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Pediatrics > Perinatal Period > Flashcards

Perinatal Period Flashcards

1
Q

What is considered preterm gestation?

A

Less than 37 weeks

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2
Q

What is considered preterm gestation?

A

Less than 37 weeks

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3
Q

What is considered gestation?

A

37 to 42 weeks

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4
Q

What is considered post-term gestation?

A

> 42 weeks

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5
Q

What is the neonatal period?

A

The first 28 days of life (+ preterm time period)

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6
Q

What does the perinatal period include?

A

20 weeks GESTATION to 1 month after birth

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7
Q

Where is the ductus venosus?

A

Connects umbilical vein to inferior vena cava

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8
Q

What is the ductus arteriosus?

A

A channel of communication between the main pulmonary artery and the aorta

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9
Q

What is the foramen ovale?

A

Opening between the two atria of the fetal heart

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10
Q

What does the ductus venosus do?

A

Allows oxygenated blood directly from mom to enter circulation (bypasses liver) via inferior vena cava

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11
Q

What does the ductus arteriosus do?

A

Allows majority of blood which would enter pulmonary vasculature to bypass directly to the aorta

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12
Q

What happens with the shunts at birth?

A

Increased systemic vascular resistance
Decreased pulmonary vascular resistance
Closes shunt and eliminates shunting

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13
Q

What happens with the shunts at birth?

A

Increased systemic vascular resistance
Decreased pulmonary vascular resistance
Closes shunt and eliminates shunting

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14
Q

What is considered gestation?

A

37 to 42 weeks

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15
Q

What is considered post-term gestation?

A

> 42 weeks

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16
Q

What is the neonatal period?

A

The first 28 days of life (+ preterm time period)

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17
Q

What does the perinatal period include?

A

20 weeks GESTATION to 1 month after birth

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18
Q

Where is the ductus venosus?

A

Connects umbilical vein to inferior vena cava

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19
Q

What is the ductus arteriosus?

A

A channel of communication between the main pulmonary artery and the aorta

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20
Q

What is the foramen ovale?

A

Opening between the two atria of the fetal heart

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21
Q

What does the ductus venosus do?

A

Allows oxygenated blood directly from mom to enter circulation (bypasses liver) via inferior vena cava

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22
Q

What does the ductus arteriosus do?

A

Allows majority of blood which would enter pulmonary vasculature to bypass directly to the aorta

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23
Q

What does the foramen ovale do?

A

Allows oxygenated blood from mom which enters the right atrium to be channeled directly to left atrium and then into the left ventricle, aorta, and system

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24
Q

What happens with the shunts at birth?

A

Increased systemic vascular resistance
Decreased pulmonary vascular resistance
Closes shunt and eliminates shunting

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25
What happens to the ductus arteriosus at birth?
Increased oxygen initiates constriction and subsequent closure
26
Asymmetric IUGR
ONLY weight at or below 10th percentile Head = normal but body is smaller Late in pregnancy
27
What occurs in the third trimester for the respiratory system?
Surfactant is produced Surfactant reduces surface tension & stabilizes alveoli Production sufficient by 34 weeks gestation
28
What needs to be done immediately after birth to help the infant maintain their temperature?
Dry the infant | Provide radiant heat (heating lamp)
29
Growth transition of a neonate
Loss of body weight in the first week | Back to birth weight or more by 2 weeks
30
Parts of the APGAR Scoring System
``` Activity Pulse Grimace (reflex irritability) Appearance Respiration ```
31
Important Principles of Neonatal Resuscitation
Oxygen Bulb suctioning Stimulation Drying & warming
32
What conditions are commonly screened for?
``` Phenylketonuria (PKU) Galactosemia Hemoglobinopathies Hypothyroidism Hearing screening ```
33
Signs of Neonatal Hypothyroidism
``` Lethargy Lack of ton Large tongue Developmental delays Mental delays ```
34
What is considered small for gestational age (SGA)?
Less than the 10th percentile on the growth chart
35
What is appropriate for gestational age (AGA)?
Between the 10th and 90th percentile on the growth chart
36
What is considered large for gestational age (LGA)?
Above the 90th percentile for weight on growth chart | Fetal macrosomia
37
Symmetric IUGR
Can by SGA due to genetics & is normal but small Early in pregnancy Whole baby is small
38
Asymmetric IUGR
ONLY weight at or below 10th percentile Head = normal but body is smaller Late in pregnancy
39
Is symmetric or asymmetric associated with a better prognosis for development?
Asymmetric
40
Causes of Large Gestational Age
``` Infant of diabetic mother Erythroblastosis fetalis Genetic predisposition Male fetus Post-dates gestation Multiparity ```
41
Why is the infant of a diabetic mother usually large for gestational age?
Extra sugar to metabolize
42
Why is the infant of a diabetic mother at risk for hypoglycemia?
Rapid removal of excess blood sugar due to excess insulin production from being hyperglycemia in utero
43
How quickly can and infant of a diabetic mother become hypoglycemic?
Within 3 hours
44
In infants with diabetic mothers, how long does continued surveillance need to occur?
Until full enteral feedings without IV supplementation for 24-hour period
45
Signs of Hypoglycemia in Neonates
``` Lethargy Poor feeding Irritability Tremulousness Jitteriness Apnea Seizures ```
46
Treatment of Infants with Hypoglycemia
IV glucose | Dose depends on level of hypoglycemia
47
Respiratory Distress Syndrome (RDS)
When there is a deficiency in surfactant Uncommon 37 weeks and beyond 70% chance at 28-30 weeks gestation
48
Signs of Respiratory Distress Syndrome (RDS)
``` Tachypnea Retractions Nasal flaring Grunting Cyanosis ```
49
Chest X-ray Findings of RDS
``` Reticulogranular patter ("Ground glass") Air bronchograms ```
50
Management of RDS
``` Oxygen therapy Monitoring of blood gases CPAP Mechanical ventilation Artificial surfactant replacement ```
51
Define Meconium Aspirations Syndrome (MAS)
Staining of amniotic fluid with meconium in association with respiratory distress More common in longer gestation
52
Signs of Meconium Aspiration Syndrome (MAS)
``` Grunting Nasal flaring Retractions Marked tachypnea Varying degrees of cyanosis ```
53
Chest X-ray findings of MAS
Fluffy infiltrates with alternating areas of lucency
54
Management of MAS
``` Suctioning of nose & oropharynx Chest physiotherapy Oxygen therapy Blood gases CPAP Mechanical ventilation Routine administration of antibiotics ```
55
Persistent Pulmonary HTN of Newborn (PPHN)
Persistent fetal circulation | Right to left shunting of desaturated blood through fetal pathways in structurally normal heart
56
Transient Tachypnea of the Newborn (TTN)
``` Retained fetal lung fluid Distress from birth Requires mild to moderate oxygen Occurs in term or near-term infants Resolves in 12-24 hours ```
57
Chest X-ray findings in Transient Tachypnea of the Newborn (TTN)
Perihilar streaking and fluid in interlobar fissures
58
Physiology of Jaundice
Excessive levels of bilirubin in the blood stream
59
How is Bilirubin Produced?
RBCs destroyed in the liver & spleen | Unconjugated and binds to albumin & transported to the liver
60
Excretion of Bilirubin
Conjugated in the liver Excreted in the bile Eliminated in the urine & feces
61
Conditions for Unconjugated Bilirubin Becoming Neurotoxic
Bilirubin induced neurologic dysfunction (BIND) Acute bilirubin encephalopathy Kernicterus
62
What is Acute Bilirubin Encephalopathy Characterized by?
Hypotonia | Seizures
63
What is Kernicterus?
Chronic &permanent sequelae of BIND
64
Why is bilirubin production higher in newborns?
Higher hematocrit Fetal RBCs have a shorter life span Greater turnover of RBCs
65
Why is there increased enterohepatic circulation?
Beta-glucuronidase in the infant's gut acts on the bilirubin to make it unconjugated and then it is reabsorbed into the circulation again
66
Physiologic Jaundice of Newborn
Begins 24 hours of life Returns to normal by 10-12 days Progresses cephalocaudally
67
Difference Between Direct & Indirect Bilirubin
Direct: water soluble by the liver Indirect: not water soluble
68
What does the Indirect Coomb's Test, Test For?
Presence of blood type antibodies in serum
69
How often should newborns feed?
Minimum every 2-3 hours
70
How many wet diapers should a newborn have per day?
6-8 wet diapers
71
How many stools per day should a newborn infant have?
5-6 stools a day
72
Treatment for Hyperbilirubinemia
Frequent feeding Adequate hydration Consider phototherapy Rarely exchange transfusion
73
What does phototherapy in an infants body?
Light converts bilirubin to lumirubin which is excreted in the bile and urine
74
Risks of Phototherapy
Retinal degeneration Dehydration Hyperthermia Rashes
75
Phototherapy Monitoring
Temperature Hydration status Total bilirubin levels Time of exposure
76
What is Exchange Transfusion?
Irradiated blood is used to reduce the risk of graft vs. host disease
77
Differentiating Physiologic from Pathologic Jaundice
Physiologic jaundice: 7-17 mg/dL | Pathologic jaundice: 17+ mg/dL in full-term infants
78
Other Incidences Where Jaundice is Pathologic
Onset in first 24 hours Rate of increase in 0.5 mg/dL/h Conjugated serum exceeds 10% of total bilirubin
79
Increased Production of Unconjugated Bilirubin
``` Hemolytic disease Inherited RBC membrane defects G6PD Sepsis causes he,lysis Increased RBC breakdown ```
80
Decreased Clearance of Unconjugated Bilirubin
Inherited liver defects | Gilbert syndrome
81
Increased Enterohepatic Circulation
Human milk jaundice Breast milk jaundice Impaired intestinal motility
82
When does ABO hemolytic disease occur?
Mom having type O blood Baby having type A or B Within first 24 hours
83
Rh Hemolytic Disease
More severe Antibodies directed against Rh protein Symptoms in first 24 hours
84
How to prevent Rh hemolytic disease?
Rhogam
85
What does Erythroblastosis Fetalis Result In?
Fetal or neonatal death without appropriate prenatal intervention
86
Treatment of Rh Hemolytic Disease
Prenatally: transfusion of fetus with Rh-negative cells | Post-delivery: phototherapy started immediately
87
Human Milk Jaundice
``` Prolonged unconjugated hyperbilirubinemia Uncommon Etiology: possible beta-glucuronidase Duration: 3 weeks to 3 months Peaks: 10-15 days ```
88
Treatment of Human Milk Jaundice
Interrupted nursing for 24-48 hours
89
Breast Milk Jaundice
Occurs within 1st week of life | Breastfeeding is difficult
90
Risk Factors for Breast Milk Jaundice
Inadequate education from clinicians & lactation consultants Inadequate documentation of latching on by infant Inadequate recording of urine output & stool pattern Mother/infant breast feeding complications Short hospital stays First time mothers
91
Treatment of Breast Milk Jaundice
Education Supplemental feeding with pumped breast milk Phototherapy Prevention
92
How can total serum bilirubin levels be estimated?
Degree of caudal extension
93
Pathologic Cause of a Jaundiced Newborn
First 24 hours Total bilirubin >95th percentile Rate of total bilirubin >0.2 mg/dL per hour Jaundice in newborn >2 weeks
94
Common Etiologies of Unconjugated Hyperbilirubinemia With Hemolysis
Blood group incompatibility Sepsis Polycythemia
95
Common Etiologies of Unconjugated Hyperbilirubinemia Without Hemolysis
``` Physiologic jaundice Human milk jaundice Breast milk jaundice Internal hemorrhage Infant of diabetic mother ```
96
Define Sudden Infant Death Syndrome (SIDS)
Unexplained death
97
Risk Factors of SIDS
Back sleeping Bottle feeding Maternal smoking Infant overheating

Pediatrics (23 decks)

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