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PHM Board Review > Newborn - General > Flashcards

Newborn - General Flashcards

1
Q

Erythromycin ointment prevents opthalmia neonatorium due to which sexually transmitted infection?

A

Gonorrhea, but not chlamydia.

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2
Q

What is the treatment for opthalmia neonatorium secondary to N. gonorrhea?

A

A single dose of ceftriaxone

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3
Q

Which newborns require empiric antibiotic treatment for sepsis?

A
  1. Those with signs and symptoms of sepsis.
  2. Those born to mother with known or suspected chorioamnionitis.
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4
Q

Which term newborns require a full 48 hours of observation after delivery?

A

Well appearing infants born to GBS+ mothers who were not adequately prophylaxed. (Some algorithms permit observation of infants born to mothers with fevers or suspected chorioamnionitis as well.)

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5
Q

How can the probability of vertical transmission of chlamydia trachomatis be minimized?

A
  1. Treatment of mother (with Azithromycin, as doxycycline is contraindicated in pregnancy).
  2. C-section without rupture of membranes.
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6
Q

What maternal medications are associated with vitamin k deficiency bleeding in the neonatal period?

A

Carbamazepime
Phenytoin
Isoniazid
Rifampin

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7
Q

What is the GOAL glucose level in the first 24 hours of life and the second 48 hours of life?

A

45-50mg/dl
50-60mg/dl

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8
Q

IV dextrose is indicated in any symptomatic newborn with a blood sugar below what threshold?

A

40 mg / dl (and any newborn with a blood sugar below 25 whether symptomatic or not)

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9
Q

What is the empiric treatment for presumed GBS related early onset sepsis?

A

0-7 days: Amp + Gent
7-28 days: Amp + ceftazidime
>28 days: ceftriaxone
** > 8 days, add vancomycin if meningitis or critically ill **

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10
Q

What is the duration of treatment for GBS related early onset sepsis?

A

10 days (bacteremia)
14 days (meningitis)

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11
Q

What are the three ways of diagnosing chorioamnionitis?

A
  1. Amniotic fluid gram stain
  2. Intrapartum fever > 39.0
  3. Intrapartum fever 38.0 - 39.0 + one of leukocytosis, purulent discharge, or fetal tachycardia
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12
Q

Which infants are at increased risk of hyperbilirubinemia?

A
  1. GA < 38 weeks
  2. LGA born to mother with gestational diabetes
  3. Hematoma
  4. Down syndrome
  5. Positive family history
  6. Inherited enzyme or RBC membrane defect.
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13
Q

Which infants are at increased risk of neurotoxicity from hyperbilirubinemia?

A
  1. Albumin < 3.0 (if measured)
  2. Isoimmune or other hemolytic condition
  3. Sepsis
  4. Clinical instability

NOTE: While < 38 weeks gestation is a risk factor, the curves in the 2022 guidelines are stratified by gestational age, so gestational age is not used to determine high risk vs. low risk. Under the old guidelines, infants that were < 38 weeks gestation would use the medium or high risk curves (depending on presence or absence of other risk factors).

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14
Q

What is the definition of Late Preterm?

A

Gestational age of 34/0 to 36/6

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15
Q

What endocrine disorder is associated with hyperbilirubinemia?

A

Hypothyroidism

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16
Q

When does chlamydial pneumonia typically occur in infants and what is the treatment?

A

2-19 weeks of life
Azithromycin x 3 days (same as for conjunctivitis)

17
Q

What is the prophylaxis for infants born to mothers with active gonorrhea infection?
Chlamydia infection?

A
  1. Ceftriaxone 25-50 mg/kg x 1
  2. Nothing (treat mother during pregnancy if possible, otherwise deliver via c-section).
18
Q

What is the treatment for neonatal gonorrhea?

A

Ceftriaxone or cefotaxime, 7 days (14 days for meningitis).

19
Q

What are the criteria for a Brief Resolved Unexplained Event to be classified as Low Risk?

A
  1. Born at 32 weeks GA or later
  2. Present GA 45 weeks or greater.
  3. 60 - 365 days old
  4. No CPR by a trained medical professional
  5. Event lasted < 1 minute
  6. First event
  7. Negative PE, history, PMH, social history, and family history (e.g. no family history of unexplained death at a young age or sibling who died as an infant).
20
Q

What are the three criteria indicating that a newborn infant does not require resuscitative maneuvers following birth?

A
  1. Term?
  2. Good tone?
  3. Breathing or crying?
21
Q

You are handed a blue, flaccid 34 week GA infant at delivery. You dry and stimulate the baby, position the infant in the sniffing position, and suction a small amount of amniotic fluid out of the oropharynx. What are indications to proceed to positive pressure ventilation?

A
  1. Apnea or gasping
  2. HR < 100
22
Q

You are handed a blue, flaccid 34 week GA infant at delivery. You dry and stimulate the baby, position the infant in the sniffing position, and suction a small amount of amniotic fluid out of the oropharynx. You palpate at the umbilical cord stump and find the heart rate is 60. You initiate PPV. How long should you perform PPV before rechecking HR?

A

30 seconds. During that time ensure adequate chest rise and troubleshoot if inadequate chest rise.

23
Q

You have been resuscitating a newborn infant with PPV. After 30 seconds you recheck the heart rate. It is 75. What is the next step?

A

Continue PPV, ensuring adequate chest rise. Titrate FiO2 to acheive saturation targets.

24
Q

You have been resuscitating a newborn infant with PPV. After 30 seconds you recheck the heart rate. It is 45. What is the next step?

A
  1. Intubation or laryngeal mask
  2. Chest compressions
  3. Insert UVC
25
Q

You have been resuscitating a newborn infant who is now intubated and you have been performing chest compressions for 60 seconds. You check HR and it is 35. What is the next step?

A

Epinephrine (0.02 mg/kg IV or 0.1 mg/kg ET, which is equivalent to 0.2ml/kg or 1ml/kg, respectively) every 3-5 minutes. Continue compressions, consider fluid bolus, consider pneumothorax.

26
Q

What is the initial FiO2 for neonatal resuscitation?

A

35 weeks GA or older: 21%
Less than 35 weeks GA: 21-30%

(So, basically, you can just start with 21% and titrate up to achieve saturation goals).

27
Q

What is the goal pulse oximetry saturation for a newborn infant in the first 10 minutes post delivery?

A

55% + (5 x age in minutes)

So…
1 min: 60-65
2 min: 65-70
3 min: 70-75
4 min: 75-80
5 min: 80-85
10 min: 85-95

28
Q

What initial PIP and PEEP is suggested for neonatal resuscitation?

A

PIP: 20cm H2O
PEEP: 5cm H2O

29
Q

What are the steps to trouble shoot ventilation during neonatal resuscitation?

A

Mask Adjustment
Reposition
(try again)
Suction
Open mouth
(try again)
Pressure increase
Alternative airway

30
Q

How long does it typically take an infant to regain birthweight?

A

Up to two weeks

31
Q

You are caring for a 3 month old breast fed infant who presents with complaint of blood tinged stool. The infant is feeding well without vomiting. Physical exam is completely reassuring. Vital signs are normal. The ER checked some labs and they are all normal. You suspect milk protein allergy. What are your treatment options?

A
  1. Elimination of all milk products from maternal diet (possible followed by elimination of all soy products).
  2. Transition to an extensively hydrolyzed (alimentum, nutramigen) or amino acid (Elecare, Neocate) formula.

Note that many patients with milk protein allergy are also allergic to soy products.

32
Q

What are the clinical features of fetal alcohol syndrome?

A
  1. Facial
    - Short palpebral fissures
    - Smooth filtrum
    - Thin upper lip
  2. Growth retardation
  3. CNS
    - Structural abnormalities
    - Seizures
    - Microcephaly
    - Neurological deficits
  4. Neurobehavioral deficits
    • Developmental delay
    • Learning disabilities
    • Attention / regulation deficits

(Diagnosis requires all 4 features, including at least 2 facial features)

33
Q

What is the definition of adequate intrapartum antibiotic prophylaxis for group B strep?

A

Penicillin, ampicillin, or cefazolin at least 4 hours prior to delivery.

Vancomycin or clindamyin (depending on susceptibility testing) may be used for women with severe penicillin allergies. While this will reduce risk, vancomycin and clindamycin are NOT considered “adequate prophylaxis” regardless of susceptibility testing.

34
Q

For whom is intrapartum antibiotic prophylaxis for group B strep indicated?

A
  1. Group B bacteriuria during current pregnancy.
  2. Positive rectovaginal swab (recommended at 36-37 weeks)
  3. History of previous infant with GBS disease
  4. Labor or PROM prior to 37 weeks
  5. Unknown GBS status and intrapartum fever or ROM > 18 hours.
  6. Unknown GBS and history of prior colonization (at least consider in these patients)
35
Q

What are the criteria for discharging a newborn infant prior to 48 hours of observation?

A
  1. At least 37/0 weeks gestation and normal physical exam.
  2. Any GBS related evaluation and observation is complete.
  3. Normal vitals for past 12 hours
  4. Successfully fed at least twice, stooled at least once and urinating regularly.
  5. Anticipatory education complete
  6. Hyperbilirubinemia risk stratification complete and any needed follow up arranged.
  7. Newborn screening complete.
  8. Maternal labs available and do not identify risk factors.
  9. Follow up with PCP arranged within 48 hours (possible 72 hours)

PHM Board Review (15 decks)

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