PEDS - 2 - Common Problems in Newborns

Question 1

Diagnostic Criteria for Hypoglycemia of the Newborn

Answer 1

BGL < 40 at Birth to 4 Hours
OR
BGL < 45 at 4-24 Hours

Question 2

Newborns at Risk for Developing Hypoglycemia

Answer 2

LGA, SGA, Pre-Term, IUGR, Stressed

Question 3

Pathophysiology of Hypoglycemia of the Newborn

Answer 3

1. Inadequate Glycogen and Fat Supply (PT, SGA, IUGR)
   OR
2. Glucose Utilization Increases with Stress

Question 4

Possible Etiologies for Hypoglycemia of the Newborn

Answer 4

1. Hemolytic Disease of the Newborn
2. Congenital Hyperinsulinemia
3. Delayed/Inadequate Feedings

Question 5

Tx for Asymptomatic Hypoglycemia in Newborn

Answer 5

Start feedings within 1 hour (ASAP) and continue q 2-3h

Question 6

Tx for Symptomatic Hypoglycemia in Newborn

Answer 6

IV Dextrose (2mL/kg Bolus with Continuous Infusion 80-100 mL/kg/day)

Question 7

What is wrong in Physiologic Jaundice of Newborn?

Answer 7

Too much Unconjugated Bilirubin

Question 8

Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?

Answer 8

UDPGT

Question 9

Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?

Answer 9

UDPGT

Question 9

When does Physiologic Jaundice appear? What are the bilirubin results?

Answer 9

After 24 Hours; Total Bilirubin < 15

Question 10

Treatment for Physiologic Jaundice?

Answer 10

Self-Limited, Resolves within 1-2 Weeks

Question 11

What is wrong in pathologic jaundice?

Answer 11

Increased Production of Bilirubin (Increased Heme Breakdown) or Decreased Conjugation

Question 12

What are the 2 types of pathologic jaundice caused by increased production of bilirubin (from increased breakdown of heme)?

Answer 12

Antibody-Mediated

Non-Antibody Mediated

Question 13

What are the 2 etiologies of Antibody-Mediated Pathologic Jaundice?

Answer 13

1. ABO Incompatibility
2. Rh Incompatibility

Question 14

Which type of Antibody-Mediated Pathologic Jaundice is more serious?

Answer 14

Rh Incompatibility

Question 15

What is the name for the severe form of Rh Incompatibility in the Newborn?

Answer 15

Erythroblastosis Fetalis

Question 16

What are the 2 Etiologies for Non-Antibody Mediated Pathologic Jaundice?

Answer 16

1. Hereditary Spherocytosis
2. G6PD Deficiency
3. Non-Hemolytic

Question 17

What conditions develop due to Hereditary Spherocytosis?

Answer 17

Chronic Hemolytic Anemia and Splenomegaly

Question 18

Jaundice at 1 Week with Heinz Bodies

Answer 18

G6PD Deficiency

Question 19

3 possible etiologies for non-hemolytic, non-antibody-mediated pathologic jaundice

Answer 19

1. Enclosed Hemorrhage or Skin Bruising
2. Polycythemia
3. Bowel Obstruction

Question 20

Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?

Answer 20

UDPGT

Question 21

What are the 2 Syndromes associated with Pathologic Jaundice from Decreased Conjugation? Which is more severe/serious?

Answer 21

Crigler-Najjar Syndrome (more severe) and Gilbert Syndrome (mild)

Question 22

Why do we care about jaundice in the newborn?

Answer 22

Early Neuro Defects (Lethargy, Poor Feeding, Crying, etc.)

Late Neuro Effects (Irritability, Opisthotonos, Seizures, Apnea, Fever)

Chronic (Athetoid Cerebral Palsy, Hearing Loss, Dental Issues, Developmental Delays)

Question 23

Lethargy, Poor Feeding, Arching of Neck & Trunk, Apnea, Seizures, Coma

Answer 23

Acute Bilirubin Encephalopathy

Question 24

EPS, Gaze Abnormality, Dysplasia of Enamel, Deafness, Kernicterus

Answer 24

Chronic Bilirubin Encephalopathy

Question 25

What are common risk factors for newborn jaundice?

Answer 25

Breastfeeding, Fever

Question 26

What does the jaundice progression look like on a newborn?

Answer 26

Cephalocaudal Progression

Question 27

How do we test for Jaundice on Physical Exam?

Answer 27

Digital Blanching

Question 28

Newborn Respiratory Distress caused by lack of Fetal Adrenaline Surge and lack of uterine contractions within 6 hours of birth.

Answer 28

Transient Tachypnea of Newborn

Question 29

CXR Findings for Transient Tachypnea of Newborn

Answer 29

Prominent Periphilar Vascular Markings; Fluid in Fissures; Costophrenic Angles

Question 30

CXR Findings for Transient Tachypnea of Newborn

Answer 30

Prominent Periphilar Vascular Markings; Fluid in Fissures; Costophrenic Angles

Question 31

Respiratory Distress within 12 Hours due to vagal stimulation from cord or head compression (in absence of fetal distress)

Answer 31

Meconium Aspiration Syndrome

Question 32

CXR Findings in Meconium Aspiration Syndrome

Answer 32

Patchy Infiltrates & Consolidations

Question 33

Treatment for Meconium Aspiration Syndrome

Answer 33

Vigorous = Observe

Not Vigorous = Intubation, Suction, Ampicillin or Gentamicin

Question 34

Treatment for Transient Tachypnea of Newborn

Answer 34

Positive-Pressure Ventilation, O2 as Needed, Usually resolves within 2 Hours

(No Oral Feeds During this time)

Question 35

Pneumonia caused by Group B Strep, E. Coli, HSV, or Candida in a newborn

Answer 35

Congenital Pneumonia

Question 36

Treatment for Congenital Pneumonia

Answer 36

Ampicillin or Gentamicin

Acyclovir for HSV

Question 37

Pathophysiology of Respiratory Distress Syndrome / Hyaline Membrane Disease

Answer 37

Deficient Surfactant / Immature Lungs

Question 38

CXR Findings Respiratory Distress Syndrome

Answer 38

Uniform Ground-Glass Patter & Air Bronchogram

Question 39

Tx for Respiratory Distress Syndrome

Answer 39

Surfactant