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Pediatrics > Newborn & Resuscitation > Flashcards

Newborn & Resuscitation Flashcards

1
Q

Apgar score variables
what’s the max score?
when are they measured?

A
  • HR (> or < 100)
  • RR (crying or shallow gasps)
  • color (pink or blue)
  • tone (active or weak)
  • reflex irritability (active withdrawal or facial grimace)
  • max score = 10
  • at 1 and 5 minutes (reflects labor/delivery and therapy)
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2
Q

newborn care

A
  • IM vitamin K
  • prophylactic eye erythromycin
  • umbilical cord care
  • hearing test
  • newborn screening tests
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3
Q

birth injuries - brachial plexopathies

A
  • Erb-Duchenne (C5-6) -cannot abduct, externally rotate, supinate
  • Klumke (C7-T1) -hand, Horner’s

-tx: physical therapy/ self resolution

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4
Q

calvicular fracture

A
  • cause: shoulder dystocia = shoulder trapped behind pubis bone during delivery
  • palpable callus on exam
  • often self resolve
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5
Q

facial nerve palsy

A
  • facial hemiparesis (includes forehead)
  • cause: forceps delivery or pressure in utero
  • often self resolve
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6
Q

cephalohematoma vs caput succedaneum

A
  • caput hematoma can cross the suture lines

- cephalhematoma is BENEATH the periosteum and can NOT cross the suture lines

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7
Q

cutis marmorata

A
  • mottled skin when baby is cold
  • lacy, reticulated vascular pattern
  • normal unless it persists after 1 month
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8
Q

milia

A
  • firm, white papules
  • benign inclusion cysts
  • nose, palate (Epstein Pearls)
  • spontaneous resolution
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9
Q

salmon patch

A
  • pink vascular macules
  • nuchal area, eyelids, glabella (bridge of nose)
  • usually disappear
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10
Q

mongolian spots

A
  • blue-gray macules
  • presacral, back, posterior thighs
  • superficial melanocytes that have arrested in development
  • resolve in a few years
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11
Q

erythema toxicum neonatorum

A
  • benign yellow-white papules/pustules with erythematous base
  • peaks 2nd day
  • eosinophils
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12
Q

hemangioma

A
  • capillary (simple) -bright red
  • cavernous (complex) -bluish, less likely to regress
  • often darken and enlarge during first year of life –> fade eventually though
  • tx: steroids, pulsed laser
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13
Q

neonatal acne

A
  • caused by high maternal androgens

- no tx

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14
Q

pre auricular tags and pits

A
  • assess for hearing loss

- ultrasound to look for GU anomalies

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15
Q

iris coloboma

A
  • cleft at “six o’clock” position
  • look like iris is spilling out at this position
  • can interfere with vision
  • CHARGE association:
  • Coloboma
  • Heart defect
  • Atresia choanal
  • Retardation
  • GU
  • Ear
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16
Q

aniridia

A
  • no iris (hypoplasia)
  • can be associated with Wilms tumor
  • WAGR association (chromosome defect)
  • Wilms
  • Airidia
  • GI defect
  • Retardation of growth/development
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17
Q

syndactyly

A
  • fusion of fingers or toes

- tx: X-ray for surgical planning

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18
Q

polydactyly

A
  • > 5 number of fingers or toes

- no tx needed if good blood supply

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19
Q

PKU

A
  • phenylalanine hydroxylase deficiency –> phenyalanine accumulates
  • px: CNS problems, mental retardation, vomiting, athetosis, seizures, fair hair/skin, blue eyes
  • normal at birth
  • problems begin after feeding begins

-tx: low phenylalanine diet for life

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20
Q

classic galactosemia

A
  • galactose-1-phosphate uridylyltransferase deficiency –> accumulation of gal-1-p –> injury to kidney, liver, brain
  • lose extra source of gluneogenesis
  • px: jaundice, hypoglycemia, cataracts, hepatomegaly, MR
  • can begin prenatally (from transplacental galactose)
  • tx: no lactose (breast feeding contraindicated)
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21
Q

symmetric intrauterine growth restriction (IUGR)

A
  • EARLY insult in utero
  • head, length & weight all dec

-causes: chromosomal abnormality, teratogens, congenital infections

22
Q

asymmetric IUGR

A
  • LATE onset after fetal organ development (3rd trimester)
  • head & brain grows normally
  • dec length & weight

-cause: uteroplacental insufficiency (from maternal disease or placental dysfunction) –abnormal delivery of nutritional substances and O2 to fetus

23
Q

preterm

postterm

low birth weight

large for gestational age

A

42 weeks

> 4,500 grams; birth injuries; obesity, DB

<2,500 grams

24
Q

infants of DB mothers

A
  • large for gestational age
  • fetal hyperinsulinemia –> hypoglycemia after placental separation
  • worsens with poorer A1C
  • hypoglycemia, hypoCa, hypoMg
  • macrosomia –> birth trauma
  • brain is normal size
  • cardiomegaly: asymmetric septal hypertrophy = HOCM
  • tachypnea (surfactant suppression, fluid retention in lungs)
  • inc hematocrit –> plethoric & hyperviscious blood
  • inc congenital anomoly incidence (VSD, ASD, TGV, small left colon, caudal regression syndrome)
25
Q

respiratory distress syndrome

A
  • surfactant deficiency –> inability to maintain alveolar volume at end expiration –> atelectasis
  • dec FRC, atelectasis, hypoxemia, hypercarbia, respiratory acidosis
  • CXR: ground glass appearance, small lung volume, bronchogram
  • lecithin/sphingomyelin ratio >2 –> mature lungs
  • tx: oxygen, intubation, exogenous surfactant
  • prevention: antenatal betamethasone
26
Q

transient tachypnea of the newborn

A
  • retained fetal lung fluid –>
  • dec pulmonary compliance
  • dec tidal volume
  • inc dead space
  • term infants after C-section
  • CXR: air trapping, fluid in fissures, perihilar streaking
  • self resolves
27
Q

meconium aspiration syndrome

A

-hypoxia or fetal distress in utero –> aspirate meconium –> pneumonitis & inflammatory response

  • CXR: patchy infiltrates, inc AP diameter, flattening of diaphragm
  • tx: positive pressure ventilation
  • prevention: endotracheal intubation & airway suction
28
Q

choanal atresia

A

failed recanalization of nasal fossa –> abnormal bony or tissue blockage in nasal cavity

29
Q

non respiratory causes of respiratory distress

A
  • cardiac-cyanotic CHD
  • anemia
  • polycythemia
  • infectious
  • metabolic
  • neurologic
30
Q

diaphragm hernia

A
  • diaphragm fails to close
  • abdominal contents herniate into chest –> pulmonary hypoplasia & scaphoid (concave) abdomen
  • BS in chest (often on left)
  • tx: intubation, surgical correction
31
Q

necrotizing enterocolitis px, dx, tx

A
  • transmural intestinal necrosis
  • occurs in prematurity
  • px: bloody stools, apnea, lethargy, distention
  • xray: pneumatosis intestinalis = air in bowel wall
  • tx: decompression, antibiotics, surgery
32
Q

imperforate anus

A
  • failure to pass stool after birth
  • no anal opening visible
  • tx: surgery
  • VACTERL association
  • Vertebral body abnormality, Anal atresia, Cardiac defect, TracheoEsophageal atresia, Renal, Limb defects
33
Q

jaundice causes

A
  • breakdown of fetal RBC

- immaturity of hepatic conjugation or elimination of bilirubin

34
Q

kernicterus

A

-unconjugated bilirubin in basal ganglia and brain stem nuclei

  • px: hypotonia, seizures, delayed motor skills, sensorineural hearing loss
  • phototherapy needed
35
Q

pathologic bilirubinemia

A
  • first 24 hours
  • direct –> biliary atresia, sepsis, TORCH, hypothyroidism
  • indirect –> Coombs (+) or (-)
  • Coombs(+) –> hemolytic: Rh/ABO incompatibility, minor blood groups
  • Coombs(-) –> non-hemolytic; high Hgb vs low Hgb
  • high Hgb –> polycythemia (twins, IUGR, maternal-fetal transfusion)
  • low Hgb –> enzyme defects, membrane defects, hemorrhage, Crigler-Najjar, breast feeding issues
36
Q

breast feeding jaundice

A
  • baby not nursing well
  • dehydrated baby –> peristalsis in baby dec
  • beta glucoronidase removes glucorindes in intestine –> sends bilirubin to enterohepatic system
  • more enzyme activity if peristalsis is slow
37
Q

breast milk jaundice

A
  • glucoronidase in breast milk –> gives more free bilirubin –> inc enterohepatic circulation
  • jaundiced at 2nd week
  • resolved in 2-3 months
  • phototherapy needed
38
Q

phototherapy complications

A
  • diarrhea
  • erythematous macular rash
  • overheating, dehydration
  • bronze baby syndrome
39
Q

double volume exchange transfusion

A
  • catheter into umbilical vein & artery
  • remove small aliquots of blood
  • replace with fresh blood
  • do for twice the baby’s blood volume
40
Q

neonatal sepsis organisms

A
  • GBS
  • E coli
  • Listeria
41
Q

neonatal sepsis dx, tx

A
  • CBC
  • blood culture
  • UA
  • CXR
  • LP
  • tx: ampicillin + aminiglycoside
  • for 48-72 hours after cultures are negative
42
Q

neonatal meningitis tx

A

-ampicillin + 3rd generation cephalosporin

no ceftriaxone –> unbinding of bilirubin from albumin in blood

43
Q

transplacental intrauterine infections –> TORCH

A 
Toxoplasmosis
Other (HIV, parvovirus)
Rubella
Cytomegalovirus (CMV)
HSV 2
44
Q

toxoplasmosis

A
  • cysts from undercooked meat
  • fecal contamination from cats
  • chorioretinitis, hydrocephalus, intracranial calcifications –> visual impairment, psychomotor retardation, seizures
  • tx: spiramycin during pregnancy
45
Q

congenital rubella

A

-blueberry muffin spots on erythematous base

  • PDA, peripheral pulmonary artery stenosis, cataracts, congenital hearing loss
  • MR, microcephaly
46
Q

CMV

A
  • periventrical calcifications
  • IUGR
  • microcephaly
  • chorioretinitis
  • thrombocytopenia

-hearing loss, MR, neuromuscular abnormalities

47
Q

HSV2 px, dx, tx

A
  • keratoconjunctivitis, CNS, disseminated
  • blindness, seizures, psychomotor retardation
  • elective C section
  • dx: PCR
  • tx: IV acyclovir
48
Q

congenital syphilis

A
  • transplacental transmission
  • snuffles = active spirochetes in nose
  • maculopapular rash (palms & soles)
  • jaundice, periostitis, osteochondritis, choreoretinitis, nephrotic syndrome
  • Hutchinson teeth, Clutton joints, saber shins, saddle nose, mulberry molars
  • dx: IgM-FTA-ABS, dark field
  • tx: high dose penicillin
49
Q

congenital varicella

A
  • limb malformation & deformations
  • cutaneous scars from varicella lesions
  • microcephaly
  • associated with infection during 1st or 2nd trimester
50
Q

neonatal varicella

A
  • occurs at time of birth
  • worst morbidity & mortality
  • tx with VZIg 5 days before to 2 days after delivery
51
Q

maternal opiod use

A
  • low birth weight
  • inc rate of stillborns
  • early withdrawal symptoms –> tremors, hyper irritability, diarrhea, apnea, poor feeding, high pitched scream, tachypnea
  • high risk of SIDS
52
Q

maternal cocaine use

A
  • no classic withdrawal symptoms
  • preterm labor, abruption, asphyxia
  • IUGR
  • impaired auditory processing, developmental delay, learning disabilities
  • CNS ischemia, hemorrhagic lesions
  • meconium toxicology
  • tx: narcotics, sedatives, hypnotics
  • low birth weight, IUGR, SIDS

Pediatrics (3 decks)

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