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Pediatrics > Newborn Management > Flashcards

Newborn Management Flashcards

1
Q

At delivery:

Before discharge:

A

Delivery: Silver nitrate drops or Erythromycin ointment and IM Vitamin K
Discharge: Hearing test, PKU, Galactosemia, Hypothyroid screening

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2
Q

Apgar: Need to and effectiveness of resuscitation

A

1 minute: During labor and Delivery (7+ is reassuring)

5 minutes: Response to resuscitation (9+ is reassuring)

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3
Q

Port Wine Stain: Permanent vascular malformation on head/neck (Nevus Flemmus; “stork bite” or “angel kisses”)

A

Association w/: Sturge Weber syndrome (AV malformation)
-Seizures, retardation, glaucoma
Tx: anticonvulsants, evaluate for glaucoma

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4
Q

Caput Succedaneum vs Cephalohematoma

A

Caput Succedaneum: Crosses suture lines, presents early
- resolves within first few weeks of life
Cephalohematoma: Does not cross sutures lines
-resolves in 2 wks - 3 mos

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5
Q

Coloboma of the iris: hole in structure of eye

A

Associated w/: CHARGE syndrome - screen for CHD7 gene
Coloboma; Heart defects; Atresia of nasal choanae;
growth Retardation; GU abnormalities; Ear abnormalities

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6
Q

Anridia: Absence of iris

A

Highly associated w/: Wilms Tumor - screen for with abdominal U/S Q3 months until 8 yo.

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7
Q

Omphalocele

A

GIT protrusion through umbilicus WITH sac

defect: abdominal wall musculature
association: screen for trisomy 13, 18, 21

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8
Q

Gastroschisis

A

Abdominal defect lateral to midline WITHOUT sac

tx: immediate surgical gradual introduction

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9
Q

Umbilical Hernia

A

Association: Congenital Hypothyroidism; screen with TSH

  • 90% close by age 3yo
  • 4yo: surgery req’d to prevent strangulation/necrosis
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10
Q

Hydrocele

Inguinal Hernia

A
  • Hydrocele: Remnant of tunica vaginalis - differentiate from:
  • Inguinal Hernia: Failure of processes vaginalis to close (reducible scrotal swelling) Tx: surgery
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11
Q

Undescended testes (cryptorchidism)

A
  • Associated with malignancy if > 1 year of age

- No treatment until 1 yo to avoid sterility; then orchiopexy

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12
Q

Hyospadias: urethral opening is below/ventral
Epispadias: urtheral opening is on top/dorsal

A

Hypospadias: do not circumcise (surgery difficulties)
Epispadias: surgical evaluation for bladder exstrophy

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13
Q

Infant of Diabetic Mother: large, plethora, jitteriness

A

1st step: Check glucose level; hypoglycemia; hypocalcemia; hypomagnesemia; hyperbilirubinemia; polycythemia

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14
Q

Infant of Diabetic Mother: Risks

A

cardiac abnormalities (truncus arteriosis); small left colon syndrome (and distention); RDS; shoulder dystocia; – increased risk of diabetes & childhood obesity

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15
Q

RDS: (Respiratory Distress Syndrome; newborn)

A
  • hypoxemia; nasal grunting; tachypnea; IC retractions
    initial: CXR (ground-glass), atelectasis, air bronchograms
    predictive: L/S ratio of amniotic fluid prior to birth
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16
Q

RDS: treatment

A

initial: O2 + nasal CPAP (prevent barotrauma/dysplasia)

most effective: exogenous surfactant decreases mortality

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17
Q

RDS: Primary prevention

A

Antenatal Betamethasone: > 24 hrs before delivery; < 34 wks gestation & Avoid prematurity: give tocolytics

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18
Q

Corticosteroids - role in pregnancy

A

Give immediately to any fetus in danger of preterm delivery < 34 weeks!!! (do not help/not indicated postnatal)

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19
Q

Transient Tachypnea of Newborn (TTN) - retained lung fluid in term birth by C-section or rapid second stage of labor

A

Dx: CXR (air trapping, fluid, perihilar streaking)
Tx: oxygen (rapid improvement; resolves in 24-48 hrs)

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20
Q

Tachypnea > 4 hours: considered sepsis

+) Neurological signs (lethargy, temp, feeding problems

A

> 4 hrs = sepsis: blood cultures/urine cultures

(+) neurological signs: LP with CSF analysis

21
Q

Empiric antibiotics for sepsis < 1 month old

A

MCC: E.Coli & Group B Strept

  • No signs of meningitis: Ampicillin + Gentamicin
  • Meningitis possible: Ampicillin + Cefotaxime
22
Q 
Meconium Aspiration (in utero or with first postnatal breath)
-prevent by: ET intubation & suction in depressed infants
A
  • Severe respiratory distress, hypoxemia, hypoxia
    CXR: patchy infiltrates, increased AP diameter
    Tx: +pressure vent; high-freq vent; nitric oxide; ECMO
23
Q

Diaphragmatic Hernia:

respiratory distress + scaphoid abdomen + bowel sounds in chest

A

CXR: loops of bowel visible in chest; air fluid levels, mediastinal shift to affected side, hypoplastic lung
Tx: Immediate intubation, surgical correction

24
Q

Diaphragmatic Paralysis

A

Due to phrenic N. injury

h/o birth injury (Erb’s) or cardiothoracic injury

25
Q 
Meconium Plugs (lower colon): IODM- small left colon, Hirschsprungs, CF, Maternal drug abuse
Meconium Ileus (lower ileum): Cystic Fibrosis
A

Dx: abdominal XR
Tx: Ileus with gastografin enema

26
Q

Tracheoesophageal Fistula

A

Non-bilous vomiting, choking, gagging on 1st feeding
Dx: nasogastric tube placement will be coiled in chest
Associated with VACTERL syndrome

27
Q

Duodenal Actresia

A

Bilous vomiting w/i 12 hrs of birth, no relation to 1st feeding
Dx: CXR (double bubble sign - air in stomach & duodenum)
Tx: IVF; NG decompression, Surgical duodenostomy

28
Q

VACTERL syndrome -
associated with TE and Duodenal atresia:
Order XR spine, Abd U/S, Echo

A

Vertebral defects; Anal atresia; Cardiac abnormalities; TE fistula with Esophageal atresia; Radial/Renal anomalies; Limb Syndrome

29
Q

Necrotizing Enterocolitis (NEC):
Premature infant with low apgar scores
(decreased immunity, decreased birth weight)

A
  • Bowel undergoes necrosis, bacteria invades intestinal wall: ischemia, inflammation, ultimately perforation.
  • Bloody stools, apena, lethargy when feeding is started; vomiting, abdominal distention
30
Q

Necrotizing Enterocolitis: Dx, Tx

-True medical/surgical emergency with 50% mortality

A

Pathognomonic sign: Abdominal XR - Pneumatosis Intestinalis or air within bowel wall (not lumen)
Tx: NPO; Decompress gut; Broad spectrum Abx; Surg eval

31
Q

Failure to pass meconium (Hirschprung Disease)

  • do not pass stool for over 48 hours or not at all
  • frequent association with down syndrome
A

(1) rectal examination (patent rectum with passage of large voluminous stool after digital exam suggests hirschprungs) (2) barium enema (megacolon proximal to obstruction)
(3) best confirmatory test: rectal biopsy (absent ganglionic cells/auerbach plexus)

32
Q

Failure to pass meconium (imperforate anus)

A

Rectum ends in blind pouch with conservation of sphincter
P/E: No anus
Tx: Surgery is curative

33
Q

Jaundice: Physiologic Jaundice (undersecretion)

A

-Starts @ day 2-3; peaks @ < 10mg day 3-5

34
Q

Jaundice: Exaggerated Physiologic Jaundice aka breastfeeding jaundice (not enough milk/dehydration)

A

-occurs in first week of life, peaks @ 12-15mg

Tx: Increase feedings Q 20 mins/1-2 hrs

35
Q

Jaundice: Breast milk Jaundice (due to factor in breast milk that increases enterohepatic circulation of bilirubin)

A

-starts @ days 4-14; (usually after 1 week)
-may continue weeks/months while breastfeeding
Tx: continue breastfeeding, usually resolves by week 12

36
Q

When is hyperbilirubinemia considered pathologic?

A
  • First day of life or *After second week of life
  • Bilirubin rises >5 mg/dL/day
  • Bilirubin >12 mg/dL in term infant
  • Direct > 2mg/dL at any time
37
Q

Most feared complication of jaundice?

*indirect bilirubin can cross BBB, deposit in basal ganglia

A

Kernicterus/Neurologic dysfunction.
-Hypotonia, seizures, delayed motor skills, choreoathetosis
Tx: Immediate exchange transfusion

38
Q

Jaundice Tx:

A
  • Phototherapy: bilirubin > 10-12 mg/dL
    (normally decreases by 2mg/dL every 4-6 hours)
  • Exchange transfusion: failure of above, kernicterus risk
39
Q

Neonoatal Sepsis:

fever, poor appetite, increased WBC, hyperbilirubinemia

A

Workup: CXR before antibiotics; CBC w/diff; blood culture; UA/urine culture. If lethargic/irritable: LP & CSF analysis.

40
Q

Sepsis: Early Onset (within 24 hours; < 1 month old)

A

MCC: Pneumonia

Group B Strept, E.Coli, H. influenzae, L. monocytogenes

41
Q

Sepsis: Late Onset (after 24 hours; < 1 month old)

A

MCC: Meningitis, Bacteremia

E. Coli, S. Aureus, Klebsiella, Pseudomonas

42
Q

Sepsis: Empiric antibiotics < 1 month old:

A

Ampicillin (+) Gentamicin (if no evidence of meningitis)

Ampicillin (+) Cefotaxime (if meningitis suspected)

43
Q

Sepsis: Empiric antibiotics > 1 month old:

A

MCC > 1 mo: S. Pneumoniae, N. Meningitidis

Tx: Cefotaxime +/- Vancomycin if meningeal involvement

44
Q

Seizures: Work up

A

EEG; CBC, Electrolytes, Ca+, Mg2+, Po4-, Glucose;
Blood/urine cultures; LP if meningitis suspected;
Amino Acid assay, Urine organic acids;
Total cord blood IgM (t.o.r.c.h.)

45
Q

Seizures: Treatment

A

DOC: Phenobarbital
Persistent: Phenytoin

46
Q

Withdrawal: Heroin, Cocaine, Amphetamine
Withdrawal: Methadone (high risk seizures)
Best initial treatmentL

A

-Presents within 48 hours of life
- Presents within 96 hours (up to 2 weeks)
TX: Opioids, Phenobarbital

47
Q

Anesthetics, Barbituates: Respiratory/CNS depression
Magnesium sulfate: Respiratory depression
Phenobarbital: Vit K deficiency

A

Sulfonamides: displaces bilirubin from albumin
NSAIDS: premature closure of ductus arterioles
ACE inhibitors: Craniofacial abnormalities

48
Q

Isotretinoin: facial/ear anomalies, congenital heart disease
Phenytoin: hypoplastic nails, typical facies, IUGR

A

Tetracycline: enamel hypoplasia, discolored teeth
DES: Vaginal adenocarcinoma

49
Q

Lithium: Ebstein’s anomaly

Valproate/Carbamazepine: MR, NT defects

A

Warfarin: Facial dysmorphism, chondrodysplasia

Pediatrics (14 decks)

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