Perinatal Period

Question 1

connects umbilical vein to inferior vena cava

Answer 1

ductus venosus

Question 2

channel of communication between the main pulmonary artery and the aorta

Answer 2

ductus arteriosus

Question 3

opening between the two atria of the fetal heart

Answer 3

foramen ovale

Question 4

What causes foramen ovale to close at birth?

Answer 4

decreased pulmonary vascular resistance causes increased left atrial pressure and eliminates right to left shunting

Question 5

What causes ductus arteriosus to close at birth?

Answer 5

increased oxygen initiates constriction and subsequent closure

Question 6

What is the last system to form in utero?

Answer 6

pulmonary system

Question 7

When is surfactant production sufficient?

Answer 7

by 34 weeks of gestation

Question 8

Normal weight loss in first week after birth

Answer 8

5-10%

Question 9

When do disorders usually develop in newborns?

Answer 9

after baby has been feeding for 2-3 days

Question 10

Commonly screened conditions

Answer 10

PKU, galactosemia, hemoglobinopathies, hypothyroidism, hearing

Question 11

Type of growth restriction that implies event in EARLY pregnancy such as chromosomal abnormalities, drug or alcohol use, or congenital viral infections

Answer 11

symmetric

Question 12

type of growth restriction that implies problem LATE in pregnancy such as pregnancy-induced hypertension, pre-eclampsia or placental insufficiency

Answer 12

asymmetric

Question 13

What should all LGA infants be screened for?

Answer 13

hypoglycemia (40-45 mg/dL)

Question 14

Chance of RDS at 28-30 weeks gestation

Answer 14

70%

Question 15

Signs within 6 hrs of birth that include: tachypnea, retractions, nasal flaring, grunting, cyanosis

Answer 15

RDS

Question 16

CXR findings of RDS

Answer 16

reticulogranular (ground glass) pattern and air bronchograms

Question 17

Managment of RDS

Answer 17

oxygen, CPAP, vent if needed, artifical surfactant replacement

Question 18

Syndrome that is common with postmaturity and fetal distress

Answer 18

Meconium Aspiration Syndrome(MAS)

Question 19

Chest xray reveals fluffy infiltrates with alternating areas of lucency. Pneumothorax or pneumomediastinum and hyperinflation with flattening of diaphragm

Answer 19

Meconium Aspiration Syndrome(MAS)

Question 20

Management of Meconium Aspiration Syndrome(MAS)

Answer 20

gentle suctioning, chest physiotherapy, oxygen, CPAP/vent, abx

Question 21

Caused by sustained elevation in pulmonary vascular resistance
Can be idiopathic or secondary to MAS, RDS, congenital diaphragmatic hernia, hyperviscosity, sepsis, or other causes

Answer 21

Persistent Pulmonary HTN of Newborn (PPHN). aka- persistent fetal circulation

Question 22

Retained fetal lung fluid that often occurs in term or near-term infants and resolves within 24 hrs

Answer 22

Transient Tachypnea of the Newborn

Question 23

CXR shows perihilar streaking and fluid in interlobar fissures

Answer 23

Transient Tachypnea of the Newborn

Question 24

Type of jaundice that begins after 24 hrs of life, peaks around 3 days, and progresses cephalocaudally

Answer 24

physiologic

Question 25

Three mechanisms of physiologic jaundice

Answer 25

bilirubin production is higher, bilirubin clearance is decreased in liver, increased enterohepatic circulation

Question 26

At what serum bilirubin level does jaundice appear?

Answer 26

3-5

Question 27

Tests for presence of blood type antibodies in serum. A positive test results in agglutination of the RBCs

Answer 27

Indirect Coomb’s Test

Question 28

Use of a blue light that converts bilirubin to lumirubin to treat jaundice

Answer 28

phototherapy

Question 29

Used when phototherapy fails or an infant shows signs of bilirubin-induced signs of neurologic-dysfunction (BIND), including “acute-bilirubin encephalopathy” (reversible) and kernicterus (irreversible)

Answer 29

exchange transfusion

Question 30

Type of jaundice that is exaggerated when the milk takes longer to come in
Or when there is mild dehydration

Answer 30

Exaggerated physiologic hyperbilirubinemia or breast milk jaundice

Question 31

How often should a newborn feed?

Answer 31

every 2-3 hrs

Question 32

How many wet diapers should a newborn produce?

Answer 32

6-8 per day

Question 33

Can occur when unconjugated bilirubin reaches high levels and subsequently crosses the blood-brain barrier to damage cells of the brain

Answer 33

kernicterus

Question 34

level that kernicterus can occur in full term newborns

Answer 34

unconjugated bilirubin levels are above 20-25mg/dL

Question 35

How do you distinguish between pre-liver and post-liver problem?

Answer 35

Indirect bilirubin usually indicates a pre-liver problem while direct usually indicates a post-liver problem

Question 36

Peak age of SIDS

Answer 36

2-4 months of age.

Question 37

Risk factors for SIDS

Answer 37

sleeping position, bottle feeding, maternal smoking, infant overheating

Question 38

Treatment for breast milk failure jaundice

Answer 38

Nursing is interrupted for 24-48 hours

Question 39

Administered to any Rh-negative woman after any invasive procedure during pregnancy as well as after any miscarriage, abortion, or delivery of an Rh-positive infant

Answer 39

Rhogam

Question 40

Occurs in Rh-negative women who have NOT received appropriate care with Rhogam. Often results in fetal or neonatal death without appropriate prenatal intervention

Answer 40

Erythroblastosis fetalis (hydrops fetalis)

Question 41

antibodies directed against Rh protein. Can accompany any pregnancy where mom has Rh negative blood

Answer 41

Rh hemolytic disease

Question 42

Occurs in context of mom having type O blood and baby having type A or B. Disease usually is not severe

Answer 42

ABO hemolytic disease