Newborn & Resuscitation Flashcards
Apgar score variables
what’s the max score?
when are they measured?
- 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)
newborn care
- IM vitamin K
- prophylactic eye erythromycin
- umbilical cord care
- hearing test
- newborn screening tests
birth injuries - brachial plexopathies
- Erb-Duchenne (C5-6) -cannot abduct, externally rotate, supinate
- Klumke (C7-T1) -hand, Horner’s
-tx: physical therapy/ self resolution
calvicular fracture
- cause: shoulder dystocia = shoulder trapped behind pubis bone during delivery
- palpable callus on exam
- often self resolve
facial nerve palsy
- facial hemiparesis (includes forehead)
- cause: forceps delivery or pressure in utero
- often self resolve
cephalohematoma vs caput succedaneum
- caput hematoma can cross the suture lines
- cephalhematoma is BENEATH the periosteum and can NOT cross the suture lines
cutis marmorata
- mottled skin when baby is cold
- lacy, reticulated vascular pattern
- normal unless it persists after 1 month
milia
- firm, white papules
- benign inclusion cysts
- nose, palate (Epstein Pearls)
- spontaneous resolution
salmon patch
- pink vascular macules
- nuchal area, eyelids, glabella (bridge of nose)
- usually disappear
mongolian spots
- blue-gray macules
- presacral, back, posterior thighs
- superficial melanocytes that have arrested in development
- resolve in a few years
erythema toxicum neonatorum
- benign yellow-white papules/pustules with erythematous base
- peaks 2nd day
- eosinophils
hemangioma
- 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
neonatal acne
- caused by high maternal androgens
- no tx
pre auricular tags and pits
- assess for hearing loss
- ultrasound to look for GU anomalies
iris coloboma
- 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
aniridia
- no iris (hypoplasia)
- can be associated with Wilms tumor
- WAGR association (chromosome defect)
- Wilms
- Airidia
- GI defect
- Retardation of growth/development
syndactyly
- fusion of fingers or toes
- tx: X-ray for surgical planning
polydactyly
- > 5 number of fingers or toes
- no tx needed if good blood supply
PKU
- 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
classic galactosemia
- 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)
symmetric intrauterine growth restriction (IUGR)
- EARLY insult in utero
- head, length & weight all dec
-causes: chromosomal abnormality, teratogens, congenital infections
asymmetric IUGR
- 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
preterm
postterm
low birth weight
large for gestational age
42 weeks
> 4,500 grams; birth injuries; obesity, DB
<2,500 grams
infants of DB mothers
- 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)
respiratory distress syndrome
- 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
transient tachypnea of the newborn
- 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
meconium aspiration syndrome
-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
choanal atresia
failed recanalization of nasal fossa –> abnormal bony or tissue blockage in nasal cavity
non respiratory causes of respiratory distress
- cardiac-cyanotic CHD
- anemia
- polycythemia
- infectious
- metabolic
- neurologic
diaphragm hernia
- diaphragm fails to close
- abdominal contents herniate into chest –> pulmonary hypoplasia & scaphoid (concave) abdomen
- BS in chest (often on left)
- tx: intubation, surgical correction
necrotizing enterocolitis px, dx, tx
- transmural intestinal necrosis
- occurs in prematurity
- px: bloody stools, apnea, lethargy, distention
- xray: pneumatosis intestinalis = air in bowel wall
- tx: decompression, antibiotics, surgery
imperforate anus
- 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
jaundice causes
- breakdown of fetal RBC
- immaturity of hepatic conjugation or elimination of bilirubin
kernicterus
-unconjugated bilirubin in basal ganglia and brain stem nuclei
- px: hypotonia, seizures, delayed motor skills, sensorineural hearing loss
- phototherapy needed
pathologic bilirubinemia
- 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
breast feeding jaundice
- 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
breast milk jaundice
- glucoronidase in breast milk –> gives more free bilirubin –> inc enterohepatic circulation
- jaundiced at 2nd week
- resolved in 2-3 months
- phototherapy needed
phototherapy complications
- diarrhea
- erythematous macular rash
- overheating, dehydration
- bronze baby syndrome
double volume exchange transfusion
- catheter into umbilical vein & artery
- remove small aliquots of blood
- replace with fresh blood
- do for twice the baby’s blood volume
neonatal sepsis organisms
- GBS
- E coli
- Listeria
neonatal sepsis dx, tx
- CBC
- blood culture
- UA
- CXR
- LP
- tx: ampicillin + aminiglycoside
- for 48-72 hours after cultures are negative
neonatal meningitis tx
-ampicillin + 3rd generation cephalosporin
no ceftriaxone –> unbinding of bilirubin from albumin in blood
transplacental intrauterine infections –> TORCH
Toxoplasmosis Other (HIV, parvovirus) Rubella Cytomegalovirus (CMV) HSV 2
toxoplasmosis
- cysts from undercooked meat
- fecal contamination from cats
- chorioretinitis, hydrocephalus, intracranial calcifications –> visual impairment, psychomotor retardation, seizures
- tx: spiramycin during pregnancy
congenital rubella
-blueberry muffin spots on erythematous base
- PDA, peripheral pulmonary artery stenosis, cataracts, congenital hearing loss
- MR, microcephaly
CMV
- periventrical calcifications
- IUGR
- microcephaly
- chorioretinitis
- thrombocytopenia
-hearing loss, MR, neuromuscular abnormalities
HSV2 px, dx, tx
- keratoconjunctivitis, CNS, disseminated
- blindness, seizures, psychomotor retardation
- elective C section
- dx: PCR
- tx: IV acyclovir
congenital syphilis
- 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
congenital varicella
- limb malformation & deformations
- cutaneous scars from varicella lesions
- microcephaly
- associated with infection during 1st or 2nd trimester
neonatal varicella
- occurs at time of birth
- worst morbidity & mortality
- tx with VZIg 5 days before to 2 days after delivery
maternal opiod use
- 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
maternal cocaine use
- 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
