Newborn/NICU

Question 1

TTN- what is it

Answer 1

transient pulmonary edema due to delayed clearance of fetal lung liquid

Question 2

TTN-physiology

Answer 2

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

Question 3

TTN-risk factors

Answer 3

C/S before labor
maternal DM
late preterm or early tearm

Question 4

TTN- CXR

Answer 4

increased interstitial markings, fluid in interlobar fissures

Question 5

TTN- Symptoms

Answer 5

tachypnea, increased WOB for 24-72 hours

minimal oxygen needs although may required CPAP

Question 6

Neonatal PNA CXR-

Answer 6

diffuse infiltrates, air bronchograms, lobar consolidation

Question 7

Neonatal PNA Treatment

Answer 7

PCN + aminoglycoside

> 4 days in hospital, add vancomycin

Question 8

RDS

Answer 8

previously known as hyaline membrane disease, deficiency of alveolar surfactant
respiratory distress in first hours of life

Question 9

Grunting =

Answer 9

trying to maintain an adequate FRC with poorly compliant lungs and partial subglottic closure

Question 10

RDS risk factors

Answer 10

prematurity
GDM
male infant
multiple gestations

Question 11

RDS CXR

Answer 11

diffuse fine granular infiltrates

+ pulmonary edema

Question 12

RDS Course of Illness

Answer 12

usually improved in 3-4 days with onset of diuretic stage

Question 13

Meconium Aspiraton Syndrome

Answer 13

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

Question 14

MAS Cxr-

Answer 14

streaky with diffuse infiltrates

hyperinflated with patchy areas of atelectasis

Question 15

Early onset GBS

Answer 15

0-6 days

most common in first 24 hours

Question 16

Late onset GBS

Answer 16

7d-3m

most common at 3-4 weeks

Question 17

Late, Late-onset GBS

Answer 17

beyond 89 days

typically very preterm infants

Question 18

ROP and oxygen

Answer 18

oxygen increases risk of ROP

but hypoxia increases risk of cerebral palsy and mortality

Question 19

Highest risk of IVH (time period)

Answer 19

first 3 days after birth, most occurs in 7 days after birth

Question 20

What can be used for IVH prophylaxis

Answer 20

• ANCS

- Indomethacin

Question 21

Apnea in preterm infants, type of event pathology

Answer 21

mixed, central causing obstruction or vice versa

Question 22

When does apnea of prematurity stop?

Answer 22

37 PMA in 92%
40 PMA in 98%
prolonged by 2-4 weeks if BPD present

Question 23

When to stop caffeine for apnea?

Answer 23

off of positive pressure
no events in 5-7 days
33-34 PMA

Question 24

Apnea of prematurity and reflux

Answer 24

preterm infants have a hyperreactive laryngeal chemoreflex

Question 25

BPD VON definition

Answer 25

oxygen supplementation at 36w PMA

Question 26

BPD NIH mild definition

Answer 26

oxygen for at least 28 days and at 36w PMA | on room air

Question 27

BPD NIH moderate definition

Answer 27

oxygen for at least 28 days and at 36w PMA | <30% FiO2

Question 28

BPD NIH severe definition

Answer 28

oxygen for at least 28 days and at 36w PMA | >30% FiO2 or positive pressure

Question 29

BPD Complications

Answer 29

pulm HTN cor pulmonae apnea

Question 30

Caput

Answer 30

- soft tissue swelling - crosses suture lines - should resolve within hours to days

Question 31

Physiological cause of caput

Answer 31

pressure of fetal head against cervix during labor | resultant decreased blood flow and edema

Question 32

Cephalohematoma

Answer 32

- subperiosteal hemorrhage - does not cross suture lines - can worsen days after birth

Question 33

Consequences of cephalohematoma

Answer 33

- underlying skull fracture - intracranial pressure - jaundice

Question 34

Sub-Galeal Hematoma

Answer 34

- bleeding in the space between skull periosteum and scalp aponeurosis - can cross suture lines - usually due to vacuum

Question 35

Nevus Sebaceous of Jadassohn

Answer 35

yellow to tan hairless patch on face, scalp enlarges with growth often removed due to risk for secondary malignancy

Question 36

Cutis Aplasia

Answer 36

hair collar sign | get xray for underlying abnormalities of bone/skull

Question 37

cutis marmorata

Answer 37

normal reticuled bluish mottling of the skin | response to chilling with dilation of capillaries and small venules

Question 38

Time course of Mongolian spots

Answer 38

increase over first year, then regress

Question 39

Time course of seborrheic dermatitis in infants

Answer 39

appears 2-10 weeks of life resolves by 12 months anti-keralytics, topical steroids, etc

Question 40

erythema toxicum neonaturm time line

Answer 40

day 3 of life | usually gone by 2 weeks

Question 41

erythema toxicum neonaturm - description

Answer 41

resemble flea bites | wright stain shows eosinophils

Question 42

congenital neonatal acne

Answer 42

first few weeks of life, regresses over several months | open and closed comedones

Question 43

infantile neonatal acne

Answer 43

3-6 months of life | more persistent

Question 44

Rationale for why babies are low in Vitamin K

Answer 44

- absence of gut flora - inability of fetal liver to store K - low levels of tranplacental passage

Question 45

Hemmorhagic disease of newborn

Answer 45

low vitamin k | bruising, bleeding, umbilical bleeding, ICH

Question 46

indications for vitamin d supplemention

Answer 46

400 units if brestfed | less than 1 L or 32 ounces of formula

Question 47

Prune Belly (triad)

Answer 47

abdominal muscle deficit severe urogenital tract abnormalities (like VUR) bilateral cryptochoridisim in males

Question 48

Hemolytic anemia --> PATHOPHYS

Answer 48

destruction of RBC

Question 49

Most common infection following cephalohematoma

Answer 49

S aureus

Question 50

Neonatal Jaundice and tonicity

Answer 50

initially hypotonic --> hypertonic --> back arching

Question 51

Galeazzi maneuver for DDH

Answer 51

difference in knee/leg length

Question 52

Most important complication of DDH

Answer 52

avascular necrosis

Question 53

DDH - gait abnormalities in older children

Answer 53

toe walking due to longer leg

Question 54

Rales

Answer 54

``` small airways (often filled with fluid) popping/Velcro pulling apart ```

Question 55

Breast Milk - Immune Mechanisms

Answer 55

Secretory IgA acts at mucosal level oligosaccharides in milk promote growth of GI microbiota

Question 56

Breast Feeding benefits

Answer 56

decreased resp infections, OM

Question 57

Meconium physiology in air way

Answer 57

acts as ball valve | air gets into it, but cannot get out

Question 58

PHHI - persistent hyperinsulinemic hypoglycemia of infancy

Answer 58

hypoglycemia persiting beyond two weeks m positive response to glucagon

Question 59

Treatment for PHHI/continued hypoglycemia

Answer 59

diazoxide

Question 60

Octerotide - AE for treating hypoglycemia

Answer 60

necorizing enterocolitis

Question 61

Iris Heterochromia

Answer 61

irises are different colors | associated w/ HIrschsprung and Waardenburg Syndrome

Question 62

Hirschsprung Disease cause

Answer 62

absence of parasympathetic ganglion cells (failure of neural crest cells to migrate)

Question 63

Lymphedema in newborns...

Answer 63

Turner syndrome

Question 64

Anemia in preterm infants

Answer 64

lower HCT than full term infants impaired production of eryhtopoietin earlier, deeper and longer nadir in Hct

Question 65

normal liver span

Answer 65

plus/minus 2-3 cm

Question 66

Still's murmur

Answer 66

innocent systolic murmur LLSB and apex , vibratory

Question 67

When does PDA close

Answer 67

10-15 h after birth

Question 68

PDA - in utero function

Answer 68

directs blood away from pulmonary bed

Question 69

PDA - connection between

Answer 69

pulmonary artery | (thoracic) aorta

Question 70

IUGR risk factors

Answer 70

fetal infection (CMV, toxoplasmosis) structural/genetic anomalies placental ischemia- preeclampsia, abruption maternal factors- DM, smoking, chronic illness