Newborn Medicine Flashcards
Maternal depression usually occur starting from when and up to?
starts 1st week post partum up to 6 months post partum
Most neonates void by __ hr and approximately 95% of preterm and term infants void within ___ hr
12 hours, 24 hours
Passage of meconium in term and preterm infants happen within __ hr of birth
48 hours
benefits of delayed clamping of the umbilical cord
improve transitional circulation
increase neonatal RBC volume
practical method of systemically evaluating infants immediately after birth
Apgar score
— done at 1 and 5 minutes of life
4 mechanisms of heat loss in newborn
convection
conduction
radiation
evaporation
optimal method of maintaining temperature in the stable newborn
skin-to-skin contact with mother
first bath in newborn should be delayed until __ hr of life to allow full transition to extrauterine life
24 hours
normal temperature range in newborn
36.5-37.4 C
this is given to infants shortly after birth to prevent hemorrhagic disease of the newborn
1 mg of water soluble vitamin K1 (phytonadione)
screening for hypoglycemia is performed in these infants
SGA
LGA
infants with GDM mothers
Preterm babies
Symptomatic
Medical contraindications to breastfeeding
Galactosemia
MSUD
Phenylketonuria
Maternal conditions that contraindicate breastfeeding
Infection with human T-cell lymphotropic virus types 1 and 2
Active TB
Herpes virus infection on breast
Use of or dependence on illicit drugs
Maternal treatment with some radioactive compounds
site of origin for embryonal neurons and fetal glial cells, a highly vascular region of the developing brain where IVH in premature infants occur
Subependymal germinal matrix
Indication to undergo routine cranial UTZ in premature infants
<32 weeks AOG
birthweight <1000 g
- with ff up UTZ at 36-40 weeks postmenstrual age to evaluate for PVL
What are the predisposing risk factors for IVH
Prematurity
RDS
Hypoxia-ischemia
Exaggerated fluctuations in cerebral blood flow (Hypotensive injury, hypervolemia, hypertension)
Reperfusion injury of damaged vessels
Reduced vascular integrity
Increased venous pressure (Pneumothorax, venous thrombosis)
Thrombocytopenia
percentage of incidence of definite neurologic sequelae in grade 1 IVH
15%
What is therapeutic hypothermia
exposing the newborn to a temperature of 33.5 C within the 1st 6 hours after birth and be maintained for 72 hours
what is the definition of Apnea
cessation of breathing for a period of >20 seconds or
cessation of breathing <20 seconds + change in tone, pallor, cyanosis or bradycardia (<80-100 bpm)
what type of apnea is most often observed in apnea of prematurity?
mixed apnea
Apnea of prematurity usually occurs in premature infants of what AOG?
<34 weeks
Infants born well <28 weeks can still have apnea of prematurity up to what PMA?
44 weeks PMA
risk factors for RDS development
Maternal DM
Multiple births
CS delivery
Precipitous delivery
Asphyxia
Cold stress
Maternal history of previously affected infants
risk of RDS is reduced in these pregnancies
Chronic or pregnancy-associated hypertension
Maternal heroine use
Prolonged rupture of membranes
Antenatal corticosteroid prophylaxis
Primary cause of RDS
Surfactant deficiency
Surfactant appears in amniotic fluids between what AOG?
28 and 32 weeks
Mature levels of pulmonary surfactant are present usually at this AOG
after 35 weeks of gestation
characteristic findings of RDS in chest xray
low lung volume
diffuse, fine reticular granularity of the parenchyma/“ground-glass appearance”
air bronchograms
approach of choice for the delivery room management of a preterm neonate at risk for RDS
prophylactic nCPAP
most common etiology of tachypnea in the newborn
Transient tachypnea of the newborn (TTN)
Major limiting factor for survical in patients with CDH
Pulmonary hypoplasia
most common life-threatening emergency of the GI tract in the newborn period
Necrotizing enterocolitis
this xray finding confirms the clinical suspicion of NEC and is diagnostic
air in the bowel or pneumatosis intestinalis
what are the circumstance/conditions that warrants determination of the cause of jaundice
- appears in the 1st 24-36 hr after birth
- bilirubin rising at a rate faster than 5 mg/dL/24 hr
- serum bilirubin >12 mg/dL in full term, 10-14 mg/dL in preterm
- jaundice persists after 10-14 days after birth
- direct bilirubin fraction is > 2 mg/dL at any time
what are the signs/symptoms of Triple I
fetal tachycardia
maternal leukocytosis (>15,000 cells in the absence of corticosteroids)
purulent fluid from the cervical os
biochemical or microbiologic amniotic fluid changes consistent with infection
fever
appropriate cutoff of hours from rupture of membrane for increased risk of neonatal infection
18 hours
most common source of postnatal infections in hospitalized newborns
hand contamination of healthcare personnel
rooting reflex is present at what AOG
32 weeks AOG
Moro reflex is one of the primary newborn reflexes and is present at birth, it is gone by what age?
3-6 months
Palmar grasp reflex is present at what age and gone by what age
28 weeks AOG, gone by 4 months
Components of APGAR score
A - Appearance (0- pale/blue, 1- acrocyanosis, 2- pink)
P - Pulse (0 - No pulse, 1 - HR <100, 2 - HR >100)
G - Grimace (0- no response, 1- grimace, 2- cough/sneeze)
A - Activity (0 -limp, 1 - some flexion, 2 - active motion)
R - Respiratory (0- absent, 1- slow, irregular, 2-good, crying)
factors affecting the apgar score and give a false-negative result
Maternal acidosis
High fetal catecholamine levels
Some full-term infants
What is the usual delivery toom temperature to be maintained
20-25 C
most frequently involved part of the intestine in NEC
distal part of ileum and proximal segment of the colon
Syndrome vs Sequence
Syndrome - pattern of multiple abnormalities that are related by pathophysiology, resulting from a single defined etiology
Sequence - consists of multiple malformations that are caused by a single event
What si MR SOPA
Mask adjustment
Reposition the head
Suction secretions (oral/nasal)
Open the mouth
Pressure increase
Alternate airway
most important indicator of successful PPV
increasing heart rate
What is DOPE
Displaced Endotracheal Tube
Obstructed Endotracheal Tube
Pneumothorax
Equipment failure
what epinepherine concentration is used for neonatal resuscitation
1:10,000 (0.1 mg/mL)
Persistent absence of a detectable heart rate (APGAR score 0) at ___ minutes is a strong but not absolute predictor of mortality and serious morbidity in late preterm and term newborns
10
Maternal drugs that can cause Early-onset Vit K deficiency bleeding
Phenobarbital
Phenytoin
Warfarin
Rifampin
Isoniazid
3 major risk factors implicated in NEC
prematurity
bacterial colonization of the gut
formula feeding
