Perinatal Period - Exam 1 Flashcards
Within what time frame is the comprehensive newborn assessment ideally completed in? What 2 things are important to note?
within the first 24 hours
review the baby’s gestational age and growth parameters
What is preterm infant defined as?
born at or before 36 weeks 7 days.
What is late preterm infant defined as?
born between 34 0/7 and 36 6/7 weeks’ gestation
What is term infants defined as?
37 weeks 0 days and 41 weeks 7 days
What is considered a post- term infant?
gestations of 42 weeks 0 days and longer.
What are late preterm infants at higher risks for? What is the standard protocol for late preterm babies?
Hypoglycemia, jaundice, respiratory distress, temperature instability, feeding challenges, and increased rates of readmission compared with a term counterpart.
usually monitored for 48 hours and must pass a car seat trial
What are post-term infants at higher risk for?
Post term neonates are at risk for FGR secondary to uteroplacental insufficiency as well as increased risk of meconium aspiration, intrauterine infection, and dysmaturity.
What is considered small for gestational age? Large for gestational age? What is considered appropriate?
Small for gestational age (SGA): Birthweight less than the 10th percentile.
Large for gestational age (LGA): Birthweight greater than the 90th percentile
Appropriate for gestational age (AGA): Birthweight within the 10th to 90th percentiles.
What are the major differences between symmetrical fetal growth retardation (FGR) and asymmetrical FGR?
Symmetrical FGR/IUGR is typically caused by EARLY FIRST-trimester insults, such as chromosomal abnormalities or congenital infection, resulting in a global growth delay.
Asymmetrical FGR is characteristic of UTEROPLACENTAL INSUFFICIENCY or MATERNAL MALNUTRITION often occurring later in the second or third trimester,
What do asymmetrical FGR usually result in?
“head-sparing” growth delays due to fetal blood flow redistribution to vital organs.
neonates who are LGA have an increased risk for what 3 things?
brachial plexus injuries
clavicular fractures
scalp hematomas
the vascular supply of the umbilical cord is composed of _____ and _____
2 arteries and 1 vein that is usually centrally located
in fetal circulation, what are the arteries of the lungs doing?
arteries of the lungs are constricted and have INCREASED vascular resistance in lungs, INCREASED pressure in the pulmonary arteries (arterioles squeeze down) so LITTLE blood reaches the lungs
What are the 3 fetal shunts that allow blood to bypass certain organs? What is the purpose of these shunts?
ductus arteriosus: connects pulmonary artery and aorta
foramen ovale: in the heart
ductus venosus: inferior vena cava?
purpose is to maximize the oxygenated blood that is being delivered to the heart and brain
towards the end of gestation, what 2 steps do the fetal lungs make to help prepare it for life outside the uterus?
increased production of surfactant
decreased production of fetal lung fluid
during birth, what 3 things help to stimulate respiratory adaptation in the newborn? What do these things help trigger?
- thermal stimulation: abrupt change in temp is detected by thermoreceptors in skin that stimulates the respiratory center in the medulla
- exposure to light and sound
- tactile stimulation for labor contractions as fetus descends through birth canal
all help to trigger the infant’s first breath and the INCREASED the intrapulmonary pressure and forces an remaining lung fluid out
CV adaptation, once the umbilical cord is cut and respirations begin, what does this trigger?
the oxygen content in the blood rises, oxygen is a potent pulmonary vasodilator and pulmonary vascular resistance DECREASES!
CV adaptation, once there is increased venous blood flow in the left atrium, what does this trigger?
promotes the closure of the foramen ovale
CV adaptation, Oxygen is a potent constrictor of ________. What does this prevent
constricts the ductus arteriosus
prevents the blood for shunting from the pulmonary arteries to the aorta like it once did in fetal circulation
CV adaptation, once the umbilical cord is cut, what happens to the ductus venosus?
ductus venosus collapses
INCREASE in systemic vascular resistance and increase systemic oxygen content and the umbilical arteries vasoconstrict
all fetal shunts and umbilical arteries and vein undergo fibrotic changes and close completely
Why is crying helpful in newborns? What is the breathing pattern for a newborn?
it helps promote lung expansion and protect lung volume.
Initially, the breathing pattern is irregular, but soon after birth, modulation of chemoreceptors and stretch receptors makes it rhythmic.
Why is the breathing pattern for preterm infants different?
may not be rhythmic soon after birth because of poor respiratory drive, weak muscles, flexible ribs, surfactant deficiency, and impaired lung liquid clearance
The ______, _________ muscles, and ______ muscles aid in adequate ventilation. the _______ is the primary muscle used during quiet breathing.
diaphragm
intercostal and accessory
abdominal
diaphragm
physiologic adaptation of the newborn, It is a complex process involving ion exchange across the pulmonary and airway epithelium, and ______ uptake plays an important role in alveolar fluid clearance. _______, ______, and _____ play an important role in regulating the activity of this uptake
sodium
Glucocorticoids
catecholamines
oxygen
_______, ______ and _______ help processes the removal of fetal lung fluid from the air space through _________, _______ and ________
Glucocorticoids, catecholamines, oxygen
pulmonary epithelial, vascular, and lymphatic channels.
During fetal life, pulmonary vascular resistance is (low/high) and pulmonary blood flow is (low/high), with most of the blood shunting across the ______ from the right side of the heart into the _____.
high
low
ductus arteriosus
aorta
The ______ is the preferred vascular access point for IV medications
umbilical vein
during the first 30 seconds of life, what position would you want to see the baby in?
FLEXION of the extremities
want to see frog position
If the baby is not breathing or crying, what should you do?
º Stabilize: warm, dry, stimulate, position airway, clear secretions
º Tactile stimulation is typically performed while drying and suctioning infant. Should take no more than 30 seconds
º Suction should only be performed if necessary. If bulb suction needed clear mouth before nose
º Start the APGAR monitor clock and begin resuscitation
When suctions a newborn, what order should it be preformed in?
clear MOUTH first, then nose
30 seconds- 1 min of life, if labored breathing or persistent cyanosis, what do you do next?
Position and clear airway
Place SpO2 monitor on right hand or wrist: needs to be above 92%
provide supplemental O2 prn
consider CPAP
is baby is apnea/gasping for air and HR is less than 100 bpm, what do you do next?
Begin Positive Pressure Ventilation (PPV), typically with bag-mask ventilation at a rate of 40-60 breaths per minute
place on o2 monitor and continuous ECG
if baby is apena/gasping and HR is below 100 bpm and PPV is not effective what do you need to check? What is the next step?
If positive pressure ventilation is not effective it can be addressed using the mnemonic MR. SOPA:
- M-Mask adjustment
- R- Reposition
- S- Suction
- O- Open the mouth
- P- Increase the pressure
- A- Change the airway
This may mean transitioning from non-invasive ventilation to a laryngeal mask or endotracheal intubation
If the baby fails PPV and O2 is not improving and the HR is below 60, what do you do next?
intubate and start chest compression if the HR is below 60 despite adequate PPV for 30 seconds
What is the recommended ratio for newborn CPR? What is the position? What should you do next with supplemental Oxygen?
When providing chest compressions to a newborn a 3:1 ratio is preferred (3 compressions before or after each inflation). 30 inflations and 90 compressions per minute
º Recommended compression technique is hands encircling chest while the thumbs depress sternum.
FiO2 should be increased to 100%
If the babies HR is persistently below 60 BPM despite CPR, what is the next step?
administer IV epinephrine in a 1: 10,000 ratio
What is the venous dose of IV epinephrine? What is the endotracheal tube dose?
The venous dose (through umbilical vein or intraosseous line) is 0.01- 0.03mg/kg with a normal saline flush
Endotracheal tube dose is 0.05-0.1 mg/kg and can be bagged in (no saline flush)
If the baby is still not responding to resuscitation despite respiratory and cardiac efforts, what else needs to be considered?
hypoglycemia
hypovolemia
potential pneumothorax
What is the tx for hypoglycemia in a newborn?
Correct with 2 mL/kg of D10 W in an infusion over 5 minutes
What is the tx for hypovolemia in a newborn?
normal saline
if substantial blood loss: Volume of 10 mL/kg given IV over 5 to 10 minutes
If no response to resuscitation efforts in _______ may consider termination of efforts
20 minutes
what is considered a successful rescitation?
Once HR increases to > 100 bpm and there are effective spontaneous respirations then can d/c PPV
Infants ≥ 36 weeks estimated gestational age who received resuscitation should be examined for signs of _____ to determine if they meet criteria for therapeutic hypothermia.
HIE
hypoxic ischemic encephalopathy
What are risk factors for neonatal respiratory distress?
c-section deliveries
decreased gestational age
low birth weight
male sex
maternal asthma
maternal gestational diabetes
What is considered a normal respiratory rate for a newborn? What is consider tachypnea?
30-60 bpm
60-80 bpm
What is the underlying cause of transient tachypnea of the newborn TTN?
TTN is a disease of the lung parenchyma with pulmonary edema due to delayed resorption of the alveolar fluid, leading to decreased lung compliance and tachypnea
Describe the mechanism of fetal lung fluid clearance.
What will the chest xray look like with a pt with TTN?
CXR revealing hyperexpansion, perihilar densities with fissure fluid, or pleural effusions, diaphragm flattening
When does TTN usually present? What diagnostics should you order? What is the tx?
within the first 2 hours of life and can continue up to 72 hours
Pulse oximetry, physical examination and chest radiograph, blood cultures, CBC and CRP to rule out other causes
self-limiting, supportive care
What medication is contraindicated in TTN?
º Furosemide (Lasix) may cause weight loss and hyponatremia, and it is contraindicated despite the excess pulmonary fluid present in newborns with TTN.
When does the risk for meconium aspiration increase? What date should a female be induced?
after 41 weeks gestation
herefore after 39 weeks, healthy women should consider induction if no contraindications exist
What is meconium? Where is it produced?
Meconium is the sterile substance that is produced in the fetus’ intestines prior to birth and becomes the newborn’s first stool after birth
Why is meconium aspiration dangerous?
cause airway obstruction
inactivate surfactant as well as trigger inflammatory changes
What is the diagnostic criteria for meconium aspiration?
Diagnostic criteria for MAS include respiratory distress in the infant plus one of the following:
º Meconium present in the amniotic fluid or the trachea if intubated
º Chest x-ray: shows bilateral fluffy densities with hyperinflation
What will the chest xray show of a pt with meconium aspiration?
fluffy densities throughout both lungs fields
What is the tx for meconium aspiration?
º Newborn dried, warmed and stimulated
oxygen supplementation
+/- suction
full neonatal resuscitation if baby is not improving
______ is NOT recommended in MAS
routine intubation
______ is the leading respiratory disorder for PRETERM infants
Respiratory distress syndrome
Why are preterm infants at the highest risk of RDS?
insufficient amounts of surfactant present in their lungs.
The younger the gestational age of the infant, the higher the incidence of RDS.
º Retractions, nasal flaring, cyanosis, grunting, tachypnea
º Symptoms typically get worse by the third day
What am I? What are the dx that should be ordered?
respiratory distress syndrome
º Pulse oximetry
º Chest radiographs
º Blood gas, blood culture, CRP, glucose level
º Echocardiogram (to rule out cardiac problems with similar symptoms).
What will the chest xray should of a newborn with respiratory distress syndrome?
“ground glass” appearance
What is the management for respiratory distress syndrome?
Prenatal administration of glucocorticoids (given to mother) and postnatal surfactant (given to baby) therapy for early preterm infants
º Ventilation, nasal continuous positive air pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) is used for respiratory support after birth, with supplemental oxygen if required for hypoxemia
What is the etiology of persistent pulmonary hypertension of a newborn (PPHN)? What does it result in?
Occurs when pulmonary vascular resistance (PVR) remains abnormally elevated after birth
Resulting in right to left shunting of blood through fetal circulatory pathways (foramen ovale, ductus arteriosus)
What is the end result of a newborn with PPHN? What age groups does this primarily occur in?
This in turn leads to severe hypoxemia that may not respond to conventional respiratory support
Occurs primarily in term or late preterm infants (gestational age greater than 34 weeks)
What are two associated prenatal factors that are linked to PPHN?
intrauterine/perinatal asphyxia
in utero exposure of SSRIs during SECOND half of pregnancy
What are the 3 underlying mechanisms of PPHN?
What are 3 clinical findings associated with PPHN?
Most neonates present within first 24 hours of life with signs of respiratory distress including tachypnea, retractions, grunting, and cyanosis
May have meconium staining of skin and nails
Cardiac exam may shows harsh systolic murmur at lower left sternal border
______ confirms dx of PPHN. What will it show?
echocardiogram
demonstrates normal cardiac anatomy with pulmonary hypertension
What diagnostic tests should you order on a newborn with PPHN?
ABGs
pulse ox
chest xray
echo
blood cultures and empiric antimicrobial therapy
What is the management for PPHN?
General supportive cardiorespiratory care (O2 ventilation, fluid therapy, correction of acidosis)
In severe cases, pulmonary vasodilator agents (inhaled nitric oxide, sildenafil)
ECMO if all other therapies fail
_______ is used in PPHN in VERY SEVERE cases if all other management strategies fail. These kids are at increased risk for ________
ECMO
developmental delay
______ is one of the most common reasons for admission to neonatal units in term infants worldwide.
neonatal hypoglycemia
according to the AAP what should the ideal glucose concentration be between 0-4 hours hold? for a pt between 4-24 hours old? What is important to note about BS values?
0-4 hours: blood glucose > 40 mg/dl
4-24 hours: blood glucose > 45 mg/dl
No established threshold has been identified despite many studies looking at a hypoglycemic value at which to intervene.
Describe what happens to the healthy term infants BS level in the first 24 hours of life.
BS will decrease in the first 1-2 hours of life, with the lowest glucose level generally reached in the first 2-4 hours of life but will stabilize around 4-6 hours at 45-70mg/dL
natural glucose drop is usually short lived and asymptomatic and is easily compensated through other energy sources
What are risk factors for neonatal hypoglycemia?
DM mother
LGA
SGA
late preterm babies
babies exposed to labetalol or terbutaline
babies with certain genetic syndromes
T/F: all babies get screen for NH during the first 24 hours after birth
FALSE, routine glucose screening is NOT recommended in an asymptomatic, healthy, tern newborn
What 3 categories of high risk infants warrant screening for NH even if asymptomatic?
preterm and late preterm infants
LGA or SGA
infants born to DM mother
If you have a high suspicion for NH, what 2 things should you order?
POC glucose and NEED TO CONFIRM with serum glucose testing
If the glucose levels are unable to normalize after 24 hours, what should you consider?
consider the diagnosis of hyperinsulinemic hypoglycemia, which is the most common cause of persistent hypoglycemia in the newborn period.
What is considered physiologic jaundice in a newborn? Unconjugated or conjugated?
UNconjugated that arises AFTER 24 hours old and peaks in 3-4 days but may persist for 1 week
Why is the underlying cause behind physiologic jaundice?
This jaundice occurs due to catabolism of red blood cells (RBCs) (the half-life of RBCs in neonates is 90 days compared with 120 days in adults), increased RBC volume, immature hepatic conjugation, and delayed establishment of feedings, leading to reduced excretion of bilirubin and increased enterohepatic circulation of bilirubin.
**If a newborn becomes jaundice within the first 24 hours, what should that make you think?
PROMPTLY need to investigate a pathologic etiology
What are the 13 risk factors for hyperbilirubinemia?
lower gestational age
jaundice within the first 24 hours
Predischarge bilirubin close to phototherapy threshold
hemolysis
high rate of bilirubin rise
High rate of rise = increase of 0.3 mg/dL/hour in the first 24 hours of life or more than 0.2 mg/dL/hr after the first 24 hours
phototherapy prior to discharge
Parent or sibling who had phototherapy or exchange transfusion
G6PD deficiency
exclusive breastfeeding with suboptimal intake
scalp hematoma or significant bruising
trisomy 21
big infant of a DM mother
What are the neurotoxicity risk factors?
Gestational age < 38 weeks (the more premature, the greater the risk),
Albumin < 3 g/dL,
Isoimmune hemolytic disease, G6PD or other hemolytic conditions,
Sepsis, significant clinically
Instability in the previous 24 hours.
When should you assess a newborn for jaundice? If they notice jaundice, what should you do next?
at least every 12 hours
TcB or TSB should be measured
transcutaneous bilirubin (TcB)
total serum bilirubin (TSB)
What are the treatment guidelines with regards to Tcb and TSB? Which one should be used when deciding phototherapy and escalation of care?
TSB should be measured if the TcB exceeds or is within 3 mg/dL of the phototherapy treatment threshold or if the TcB is ≥15 mg/dL
TSB is the definitive test
What is considered significant hyperbilirubinemia and needs to be evaluated?
A conjugated or direct bilirubin level greater than 1 mg/dL (>17.10 µmol/L) when the TSB level is less than 5 mg/dL (<85.52 µmol/L) or 20% of TSB if the TSB level is greater than 5 mg/dL (>85.52 µmol/L) is significant and needs evaluation
______ should be considered to evaluate for evidence of biliary atresia or a choledochal cyst.
Fasting abdominal ultrasonography
When does breastfeeding jaundice occur? What is the underlying cause? What is the tx?
occurs within the first week from inadequate feeding
Intestinal hypomotility and poor elimination of bilirubin in stool are underlying causes for breastfeeding jaundice
supplementation
When does breast milk jaundice occur? What is the underlying cause? What is the tx?
Occurs AFTER the first week and can persist for up to 3 weeks.
Inhibition of uridine diphosphate glucuronosyltransferase by pregnanediol and deconjugation of conjugated bilirubin by β-glucuronidase in breast milk are possible underlying causes.
As long as the baby is adequately feeding and have good weight gain no need to change anything
How is it determined when to tx jaundice in a newborn? what 3 things are needed to make the decision?
compare their age in hours against the TSB against a national set curve, and neurotoxicity risk factors as long as the levels are below the curve no need to treat
age in hours, TSB levels and number of neurotoxicity risk factors
What are the 2 treatments for hyperbilirubinemia? Which one is more important?
phototherapy WITHOUT IV fluids
feeding!!! because bilirubin is excreted through the stool
What are the different phases of neonatal acute bilirubin neurotoxicity?
maybe memorize this chart?? maybe not
When is it safe to d/c phototherapy?
Discontinuing phototherapy is an option when the TSB has decreased by at least 2 mg/dL below the hour-specific threshold at the initiation of phototherapy.
What is rebound hyperbilirubinemia? What are the 3 risk factors?
A TSB that reaches the phototherapy threshold for the infant’s age within 72-96 hours after discontinuing phototherapy.
Gestational age < 38 weeks
- < 48 hours old at the start of phototherapy
- Hemolytic disease
How is G6PD inherited? What race?
x-linked recessive
Genetic ancestry from Sub-Saharan Africa, Middle East, Mediterranean, Arabian Peninsula and Southeast Asia may be helpful in predicting risk.
If you have a high clinical suspicion for G6PD, when do you need to do repeat testing?
need to repeat testing 3 months post discharge
_______ is the MC cause of hemolytic disease in the newborn. What is the underlying cause? When does it happen?
ABO INCOMPATIBILITY
Results from transplacental passage of maternal antibodies that destroy fetal red cells
Happens when a mother’s blood type is O, and her baby’s blood type is A or B. generally, only seen in the FIRST child
If maternal antibody screen is positive or unknown, the infant should have a _______ and the infant’s ______ should be determined as soon as possible.
direct antiglobulin test (DAT)
blood type
When is RH incompatibility likely to occur? What happens next?
The father passes down Rh positive to the baby, the mother is Rh negative, Fetal red blood cells pass into mother’s circulation
IgG antibodies develop, cross placenta causing significant hemolysis
in RH incompatibility, anemia stimulates ________ to produce and release ______ into the fetal circulation
fetal bone marrow
immature RBCs
resulting in erythroblastosis fetalis
What is the tx for RH incompatibility?
What is the lab findings consistent with polycythemia? What is the consequence of polycthemia?
Hematocrit > 65% (venous) at term
Consequence of polycythemia is hyperviscosity with decreased perfusion of the capillary beds. Renal vein, other deep vein, or artery thrombosis is a severe complication
______ is the most common cause of benign neonatal polycythemia
Delayed cord clamping
When is cord clamping or milking of the umbilical cord not a good thing?
When cord clamping is delayed at birth or the umbilical cord is “milked,” infants obtain a placental transfusion resulting in approximately a 20-30% increase in blood volume and 50% increase in red cell volume conflicting studies
What is the screening for POLYCYTHEMIA?
capillary heelstick hematocrit
if capillary heelstick hematocrit is greater than ____, what do you do next?
If greater than 68%, do venous
When does polycythemia need tx? What is the tx?
only when the pt is symptomatic!!!
Isovolemic partial exchange transfusion with normal saline ,“dilutes” the blood, effectively decreasing the hematocrit
What are the different types of routine newborn screenings?
metabolic testing
newborn hearing screening
Universal newborn screening for critical congenital heart disease (CCHD)
infants presents with an ACUTE crisis of any of the following, what should you be thinking? acidosis, hyperammonemia, hypoglycemia
think inborn errors of metabolism (protein, lipids or carbohydrate metabolism)
sudden onset of irritability, lethargy, seizures or sepsis with LACK OF FEVER, (aka non specific symptoms) ______ need to be high on your differential
inborn errors of metabolism
What are the top 4 differentials you should be thinking of if an infant presents with lethargy?
inborn error of metabolism
sepsis
non-accidental trauma
congenital heart disease
What is PKU a deficiency of? If left untreated, what will happen? What is the tx?
What is the acute treatment for PKU?
stop all protein intake!!
fluids
dextrose to promote an anabolic state
tx seizures if present
What is the presentation of classic galactosemia? What 3 things is it associated with?
starting lactose formula in a newborn results in metabolic decompensation
associated with liver dysfunction, jaundice and coagulopathy
Classic galactosemia is a deficiency of ________. Can also be associated with _______ and _______. If not diagnosed promptly, can lead to ________
galactose -1- phosphate uridyltransferase (GALT)
E coli sepsis and cataracts
intellectual disabilities
How are most thyroid issues in infants identified? How does it normally present?
through the newborn screening
Presentation: Typically is a diffusely enlarged, symmetrical goiter
How will neonatal hypothyroidism present?
many will have no other symptoms outside of goiter; if severe, may have persistent jaundice or myxedema.
How will hyperthyroidism present in a neonate?
irritability, hyperphagia, poor weight gain, tachycardia, hepatomegaly, and splenomegaly
On top of TSH and free T4, what additional thyroid lab should also be checked? ______ should be performed in each case of a congential goiter.
Check Thyrotropin Receptor Antibodies (TRAbs)
ultrasound
if the TRAbs is negative, what is the two most likely causes?
If negative, the cause is likely inborn error of thyroid hormone metabolism or maternal excess iodine ingestions
What is the next step if the kid fails the newborn hearing screening test?
kids needs to be rescreened within 3 months
What two infants categories should also be screened?
infants admitted to the NICU longer than 5 days
infants readmitted to the hospital for hyperbilirubinemia requiring exchange transfusion or sepsis
what are the “pass” metrics for the critical congenital heart defects screening?
greater than or equal to 95% in the right hand or foot and less than 3% difference between RIGHT hand and foot
what is gastroschisis? What direction when compared to the umbilicus?
Defect in the abdominal wall with protruding abdominal organs (typically the small intestine, but can include the stomach and colon) WITHOUT a protective membranous sac,
right of the umbilicus
What are the risk factors for gastroschisis?
teratogens
poor prenatal care
maternal infection
young maternal age
What is an omphalocele?
Defect in the abdominal wall with protruding abdominal organs through the umbilicus however HAS thin membranous SAC overlies the procuring organs (small intestine, liver, stomach, spleen, bladder, uterus, ovaries)
What are the major differences between gastroschisis and omphalocele when comparing location and +/- sac
for both gastroschisis and omphalocele _______ will be elevated in the mother’s blood
(alpha- fetoprotein) AFP
(alpha- fetoprotein) AFP enters the maternal circulation and its levels increase with ______ or _____
gestational age
number of fetuses
What are 5 causes of elevate maternal serum AFP levels?
dating errors
underestimation of gestational age
multiple gestation
neural tube defect
abdominal wall defects
What is esophageal atresia present? What is it?
Present in first hours of life with copious secretions, DROOLING, choking, cyanosis, respiratory distress - hx of polyhydramnios (excess amniotic fluid)
Characterized by a blind esophageal pouch w/wo a fistulous connection between proximal or distal esophagus and airway
How do you diagnosis esophageal atresia? What is the tx?
Confirmed with chest x ray after careful placement of NG tube to point of resistance is met (tube seen in blind pouch)
Suction to drain secretions, elevate head of bed, IV glucose and fluids
Definitive tx: surgical ligation of fistula and ends of esophagus anastomosed
esophageal atresia is associated with a defect in ____________
trachoesophageal septum
most obstructions in infants are ______. That are often caused by ______ during development
bowel atresias
ischemic event
________ is the most common surgical emergency seen in neonate. How will it present?
intestinal obstruction
abdominal distention, vomiting and no stools in the first 24 hours
What are the 2 common types of intestinal atresia? What dz are they each linked to?
duodenal and jejunoileal
Duodenal atresia is linked with Down syndrome
Jejunoileal atresia is linked with cystic fibrosis.
What are 2 risk factors for intestinal atresia?
smoking
premature birth
both types of intestinal atresia will result in _______ and _______. What will the xray look like?
blind pouch and intestinal obstruction
There will be dilation proximal to the obstruction, causing abdominal distension, while no air can be found distal to the obstruction
What “sign” is usually present on xray for duodenal atresia?
double bubble sign
duodenum and nearby stomach both become filled with air
What “sign” is usually present in jejunal atresia?
triple bubble sign
duodenum, stomach and jejunum are all filled with air
______ is present in babies with intestinal atresia before brith and _____ and ______ are present after birth
polyhydramnios: (excessive amniontic fluid surrounding the fetus because it isnt “swallowing” properly due to intestinal atresia)
vomiting and difficulty feeding
if the obstruction is proximal to the major duodenal papilla, what will the vomit look like? distal?
proximal : non-bilious vomiting.
distal: bilious vomiting
What are risk factors for neural tube defects?
inadequate folic acid
maternal diabetes
maternal obesity
maternal hyperthermia
exposure to valproate
_______ is the absence of structures derived from the forebrain and skull, forehead is absent or shortened. ______ doesn’t close properly and the forebrain fails to develop
Anencephaly
anterior neuropore
What am I? Why is polyhydroamnios present?
anencephaly
the part of the brain that is responsible for neural control of swallowing is absent which leads to increased amniotic fluid in the sac
What is another name for spina bifida? What is it caused by?
MENINGOMYELOCELE
Caused by failure to close the posterior spinal portion of the neural tube, often affects the lumbar region
what will you find on PE of a pt with spina bifida? What diagnostic study should you order?
cystic mass containing neural tissues protrudes from a bony defect in the vertebral arches
US
What am I?
spina bifida occulta
What am I? What are my distinguishing features?
meningocele
meninges NOT spinal nerves slip between vertebrae
What am I? What are the distinguishing features?
myelomeningocele
spinal cord and meninges protrude out of vertebrae
What 3 things produce maternal serum alpha-fetoprotein?
fetal yolk sac
GI tract
liver
______ will be elevated in all neural tube defects except ______
maternal alpha- fetoprotein
spina bifida occulta AFP will be normal
When can you test for neural tube defects? increased ______ confirms the diagnosis of NTD
serum testing at 16-18 weeks
increased acetylcholinesterase in amniotic fluid
What is the tx for neural tube defects? How can NTD be prevented?
delivery via C-section and then sx for closure
will need lifelong course of PT, OT and orthopedic management
folate!!!!
