Newborn/NICU Flashcards
TTN- what is it
transient pulmonary edema due to delayed clearance of fetal lung liquid
TTN-physiology
pulmonary epithelium changes from a chloride secreting membrane to a sodium absorbing membrane 2-3 days before birth
hence liquid goes away from alveolar spaces
TTN-risk factors
C/S before labor
maternal DM
late preterm or early tearm
TTN- CXR
increased interstitial markings, fluid in interlobar fissures
TTN- Symptoms
tachypnea, increased WOB for 24-72 hours
minimal oxygen needs although may required CPAP
Neonatal PNA CXR-
diffuse infiltrates, air bronchograms, lobar consolidation
Neonatal PNA Treatment
PCN + aminoglycoside
> 4 days in hospital, add vancomycin
RDS
previously known as hyaline membrane disease, deficiency of alveolar surfactant
respiratory distress in first hours of life
Grunting =
trying to maintain an adequate FRC with poorly compliant lungs and partial subglottic closure
RDS risk factors
prematurity
GDM
male infant
multiple gestations
RDS CXR
diffuse fine granular infiltrates
+ pulmonary edema
RDS Course of Illness
usually improved in 3-4 days with onset of diuretic stage
Meconium Aspiraton Syndrome
respiratory distress after delivery
seldom seen in those less than 37 weeks (34 weeks is when it gets into low colon)
toxic meconium causes a chemical pneumonitis, partial obstruction, and air trapping
MAS Cxr-
streaky with diffuse infiltrates
hyperinflated with patchy areas of atelectasis
Early onset GBS
0-6 days
most common in first 24 hours
Late onset GBS
7d-3m
most common at 3-4 weeks
Late, Late-onset GBS
beyond 89 days
typically very preterm infants
ROP and oxygen
oxygen increases risk of ROP
but hypoxia increases risk of cerebral palsy and mortality
Highest risk of IVH (time period)
first 3 days after birth, most occurs in 7 days after birth
What can be used for IVH prophylaxis
- ANCS
- Indomethacin
Apnea in preterm infants, type of event pathology
mixed, central causing obstruction or vice versa
When does apnea of prematurity stop?
37 PMA in 92%
40 PMA in 98%
prolonged by 2-4 weeks if BPD present
When to stop caffeine for apnea?
off of positive pressure
no events in 5-7 days
33-34 PMA
Apnea of prematurity and reflux
preterm infants have a hyperreactive laryngeal chemoreflex
BPD VON definition
oxygen supplementation at 36w PMA
BPD NIH mild definition
oxygen for at least 28 days and at 36w PMA
on room air
BPD NIH moderate definition
oxygen for at least 28 days and at 36w PMA
<30% FiO2
BPD NIH severe definition
oxygen for at least 28 days and at 36w PMA
>30% FiO2 or positive pressure
BPD Complications
pulm HTN
cor pulmonae
apnea
Caput
- soft tissue swelling
- crosses suture lines
- should resolve within hours to days
Physiological cause of caput
pressure of fetal head against cervix during labor
resultant decreased blood flow and edema
Cephalohematoma
- subperiosteal hemorrhage
- does not cross suture lines
- can worsen days after birth
Consequences of cephalohematoma
- underlying skull fracture
- intracranial pressure
- jaundice
Sub-Galeal Hematoma
- bleeding in the space between skull periosteum and scalp aponeurosis
- can cross suture lines
- usually due to vacuum
Nevus Sebaceous of Jadassohn
yellow to tan hairless patch on face, scalp
enlarges with growth
often removed due to risk for secondary malignancy
Cutis Aplasia
hair collar sign
get xray for underlying abnormalities of bone/skull
cutis marmorata
normal reticuled bluish mottling of the skin
response to chilling with dilation of capillaries and small venules
Time course of Mongolian spots
increase over first year, then regress
Time course of seborrheic dermatitis in infants
appears 2-10 weeks of life
resolves by 12 months
anti-keralytics, topical steroids, etc
erythema toxicum neonaturm time line
day 3 of life
usually gone by 2 weeks
erythema toxicum neonaturm - description
resemble flea bites
wright stain shows eosinophils
congenital neonatal acne
first few weeks of life, regresses over several months
open and closed comedones
infantile neonatal acne
3-6 months of life
more persistent
Rationale for why babies are low in Vitamin K
- absence of gut flora
- inability of fetal liver to store K
- low levels of tranplacental passage
Hemmorhagic disease of newborn
low vitamin k
bruising, bleeding, umbilical bleeding, ICH
indications for vitamin d supplemention
400 units if brestfed
less than 1 L or 32 ounces of formula
Prune Belly (triad)
abdominal muscle deficit
severe urogenital tract abnormalities (like VUR)
bilateral cryptochoridisim in males
Hemolytic anemia –> PATHOPHYS
destruction of RBC
Most common infection following cephalohematoma
S aureus
Neonatal Jaundice and tonicity
initially hypotonic –> hypertonic –> back arching
Galeazzi maneuver for DDH
difference in knee/leg length
Most important complication of DDH
avascular necrosis
DDH - gait abnormalities in older children
toe walking due to longer leg
Rales
small airways (often filled with fluid) popping/Velcro pulling apart
Breast Milk - Immune Mechanisms
Secretory IgA
acts at mucosal level
oligosaccharides in milk promote growth of GI microbiota
Breast Feeding benefits
decreased resp infections, OM
Meconium physiology in air way
acts as ball valve
air gets into it, but cannot get out
PHHI - persistent hyperinsulinemic hypoglycemia of infancy
hypoglycemia persiting beyond two weeks
m
positive response to glucagon
Treatment for PHHI/continued hypoglycemia
diazoxide
Octerotide - AE for treating hypoglycemia
necorizing enterocolitis
Iris Heterochromia
irises are different colors
associated w/ HIrschsprung and Waardenburg Syndrome
Hirschsprung Disease cause
absence of parasympathetic ganglion cells (failure of neural crest cells to migrate)
Lymphedema in newborns…
Turner syndrome
Anemia in preterm infants
lower HCT than full term infants
impaired production of eryhtopoietin
earlier, deeper and longer nadir in Hct
normal liver span
plus/minus 2-3 cm
Still’s murmur
innocent systolic murmur
LLSB and apex
, vibratory
When does PDA close
10-15 h after birth
PDA - in utero function
directs blood away from pulmonary bed
PDA - connection between
pulmonary artery
(thoracic) aorta
IUGR risk factors
fetal infection (CMV, toxoplasmosis)
structural/genetic anomalies
placental ischemia- preeclampsia, abruption
maternal factors- DM, smoking, chronic illness
