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Pediatrics > Perinatal + Neonatal issues > Flashcards

Perinatal + Neonatal issues Flashcards

1
Q

What do you use the Apgar score for?

A

Helps ID infants needing resuscitation

Also helpful to evaluate resuscitation efforts

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2
Q

How often give Apgar scores?

A

1 min

5 min

every 5 min after

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3
Q

Which Apgar scores need resuscitation?

A

0-3 at 1 min

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4
Q

Birth injuries

A

Avoidable and unavoidable injuries during L&D

Cephalhematoma
Caput succedaneum
SubQ fat necrosis
Brachial palsy
Facial palsy
Clavicular fx
Subconj hemorrhage
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5
Q

Cephalhematoma

A

SubPERIOSTEAL bleed

DOES NOT cross suture lines
- b/c limited to bone

Can feel rim around edge

Resolve spontaneously over several months

Common cause of jaundice

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6
Q

Caput succedaneum

A

Swelling of scalp 2/2 pressure exerted on that part during L&D

CROSSES suture lines

Resolves in a few days

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7
Q

Subcutaneous fat necrosis

A

Hx of difficult L&D

Rubbery, firm nodules on cheeks or buttocks and extremities

Usually resolve –> but can become calcium deposits in lesions

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8
Q

Clavicular fx - tx?

A

Tx not needed

Will feel crepitus over fx
Asymmetric moro

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9
Q

Coloboma

A

a hole in one of the structures of the eye, such as the iris, retina, choroid, or optic disc.

caused when a gap called the choroid fissure, which is present during early stages of prenatal development, fails to close up completely before a child is born

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10
Q

Aniridia

A

Absence of iris

assoc w/
- hemihypertrophy –> Wilms tumor

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11
Q

Hemihypertrophy + Aniridia –> what is going on?

A

Wilms tumor

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12
Q

Branchial cleft cyst

A

failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches)

Usually unilateral

Can become infected

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13
Q

Congenital torticollis

A

Twisted neck
2/2 Injury to SCM during delivery

Tx muscular torticolis with stretching exercises

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14
Q

Breast hypertrophy

A

In neonate, 2/2 increased circ hormones

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15
Q

Supernumerary nipples (polythelia)

A

Occur along mammary line

Assoc w/ renal and cardiovascular anomalies

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16
Q

Poland syndrome

A

Amastia
Pectoalis muscle aplasia
Rib deformities

Webbed fingers
Radial nerve aplasia

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17
Q

Pectus excavatum

A

Usually benign

Surgery for cosmetic reasons

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18
Q

Pectus carinatum

A

Pigeon chest

Usually benign

Surgery for cosmetic reasons

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19
Q

Most abdominal masses in newborn 2/2

A

Renal

  • hydronephrosis
  • PCKD
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20
Q

Umbilical hernias

A

incomplete closure of fascia of umbilical ring

Assoc w/ diastasis recti (disorder defined as a separation of the rectus abdominis muscle into right and left halves)

Usually close spontaneously by 1 yo

Surgery if persists until 3-4yo, > 2cm, causes sx, or enlarges after age 1-2years

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21
Q

Omphalocele

A

Herniation of peritoneum + abdominal contents into umbilical cord

Wrap bowel with sterile saline dressings + plastic wrap
Insert orogastric tube to decompress stomach
Est IV access
Surgery ASAP

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22
Q

Gastroschisis

A

Hernation w/o sac through abdominal wall defect to RIGHT SIDE of umbilical cord

Wrap bowel with sterile saline dressings + plastic wrap
Insert orogastric tube to decompress stomach
Est IV access
Broad spectrum Abx
Then Surgery ASAP

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23
Q

Epispadia vs Hypospadia

A

Epispadia - open on dorsum of shaft of penis (pee into eye)

Hypospaida = opening on ventral side of shaft of penis

  • avoid circumcision so can repair with foreskin
  • ventral hood seen
  • chordee sometimes associated
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24
Q

When fix undescended testes?

A

If not descended by 1 year

Surgery to avoid sterility or malignant degeneration

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25
Q

When fix retractile testes?

A

Don’t need to! It’s just an overactive cermasteric reflex

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26
Q

Hydrocele

A

Collection of fluid in scrotum (tunica vaginalis)

Usually resolves by 1 yr –> if not –> surgery

Dx w/ transillumination

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27
Q

Most common hernias in kids

A

Inguinal (indirect)

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28
Q

Presentation of infants born to Diabetic mothers

A

Ruddy plethoric complexion

Large for gestation age

Hypocalcemia
Hypomagnesemia

Insulin —| surfactant
- prone to respiratory distress

Hypertrophic cardiomyopathy

Hyperbilirubinemia

Polycythemia

Heart defects

  • ASD
  • VSD
  • transposition
  • asymmetric septal hypertrophy
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29
Q

Tx infants of diabetic mothers

A

Control mom’s blood sugar

monitor baby, tx hypoglycemia aggressively

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30
Q

What is counted as small for gestational age/IUGR?

A

Birth wts below 3rd percentile for calculated gestational age

Symmetric (if all ht, wt, etc small) vs asymmetric (if only one part of body is small)

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31
Q

Factors affecting growth of fetus

A

Fetal

  • chromosomal DO
  • TORCH infections
  • congenital anomalies
  • insulin deficiency

Placental

  • infarction
  • separation
  • twin twin transfusion

Maternal

  • toxemia
  • HTN
  • malnutrition
  • smoking
  • EtOH
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32
Q

Which scoring system helps determine gestational age using physical and neuromuscular criteria?

A

Ballard scoring system

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33
Q

Onset of WD in babies for

  • heroin
  • methadone
  • phenobarbital
A

Heroin = 48 hrs after birth

Methadone = several wks (higher risk seizures)

Phenobarbital = 1-2 weeks

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34
Q

Respiratory distress syndrome

  • presentation
  • CXR
A

Tachypnea
Nasal flaring
Retractions
Cyanosis

Condition peaks at 3rd day

CXR

  • reticular granular pattern
  • air bronchograms
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35
Q

Tx RDS

A
  • full term baby

- steroids 48 h before delivery

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36
Q

Transient tachypnea of newborn (TTN)

A

Self limited

Mostly in babies after C section

O2 requirement minimal

CXR = fluid in fissure and prominent vascular markings

2/2 retained fetal lung gluid

37
Q

Meconium aspiration syndrome

A

Tachypnea + hypoxia

CXR = patchy infiltrates
PTX common finding

Tx - mech ventilation, NO, extracorporeal membrane oxygenation

38
Q

Persistent fetal circulation

A

Severe hypoxemia –> pulm vasoconstrict –> R to L shunting through PFO or PDA

Echo = increased pulm A pressures, shunting

Tx

  • hyperventilation to avoid acidosis
  • maintain O2
  • NO
  • ECMO
39
Q

Diaphragmatic hernia

A

Ab contents into cehst –> pulmonary hypoplasia

Scaphoid abdomen _ respiratory distress

Surgery to correct

40
Q

Neonatal jaundice 2/2

A

Unconj bilirubin deposits in skin

41
Q

Physiologic jaundice vs pathologic jaundice vs breast milk jaundice

A

Physio

  • after day 1
  • 12.9-15 mg/dL unconj
  • resolves 1 wk

Anything else outside of this is pathological

Breast milk
- present at 1 wk

42
Q

Tx neonatal jaundice

A

Phototherapy
- isomerizes unconj bilirubin to form more easily excreted

Exchange transfusion

  • remove bilirubin
  • remove circulating Abs to Hgb
43
Q

Complications of neonatal jaundice

A

Unconj:

  • Neurotoxicity
  • Kernicterus (bilirubin accumulate in gray matter)
44
Q

Cause neonatal sepsis

Risk factors

A

Group B strep (#1)
Ecoli
Listeria

UTI
Chorioamniotiis
Prematurity
Prolonged rupture of membranes

45
Q

Signs of neonatal sepsis

A

May not always have fever

Full fontanel palpated on PE

46
Q

Intrapartum antimicrobial ppx if…

A

+ GBS at 3-37 wks

OR

Prev infant w/ invasive dz
GBS bacteruria during preggers
Prematuirty
Rupture of membranes > 18 h
Intrapartum temp > 38 C
Unknown GBS status
47
Q

Tracheoesophageal fistula

A

85% are atretic + fistula between trachea + distal esophagus

Coughing / choking w/ swallowing
Polyhydramnios

Higher risk congenital heart dz (PDA, coarctation of aorta)

VACTERL association

  • vertebrae
  • anus
  • cardio
  • trachea
  • esophagus
  • renal
  • limb buds
48
Q

Duodenal atresia

A

Bilious vomiting w/ feeding

Double bubble on abdominal films

Higher risk in Trisomy 21

Tx surgery

49
Q

Hirschsprung disease

A

Suspect in any newborn fail to pass meconium in 1st 24-48 hrs life

Absence of ganglion cells

Gold st dx - bx rectal mucosa –> no ganglion cell

Tx surgery

50
Q

Necrotizing enterocolitis

A

1 surgical + medical GI emergency in newborn

Related to introduction of feeds

Bloody stools
Apnea
Lethargy

Pneumatosis intestinalis on Xray pathognomonic

Tx

  • medical –> stop feeds, decompress, supportive
  • surgery if necrotic bowel
51
Q

Why are tonic clonic seizures uncommon in neonates?

A

b/c immaturity of NS

52
Q

1 cause neonatal seizures

A

Hypoxic ischemic encephalopathy

12-24 hr present

53
Q

More common cause of seizures in premies

A

Intraventricular hemorrhage

- occurs 1-3 days age

54
Q

Maternal dz affecting baby:

  • cyanotic heart dz
  • hyperparathyroidism
  • SLE
A

Cyanotic heart dz –> intrauterine growth retardation

Hyper PTH –> HYPOcalcemia

SLE –> congenital heart block

55
Q

Maternal drugs affecting neonate

  • phenobarbital
  • sulfonamides
A

Phenobarbital –> vit K deficiency

Sulfas –> displace bilirubin from albumin

56
Q

Maternal intake affecting babies:

  • EtOH
  • isotretinoin
  • phenytoin
  • stilbestrol
  • tetracycline
A

EtOH –> FAS

Isotretinoin

  • facial, ear anomalies
  • congenital heart dz

Phenytoin

  • hypoplastic nails
  • typical facies
  • IUGR

Stilbestrol
- vaginal adenocarcionma

Tetracycline
- enamel hypoplasia

57
Q

Sequence of resuscitation in neonate

A

Position ,suction, tactile stimulation

O2

Bag valve ventilation

Chest compression

Intubation

Meds

58
Q

How old can you be to get heimlich?

A

> 1 yo

< 1 yo = back blows + chest thrusts

NO BLIND FINGER SWEEPS

59
Q

Immunological factors in breasmilk

A

IgA
Lactoglobulin
Maternal macrophages

60
Q

Contraindications to breastfeeding

A

Active or untreated TB (can start MF 2 wks after anti-TB tx)
HIV
Syphilis
Galactosemia
Varicella < 5d earlier or 2 d after delivery

Herpes if active lesions on breast

Drugs - EtOH, nicotine, antineoplastics, ergot alkaloids, Lithium, cyclosporine, street drugs

Mastitis is OK

INFANT galactosemia

61
Q

Cons of whole milk

A

Higher renal solute load –> damaging

Can provoke intolerance of whole milk protein

Increase incidence of Fe deficiency anemia

62
Q

What should you supplement with in kids drinking goat milk?

A

Folate

63
Q

Milk or soy protein induced proctocolitis

A

Exclusive to infants
Presents at 2-8 wks

Non-IgE mediated immuno response to dairy and/or soy proteins

Severe reflux or vomiting
+/- Painless bloody stools
+/-Eczema

Dx/Tx

  • elim milk/soy from diet in mom of breastfed infants
  • hydrolyzed formula in formula fed

Spontaneous resolution by year 1

64
Q

Clubfoot (talipes equinovarus)

A

Equinus + varus of calcaneum and talus
varus of midfoot
Adduction of forefoot

Tx

  • nonsurgical: stretch + manipulate foot, serial plaster casts
  • Start ASAP
  • surgery if no good results between 3-6 mo old, definitely < 12 mo

DDX:

  • metatarsus adductus
  • tibial torsion
  • femoral anteversion
65
Q

1 cause congenital aplastic anemia

A

Fanconi anemia

66
Q

Race tending to have above average birth weights

A

African american boys

67
Q

Risk factors for fetal macrosomia

A

Wt > 4kg

Maternal

  • advanced age
  • diabetes
  • excessive wt gain during preggers
  • preexisting obesity
  • multiparity

Fetal

  • AA or hispanic
  • male baby
  • post term
68
Q

Recommend csection for suspected fetal macrosomia?

A

No

Rate of shoulder dystocia is not different with csection and vaginal

69
Q

Intraventricular hemorrhage

A

Bleeding in germinal matrix
Grades 1-4 (3 and 4 have most long term sequelae)

Mostly in:

  • premature
  • LBW infants

Sx:

  • seizures
  • cyanosis
  • bulging or tense fontanel
  • apnea, bradycardia

Ppx:
- transfontanel ultrasound for all newborns with predisposing risk factors

70
Q

Hyaline membrane disease

A

Usually in preemies

2/2 decreased production and secretion of surfactant –> atelectasis

CXR = fine reticular granularity of lung parenchyma

Can happen right after birth

Tx

  • mech ventilation
  • surfactant admin
71
Q

Transient tachypnea

A

Usually follows uneventful normal term vaginal delivery or C section

LUngs clear
CXR = prominent pulm vascular markings, fluid lines in fissures, overaeration, flat diaphragm, sometimes pleural fluid

72
Q

Persistent pulmonary hypertension of the newborn

A

Should be suspected in all term and post term infants w/ cyanosis with or without fetal distress

Unresponsive hypoxia to 100% O2

73
Q

Meconium aspiration syndrome

A

Usually in term or post-term infants

Patchy infiltrates
Coarse streaking of both lung fields
Increased AP diameter
Flattening of diaphragm

74
Q

When should babies stop having meconium?

A

Day 3 of life

75
Q

Pierre Robin Sequence

A

2/2 to hypoplasia of mandibular area

Tongue is posteriorly located preventing closure of posterior palatal shelves

Micognathia
Glossoptosis
Cleft soft palate

Can be a feature of other syndromes:

  • edwards
  • Stickler (AD, early arthritis, ocular problems)
76
Q

Potter sequence

A

Bilateral renal agenesis –> incompatible with life

Hx of oligohydramnioas

Death by pulmonary hypoplasia

Potter facies:

  • hypertelorism
  • epicanthal folds
  • low set ears
  • micrognathia
  • limb abnormalities
77
Q

Fetal Alcohol syndrome

A

EtOH #1 teratogen to which fetus exposed

Features:
3 main facial dysmorphisms:
- small palpebral fissures
- smooth philtrum
- thin vermillion border
  • growth deficiency / FTT
  • MR
  • irritable, hyperactive
  • fine motor dysfunction
  • microcephaly
  • maxillary hypoplasia
  • short nose

Cardiac:
- septal defects

78
Q

Beckwith-Wiedemann Syndrome

A

Hemihypertrophy

Macroglossia
Omphalocele

Hypoglycemia
Apnea cyanosis
Feeding issues
Seizures

Wilms tumor common

Route US and a-fetoprotein should be performed 6 mo - 6 yo

Survivors of infancy do ok

79
Q

Sotos syndrome

A

Rare genetic DO

Excessive growth during first 2-3 years of life

+/-
Autism
MR
Hypotonia

Tx symptomatic

Prognosis is normal life span

80
Q

Formerly most common cause of hydrous fetalis

A

Rh incompatibility

Now parvovirus can do this

81
Q

How can you figure out if baby in utero has anemia?

A

Blood flow through MCA can correlate with Hg status and know if in utero baby has anemia

82
Q

Bloody vaginal discharge in neonate…what do you do?

A

Reassure

Infants < 3 mo can sometimes get vaginal spotting or bleeding as estrogen from mom is clearing from infant circulation

83
Q

small gestational age infants higher risk for…

A 
Hypoxia
Polycythemia
Hypoglycemia
Hypothermia
Hypocalcemia
84
Q

Reason for increased risk of intraventricular hemorrhage in premie

A

Capillary fragility of subependymal germinal matrix adn immature autoregulation of cerebral blood flow

Screen for this with serial head US!!
- 25-50% cases asymptomatic

85
Q

Ways to reduce incidence of intraventricular hemorrhage

A

Prevent preterm labor

Antenatal admin of maternal steroids

86
Q

Physiologic jaundice

A

Starts day 2 of life –> age 1-2 weeks

Increased unconj bilirubin because:

  • At birth, RBC is increased w/ shorter lifespan –> high Hg turnover and bili production
  • bili clearance is slow at first because hepatic uridine diphosphogluconurate glucuronosyltransferase (UGT) doesn’t reach adult levels until 2 yo
  • –> asian newborns have decreased UGT activity compared to other ethnicities
  • enterhepatic recycling increased in newborns b/c sterile newborn gut can’t break down bilirubin to urobilinogen for fecal excretion –> more bili resorbed and recycled until gut is colonized
87
Q

Birth weight should be regained by age

A

10-14 days

Healthy infants normally lose up to 7% of BW in first 5 days of life - no tx required.

88
Q

Prune belly syndrome

A

Malformation mostly in males

Lax wrinkled ab wall
dilated urinary tract
intraabdominal testicular tissue

Oligohydramnios
Congenital hip dislocation, club feet

NO genetic predisposition

Pediatrics (17 decks)

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