PEDS - 2 - Common Problems in Newborns Flashcards
Diagnostic Criteria for Hypoglycemia of the Newborn
BGL < 40 at Birth to 4 Hours
OR
BGL < 45 at 4-24 Hours
Newborns at Risk for Developing Hypoglycemia
LGA, SGA, Pre-Term, IUGR, Stressed
Pathophysiology of Hypoglycemia of the Newborn
- Inadequate Glycogen and Fat Supply (PT, SGA, IUGR)
OR - Glucose Utilization Increases with Stress
Possible Etiologies for Hypoglycemia of the Newborn
- Hemolytic Disease of the Newborn
- Congenital Hyperinsulinemia
- Delayed/Inadequate Feedings
Tx for Asymptomatic Hypoglycemia in Newborn
Start feedings within 1 hour (ASAP) and continue q 2-3h
Tx for Symptomatic Hypoglycemia in Newborn
IV Dextrose (2mL/kg Bolus with Continuous Infusion 80-100 mL/kg/day)
What is wrong in Physiologic Jaundice of Newborn?
Too much Unconjugated Bilirubin
Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?
UDPGT
Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?
UDPGT
When does Physiologic Jaundice appear? What are the bilirubin results?
After 24 Hours; Total Bilirubin < 15
Treatment for Physiologic Jaundice?
Self-Limited, Resolves within 1-2 Weeks
What is wrong in pathologic jaundice?
Increased Production of Bilirubin (Increased Heme Breakdown) or Decreased Conjugation
What are the 2 types of pathologic jaundice caused by increased production of bilirubin (from increased breakdown of heme)?
Antibody-Mediated
Non-Antibody Mediated
What are the 2 etiologies of Antibody-Mediated Pathologic Jaundice?
- ABO Incompatibility
- Rh Incompatibility
Which type of Antibody-Mediated Pathologic Jaundice is more serious?
Rh Incompatibility
What is the name for the severe form of Rh Incompatibility in the Newborn?
Erythroblastosis Fetalis
What are the 2 Etiologies for Non-Antibody Mediated Pathologic Jaundice?
- Hereditary Spherocytosis
- G6PD Deficiency
- Non-Hemolytic
What conditions develop due to Hereditary Spherocytosis?
Chronic Hemolytic Anemia and Splenomegaly
Jaundice at 1 Week with Heinz Bodies
G6PD Deficiency
3 possible etiologies for non-hemolytic, non-antibody-mediated pathologic jaundice
- Enclosed Hemorrhage or Skin Bruising
- Polycythemia
- Bowel Obstruction
Enzyme that converts unconjugated bilirubin to conjugated bilirubin in the liver?
UDPGT
What are the 2 Syndromes associated with Pathologic Jaundice from Decreased Conjugation? Which is more severe/serious?
Crigler-Najjar Syndrome (more severe) and Gilbert Syndrome (mild)
Why do we care about jaundice in the newborn?
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)
Lethargy, Poor Feeding, Arching of Neck & Trunk, Apnea, Seizures, Coma
Acute Bilirubin Encephalopathy
EPS, Gaze Abnormality, Dysplasia of Enamel, Deafness, Kernicterus
Chronic Bilirubin Encephalopathy
What are common risk factors for newborn jaundice?
Breastfeeding, Fever
What does the jaundice progression look like on a newborn?
Cephalocaudal Progression
How do we test for Jaundice on Physical Exam?
Digital Blanching
Newborn Respiratory Distress caused by lack of Fetal Adrenaline Surge and lack of uterine contractions within 6 hours of birth.
Transient Tachypnea of Newborn
CXR Findings for Transient Tachypnea of Newborn
Prominent Periphilar Vascular Markings; Fluid in Fissures; Costophrenic Angles
CXR Findings for Transient Tachypnea of Newborn
Prominent Periphilar Vascular Markings; Fluid in Fissures; Costophrenic Angles
Respiratory Distress within 12 Hours due to vagal stimulation from cord or head compression (in absence of fetal distress)
Meconium Aspiration Syndrome
CXR Findings in Meconium Aspiration Syndrome
Patchy Infiltrates & Consolidations
Treatment for Meconium Aspiration Syndrome
Vigorous = Observe
Not Vigorous = Intubation, Suction, Ampicillin or Gentamicin
Treatment for Transient Tachypnea of Newborn
Positive-Pressure Ventilation, O2 as Needed, Usually resolves within 2 Hours
(No Oral Feeds During this time)
Pneumonia caused by Group B Strep, E. Coli, HSV, or Candida in a newborn
Congenital Pneumonia
Treatment for Congenital Pneumonia
Ampicillin or Gentamicin
Acyclovir for HSV
Pathophysiology of Respiratory Distress Syndrome / Hyaline Membrane Disease
Deficient Surfactant / Immature Lungs
CXR Findings Respiratory Distress Syndrome
Uniform Ground-Glass Patter & Air Bronchogram
Tx for Respiratory Distress Syndrome
Surfactant
