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Pediatrics > Perinatal period > Flashcards

Perinatal period Flashcards

1
Q

What do you need to do for determing a newborn assessment

A

Growth and gestiational age
within the first 24 hours

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2
Q

Difference between preterm, late preterm (near-term), term, post term

A

preterm = before completion of 36 weeks and 7 days (gestational age)
late preterm = between 34 weeks 0 days and 36 weeks and 6 days
term infants = 37 weeks to 41 weeks

might not be accurate

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3
Q

What is a risk factor for most conditions in neonates

A

premature

almost ALL of these conditions

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4
Q

what is early discharge?

A

Discharge before 24 hours

late preterm and preterm should be there for at least 48 hours

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5
Q

What is a carseat challenge

A

put in carseat for an hour and check pulse ox for apnea or hypoxia
parents should get CPR certified if positive

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6
Q

What can hypoxemia lead to in late term babies

A

meconium aspiration

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7
Q

Define small for gestational age large for gestational age appropriate for gestational age

A

SGA < 10 %
LGA > 90%

AGA = 10-90% is what you want!

A = approprioate
L = large

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8
Q

FGR = fetal growth

What is the order of delayed growth/

A

Weight
height
head circumference (poor prognosis, because it has been going on for a while)

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9
Q

why is symmetrical IUGR a worry?

A

Congenital oftentimes d/t 1st trimester insult that effects weight, height, and head circumfrence

will remain small

assymetric = more likely to grow out of it because it likely did not effect the head circumference

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10
Q

Intrauterine o2 to after birth conversion

A

through placenta

after birth - adaptation to new environment (respiratory and CV system)

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11
Q

Intrauterine lungs

A

Low O2 environment causes constriction of smooth muscle and increased vascular resistance not enough for gas exchange. Alveoli is filled with fluid

Placenta is the source of o2 and nutrition

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12
Q

What is the blood flow of fetal atrial circulation

A

Right atrium is the oxygenated blood
IVC
Right atrium
significant increase in pulmonary pressure makes it to where there is no BF from atrium to lung, and the shunt allows blood to move from RA to LA

Ductus arteriorsus allows it to bypass the lungs

Left is deoxygenated, goes to the placenta for exchange

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13
Q

What is the respiratory adaptation neonates go through

A

increase production of surfactant to prevent pulmonary collapse (liquid and protein)
increase production of fetal lung fluid (lungs start removing fluid out of alveoli and into the interstitial space)

Baby cries, the lungs fill with fluid, and then

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14
Q

What stimulates the cry of a baby?

A
  1. thermal stimulation because of major drop of temperature which triggers respiratory center of the medulla
  2. light and sound = sitimulates medulla
  3. tactile from contractions
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15
Q

What are the CV adaptations

A

O2 content in blood increases (vasodilates)
decreases pulmonary pressure to help circulation
blood can now flow from right ventricle to the lungs

ductus arteriorsus now closes d/t no longer having a right to left shunt

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16
Q

What is a common respiratory response for an hour or so after birth

A

hyperventilation - common physiologic reasons

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17
Q

what two things are needed for normal breathing of a newborn?

A

Surfactant
Muscle tone of respiratory muscles

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18
Q

What percentage of babies need resuscitation?

A

<1%

even if the baby is not crying (not vigorous) you do not intubate

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19
Q

What is the preferred vascular access for IV access in babies?

A

umbilical vein

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20
Q

As soon as a baby is delivered, what three things should you ask

A

is baby term
is the baby have muscle term
crying

if no, do tactile stim, clear secretion, keep patient warm

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21
Q

What is the golden hour of a babies life

A

First hour should be with skin to skin of mother

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22
Q

If cyanosis persists, what is the step ladder approach

A

reposition the baby to open airway
then pulse ox on right extremity (because it is preductal)
provide O2 with PPV (bagging the baby)
CPAP

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23
Q

If apnea/gasping and HR 100 BPM after PPV

A

MRSOPA

Mask adjustment
Reposition

Suction
Open the mouth
Pressure increase
Airway change (meaning you might need to intubate)

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24
Q

When do you do chest compression ALWAYS

A

<60 BPM right away (also less than 100 should still be performed)

3:1 compressions per breath (instead of 30:1 in adults)

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25
Q

If a HR <60 BPM persists, what do you do? What if this is still the case?

A

EPI through IV line

if not help - then it might be a 2ndary cause hypoglycemia (give sugar), hypovolemia (from hemmorage)

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26
Q

When do you stop ventilation or PPV?

A

> 100 BPM

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27
Q

What is the common pulse ox of a 1 min, 2, 3, 4, 5, and 10 min neonate?

A

1 min = 60-65%
+ 5 % each minute after

10 min = 85-95%

increases

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28
Q

What are we worried about the most for post resusication care?

A

Hypoxic encephalgopahy leading to neonatal seizure

Need to be monitored in NICU for sugar levels

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29
Q

What are risk factor of respiratory distress

A

c-section, decreased gestational age, low birth weight

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30
Q

What is the most benign respiratory distress syndrome

A

TTN

transient tachypnea up to 60 BPM

can happen in term infants

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31
Q

What is the difficulty with TTN

A

clearing fluid from the airspace in TERM infant

32
Q

What does TTN look like on xray

A

hyperexpansion and fissures with fluid d/t fluid retention

33
Q

What is the treatment of TTN

A

Resolves on it’s own
sometimes o2 for 4 hours
should resolve in 12-24 hours
self limited
can order CBC or CRP

34
Q

What is CI in TTN

A

Lasix

35
Q

What is meconium aspiration

A

Meconium stain

post term is MC, which is why you should induce labor after 41 weeks

36
Q

What can cause early release of poop

A

hypoxia from stress relaxes anal sphincter causing you to poop and meconium stain (thick liquid that gets stuck in the airways and stops surfactant)

37
Q

What does a CXR look like in meconium

A

ateletcasis d/t collapse from no surfactant. Fluffy lungs.

can lead to pneumothorax from collapsed lung

eventually leads to pulmonary HTN which is a downhill prognosis (want to intubate before this )

38
Q

Management of meconium

A

O2 supplementation
intubation is not recommended (follow process)
neonatal protocol

39
Q

What is respiratory distress syndrome seen in?

A

Pre term (inadequate surfactant)

TTN is term (poor abs of fluid)

40
Q

What is the s/s of respiratory distress syndrome? CXR?

A

Same as TTN (tachypnea)

ground glass/ sand. Very hazy

41
Q

What is the management of RTS

A

corticosteroids to release surfactant in babies

42
Q

What is persistent pulmonary hypertension of the newborn

A

most severe

leads to hypoxemia

43
Q

What is the pathophys of pulmonary hypertension

A

vasconstrction 2ndary to hypoxia
prenatal increase in pulmonary vascular smooth muscle
hypoplagia of lungs

44
Q

How to diagnose pulmonary hypertension

A

ABGs
Pulse ox
CXR

r/o sepsis

45
Q

Goal of pulmonary persistent hypertension

A

decreasing the pulmonary arteriole pressure
supportitve care
severe cases lead to mental delay

46
Q

what is neonatal hypoglycemia most common

A

within first 24 hours

47
Q

what is the hypoglycemia protocol for peds

A

0-4 hours > 40
4-24 hours > 45

no number to treat - treat by symptoms

48
Q

what are the MC risk factors of hypoglycemia in peds

A

DM mother
LGA
SGA (not enough sugar storage)
preterm babies
babies exposed to certain meds

49
Q

what symptoms do you look for hypoglycemia

A

lethargy
high pitch cry
exafggerated reflex
seizure
irritability
apnea

the same as sepsis!

50
Q

lab tests for hypoglycemia

A

screening for high risk babies asap

51
Q

What are the high risk groups that need glucose screening

A

preterm
LGA SGA
DM mother

with POC glucose with heel stick confirmed with serum glucose

52
Q

What is the treatment of low blood glucose w/ symptoms

A

IV glucose

53
Q

What is the treatment of low blood glucose w/OUT symptoms

A

feed and recheck within an hour

54
Q

What is neonatal jaundice seen

A

Increased RBCs break down and causes jaundice

appears AFTER 24 hours (if within 24 hours it is physiologic)

55
Q

RF for hyperbilirubinemia

A

lower gestational age (premature)
jaundice w/in 24 hours
predischarge bilirubin close to phototherapy treatment
hemolysis
high rate of bilirubin rise
phototherapy prior to discharge
parent or sibling with phototherapy
G6PD
exclusively breast fed
scalp hematoma
downsyndrome

56
Q

What are the neurotoxicity RF

A

premature
low albumin level
sepsis
instability w.in the last 24 hours

57
Q

How to diagnose jaundice

A

visual
check transcutaenous bilirubin w/in 24 hours

unconjugated bilirubin elevation

58
Q

Breastfeeding vs breast milk jaundice

A

Breastfeeding: dehydration from not sufficient milk
Breast milk jaundice: takes month for it to go away inhibits uridine diphosphate gluco

59
Q

When do you consider phototherapy of jaundice

A

neurotoxic or no neurotoxic RF

based on gestational age in hours (because physiologic bilirubin increases with age)

60
Q

What are the clinical findings of neonatal acute bilirubin neurotoxicity

A

stiff

61
Q

When do you discontinue phototherapy?

A

Once below the curve of treatment

rebound can occur though

when you do so, give neonatal jaundice education

should transfer info to the primary care physician

62
Q

G6PD

A

x linked recessive (males)
africa
during stress

63
Q

MCC of jaundice

A

immune hyemolytic ABO incompatbility

d/t maternal IgG attacking

64
Q

RH negative or positive for mother an cause hemolysis

A

Rh negative mother

should get RhoGAM

65
Q

What is polycythemia in neonates

A

HCT > 65%

this can increase viscosity and decrease perfusion to major organs

66
Q

What can cause polycythemia in neonates

A

Larger twin hogging blood from sibling

67
Q

what is the treatment of polycythemia

A

only symptoms
use transfusion with saline

68
Q

what does a heal stick look for?

A

Based on state guidlines and saves cost/lives

need to be able to treat
needs to be easily missed
relatively common

69
Q

What are the major inborn errors

A

problem with metabolism typically

70
Q

If you have a lethargic patient

A

inborn error
sepsis
trauma

71
Q

What is PKU

A

accumulation of phe to the brain

lifelong restriction of these proteins

energy from dextrose fluids should be given

72
Q

What is e coli sepsis in neonates until proven otherwise?

A

galcatosemia

73
Q

what is galcatosemia

A

jaundice
elevated PT/PTT
E coli sepsis
cataracts

74
Q

When should babies be screened for hearing loss

A

< 1 month

if they did not pass, they should check within 3 months

if they fail again, they need to be referred by 6 months of ages

75
Q

What is a failed congential heart screening

A

pulse ox of LE and UE of >3%
or pulse ox of < 95%

need to get an echo

Pediatrics (7 decks)

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