Perinatologia Flashcards
APGAR evauation
FC:
0 - none
1 - /= 100bpm
Resp:
0 - none
1 - irregular
2 - good scream
Muscle Tone:
0 - flacid
1 - some flexion
2 - very active
Irritabilidad refleja (cateter en fosas nasales, estimulacion tactil)
0 - no response
1 - gesticulacion
2 - cough, sneeze, scream
Color:
0 - blue , pale
1 - pink body, blue extremeties
2 - all pink
Classifying with Weight and Age of Gestacion
GEG?
>
AEG?
PEG?
tabla de ?? gives you prognosis
when do you check for apgar
first min
5th min
if low continue
Valsalva maneuver
performed by moderatley forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon.
Downes Score
Respiratory rate
0 - 60
1 - 60-80
2 - >80 or apnoiec episode
Cyanosis
0 - none
1 - in room air
2 - in 40% oxygen
Retractions
0 - none
1- mild
2 - moderate to severe
Grunting
0 - none
1 - audible without a stethoscope
2 - audible withhout a stethoscope
Air entry (crying)
0 - clear
1 - delayed or decreased
2 - barely audible
valora SDR
La evaluacion se realiza en todo neonato despues de los primeros 10 minutos de vida y se repite si el puntaje es igual o mayor de 4 puntos.
NO PUEDE OCUPARSE ESTAS ESCALAS PARA EVALUAR UN RECIEN NACIDO APNEICO O INTUBADO.
EN AMBAS,UNA PUNTUACION MAYOR DE 4 PUNTOS INDICA INTERVENCION Y UNA PUNTUACION MAYOR DE 7 PUNTOS,INDICA UNA INSUFICIENCIA RESPIRATORIA CON PARO RESPIRATORIO INMINENTE Y LA NECESIDAD DE DAR VENTILACION AISITIDA.
> 4 Downes score
> 4 = respiratory dificulty:: must monitor arterial gases
> 8 Downes Score
Respiratory failure (not the same as insuficiency)
respiratory insufficiency vs. respiratory failure
Respiratory insufficiency: The condition in which the lungs cannot take in sufficient oxygen or expell sufficient carbon dioxide to meet the needs of the cells of the body. Also called pulmonary insufficiency.
Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide or both cannot be kept at normal levels. A drop in the oxygen carried in blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia.
CPAP vs. positive pressure vs. mechanical ventilation
CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open. CPAP typically is used by people who have breathing problems, such as sleep apnea
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing.
Positive pressure ventilation: The provision of air under pressure by a mechanical respirator, a machine designed to improve the exchange of air between the lungs and the atmosphere. The device is basically designed for administering artificial respiration, especially for a prolonged period, in the event of inadequate spontaneous ventilation or respiratory paralysis.
Ballard Maturational Assessment, Ballard Score, or Ballard Scale
a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby.
Neuromuscular
Physical maturity
Total – correlates to weeks gestation in table
5-26wks 10 - 28wks 15 - 30wks 20 - 32wks 25 - 34wks 30 - 36wks 35 - 38wks 40 - 40wks 45 - 42wks 50 - 44wks
Neuromuscular Maturity Posture Square window Wrist flexion Flex hand to the forearm using gentle pressure – avoid rotation of the wrist Angle decreases as gestational age increases -1 >90 0 90 1 60 degrees 2 45 3 30 4 0
Arm recoil
Supine position
Arms flexed for five seconds – then fully extended and released
Scores based on extent arms return rapidly to full flexion
0 180 degrees 1 140-180 2 110-140 3 90-110 4 50 mm No crease 1 Faint red marks 2Anterior transverse crease only 3 Creases anterior 2/3 4 Creases over entire sole
Breast bud -1 imperceptible 0 - barely percptible 1 - flat areola, no bud 2stippled areola 1-2mm bid 3 raised areola 3=4mm bud 4 full areola 5-10mm bud
Genitals Male -1 - Scrotum flat, smooth 0 - Scrotum empty Faint rugae 1 - Testes in upper canal Rare rugae 2Testes descending Few rugae 3 - Testes down Good rugae 4Testes pendulous Deep rugae
Genitals Female -1 - Clitoris prominent Labia flat 0 - Prominent clitoris Small labia minora 1 - Prominent clitoris Enlarging minora 2- Majora and minora equally prominent 3 - Majora large Minora small 4 Majora cover clitoris and minora
Usher’s criteria
Prematuro
Pelo: escaso,fino ,despegable
Cartilago auricular:blando,retroceso lento
Nodulo mamario: ausente o 4-7 mm
Genitales: Femenino(labios menores protruyentes)
Masculino: testiculo en canal o no descendidos,escroto hipopigmentado.
Pliegues plantares:ausentes o uno en 1/3 anterior,surcos finos.
RN a termino
Pelo: grueso y abundante
Cartilago auricular:grueso,regresion rapida.
Nodulo mamario: 7-10 mm
Genitales:Femenino(labios mayores cubren los menores)
Masculino: escroto hiperpigmentado,testiculos descendidos y pendulos.
Pliegues plantares: ocupan todo el pie,surcos profundos.
RN Postermino Piel brillante,reseca,descamada “Mirada fija y penetrante” RN “alerta” Piel teñida de meconio Uñas largas y con meconio Ombligo “reseco” y con meconio Todo lo anterior indica insuficiencia placentaria
Silverman - Anderson Score
a system for evaluation of breathing performance of premature infants. It consists of five items: (1) chest retraction as compared with abdominal retraction during inhalation;
0 - ritmico y coordinado
1 - torax imovil
2 - balancin
(2) retraction of the lower intercostal muscles;
0 - none
1 - discrete
2 - acentuado y marcado
(3) xiphoid retraction;
0 - none
1 - discrete
2 - marked
(4) flaring of the nares with inhalation; and
0 - none
1 - discrete
2 - marked
(5) grunting on exhalation. Each of the five factors is graded 0, 1, or 2. The sum of these factors yields the score. Adequate ventilation is indicated by a 0, severe respiratory distress is indicated by a score of 10.
0 - none
1 - audible with stethoscope
2 - audible at a distance
causes of respiratory diffuclty in el RN
SDR
pneumonia
…
peso bajo
peso muy bajo
peso extremeadamente baja
ABORTO
Causas de hiperbillirubinemia
Jaundice occurs because your baby’s body has more bilirubin than it can get rid of. Bilirubin is a yellow substance that’s made when the body breaks down old red blood cells. It leaves the body through urine and stool. When you’re pregnant, your body removes bilirubin from your baby through the placenta.
Physiologic jaundice is the most common form of newborn jaundice. The baby’s liver plays the most important part in bilirubin breakdown. The type of bilirubin that causes the yellow discoloration of jaundice is called unconjugated or indirect bilirubin. This form of bilirubin is not easily removed from the baby’s body. The baby’s liver changes this unconjugated bilirubin into conjugated or direct bilirubin, which is easier to excrete. The liver of a newborn baby is immature, so the job of conjugating and removing bilirubin is not done completely well. This causes an elevation of bilirubin, which results in the yellow discoloration of the baby’s eyes skin. As the breakdown of red blood cells slows down, and the baby’s liver matures, the jaundice rapidly disappears. When jaundice is due to these factors alone, it is termed physiologic jaundice.
Neonatal jaundice can be seen in cases of maternal-fetal blood type incompatibility. The mother’s body will actually produce antibodies that attack the fetus’s blood cells. This causes a breakdown of the red blood cells and thus an increased release of bilirubin from the red cells.
Healthy red blood cells can be destroyed in a condition called hemolysis.
Polycythemia is a condition in which a child is born with an excess of red blood cells.
A large scalp bruise called a cephalohematoma can occur during the birthing process. Such a bruise is really a collection of clotted blood just beneath the skin surface. As the body naturally breaks down this clotted blood, a large amount of bilirubin is released at once. This sudden excess in serum bilirubin may be too much for the baby’s liver to handle, and jaundice will develop.
Sometimes a baby swallows blood during birth. This swallowed blood is broken down in the baby’s intestines and absorbed into the bloodstream. Just as the excess blood from a blood clot will cause a rise in serum bilirubin, so will this.
A mother who has diabetes may cause a baby to develop neonatal jaundice.
Crigler-Najjar syndrome and Lucey-Driscoll syndrome are also conditions that can cause jaundice
complicaciones de hiperbilirubinemia
The complications associated with neonatal jaundice occur when bilirubin levels reach toxic levels, and the bilirubin gets into the central nervous system and damages the brain. The brain toxicity can either be reversible (early acute bilirubin encephalopathy) or the damage may be permanent and irreversible (kernicterus). Permanent damage may lead to cerebral palsy, deafness, and intellectual impairment
Tabla de Buthani
measures gravedad de ictericia
tx de ictericia
fototerapia
interpretation of Capurro
La Edad gestacional se calcula sumando todos los puntajes parciales + 204,y se divide entre 7
Ejemplo: 76+204
———- = 40 semanas
7
Haroldo capurro
Air Shape Size of mammary gland Shape of Nipple Texture of Skin Pliegues Plantares
Si no tiene bascula calculo del peso al nacer utilizando
la medida de pie
