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Boot camp > Pediatrics - Neonatal Distress > Flashcards

Pediatrics - Neonatal Distress Flashcards

1
Q

In a patient with respiratory disease and hepatosplenomegaly what are you considering?

A

Congestive heart failure

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2
Q

What is transient tachypnea of the newborn?

A
  • Tend to be in term babies
  • More common in kids born by C-section
  • Fluid not adequately removed from the lungs going through birth canal causing respiratory distress
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3
Q

What do you see in a CXR in TTN?

A

Fluid in the fissures of the lungs

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4
Q

How do you manage TTN?

A
  • Intermittent oxygen as needed

- Feeding by NG tube if not tolerating feeds

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5
Q

In meconium aspiration how does your approach to resuscitation change?

A
  • Intubate and suction the trachea
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6
Q

In resuscitation of a newborn what do you do before your ABC’s?

A

Warm and stimulate the baby.

- Suction if mec present

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7
Q

When do you start chest compressions on a newborn?

A

heart rate less than 60

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8
Q

When do you use positive pressure ventillation in newborn resuscitation?

A

HR less than 100 or apneic

- PPV set at 40-60

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9
Q

What does APGAR mean?

A 
Appearance 
Pulse
Grimace
Activity
Respiration
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10
Q

A post-term newborn, delivered with a breech presentation, develops respiratory distress which does not improve. Chest radiograph shows streaky, linear densities, and cultures are negative.

What is the most likely diagnosis?

A. Meconium aspiration syndrome
B. Persistent pulmonary hypertension of the newborn
C. Pneumonia
D. Transient tachypnea of the newborn (TTN)
E. None of the above

A

Meconium aspiration

  • linear densities that are streaky are classic for this
  • cultures negative rule out pneumonia
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11
Q

A 38 5/7-week estimated gestational age girl is examined in the special care nursery at 3 hours of life who developed tachypnea and mild respiratory distress 10 minutes ago. Mom’s prenatal history was uncomplicated and her prenatal labs were not concerning for infection. She required no ventilatory support at delivery. The baby has the following vital signs: temperature 36.9°C (98.4°F), heart rate 136/min, respiratory rate 83/min, blood pressure 75/42, and oxygen saturation 93%. She has some shallow breathing with mild subcostal retractions and no grunting or nasal flaring, and she is otherwise well perfused with good femoral and brachial pulses. A chest X-ray reveals a flat diaphragm, prominent vascular markings, and fluid in the interlobar fissures. No granular densities or opacities/air brochograms are seen.

What is the next step in management of this patient?

A. Continuous positive airway pressure (CPAP)
B. O2 via nasal cannula
C. Surfactant
D. Conservative management with orogastric tube feeds or IV fluids for nutrition
E. Intubation

A

Conservative management with orogastric tube feeds or IV fluids for nutrition

  • Term baby, otherwise alright
  • fluid in the fissures
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12
Q

One hour after delivery, a 1 077-g (2-lb 6-oz) newborn is in respiratory distress. She was born at 28 weeks’ gestation following an otherwise uncomplicated pregnancy and delivery. The mother received routine prenatal care and intrapartum antibiotic prophylaxis. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. On initial examination, the newborn appeared pink and was active. Currently, her temperature is 36.4°C (97.5°F), pulse is 160/mm, respirations are 60/mm and shallow, and blood pressure is 68/44 mm Hg. Examination shows grunting, nasal flaring, and intercostal retractions A chest x-ray shows a granular appearance of the parenchyma with air bronchograms. Which of the following is the most likely diagnosis?

Meconium aspiration pneumonia
Respiratory distress syndrome of the newborn
Streptococcus agalactiae (group B) infection
Total anomalous pulmonary venous return
Transient tachypnea of the newborn

A
  • Respiratory distress syndrome of the newborn

- Ground glass, premature, temperature is normal

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13
Q

Risk factors for neonatal sepsis?

A
  • prolonged rupture of membranes > 18 hours
  • APGAR score < 5
  • Prematurity
  • Low birth weight
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14
Q

What is the most common organism for neonatal sepsis? (less than 1 week)

A
  • GROUP B STREP

- others from mom include Listeria, E.coli

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15
Q

Most common cause of neonatal sepsis after 1 week?

A

Infections from their environment

- Coagulase negative staph infections

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16
Q

How could have a GBS Strep infection in newborn have been infected?

A

GBS prophylaxis with penicillin (IV)

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17
Q

What physical exam finding would you look for if you were suspecting intracerebral hemorrhage?

A

Bulging fontanelles

18
Q

A 3 day term infant has episodes of breathing for 10-15 seconds followed by apnea for 5 to 10 seconds. There are no changes in skin color or heart rate. Which of the following is the most appropriate step in management?

Administer caffeine
Administer theophylline
Apply continuous positive airway pressure
Provide supplemental oxygen
Reassure the parents
A

reassure the patents

19
Q

If an infant is not breathing for 5-10 seconds in between normal breathing what is the diagnosis?

A

Periodic breathing

20
Q

When do you adminsiter caffeine to an apneic child?

A

When premature. Brain stem is not developed and caffeine stimulates this center. Will not work in full term child will developed brain stem

21
Q

By definition apnea is the absence of breathing for how long?

A

20 seconds or longer (less is decreased HR or desaturations)
- 10-15 seconds is periodic breathing

22
Q

What are the causes of apnea of prematurity (<34 wks)

A
  • Sepsis
  • ICH
  • Hypoglycemia
  • Na/Ca abnormality
  • CHF
23
Q

Management of apnea of prematurity?

A
  • O2
  • Tactile stimulation
  • Ventilation
  • Caffeine
24
Q

How many vessels are there in the umbilical cord?

A

Three, 2 arteries and 1 vein

25
Q

Which vessel provides the baby with oxygenated blood from the mother?

A
  • Umbilical VEIN
26
Q

What are the 5 T’s of cyanotic heart disease?

A
  • Transposition of great vessels
  • Truncus arteriosus
  • Tricuspid atresia
  • Tetralogy of fallot
  • Total anomalous pulmonary venous return
27
Q

What is the most common cause of cyanotic baby in the first 48 hours?

A
  • Transposition of the great arteries
28
Q

What is the treatment for transposition of the great vessels?

A
  • Prostaglangins to keep the ductus arteriosus open while awaiting corrective surgery
29
Q

Will a patient with transposition of the great vessels respond to the application of oxygen mask?

A

No, blood does get oxygenated in this condition, however the blood travelling to the body in not oxygenated aside from the small amount through the PDA

30
Q

What is coarctation of the aorta?

A
  • a kink in the aorta allows more blood to go to upper body but impairs flow to lower body
31
Q

In which condition would you expect to find a radial-femoral delay?

A
  • Coarctation of the aorta

- strong pulse to upper extremities, lower extremities blocked and supplied by collateral circulation

32
Q

What is your initial management of coarctation of the aorta?

A
  • prostaglandin - ensure PDA
33
Q

What is the most common cause of cyanotic heart disease overall?

A

Tetrology of fallot

- presents at 2-4 months with signs of CHF

34
Q

What is a tet spell?

A

Cyanotic episodes

35
Q

What are the malformations in tetrology of fallot?

A

1) Pulmonic stenosis**
2) Ventricular Septal Defect (R-L shunt)
3) Over-riding aorta
4) Right ventricular hypertrophy

36
Q

Prostaglandin E infusion can be used for initial management in each of the following neonatal heart lesions EXCEPT:

Pulmonary atresia 
Coartaction of the aorta
Tetralogy of fallot 
Patent ductus arteriosus
Hypoplastic left heart syndrome
A

Patent ductus arteriosus

- if its already open it would serve no function

37
Q

A 3-week-old male infant is brought into the pediatrician for several episodes of cyanotic lips during feeding. His mother notes he becomes severely agitated during his feeds and looks as though he is holding his breath. Physical examination reveals a calm male infant sleeping in his mother’s arms. Cardiac examination reveals a crescendo-decrescendo murmur best heard at the left upper sternal border and a single S2. Lungs are clear to auscultation bilaterally, with no rales or rhonchi noted. Abdomen is soft, nondistended, with normoactive bowel sounds. Skin examination reveals no signs of cyanosis. A chest x-ray is performed in the office and reveals an elongated apex of the heart
What is the most likely diagnosis?

 A. Large VSD
 B. Transposition of the great vessels
 C. Breath Holding spell - review
 D. Hypertrophic obstructive cardiomyopathy (HOCM)
 E. Tetralogy of fallot
A

Tetralogy of fallot

  • single S2, due to pulmonic stenosis
  • Boot shaped heart on Xray (elongated apex)
38
Q

What is hemorrhagic disease of the newborn and how do we prevent it?

A
  • Bleeding disorder due to vitamin K deficiency.

- If born in hospital given vitamin K injection to prevent this.

39
Q

A 2 day old breast fed newborn, who was delivered at home, presents to the Emergency Department with umbilical stump bleeding. The mother has been on phenytoin during her pregnancy, PT and PTT are prolong which of the following is the most appropriate treatments?

Administer factor VIII
Administer 1-2 mg of vitamin K
Administer 20 ml/kg of whole blood
Administer platelets
Administer 10 mL/kg of packed cells
A

Administer 1-2 mg of vitamin K

  • hemorrhagic disease of the newborn
  • born at home and thus not given vit K at birth
40
Q

A pateint presents with a scaphoid abdomen (flat belly) and decreased air entry to the left lung. What are you suspicious for?

A

Diaphragmatic herniation

  • small bowel into the left lung space
  • DO NOT BAG, these patients must be intubated
41
Q

What is pneumatosis intestinalis and hepatic portal venous gas on abdominal Xray suggestive of?

A

Necrotizing enterocolitis

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