NICU Boards Review 1

Question 1

In this autoimmune disease, the body makes antibodies against acetylcholine receptors

Answer 1

Myasthenia Gravis

Question 2

What percentage of neonates born to mothers with Myasthenia Gravis will develop transient neonatal myasthenia gravis?

Answer 2

10-20%

Question 3

Pathophys of transient neonatal myasthenia gravis

Answer 3

Results from placental passage of maternal antibodies (IgG) to acetylcholine receptors

Question 4

Symptoms of neonatal myasthenia gravis include….
These symptoms last for how long…?

Answer 4

Symptoms: weak cry, hypotonia, poor oral feeding (due to difficulty swallowing due to weak oropharyngeal muscles from the acetylcholine receptors getting attacked by maternal IgG antibodies to these receptors)

Symptoms show up early (by 72 hours of life) and peak around 3 weeks. Almost always resolved by 2 months of age, but sometimes (for 10% of infants) takes up to 4 months. But MOST infants will be symptom free by age 2 months.

Question 5

Infant has stippled bone epiphyses. Mom took what drug between 6-12 weeks gestation?

Answer 5

Warfarin

Question 6

Describe the clinical findings of a neonate affected by early (6-12 wks gestation) maternal warfarin use:

Answer 6

-depressed nasal bridge and nasal hypoplasia
-low birthweight
-stippled bone epiphyses
-can also have seizures and cognitive disabilities

Question 7

What is the maternal quad screen–what tests does it consist of, and when should it be performed?

Answer 7

Quad screen: AFP, unconjugated estriol, b-hCG, inhibin A

Optimal timing: 16 weeks (but can be done between 14-20 weeks)

Question 8

Ileal atresia is associated with this in utero drug exposure

Answer 8

cocaine

Question 9

Early decels are caused by

Answer 9

fetal head compression

Question 10

Why do early decels happen, what causes them?

Answer 10

Fetal head gets compressed
This causes fetus to vagal
which causes fetal heart rate to get lower

Question 11

What causes variable decels?

Answer 11

umbilical cord compression

Question 12

Pathophys of variable decels

Answer 12

Caused by umbilical cord compression
This leads to either a baro or chemoreceptor vagal response that causes the HR to drop, OR, it causes more direct fetal myocardial depression

Question 13

The most common cause of late decels is

Answer 13

placental insufficiency

Question 14

Describe the 2 mechanisms (both of which lead to placental insufficiency) that cause late decels in a fetus:

Answer 14

1. Placental insufficiency leads to fetal hypoxemia–> chemoreceptors respond by increasing alpha adrenergic activity–> fetal blood pressure goes up–> fetal HR goes down (baroreceptor/parasympathetic response to the hypertension)
2. Placental insufficiency–> fetal hypoxemia–>myocardial depression–> HR slows

Question 15

Placental insufficiency leads to this kind of decel:

Answer 15

Late

Question 16

Cord compression leads to this kind of decel:

Answer 16

variable

Question 17

What is the incidence of a single UA (aka 2 vessel cord)?

Answer 17

<1% of the population

Question 18

Fetal head compression leads to this kind of decel:

Answer 18

early

Question 19

This maternal medication increases the risk of neonatal PPHN

Answer 19

Indomethacin

Question 20

Bad effects that maternal indomethacin use can have on neonate (aka why prolonged maternal use is not recommended):

Answer 20

PPHN
renal insufficiency
ileal perforation
NEC

Question 21

What is indomethacin used for in obstetric care? MOA?

Answer 21

= a prostaglandin synthase inhibitor
used as a tocolytic (aka to stop contractions in PTL)

Question 22

Congenital heart defect associated with lithium

Answer 22

Ebstein’s anomaly

Question 23

What is the most common complication of pregnancy?

Answer 23

pre eclampsia

Question 24

Incidence of pre-eclampsia

Answer 24

5-10% of pregnant women

Question 25

Name 5 risk factors for pre-eclampsia:

Answer 25

Primaparity
Twin/multiple gestation
Chronic hypertension
Obesity
Diabetes

Question 26

Define pre-eclampsia

Answer 26

= hypertension that develops after 20 weeks gestation with associated proteinuria

Question 27

HELLP syndrome stands for

Answer 27

H emolysis
E levated L iver enzymes
L ow P latelets

Question 28

Which is more common, transient neonatal myasthenia gravis, or congenital myasthenia gravis?

Answer 28

Transient neonatal myasthenia gravis is much more common. This occurs in 10-20% of infants born to moms with MG. Congenital MG on the other hand is rare, and shows up later in childhood.

Question 29

In transient neonatal myasthenia gravis, do maternal antibody titers and the severity of maternal disease affect how severe the neonate’s disease will be?

Answer 29

Nope. No correlation.

Instead it’s just related to how well the maternal antibody against maternal acetylcholine receptor binds to the FETAL acetylcholine receptor.

Question 30

Does the severity of NAS symptoms correlate with the amount of drug (dose) or duration of intake by the mother?

Answer 30

NO

Although I mean come on, one dose of morphine won’t be the issue.
It must be somewhat sustained use. So sure. But the point here is the dose does NOT correlate with how severe the NAS symptoms are, oddly enough.

Question 31

What is the palpebral fissure

Answer 31

= distance between the medial and lateral corners of one eye

Question 32

Short palpebral fissures, smooth area between nose and mouth (philtrum), and thin upper lip =

Answer 32

Fetal alcohol syndrome

Question 33

Describe the physical features of a newborn with fetal alcohol syndrome:

Answer 33

Dysmorphic facies (thin vermillion border of upper lip), smooth philtrum, short palpebral fissures, microcephaly, and low birth weight. Later on, intellectual disability.

VSD or other cardiac defects also common ish.

Question 34

Is twin to twin transfusion syndrome more common in mono di or mono mono twins?

Answer 34

Mono di

Can occur in mono mono twins but the risk is lower than in mono di twins. huh.