perinatal period Flashcards
umbilical vessels have how many veins and arteries
1 vein 2 arteries
oxygen rich is in the vein
consequence if PDA does not close
pulmonary edema
2 ways to medically close PDA
- ibuprofen or acetaminophen
- severe– ligation or device closure
2 ways to medically close PDA
- ibuprofen or acetaminophen
- severe– ligation or device closure
by ____ week, breast fed babies should be back to their birth weight
2nd
staff can do this to allow for continued blood flow from the placenta to the baby during delivery
delayed cord clamping
effects of umbilical cord clamping
increases systemic vasc. resistance leading to DV constriction
very preterm week range
week 20 to 32
moderate preterm range
week 32 to 34
late preterm range
34 - 37 week
increases end-expiratory lung volume
grunting
tx for apnea d/t prematurity
caffeine
tx for asphyxia d/t placental abruption or umbilical cord compression
therapeutic hypothermia
3 causes of apnea
prematurity
asphyxia
infection
first ____ days of life is considered neonate
28
most important part of neonatal resuscitation
ventilation
breath:compression ratio in neonatal resus
3:1
normal temp for neonatal
97.7-99.5
Below the 10th percentile for weight causing thermoregulation issues & hypoglycemia
small for gestational age (SGA)
Feed Baby! Dextrose gel, D10 Bolus followed by infusion
tx for SGA
Above the 90th percentile
most commonly seen in infants of diabetic moms
LGA
normal sugar for babies
45-90 mg/dL
- RDS, PDA
- necrotizing enterocolitis (NEC)
- intraventricular hemorrhage (IVH)
prematurity conditions
exclusively in preterm infants; air within wall of the bowel; can progress very fast and cause death
necrotizing enterocolities (NEC)
tx for NEC
no feeding for 14 days, surgery
no good way of preventing it; typically happens within first 72 hrs of premature birth
intraventricular hemorrhage (IVH)
Qualitative or quantitative surfactant deficiency
respiratory distress syndrome
premature white male
c-section
Gestational Diabetes
Multiple Gestation Pregnancy
fam hx
these are risk factors for?
respiratory distress syndrome
3 ways to manage respiratory distress syndrome
- maternal steroids in moms w/ preeclampsia or preterm labor
- respiratory support
- surfactant right away
first intestinal discharge of newborn; contains epithelial cells, fetal hair, mucus, bile
meconium
Intrauterine stress may cause passage of meconium in amniotic fluid before delivery; fetus aspirates it during gasping in response to hypoxia or hypercapnia
meconium aspiration syndrome (MAS)
airway obstruction–> trapped air–> hyperinflammation–> chemical pneumonitis–> inactivation of surfactant production and activity
pathophys of MAS
3 ways to manage MAS
resp support PRN
maybe surfactant
abx for 48hrs incase they get pneumonia
- Failure to achieve or sustain the normal decrease in pulmonary vascular resistance at birth, causing Profound cyanosis
- In conjunction with lung parenchymal dz or systemic illness but can be idiopathic
persistent pulmonary HTN of newborn (PPHN)
- breathing fast but doesn’t need resp. support & eating well
- caused by Delayed resorption of fetal lung fluid by the pulmonary lymphatic system
transient tachypnea of the newborn (TTN)
in addition to starburst pattern of white lines shooting from center on CXR, what else confirms diagnosis of TTN
quick resolution in 24 hrs
venous HgB of less than 13.3 g/dl indicates what
baby anemia
most common type of anemia in babies
hemorrhagic
- Immune hemolysis
- Sepsis
- Congenital erythrocyte defect: metabolic enzyme deficiency, thalassemia, hemoglobinopathies
- Systemic diseases: galactosemia
these cause what type of anemia
hemolytic anemia
- Congenital: Diamond-Blackfan syndrome (congenital hypoplastic anemia) congenital leukemia
- Acquired: rubella, syphilis infections; aplastic crisis/anemia
these cause what type of anemia
hypoplastic
Venous Hgb >20g/dL (Hct >68%) indicates what
polycythemia
- Rarely occurs in premature newborns
- Associated with IDM
- Increased incidence of jaundice
polycythemia
what is the tx for polycythemia and when do you tx it
- partial to double volume exchange transfusion
- tx only if sx and only on central Hgb results
list some sx of polycythemia (9)
lethargy, hypotonia, irritability, jitteriness, weak suck, vomiting, seizures, tremulousness, apnea, desaturation
2 ways to manage neonatal jaundice
- blue light phototherapy (oxidizes bilirubin)
- exchange transfusion if 1+ neurotoxicity risk factor
- Initially reversible neurologic sequelae of untreated indirect hyperbilirubinemia that precedes the development of the most devastating complication, kernicterus
acute bilirubin encephalopathy
- Initial phase: lethargy, hypotonia, poor suck
- Progresses: moderate stupor, irritability, increased tone, arching, fever
- Next stage: deep stupor, coma, increased tone, inability to feed, seizures
these describe the phases of what
acute bilirubin encephalopathy
(note that it goes from hypotonia to hyper tonia)
- jaundice that starts after 24hrs of life, peaks around 3 days of life (5 days in premature)
- tends to progress from head to toe
jaundice WITHIN first 24 hrs is pathologic
exaggerated physiologic jaundice
- Prolonged indirect hyperbilirubinemia that can last up to 3 weeks to months with no evidence of hemolysis or incompatibility d/t breast milk
breast milk jaundice
- IgG antibodies cross the placenta and bind to and destroy RBCs
- Fetal sensitization (positive direct Coombs) occurs only in 3-4%
- Risk factors present in 12-15% of pregnancies
ABO incompatibilty
Accounts for 2/3 observed cases of hemolytic disease of the newborn but symptomatic dz occurs in less than 1%
ABO incompatibility
jaundice in first 24 hrs; usually mild anemia
ABO incompatibility
3 ways to tx ABO incompatibility
- phototherapy
- rare– exchange transfusion
- rare– IVIG
prognosis is excellent
- Incompatibility between Rh(-) mothers previously sensitized to Rh (D) antigen, and her Rh (+) fetus
- IgG cross the placenta and destroy RBCs of infants with a Rh-antigen
Rh isoimmunization
when is RhoGAM prophylaxis given to prevent maternal immune system to the Rh antigen
28 weeks gestation
Rh isoimmunization vs ABO incompatibility– which is more common and which is more severe
- ABO is more common
- Rh is more severe
sx of jaundice in first 24hrs, anemia, hydrops fetalis
what is the condition
RH isoimmunization
3 ways to manage Rho antepartum
- RhoGAM
- intrauterine transfusion
- IVIG
3 ways to manage Rho postpartum (for baby)
- phototherapy
- exchange transfusion
- IVIG
bilirubin that binds to albumin for transport in blood and its able to cross BBB and cause issues
indirect/unconjugated bilirubin
bilirubin that is conjugated into water-soluble molecule in liver and gets excreted
Direct/conjugated bilirubin
- Choreoathetoid cerebral palsy
- High-frequency sensorineural hearing loss
- Palsy of vertical gaze
- Dental enamel hypoplasia
- Cognitive deficits can be severe
- Mortality as high as 10%
kernicterus implications
consequence of untreated severe hyperbilirubinemia
kernicterus
