Newborn/NICU Flashcards by Marissa Justine

TTN- what is it

transient pulmonary edema due to delayed clearance of fetal lung liquid

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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

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TTN-risk factors

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

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TTN- CXR

increased interstitial markings, fluid in interlobar fissures

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TTN- Symptoms

tachypnea, increased WOB for 24-72 hours

minimal oxygen needs although may required CPAP

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Neonatal PNA CXR-

diffuse infiltrates, air bronchograms, lobar consolidation

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Neonatal PNA Treatment

PCN + aminoglycoside

> 4 days in hospital, add vancomycin

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RDS

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

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Grunting =

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

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RDS risk factors

prematurity
GDM
male infant
multiple gestations

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RDS CXR

diffuse fine granular infiltrates

+ pulmonary edema

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RDS Course of Illness

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

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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

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MAS Cxr-

streaky with diffuse infiltrates

hyperinflated with patchy areas of atelectasis

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Early onset GBS

0-6 days

most common in first 24 hours

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Late onset GBS

7d-3m

most common at 3-4 weeks

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Late, Late-onset GBS

beyond 89 days

typically very preterm infants

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ROP and oxygen

oxygen increases risk of ROP

but hypoxia increases risk of cerebral palsy and mortality

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Highest risk of IVH (time period)

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

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What can be used for IVH prophylaxis

ANCS

- Indomethacin

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Apnea in preterm infants, type of event pathology

mixed, central causing obstruction or vice versa

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When does apnea of prematurity stop?

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

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When to stop caffeine for apnea?

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

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Apnea of prematurity and reflux

preterm infants have a hyperreactive laryngeal chemoreflex

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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