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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
Q

What happens to the ductus arteriosus at birth?

A

Increased oxygen initiates constriction and subsequent closure

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26
Q

Asymmetric IUGR

A

ONLY weight at or below 10th percentile
Head = normal but body is smaller
Late in pregnancy

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27
Q

What occurs in the third trimester for the respiratory system?

A

Surfactant is produced
Surfactant reduces surface tension & stabilizes alveoli
Production sufficient by 34 weeks gestation

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28
Q

What needs to be done immediately after birth to help the infant maintain their temperature?

A

Dry the infant

Provide radiant heat (heating lamp)

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29
Q

Growth transition of a neonate

A

Loss of body weight in the first week

Back to birth weight or more by 2 weeks

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30
Q

Parts of the APGAR Scoring System

A 
Activity
Pulse
Grimace (reflex irritability)
Appearance
Respiration
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31
Q

Important Principles of Neonatal Resuscitation

A

Oxygen
Bulb suctioning
Stimulation
Drying & warming

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32
Q

What conditions are commonly screened for?

A 
Phenylketonuria (PKU)
Galactosemia
Hemoglobinopathies
Hypothyroidism
Hearing screening
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33
Q

Signs of Neonatal Hypothyroidism

A 
Lethargy
Lack of ton
Large tongue
Developmental delays
Mental delays
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34
Q

What is considered small for gestational age (SGA)?

A

Less than the 10th percentile on the growth chart

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35
Q

What is appropriate for gestational age (AGA)?

A

Between the 10th and 90th percentile on the growth chart

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36
Q

What is considered large for gestational age (LGA)?

A

Above the 90th percentile for weight on growth chart

Fetal macrosomia

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37
Q

Symmetric IUGR

A

Can by SGA due to genetics & is normal but small
Early in pregnancy
Whole baby is small

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38
Q

Asymmetric IUGR

A

ONLY weight at or below 10th percentile
Head = normal but body is smaller
Late in pregnancy

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39
Q

Is symmetric or asymmetric associated with a better prognosis for development?

A

Asymmetric

40
Q

Causes of Large Gestational Age

A 
Infant of diabetic mother
Erythroblastosis fetalis
Genetic predisposition
Male fetus
Post-dates gestation
Multiparity
41
Q

Why is the infant of a diabetic mother usually large for gestational age?

A

Extra sugar to metabolize

42
Q

Why is the infant of a diabetic mother at risk for hypoglycemia?

A

Rapid removal of excess blood sugar due to excess insulin production from being hyperglycemia in utero

43
Q

How quickly can and infant of a diabetic mother become hypoglycemic?

A

Within 3 hours

44
Q

In infants with diabetic mothers, how long does continued surveillance need to occur?

A

Until full enteral feedings without IV supplementation for 24-hour period

45
Q

Signs of Hypoglycemia in Neonates

A 
Lethargy
Poor feeding
Irritability
Tremulousness
Jitteriness
Apnea
Seizures
46
Q

Treatment of Infants with Hypoglycemia

A

IV glucose

Dose depends on level of hypoglycemia

47
Q

Respiratory Distress Syndrome (RDS)

A

When there is a deficiency in surfactant
Uncommon 37 weeks and beyond
70% chance at 28-30 weeks gestation

48
Q

Signs of Respiratory Distress Syndrome (RDS)

A 
Tachypnea
Retractions
Nasal flaring
Grunting
Cyanosis
49
Q

Chest X-ray Findings of RDS

A 
Reticulogranular patter ("Ground glass")
Air bronchograms
50
Q

Management of RDS

A 
Oxygen therapy
Monitoring of blood gases
CPAP
Mechanical ventilation
Artificial surfactant replacement
51
Q

Define Meconium Aspirations Syndrome (MAS)

A

Staining of amniotic fluid with meconium in association with respiratory distress
More common in longer gestation

52
Q

Signs of Meconium Aspiration Syndrome (MAS)

A 
Grunting
Nasal flaring
Retractions
Marked tachypnea
Varying degrees of cyanosis
53
Q

Chest X-ray findings of MAS

A

Fluffy infiltrates with alternating areas of lucency

54
Q

Management of MAS

A 
Suctioning of nose & oropharynx
Chest physiotherapy
Oxygen therapy
Blood gases
CPAP
Mechanical ventilation
Routine administration of antibiotics
55
Q

Persistent Pulmonary HTN of Newborn (PPHN)

A

Persistent fetal circulation

Right to left shunting of desaturated blood through fetal pathways in structurally normal heart

56
Q

Transient Tachypnea of the Newborn (TTN)

A 
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
Q

Chest X-ray findings in Transient Tachypnea of the Newborn (TTN)

A

Perihilar streaking and fluid in interlobar fissures

58
Q

Physiology of Jaundice

A

Excessive levels of bilirubin in the blood stream

59
Q

How is Bilirubin Produced?

A

RBCs destroyed in the liver & spleen

Unconjugated and binds to albumin & transported to the liver

60
Q

Excretion of Bilirubin

A

Conjugated in the liver
Excreted in the bile
Eliminated in the urine & feces

61
Q

Conditions for Unconjugated Bilirubin Becoming Neurotoxic

A

Bilirubin induced neurologic dysfunction (BIND)
Acute bilirubin encephalopathy
Kernicterus

62
Q

What is Acute Bilirubin Encephalopathy Characterized by?

A

Hypotonia

Seizures

63
Q

What is Kernicterus?

A

Chronic &permanent sequelae of BIND

64
Q

Why is bilirubin production higher in newborns?

A

Higher hematocrit
Fetal RBCs have a shorter life span
Greater turnover of RBCs

65
Q

Why is there increased enterohepatic circulation?

A

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
Q

Physiologic Jaundice of Newborn

A

Begins 24 hours of life
Returns to normal by 10-12 days
Progresses cephalocaudally

67
Q

Difference Between Direct & Indirect Bilirubin

A

Direct: water soluble by the liver
Indirect: not water soluble

68
Q

What does the Indirect Coomb’s Test, Test For?

A

Presence of blood type antibodies in serum

69
Q

How often should newborns feed?

A

Minimum every 2-3 hours

70
Q

How many wet diapers should a newborn have per day?

A

6-8 wet diapers

71
Q

How many stools per day should a newborn infant have?

A

5-6 stools a day

72
Q

Treatment for Hyperbilirubinemia

A

Frequent feeding
Adequate hydration
Consider phototherapy
Rarely exchange transfusion

73
Q

What does phototherapy in an infants body?

A

Light converts bilirubin to lumirubin which is excreted in the bile and urine

74
Q

Risks of Phototherapy

A

Retinal degeneration
Dehydration
Hyperthermia
Rashes

75
Q

Phototherapy Monitoring

A

Temperature
Hydration status
Total bilirubin levels
Time of exposure

76
Q

What is Exchange Transfusion?

A

Irradiated blood is used to reduce the risk of graft vs. host disease

77
Q

Differentiating Physiologic from Pathologic Jaundice

A

Physiologic jaundice: 7-17 mg/dL

Pathologic jaundice: 17+ mg/dL in full-term infants

78
Q

Other Incidences Where Jaundice is Pathologic

A

Onset in first 24 hours
Rate of increase in 0.5 mg/dL/h
Conjugated serum exceeds 10% of total bilirubin

79
Q

Increased Production of Unconjugated Bilirubin

A 
Hemolytic disease
Inherited RBC membrane defects
G6PD
Sepsis causes he,lysis
Increased RBC breakdown
80
Q

Decreased Clearance of Unconjugated Bilirubin

A

Inherited liver defects

Gilbert syndrome

81
Q

Increased Enterohepatic Circulation

A

Human milk jaundice
Breast milk jaundice
Impaired intestinal motility

82
Q

When does ABO hemolytic disease occur?

A

Mom having type O blood
Baby having type A or B
Within first 24 hours

83
Q

Rh Hemolytic Disease

A

More severe
Antibodies directed against Rh protein
Symptoms in first 24 hours

84
Q

How to prevent Rh hemolytic disease?

A

Rhogam

85
Q

What does Erythroblastosis Fetalis Result In?

A

Fetal or neonatal death without appropriate prenatal intervention

86
Q

Treatment of Rh Hemolytic Disease

A

Prenatally: transfusion of fetus with Rh-negative cells

Post-delivery: phototherapy started immediately

87
Q

Human Milk Jaundice

A 
Prolonged unconjugated hyperbilirubinemia
Uncommon
Etiology: possible beta-glucuronidase
Duration: 3 weeks to 3 months
Peaks: 10-15 days
88
Q

Treatment of Human Milk Jaundice

A

Interrupted nursing for 24-48 hours

89
Q

Breast Milk Jaundice

A

Occurs within 1st week of life

Breastfeeding is difficult

90
Q

Risk Factors for Breast Milk Jaundice

A

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
Q

Treatment of Breast Milk Jaundice

A

Education
Supplemental feeding with pumped breast milk
Phototherapy
Prevention

92
Q

How can total serum bilirubin levels be estimated?

A

Degree of caudal extension

93
Q

Pathologic Cause of a Jaundiced Newborn

A

First 24 hours
Total bilirubin >95th percentile
Rate of total bilirubin >0.2 mg/dL per hour
Jaundice in newborn >2 weeks

94
Q

Common Etiologies of Unconjugated Hyperbilirubinemia With Hemolysis

A

Blood group incompatibility
Sepsis
Polycythemia

95
Q

Common Etiologies of Unconjugated Hyperbilirubinemia Without Hemolysis

A 
Physiologic jaundice
Human milk jaundice
Breast milk jaundice
Internal hemorrhage
Infant of diabetic mother
96
Q

Define Sudden Infant Death Syndrome (SIDS)

A

Unexplained death

97
Q

Risk Factors of SIDS

A

Back sleeping
Bottle feeding
Maternal smoking
Infant overheating

Pediatrics (24 decks)

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