact if appears; if compliance a concern consider 1x dose of CTX
  • Infants born to mums with untreated gonorrhea (inc CS) should be tested and started on treatment without waiting for results:
  • term and preterm: Conjunctival culture + single dose CTX 50mg/kg (max 125mg) IV/IM, 1% lido w/o epi (0.45mL/125mg)
  • Unwell: blood + CSF cultures

If established gonoccocal disease do ID consult

24
Q

How to manage NB exposed to C trachomatis

A
  • Untreated (born SVD or CS): Observe, routine cultures not performed on asymptomatic infants, treat if infection occurs
  • Proph NOT recommended (association of macrolides w pyloric stenosis) - but consider if infant f/u not guaranteed
25
Q

Ankyloglossia definition

A

A congenital anomaly observed in NB and children characterized by an ABNORMALLY SHORT LINGUAL FRENULUM causing decreased tongue mobility to varying degrees

NO universally accepted, clinically consistent definition or criteria for diagnosis

Historically,

  • Anatomical - degree of fusion
  • Functional impairment - inability to protrude the tongue past incisal edge of lower gingiva/other signs decreased mobility
26
Q

Ankyloglossia - etiology

A
  • Tongue fused to floor of mouth in early dev; cell death/resorption free tongue with only frenulum remaining
  • From 6m - 5 years, lingual frenulum becomes less prominent with growth of the alveolar ridge and tooth eruption
  • Possible genetic predisposition
27
Q

Described breastfeeding difficulties with ankyloglossia (and mechanism)

A
  • Poor latch
  • Maternal nipple pain/trauma
  • Suboptimal weight gain
  • Infant breast refusal
  • Low maternal milk supply 2/2 poor milk removal

VERY LITTLE EVIDENCE

28
Q

Components of successful nursing (5)

A
  1. Infant must latch onto areola using upper gum ridge, buccal fatty pads, and tongue
  2. Suckling begins with forward movement of jaw/tongue
  3. Tongue helps to make a seal with minimal action
  4. Anterior edge of tongue thins, cupping upward to begin peristaltic ripple back toward the throat
  5. Lower jaw squeezes milk from ductules
29
Q

Ankyloglossia management

A

Conservative - parental education, lactation support, reassurance
If ankyloglossia AND feeding difficulty, SOME evidence that frenotomy can improve feeding (but limitations to literature)

30
Q

Frenotomy procedure information

A

OT or physician with experience in both procedure and analgesia (benzocaine only drug studied and ineffective; tylenol/lido/sucrose limited studies)

Complications

  • Bleeding
  • Infection
  • Injury to Wharton’s duct
  • Risk of post-op scarring limiting tongue movement further
31
Q

Procedural options for ankyloglossia

A

Frenotomy (Snipping of tongue tie)
Frenuloplasty release - excision with lengthening of ventral surface of the tongue (less postop scarring, but requires GA)
Laser ablation - no data on safety/efficacy

32
Q

What should the pediatrician do for ankyloglossia

A

R/o other anomalies causing feeding difficulties
Inspect tongue and tongue function in all NB
Interview mum regarding BF, observe feeding
Consider referral to HCP with experience in BF support

33
Q

Exclusive breastfeeding until age?

Continued breastfeeding up to age?

A

6m

2y

34
Q

Recommended first foods?

A

Iron rich (meats most bioavailable, also cereals, fish)

35
Q

How to manage nursing strikes

A

NOT rejection to breastfeeding

  • Making BF special/quiet time
  • Increase cuddling/soothing
  • Offer breast when bb sleepy or just waking
  • Offer frequently in diff nursing positions, alternating sides, or diff rooms
  • If unsuccessful, r/o illness and refer to BF specialist
36
Q

Abrupt/emergency weaning - indications?

A

Antimetabolites, drugs of abuse, therapeutic doses of radiopharmaceuticals

37
Q

Abrupt/emergency weaning - management

A

Infant may refuse bottle - offer cup, another individual should feed but mom to spend close physical time w bb

For mom - analgesics, express just enough to feel comfortable, cold packs/cabbage leaves/breastmassage, comfortable/supportive bra,
NO fluid restriction, bromocriptine, or breast binding

38
Q

Maternal depression - risks to babe?

A

Regardless of med,

  • miscarraige
  • prem
  • LBW
  • resp distress
  • longer hosp stay
39
Q

Risks of SSRI

A
  1. Congenital malformations - first trimester
    - As a group NO increased risk
    - ?paroxetine may be - consider switch
  2. SSRI neonatal behavioural syndrome (10-30%)
    - tachypnea, cyanosis, jittery, increased tone, feeding diff
    - present within hrs, mild, resolves by 2wks
    - higher risk with late gestation exposure, paroxetine, fluoxetine
    - Observe for 48h, anticipatory guidance
  3. PPHN (<1%)
  4. ?LBW ?premm ? resp distress ? NICU admit

NO ADVERSE DEV OUTCOMES
BF RECOMMENDED

40
Q

Who should get hearing screen and when?

A

all newborns, by one month

41
Q

Risk factors for hearing loss

A
  • Hyperbili (exchange)
  • TORCH infection
  • BW <1500g
  • ototoxic meds
  • bacterial meningitis
  • craniofacial abn
  • NICU >2d
  • ECMO
  • +family history SNHL
  • mechanical vent
  • syndrome
42
Q

If untreated, hearing loss can lead to?

A
  • decreased academic achievement
  • decreased employment
  • social maladaptation
  • psychological distress

speech/language delay proportional to severity AND TIME DELAY TO DX

43
Q

MC type of hearing loss (and MC cause)

A

Sensorineural

Genetic (50%, 70% of which are nonsyndromic related to connexin 26)

44
Q

OAE detects what kinds of hearing loss

A

Conductive and cochlear, external ear to outer hair cells in cochlea

45
Q

AABR detects what kinds of hearing loss

A

conductive, cochlear, and neural hearing loss from external ear to brainstem (inc CN8)

NOT CORTICAL DEAFNESS

46
Q

Limitations of newborn hearing screen

A

cannot detect late onset or progressive HL

misses HL < 30-40dB loss

CPS statements (3 decks)

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