Newborn/NICU + Gene + Met Flashcards
Trisomy 18
Edwards Syndrome
*Rockerbottom feet
IUGR
Hypertonia
prominent occiput
small mouth
micrognathia
pointy ears
short sternum
horseshoe kidney
flexed fingers (index finger overlapping the 3rd finger and the 5th finger overlapping the 4th
Congenital heart disease (valvular involvement, VSD, PDA)
GI involvement (Meckel diverticulum, malrotation, Omphalocele)
Trisomy 13
Patau Syndrome
Classic triad:
micro/anophthalmia
cleft lip and/or palate
postaxial polydactyly
*Cutis aplasia
Normal weight
CNS: Holoprosencephaly with incomplete development of forebrain and olfactory and optic nerves, severe intellectual disability, deafness
Craniofacial: Abnormal auricles, microphthalmia/anophthalmia, colobomata, sloping forehead (fissure or cleft of the iris, ciliary body, or choroid)
Skin and limbs – Capillary hemangiomata, simian crease, hyperconvex narrow fingernails, polydactyly of hands and sometimes feet, prominent heel
Cardiac – VSD, PDA, ASD, dextroposition
Genitalia – Cryptorchidism in males; bicornuate uterus in females
Less common:
●Growth – Prenatal growth deficiency
●CNS – Hyper- or hypotonia, agenesis of corpus callosum, cerebral hypoplasia
●Eyes – Hypo- or hypertelorism, cyclopia, upslanting palpebral fissures
●Nose, mouth, mandible – Absent philtrum, narrow palate, micrognathia
●Hands and feet – Retroflexible thumb, syndactyly, cleft between first and second toes, hypoplastic toenails, radial aplasia
●Abdomen – Omphalocele, incomplete rotation of colon, Meckel diverticulum
●Renal – Polycystic kidney, hydronephrosis, horseshoe kidney
Antenatal steroid
- when
- why
<34 weeks
lung development
IVH
NEC
mortality
Antenatal magnesium sulphate
<32 weeks
neuroprotection (cerebralpalsy)
Associations:
A. Maternal Graves disease B. Maternal diabetes mellitus C. Maternal hyperparathyroidism D. Maternal SLE E. Maternal vitamin D deficiency
A. Maternal Graves disease – hyperthyroidoism
B. Maternal diabetes mellitus – hypoglycemia, renal vein thrombosis
C. Maternal hypoparathyroidism – hyponatremia
D. Maternal SLE – heart block
E. Maternal vitamin D deficiency – hypocalcemia
William Syndrome
Elfin facies
irritability
supra-valvular aortic stenosis
Russell Silver Syndrome
IUGR, triangular-shaped face, clinodactyly
Noonan Syndrome
(similar to turner but no chrom abnormalities)
Short stature
webbed neck
pulmonic stenosis
epicanthal folds ptosis low nasal bridge, upturned nose dental malocclusion nystagmus myopia hypertrophic cardiomyopathy cognitive delay ASD, VSD shield chest lymphedema high arched palate
Congenital Myotonia
Weakness, club feet, tented mouth, inadequate respirations
Uncontrolled gestation DM - associations
RDS
Hypoglycemia
LGA
Risk fo preterm delivery
• SES status – <20or>40years – Very low SES, Low BMI • Past Gyne/OB - Pyelonephritis - Uterine / cervical anomalies - Multiple abortions - Preterm delivery • Lifestyle – > 10 cigarettes/day – Heavy work • Pregnancy – Multiples
Risk of IUGR
• Maternal – Hypertensive, preeclampsia – Renal disease – Diabetes – Antiphospholipid syndrome – Severe nutrition deficiency – Smoking / substances – Maternal hypoxia (CHD, lung) • Fetal – Multiple gestation – Placental abnormalities – Infection (viral) – Congenital anomaly, chromosomes
IUGR – oligohydramnios or polyhydramnios?
Oligo
Vit K Prophylaxis
0.5mg (<1500g) or 1mg (>1500g) IM in first 6 hours of life
Oral alternative if parents refuse (less optimal):
• 2mg at 1st feed, repeat at 2-4 weeks and 6-8 weeks
Vit K deficiency bleeding
- types
- tx
Early VKDB
– 1st 24 hours
due to maternal medication
Classic VKDB
- preventable by VitK prophylaxis
– bleeding 1st wk of life
LateVKDB
– bleeding 2nd-12th wk of life up to 6 months
– Exclusive breastfeeding, no Vit K (or only 1 oral dose!), fat malabsorption
Treatment of VKDB: VitaminK, FFP
What type of vit K def bleeding is due to no prohphylaxis
Classic - 1st week
What are the shunts in fetal circulation
1. Ductus Venosus UV -> IVC 2. Foramen Ovale RA -> LA 3. Ductus Arteriosus PA -> Ao
Advantages of Breastfeeding
prevent SIDS,
enhance cognitive development, social,
immune / allergy / infection (IgA, WBC, bifidus factor)
CCHD screening - where are the sat probes
right hand
either foot
Who meets criteria for therapeutic cooling
<6h old
≥36 weeks GA
Meets (A or B) and C:
A: Cord pH ≤7.0 or base deficit ≥−16
B. pH 7.01 to 7.15 or base deficit −10 to −15.9 on cord gas or blood gas within 1 h AND
- Hx of acute perinatal event (ex: cord prolapse, plac abruption or uterine rupture) AND
- Apgar score ≤5 at 10 minutes or at least 10 minutes of PPV
C. Evidence of moderate-to-severe encephalopathy, demonstrated by the presence of seizures OR at least one sign in three or more of the six categories
Side effects of cooling
Sinus bradycardia (80-100 bpm)
Hypotension with possible need for inotropes
Mild thrombocytopenia
Persistent pulmonary hypertension with impaired oxygenation
Hypothermia can also prolong bleeding time
Subcutaneous fat necrosis, with or without hypercalcemia, has been reported as a potential rare complication
Infants with HIE, whether they receive therapeutic hypothermia or not, are more prone to
Temp for whole body cooling?
rectal temp of 33.5°C ± 0.5°C
How long to cool for and how fast to rewarm
Cool 72 hours then rewarm 0.5°C q1-2h
Outcomes of HIE
Cerebral palsy or severe disability in > 30%
Severe visual impairment or blindness in up to 25%
Sensorineural hearing loss
Cognitive deficits (partic difficulties with reading, spelling and arithmetic) in 30-50%
Behavioural difficulties, such as hyperactivity and emotional problems
Childhood epilepsy in 13% of mod-sev
Survival rates for <22wga to 26wga
Survival <22wga: extremely rare 22+0-6: 18% 23+0-6: 41% 24+0-6: 67% 25+0-6: 79%
What gestational age do we use plastic bags
<32wga
Pierre Robin Sequence
micrognathia
glossoptosis
airway obstruction
often assoc w Cleft palate (don’t need to have)
Risk factors for RDS
Prematurity
IDM
Asphyxia
Surfactant therapy - benefits
Decreases: mortalitiy pneumothorax PIE duration of vent suport LOS Hospital costs
(No effect on IVH, BPD, NEC, ROP)
How to fix oxygenation on a vent
FiO2
PEEP
How to fix CO2 on a vent
PIP and RR
BPD definition
Oxygen dependence beyond 28 days or at 36 weeks post- gestational age
LBW
VLBW
ELBW
LBW < 2500g
VLBW < 1500g
ELBW <1000g
Complications of prematurity
– Apnea of prematurity - Respiratory distress syndrome – Chronic lung disease - Patent Ductus Arteriosus – Intraventricular hemorrhage - Anemia requiring transfusions – Sepsis, Necrotizing enterocolitis - Retinopathy of prematurity – Neurodevelopment ( CP, cognitive, hearing, blindness, learning disability, behaviour)
Apnea definition
cessation of breathing 20 seconds or 10-20s with bradycardia (<80)
ROP screening
GA < 30 6/7 weeks OR Birth weight < 1250 g
At 4 weeks of age (>26+6) After 31 weeks for (<26+6)
Xray features of NEC
pneumatosis intestinal
porta venous distension
pneumoperitoneum
Long term complications of NEC
Short gut (surgical), stenosis/obstruction, recurrence
Sarnat Scoring
Sarnat 1
Hyperalert, hypertonic, tachycardia, hyperactive reflexes
Sarnat 2
Lethargic, flexed posture, mild hypotonia, weak moro, seizures, bradycardia, hyperactive reflexes
Sarnat 3
Stuporous, flaccid, no reflexes
Therapeutic cooling hypothermia criteria
at least 35 wga
Criteria A or B AND C
A. Cord pH ≤7 or BD ≥-16
OR
B. pH 7.01 – 7.15 of -10 to -16 (cord or 1 hour gas)
AND Hx of acute perinatal event AND APGAR ≤ 5 at 10m or at least 10m of PPV
C. Signs of moderate to severe encephalopathy
When to initiate therapeutic cooling
Temp goal
within 6 hours
33-34 deg C
When to image and what to look for
After rewarming at day 3-5
Can repeat 10-14 days
• Basal ganglia / thalamus / PLIC
= motor + cognitive
• Watershed areas = more cognitive than motor
Erb’s Palsy
- when to refer
C5, 6, 7
possibly phrenic - resp depression
refer at 1 month
Klumpke
C8-T1
Horner
- char
- tx
C5-T1
ptosis
meiosis
observe q1month
refer to surf If present at 3mo
Hyperinsulinism - who at risk
IDM
BWS
SGA
Urea cycle defect:
Organic acidemias:
Urea cycle defect: normal gas – high ammonia
Organic acidemias: acidotic +/- high ammonia
normal gas – high ammonia
acidotic +/- high ammonia
Urea cycle defect: normal gas – high ammonia
Organic acidemias: acidotic +/- high ammonia
Neonatal unconjugated jaundice
– Dehydration – ‘Breastmilk’ – Infection – Polycythemia – Hemolysis – Endocrinopathies – Extravascular blood – Geneticdisorders – Increased enterohepatic circulation (GI obstruction, delayed meconium)
Neonatal conjugated jaundice
– Extrahepatic obstructive • Biliary atresia, choledochal cysts – Bacterial infection – TORCH – Neonatal hepatitis • viral, bacterial, parasitic, idiopathic – Metabolic: • alpha-1 antitrypsin, IEM, endocrinopathies, CF, Iron storage disease, bile acid synthesis defects – Cholecystasis syndromes • Dubin Johnson, Byler – Toxic: hyperalimentation
Red Flags for hyperbilirubinemia
Workup
Onset before 24 hours Hemolysis is a predictor of severity Pallor, Unwell Hepatosplenomegaly
Pale stools, dark urine Conjugated hyperbilirubinemia
Total and conjugated bilirubin CBC, blood group, Coombs test \+/- G6PD, blood film Liver function, Metabolic / Endocrine workup MRI if signs of acute encephalopathy
Cutoffs for severe and critical hyperbili
Severe: TSB > 340 umol/L in 1st 28d
• Critical: TSB > 425 umol/L in 1st 28d
Kleihauer test - what does it do
Checks mom’s blood for fetal hb
Causes of thrombocytopenia in newborn
– Infection: bacterial, TORCH
– Neonatal alloimmune thrombocytopenia
– Other maternal causes
• toxemia, ITP, SLE, Drugs (hydralazine, thiazides)
– Consumption: DIC, Kassabach-Merrit (hemangioma)
– Syndromes: IUGR, TAR, Fanconi’s
– Bone marrow suppression: pancytopenia, leukemia
TEF - polyhydramnios or oligohydramnios?
poly
Causes of symmetrical IUGR
Infection
chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies.
Causes of asymmetrical IUGR
Poor maternal nutrition
Late onset or exacerbation of maternal vascular disease (preeclampsia, chronic hypertension).
Most common cause of hypertension int he newborn
Renovascular
CXR - RDS
Ground glass opacities/Diffuse Reticulogranular pattern
Air bronchograms
Low lung volumes
Polycythemia - who is at risk
SGA Post term IDM Twin to twin transfusions T21, T18, T13 Placental insufficiency - pre eclampsia, maternal hypertension
Definition of polycythemia
When to treat
Hct > 0.65
Treat if
>0.70 and symptomatic
>0.75 and asymptomatic
PPHN tx
(1) minimal stimulation
(2) sedation and analgesia with a narcotic agent and a benzodiazepine (avoid muscle paralysis if possible)
(3) maintain preductal oxygen saturation in the low to mid-90s and postductal saturations above 70% as long as metabolic acidosis, lactic acidosis, and/or oliguria are not present
(4) lung recruitment with adequate PEEP or mean airway pressure and/or surfactant to maintain 8- to 9-rib expansion during inspiration
(5) maintain adequate blood pressure and avoid supraphysiological systemic pressure
When does PVL occur
24-32 weeks gestation
Conditions associated w choanal atresia/stenosis
CHARGE Apert Crouzon Velocardiofacial Treacher Collins T18
Sacral agencies associated with?
IDM
22q11 deletion syndrome
characteristics
how to dx
§Cleft palate
§Thymic hypoplasia
§Cardiac defects- conotruncal (TOF, IAA, VSD, TA)
§Hypoparathyroidism
FISH
William syndrome
characteristics
- Idiopathic hypercalcemia
- CHD – supravalvular aortic stenosis
- Hypertension (renal artery stenosis / essential HTN)
- Developmental delay –
- Receptive language delay
- Visuospatial difficulties
- Personality- ++ friendly
- Attention deficit, anxiety
full lips
broad forehead, short palpebral fissures, low nasal bridge, anteverted nostrils, long filtrum, full cheeks, and relatively large and often downturned mouth.
X linked inheritance who can pass to who
Female to male
no male to Male
Fragile X
- genetics
- gene
characteristics
- what type of cardiac
CGG trinucleotide repeat
FMR1
Full mutation >200
Intellectual disability Macroorchidism Gaze avoidance Persevered speech Family history of premature ovarian failure Macrocephaly ADHD,Anxiety, Autism Hyperextensible joints Long wide protruding ears
MVP
Prader Willi Syndrome
Initial failure-to-thrive
Severe hypotonia
Cryptorchidism
Hyperphagia
Beckwith Weidemann Syndrome
Triad
Monitor
Triad of:
E – exomphalos
M - macroglossia
G – gigantism
hemihypertrophy
macrosomia
Monitor:
AFP- hepatoblastoma
US – Wilms tumour
Renal ultrasounds - nephrocalcinosis
Bloodwork for presentation of IEM
Plasma Amino acids
Plasma Acylcarnitine
Urine Organic acids
Ectopia lentis
Homocystinuria
- check AA
Rett Syndrome (5 char)
1) developmental regression
2) loss of purposeful hand movements
3) stereotypic hand movements (wringing, squeezing, clapping, mouthing, rubbing)
4) Loss of acquired spoken language
5) gait abnormalities
Fetal alcohol syndrome
- characteristics
- cardiac?
Smooth philtrum Short palpebral fissues Short nose Thin upper lip Epicanthal folds Low nasal bridge Micrognathia
Microcephaly
Developmental delay
Low IQ
ASD/VSD/conotruncal defects
Turner syndrome Characteristics
- Short stature
- Cardiac: bicuspid aortic valve, coarctation
- Horseshoe kidneys
- Streak ovaries - 1ary amenorrhea
- Recurrent OM
- Cubitus valgus
- Lymphedema
- Short webbed neck
- Shield chest, wide spaced nipples
- Low posterior hairline
- Lowset eats and malformed lobes
- High arch palate
- short 4th metacarpal
Autoimmune
Thyroid disease
Celiac disease
Hydantoin syndrom
Hypoplastic nails/fingers
carb or pheny
First month screening in T21
· CBC, diff smear
· TSH, T4
· Echocardiogram
· Universal newborn hearing screen
T21 1m-1y screening
· Repeat hearing test at 6 months
· Repeat TSH at 6 months and 1 year
· Refer to Ophthalmology within the first 6 months
· Discuss sx of OSA
· Discuss importance of maintaining C-spine in neutral position
· Influenza vaccine + routine vaccines
· Monitor growth (use regular growth charts) and development
PKU inheritance
Autosomal recessive
IEM - resp alkalosis``
Urea cycle defect
IEM - Met acidosis big gap
Organic academia
IEM - Hyperchloremic acidosis
FAOD
hypoketotic hypoglycaemia
WAGR
= Wilms tumor, aniridia, genitourinary anomalies, mental retardation
MELAS
Mitochondrial Encephalopathy, Lactic acidosis, and Stroke-like episodes
Miochondrial
Maternal inheritance
White forlock
Waardenburg syndrome (dystopia canthorum (Wide eyes), congenital hearing loss, heterochromic irises, white forelock)
Klinefelter Syndrome
XXY
infancy: hypospadias, small phallus or cryptorchidism
toddler: boys with developmental delay, esp expressive language skills
school-aged may have language delay, learning disability, behavioural problems
older/adolescent: incomplete pubertal development with eunuchoid body habitus, gynecomastia and small testes
hypogonadism
labs: increased FSH/LH, low testosterone, non-motile sperm
Recurrence risk for T21 if maternal age not high
<1%
What is chance that unaffected parents of a child with a cleft will have another child with a cleft
2% to 6%:
PHACE syndrome
Posterior fossae abnormalities (dandy walker malformation) Hemangioma (large facial IH >5cm) Arterial/Aortic anomalies Cardiac Anomalies Eye Abnormalities
Russell Silver Syndrome
SGA w relative macrocephaly
triangular facies
Peutz–Jeghers syndrome
benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa (melanosis).
increased risk of GI and extraintestinal malignancie
Rectal Prolapse DDx
malnutrition, diarrhea, ulcerative colitis, pertussis, Ehlers-Danlos syndrome, meningocele (more often associated with procidentia owing to the lack of perineal muscle support), cystic fibrosis, and chronic constipation.
Genetic syndromes that predispose to development of leukemia
T21 Noonan NF1 Bloom Ataxia Telangiectasia Fanconi anemia Li-Fraumeni syndrome Shwachman-Diamond Syndrome
Sturge Weber Syndrome
Port wine stain in V1 leptomeningeal angioma Seizures Stroke like episodes Hemiparesis Hemianopsia Headahces Developmental disabilities Glaucoma Buphthalmos intellectual disability or severe learning disabilities
DDH
RF
Dx
Tx
Female
Breech
Fix
Dynamic U/S
Pavlik harness
Complications of IDM
hypoglycemia macrosomia prematurity RDS hypertrophic cardiomyopathy caudal regression syndrome polycythemia
Neonatal conjugated hyperbilirubinemia
– Extrahepatic obstructive • Biliary atresia, choledochal cysts – Bacterial infection/sepsis – TORCH – Neonatal hepatitis • viral, bacterial, parasitic, idiopathic – Metabolic: • alpha-1 antitrypsin, IEM, endocrinopathies, CF, Iron storage disease, bile acid synthesis defects – Cholecystasis syndromes • Dubin Johnson, Byler – Toxic: hyperalimentation
Neonatal unconjugated hyperbilirubinemia
– Dehydration – ‘Breastmilk’ – Cephalohematoma – hypothyroidism – Infection – Polycythemia – Hemolysis -Intrinsic: ---Cell membrane (sphere.) ---Enzyme (G6PD) ---Hb-opathies (thal) -Extrinsic ---Immune (HDN) ---Nonimmune (MAHA) – Endocrinopathies – Extravascular blood – Geneticdisorders – Increased enterohepatic circulation (GI obstruction, delayed meconium)
CDH - mgmt
intubate
NRP
Compression:Breath ratio
supplemental O2 to start?
when to stop resuscitations
3:1
21% >35wga
21-30% <35wga
10 min of effective resuscitations w no HR
What do they do:
Antenatal Steroids
Antenatal MgSO4
Antenatal Steroids: lung development
Antenatal MgSO4: decrease risk of IVH, CP
neuroprotection
How to test for galactosemia
GALT levels
urine reducing substances
Advantages of DCC
Preterm: decreased transfusion
NEC
IVH
Neonatal lupus - 4 features
- 2 labs
heart block
discoid rash
transaminitis
heme - anemia, thrombocytopenia
anti Ro and La
IVH - grades
1: germinal matrix/subependymal
2: into ventricles, not enlarged
3: ventricles enlarged
4: bleeding into brain tissue around ventricles (venous infarction)
how to prevent IVH
antenatal steroids and DCC
PVL
spastic diplegia CP
newborn - ET tube sizes
> 35wga: 3.5-4
1kg: 3.0
<1kg: 2.5
Marfan - inheritance
AD 75%
sporadic 25%
Marfans - inheritance
- cardiac issues
- other issues
Autosomal dominant
MVP
Aortic aneurysm/dissection
Ectopia lentos
TS - inheritance
AD
2/3 have de novo
Duchenne Muscular Dystrophy
- what on bx
Bx:
•absence of staining for dystrophin
•atrophy and hypertrophy of muscle fibers
•degeneration and regeneration (foci of necrosis and regeneration)
•deposition of fat and connective tissue
Baby with non ketotic hypoglycemia - possible causes
Hyperinsulinism
FAOD
Inheritance of hemophilia
X linked
most common presentation of IEM
encephalopathy preceding focal neuro deficit
Achondroplasia - on investigation at birth
head MRI
Ways to reduce risk of SIDS
back to sleep for every sleep
eliminate tobacco/ smoke exposure
infant sleeps in crib/ bassinet that meets regulation in a single sleeper (use a lightweight blanket)
Room share with parents until 6 months old
Breast feeding decreases SIDS (by 50% at 6mos)
Pacifier use is encouraged
Surfactant therapy does what: mortality morbidity Air leaks Duration of vent support BPD
Reduces mortality
Reduces morbidity
Improves oxygenation
Decreases air leaks (pneumothorax, pulmonary interstitial emphysema)
Decreases the duration of ventilator support
Increases survival without BPD
Shorter hospital stays
Causes of oligohydramnios
Fetal UT problems - Renal anomalies - GU obstruction Uteroplacental insufficiency ROM
Causes of polyhydramnios
Maternal DM Multiple gestations Isoimmunization Pulmonary abnormalities Fetal anomalies - Duodenal atresia/TE fistula - Anencephaly Twin Twin transfusion
Gastroschisis
what is it
associations
full-thickness abdominal wall defect usually located to the right of the umbilicus beside normally inserted umbilical vessels
(No membrane or sac covers the herniated abdominal contents)
Often isolated
Can have atresia or necrosis
Omphalocele
Congenital midline abdominal wall defect in which neonates are born with variable amount of intestine and often other organs (eg, liver) herniated outside the abdominal wall
Covered by a membrane, unless it has ruptured in utero
often present with other associated major physical and/or chromosomal abnormalities eg.Beckwith-Wiedemann syndrome.
Most common reason for delayed respiratory effort in a newborn
maternal opiods in labour
Vitamin D in inuit, how much vitamin D do you give her
800 IU
ELBW infant. What causes CLD?
Barotrauma
When can most CP be diagnoses? (What age)
2y
Whats a normal GIR for baby with hypoglycemia
5-8mg/kg/min
How to treat staph infection
cloxicillin
6 Steps in Mgmt for NEC
NPO AXR NG insertion IV Fluids Triple antibiotics (Amp + Gent/Tobra + Flagyl) Surgical consultation
HIE:
Moderary/Severe encephalopathy
- LOC
Lethargic/Stupor - Spontaneous activity
Decreased/none - Posture
Distal flexion/Decerebrate - Tone
Hypotonia/Flaccid - Primitive Reflexes
Weak suck + incomplete moror/
Absent - Autonomic system
Constricted pupils + Bradycardia + Periodic breathing
/
Skew deviation/dilated/ nonreactive to light
Variable HR
Apnea
Term newborns - who gets iron supplementation
If term, LBW and breastfeeding:
<2kg: 2-3mg/kg/day for 1 year
2-2.5kg: 1-2mg/kg/day for 6 months
If normal weight, none
If formula feeding, none
How does MAS cause resp problems
Proximal and distal airway obstruction
Inflammatory and chemical pneumonitis
Decreased surfactant production and inactivation
Remodelling of pulmonary vasculature → persistent pulmonary hypertension
High GIR requirements
hyperinsulinism Beckwith Wiedemann Soto syndrome IDM Persistent hyperinsulinemic hypoglycemia of infancy
Normal GIR requirements
premature (glycogen is deposited during third trimester)
IUGR
cortisol or GH deficiency
IEMs
How do you clinically determine the gestational age of a premature baby?
Ballad Scores
Drugs that cause increased risk of NTD
trimethoprim and the anticonvulsants carbamazepine, phenytoin, phenobarbital, and primidone
Phrenic Nerve paralysis
do you need to refer
may need resp support but try to avoid mechanical ventilation if possible
usually spontaneous recover in 1-2 months
Powdered formulat in preterm infants - what bug
Cronobacter sakazakii (previously Enterobacter sakazakii)
zinc deficiency
Acrodermatitis enteropathica
classic triad = acrodermatitis, diarrhea, and alopecia
Twin twin transfusion
- complications for donor
Hypovolemia Anemia Hypoxia IUGR Decreased renal blood flow Oligohydramnios
Twin twin transfusion
- complications of recipient
Hypervolemia Polyhydramnios Polycythemia Embolization Hypertension Cardiac failure
Concerning sacral dimple?
(1) deep
(2) larger than 0.5 cm;
(3) located within the superior portion of the gluteal crease or above (greater than 2.5 cm from the anal verge); or
(4) associated with other cutaneous markers
