PPS COMPILED SAMPLEX [PART 4 OF 5] - 652 items total with Rationale Flashcards
“Which should be given attention after birth?
a. Cephalhematoma
b. Caput succedaneum
c. Tongue thrusting”
A
“Nelson 21st p869
Caput succedaneum, causd by scalp pressure from the uterus, cervix, or pelvis, appears as a circular boggy area of edema with indistinct borders and often with overlying ecchymosis.
A cephalhematoma presents as a well-circumscribed fluid filled mass that does not cross suture lines. Unlike caput succedaneum, cephalhematoma is often not present at delivery but develops over the 1st few hr of life.
Both cephalhematoma and caput succedaeneum must be distinguished from a subgaleal hemorrhage, which is not restricted bby the boundaries of the sutures and therefore is larger and more diffuse. Subgaleal hemorrhage requires prompt recognition because extensive bleeding may result in hypovolemic shock, with estimated mortality up to 20% “
Cause of symmetric facial palsy
Hypoplasia of 7th nerve nucleus: Mobius syndrome
“Newborn with asphyxia, cyanotic at birth. Responds intermittently to 100% 02 via hood. CXR is normal. What to consider?
a. Congenital heart disease
b. PPHN
c. Respiratrory distress syndrome”
B
“Nelson 21st p2395
The hyperoxia test is one method of distinguishing cyanotic CHD from pulmonary disease. Neonates with cyanotic CHD are usually unable to significantly raise their arterial partial pressure of O2 (PaO2) during administration of 100% O2. This test is usually performe dusing a hood rather tha nasal cannula or FM, to best guarantee delivery of almost 100% O2 to the infant.
If the PaO2 rises above 150mmHg during 100% O2 administration, an intracardiac right-to-left shunt can usually be excluded. In patients with pulmonary disease, PaO2 usually increases significantly with 100% O2 as ventilation-perfusion inequalities are overcome.
Hyperoxia in many heart conditions is profound and constant, whereas in respiratory disorders and PPHN, PaO2 often varies with time or changes in ventilator management. Hyperventilation may improve the hypoxia in neonates with PPHN and only occasionally in those with cyanotic CHD. “
“Period of teratogenesis?
a. 1-14 days
b. 14 days to 9 weeks
c. 9 weeks”
B
“Nelson 21st p886
Overall, only 10% of anomalies are caused by recognizable teratogens. The time of exposurue that is most likely to cause injury is usually during organogenesis at <60 days of gestation. “
“Chorioamionitis greatest risk factor with this etiology:
a. E. Coli
b. Listeria
c. Group B strep”
C
“Nelson 21st p 1011
Chorioamnionitis has been historically used to refer to microbial invasion of the amniotic fluid, often as a result of prolonged rupture of the chorioamniotic membrane for >18hr. Prematurity (<37wk) is associated with a greater risk of early-onset sepsis, especially with group B streptococcus “
“Skin to skin contact benefits except:
a. Maternal flora
b. Warmth
c. Facilitates breastfeeding
d. Prevents anemia”
D
"Which is true of cord clamping A. 2 cm above base B. Milking C. Both of the above D. None of the above"
A
"True of caput except A. Crosses midline B. Subperiosteal bleeding C. With edema D. Resorption at 3-4 days"
B
”"”Nelson 21st p869
Caput succedaneum, causd by scalp pressure from the uterus, cervix, or pelvis, appears as a circular boggy area of edema with indistinct borders and often with overlying ecchymosis.
A cephalhematoma presents as a well-circumscribed fluid filled mass that does not cross suture lines. Unlike caput succedaneum, cephalhematoma is often not present at delivery but develops over the 1st few hr of life.
Both cephalhematoma and caput succedaeneum must be distinguished from a subgaleal hemorrhage, which is not restricted bby the boundaries of the sutures and therefore is larger and more diffuse. Subgaleal hemorrhage requires prompt recognition because extensive bleeding may result in hypovolemic shock, with estimated mortality up to 20% “””
"White pearly papules with erythematous base. A. Milia B. Erythema toxicum C. Pustular melanosis D. None of the above"
B
“Neonatal Skin Lesions
1. Sebaceous hyperplasia - minute profuse yellow-white papules in forehead, nose, upper lip, cheeks
- Milia - superficial epidermal inclusion cysts with laminated keratinized materia, firm pearly opalescent white cyst 1-2mm diamter on face and gingivae and in the middle of palate (Epstein pearls)
- Cutis marmorata - evanescent lacy reticulated red and blue cutaneous vascular pattern over most of the body surface when infant is cold
- Harlequin color change - autonomic vascular regulation instability, longitudinal half pale, half red
- Nevus simplex (salmon patch) - small pale pink ill defined vascular macule on glabella eyelids, upper lip, nuchal area
- Dermal melanocytosis (mongolian spots) - blue or slate gray macular lesions with variably defined margins most common on sacral area
- Erythema toxicum - benign self limited evanescent eruption; firm yellow-white 1-2mm papules or pustules with surrounding erythematous flare; eosinophilic infiltrates
- Neonatal pustular melanosis - transient benign self-limited dermatosis; evanescent superficial pustules, ruptured pustules with colarette of fine scale, hyperpigmented macules; polymorphonuclear infiltrates
(Nelson 21st 3453-3455)”
"Most characteristic of shaken baby A. Retinal hemorrhages B. Clavicular fracture C. Limb fracture D. None of the above"
A
“Abusive head trauma / shaken baby syndrome - poor neck muscle tone and relatively large heads of infants make them vulnerable to acceleration-deceleration forces from shaking.
Features of AHT (sensitive especially when occurring together)
- Subdural hematoma
- Retinal hemorrhages - multiple, involve >1 layer of retina and extend to periphery; traumatic retinoschisis
- Diffuse actional injury
(Nelson 21st p104)”
"Lacy reticulated skin changes of a neonate exposed to cold surroundings. A. Harlequin color change B. Erythema toxicum C. Neonatal sebaceous hyperplasia D. Cutis marmorata"
D
“Neonatal Skin Lesions
1. Sebaceous hyperplasia - minute profuse yellow-white papules in forehead, nose, upper lip, cheeks
- Milia - superficial epidermal inclusion cysts with laminated keratinized materia, firm pearly opalescent white cyst 1-2mm diamter on face and gingivae and in the middle of palate (Epstein pearls)
- Cutis marmorata - evanescent lacy reticulated red and blue cutaneous vascular pattern over most of the body surface when infant is cold
- Harlequin color change - autonomic vascular regulation instability, longitudinal half pale, half red
- Nevus simplex (salmon patch) - small pale pink ill defined vascular macule on glabella eyelids, upper lip, nuchal area
- Dermal melanocytosis (mongolian spots) - blue or slate gray macular lesions with variably defined margins most common on sacral area
- Erythema toxicum - benign self limited evanescent eruption; firm yellow-white 1-2mm papules or pustules with surrounding erythematous flare; eosinophilic infiltrates
- Neonatal pustular melanosis - transient benign self-limited dermatosis; evanescent superficial pustules, ruptured pustules with colarette of fine scale, hyperpigmented macules; polymorphonuclear infiltrates
(Nelson 21st 3453-3455)”
"Breastmilk jaundice true of the following A. Starts within the 3rd day of life B. Starts after 7 days C. Caused by dehydraton D. Treatment is DVET"
B
“Breastfeeding jaundice
- 3rd-4th DOL
- Inadequate supply of breastmilk leading to increased enterohepatic circulation
- Tx: Increase breastfeeding to 8-10x/day
Breast milk jaundice
- 1st-2nd week of life
- Glucoronidase in breast milk increases enterohepatic circulation
- Tx: Increase breastfeeding frequency, phototherapy"
"Most common symptom of neonatal tetanus A. Progressive poor suck B. Fever C. Ophistotonos D. Paralysis"
A
“Neonatal tetanus, the infantile form of generalized tetanus, typically manifests within 3-12 days of birth. It presents as progressive difficulty in feeding (sucking and swallowing), associated hunger, and crying.
Paralysis or diminished movement, stiffness and rigidity to the touch, and spasms, with or without opisthotonos, are characteristic. The umbilical stump, which is typically the portal of entry for the microorganism, may retain remnants of dirt, dung, clotted blood, or serum, or it may appear relatively benign.
(Nelson 21st p1550)”
“Treatment for primary apnea of prematurity. Which is true.
A. Gentle tactile stimulation is enough for primary apnea
B. Theophylline is more effective than caffeine
C. High flow NC is more preferred than CPAP
D. All of the above”
A
“Management of apnea of prematurity
- Gentle tactile stimulation or provision of flow and/or supplemental oxygen by nasal cannula is often adequate therapy for mild and intermittent episodes
- Nasal CPAP and heated humidified high flow nasal cannula are appropriate therapies. nCPAP may be preferred in extremely preterm infants
- Recurrent or persistent apnea is treated with methylxanthines (increase respiratory drive by lowering the threshold of response to hypercapnia)
- Caffeine and theophylline are similarly effective, but caffeine is preferred due to longer half life and less side effects (tachycardia, feeding intolerance)
- Caffeine PO or IV with 20mkdose loading then maintained at 5-10mkday
(Nelson 21st p931)”
"When is gender known via fetal UTZ A. 12 weeks B. 14 weeks C. 18 weeks D. 20 weeks"
A
“For a child who was delivered non institutionally, until what month should hearing screen be ideally done?
a. 1 month
b. 2 months
c. 3 months
d. 4 months”
C
“Prev Ped 2018 p9
All infants born in hospitals in the Philippines shall be made to undergo newborn hearing loss screening before discharge, unless the parents or legal guardians of the newborn object to the screening. Infants who are not born in hospitals should be screening within 3 months of birth.
In the event of a positive newborn hearing loss screening result, the newborn shall undergo audiologic diagnostic evaluation in a timely manner to allow appropriate followup, recall, and referral for intervention before the age of 6 months. “
“A healthy full term infant was delivered via spontaneous vaginal de livery and with unremarkable course. He was discharged within 24 hours. When’s the latest time that the baby must be seen at the clinic for follow up?
a. 36 hrs
b. 48 hrs
c. 72 hrs
d. 96 hrs”
B
“Prev Ped 2018 p15 Appendix 2. Discharge and followup of healthy term newborns
The Philippine Society of Newborn Medicine lists the following minimum criteria for discharging newborns within 48hrs
- Uncomplicated antepartum, intrapartum, and postpartum courses for both mother and newborn
- Vaginal delivery, singleton, completed 37 weeks AGA
- Normal and stable VS during the preceding 12hrs
- Has urinated and passed at least one stool
- Has documented proper latch, milk transfer, swallowing, infant satiety and absence of nipple discomfort
- Normal PE
- No evidence of significant jaundice in first 24hrs of life
- Educability and ability of parents to care for their child (recognize signs of illness, care of the umbilical cord/skin/genitalia, maternal confidence in feeding her infant and parents’ understanding of the importance of ffup visit or emergency consultation
- Must followup within the next 48hrs”
“A baby left exposed and hypothermic could develop the following complications except:
a. Hypoglycemia
b. Hypoxia
c. Metabolic acidosis
d. Renal retention and will not urinate”
D
“Nelson 21st p913
Cold stress can lead to profound decompensation, including apnea, bradycardia, respiratory distress, hypoglycemia, and poor feeding. For this reason, it is paramount for the neonate to maintain normothermia in the delivery room and afterward, especially low birthweight and premature infants. For VLBW infants, a combination of occulisive plasic wrap, radiant warmers, and thermal matresses to maintain normothermmia can be used to reduce cold stress. “
“Newborn screen can be done on full term healthy baby until:
a. 48 hours
b. 72 hours
c. 96 hours”
B
“Prev Ped 2018 p8
Newborn screening should ideally be done immediately after 24 hrs from birth, regardless of gestational age and clinical status.
NSRC Memorandum 2014-028 states that preterm, LBW (<2000g) and sick neonates recieving intensive care may have a sample taken before 24hrs from birth if blood transfusion will be done but otherwise a sample should be taken immediately after 24hrs from birth and a repeat screening should be collected at the 28th day of life. “
“Which would help in decreasing the incidence of neonatal sepsis?
a. early skin to skin contact
b. timely cord clamping
c. drying and thermoregulation
d. nonseparation of mother and newborn”
A
“Fundamentals of Pediatrics vol 1 p85
Skin to skin contact and the principle of nonseparation between mother and newborn has been demonstrated to reduce the incidence of neonatal infection by virtue of the following mechanisms:
1. Colonization of the newborn by maternal skin flora
2. Stimulation of the neonates mucosa-associated lymphoid tissues
3. Less exposure to potentially harmful health care related microorganisms such as those found in neonatal units”
“Physiologic parameters measured by Apgar score:
a. Color, HR, muscle tone
b. Color, respiration, HR
c. Respiration, muscle tone, reflex response
d. Color, reflex response, HR”
B
“Fundamentals of Pediatrics vol 1 p83
The Apgar score measures 3 physiologic parameters (color, respiration, and heart rate) and 2 neurologic parameters (muscle tone and reflex response) “
“Initial response to hypoxia of neonates
a. Increase in respiration then primary apnea
b. Hypotension & bradycardia
c. Increase in respirations only
d. None of the above”
A
”
Fundamentals of Pediatrics vol 1 p87
The fetus and newborn initially respond to hypoxic insult with rapid breathing followed by primary apnea, which leads to bradycardia without hypotension. “
“Increases the risk for ROP?
a. < 32 weeks
b. < 1500 grams
c. > 32 weeks and> 1500 grams but with a stormy course
d. All of the above”
D
“Prev Ped 2018 p21
Criteria for screening retinopathy of prematurity
1. 32 weeks or younger AOG
2. 1500g or lighter
3. Older than 32 weeks or heavier than 1500g but with stormy medical course at the NICU”
"A preterm infant is suspected of having NEC. What is the imaging of choice? A. Ultrasound B. Plain film of the abdomen C. CT scan D. MRI"
B
“Nelson 21st p951-952
A very high risk of suspicion in treating preterm at-risk infants is cruical. Plain abdominal radiographs are essential to make a diagnosis of NEC. The finding of pneumatosis intestinalis (air in the bowel wall) confirms the clinical suspicion of NEC and is diagnostic; 50-75% of patients have pneumatosis when treatment is started. Portal venous gas is a sign of severe disease, and pneumoperitoneum indicates a perforation.
Ultrasound with doppler flow assessment may be useful to evaluate for free fluid, abscess and bowel wall thickness, peristalsis, and perfusion. “
“8 day old baby came in because of jaundice. The baby has good suck and activity and is purely breastfed. What will you do?
a. Stop breastfeeding and shift to formula
b. Continue breastfeeding to increase to at least 10x/day in 24 hours
c. Observe”
B
”"”Breastfeeding jaundice
- 3rd-4th DOL
- Inadequate supply of breastmilk leading to increased enterohepatic circulation
- Tx: Increase breastfeeding to 8-10x/day
Breast milk jaundice
- 1st-2nd week of life
- Glucoronidase in breast milk increases enterohepatic circulation
- Tx: Increase breastfeeding frequency, phototherapy"""
“A pregnant teenager with only one prenatal check-up gave birth. At 2months into the pregnancy the mother had an episode of rash. The baby was born with a weight of 1.8 kilograms with rashes over the body. Mother claims that she had an ““allergic rash”” during pregnancy . What would you do?
A. Do routine newborn care
B. Isolate the contact for 1 year (baby)”
A
Not sure, depends on other sources. Infant seems to have a TORCH infection. Still do routine newborn care, but workup for TORCH.
"Newborn baby was doing well until at 3 days old, the patient was noted to have increased direct bilirubin, normal coombs and reticulocyte count. Diagnosis? A. Sepsis B. Breastfeeding jaundice C. Breastmilk jaundice D. Billiary atresia"
D
"The mother contracted varicella 2 days prior to delivery. What would you do? A. Give varicella vaccine B, Give immunoglobulin C, Give Varicella immunoglobulin D, Give toxoid"
C
“Nelson 21st p1715
High titer anti-VZV immune globulin as postexposure prophylaxis is recommended for immunocompromised children, pregnant women, and newborns exposed to varicella: Newborns whose mothers have varicella 5 days before to 2 days after delivery should recieve VariZIG. VariZIG is also indicated for pregnant women and immunocompromised persons without evidence of varicella immunity.”
“Newborn child with 2 lower central incisor teeth. On PE it does not move on manipulation. What will you do?
A. Do not do anything
B. Pull out the teeth. Risk of aspirations
C. Refer to geneticist”
A
“Nelson 21st p1912
Natal or neonatal teeth occasionally result in pain and refusal to feed and can produce maternal discomfort because of abrasion or biting of the nipple during nursing. If the tooth is mobile, there is a danger of detachment, with aspiration of the tooth. Because the tongue lies between the alveolar processes during birth, it can become lacerated (Riga-Fede disease). Decisions regarding extraction of prematurely erupted primary teeth must be made on an individual basis.”
"What will you do to prevent dental caries in a exclusively breastfed 6 month old infant? A. Breastfeeding B. Bottle feeding C. Complimentary feeding D. Fluoride supplementation"
A
“What neonatal factor is responsible for predisposition to infection in preterms?
A. Maternal infection is a usual cause of preterm labor
B. Less number organisms needed for infection in preterms
C. PROM predisposes to preterm labor
D. All of the above”
D
“True about BPD in neonates?
a. Requires< 10% of PO2 at 59 days
b. Male predominant
c. It is inversely related to gestational age”
C
“Nelson 21st p936-937
BPD is a clinical pulmonary syndrome that develops in the majority of extremely preterm infants and is defined by a prolonged need for respiratory support and supplemental oaxygen. Almost 60% of infants born at <=28 wk gestation will develop BPD, and the incidence of BPD increases inversely with gestational age.
BPD is diagnosed when a preterm infant requires supplemental oxygen for the 1st 28 postnatal days, and is further classified at 36wk PMA according to the degree of O2 supplementation.
Neonates recieving PPV or >=30 supplemental O2 at 36wk PMA or at discharge (whichever occurs first) are diagnosed as having severe BPD
Those requiring 22-29% supplemental O2 have moderate BPD, and those who previously required O2 supplemenation for at least 28 days but are currently breathing room air have mild BPD. “
"What causes severe jaundice in newborns? A. Bottle feeding B. Jaundice before 24 hours C. Both of the above D. None of the above"
B
“Neonate presents with bilious vomiting and abdominal distention. On x-ray, patient had distended bowel loops with ground glass appearance of intestines and microcolon, cecum fixed in RLQ. What is the condition?
a. Meconium ileus
b. Malrotation
c. Hirschsprung disease
d. Volvulus”
A
“Nelson 21st p949-950 Meconium ileus
Clinically, neonates present with intestinal obstruction with or without perforation. Abdominal distension is prominent, and vomiting, often bilious, becomes persistent, although occasionally inspissated meconium stools may be passed shortly after birth.
Plain radiographs reveal small bowel obstruction. Air-fluid levels may not be apparent because of the thickened meconium. In contrast to the generally evenly distributed abdominal loops above an atresia, the loops may vary in width and are not as evenly filled with gas. At points of the heaviest meconium concentration, the infiltrated gas may create a bubbly, granular appearance. “
“Mother has seizure disorder. Also has bipolar disorder taking lithium. She asks you about breastfeeding. What advise can you give?
a. Discontinue lithium
b. Do not discontinue lithium
c. Add another medication for bipolar disorder
d. None of the above “
A
Lithium is teratogenic, associated with Ebstein anomaly of the heart
Associated with oligohydramnios.
RENAL AGENESIS
“Nelson 21st p880 Table 114.4 Conditions associated with disorders of amniotic fluid volume
Oligohydramnios
- amniotic fluid leak with rupture of membranes
- IUGR
- fetal abnormalities (particularly GU abnormalities
- twin-twin transfusion (donor)
- fetal akinesia syndrome
- prune-belly syndrome
- pulmonary hypoplasia
- amnion nodosum
- indomethacin
- ACE-I or ARB
Polyhydramnios
- Congenital anomalies - CNS, TEF, intestinal atresia, spina bifida, cleft lip or palate, CCAM, diaphragmatic hernia
- Syndromes - achondroplasia, Trisomy 18, 21, TORCH, hydrops, Bartter
- Other - DM, twin-twin transfusion (recepient), fetal anemia, heart failure, congenital nephrotic syndrome, neuromuscular disease, chlyothorac, teratoma, idiopathic”
“A case of twins. Twin A has hematocrit of 70%. Twin B has hematocrit of <40%. Which statement is true?
A. Twin B is at risk for respiratory distress
B. Twin A is at risk for hyperbilirubinemia
C. Both of the above
D. None of the above”
C
"Mother gave birth. Baby admitted at NICU. Nurses claim baby has high-pitch cry. With jitteriness and irritability. This is due to what substance abuse? A. Cocaine B. Heroin C. Marijuana D. Alcohol abuse"
B
“Nelson 21st p976
Neonatal abstinence syndrome is the clinical diagnosis given to infants who experience withdrawal signs after in-utero exposure to opioids.
The clinical signs of NAS result from CNS hyperexcitability and autonomic instability. NAS signs can begin within 24 hr of birth after heroin exposure. Tremors, poor feeding, excesive crying, poor sleeping, and hyperirritability are the most prominent signs. Other signs include sneezing, yawning, hiccups, myoclonic jerks, skin breakdown and abrasions, vomiting, loose stools, nasa stuffiness, and seizures in the most severe cases. “
Neonate delivered at home, purely breastfed developed bleeding? What to do?
Give vitamin K
Diagnosis is VKDB
“Case on a newborn discharged <48 hours, which should be fulfil led prior to early discharge .
A. No jaundice
B. Passage of urine and at least one stool
C. Both of the above
D. None of the above”
B
”"”Prev Ped 2018 p15 Appendix 2. Discharge and followup of healthy term newborns
The Philippine Society of Newborn Medicine lists the following minimum criteria for discharging newborns within 48hrs
- Uncomplicated antepartum, intrapartum, and postpartum courses for both mother and newborn
- Vaginal delivery, singleton, completed 37 weeks AGA
- Normal and stable VS during the preceding 12hrs
- Has urinated and passed at least one stool
- Has documented proper latch, milk transfer, swallowing, infant satiety and absence of nipple discomfort
- Normal PE
- No evidence of significant jaundice in first 24hrs of life
- Educability and ability of parents to care for their child (recognize signs of illness, care of the umbilical cord/skin/genitalia, maternal confidence in feeding her infant and parents’ understanding of the importance of ffup visit or emergency consultation
- Must followup within the next 48hrs”””
“Initiation of first breath
a. Increased Pa02
b. Increased pC02
c. Increased pH
d. Decreased pCo2”
B
“True of neonatal NEC
A. Age of onset is inversely related to age of gestation
B. Bacterial infection is the greatest risk factor
C. More common in term infants
D. None of the above”
A
“Nelson 21st p951
Incidence and case fatality rates increase with decreasing birthweight and gestational age.
3 major risk factors have been implicated: prematurity, bacterial colonization of the gut, and formula feeding. NEC develops primarily in premature infants with exposure to metabolic substrate in the context of immature intestinal immunity, microbial dysbiosis, and mucosal ischemia
The greatest risk factor for NEC is prematurity. NEC rarely occurs before the initiation of enteral feeding and is much less common in infants fed human milk. Aggressive enteral feeding may predispose to the development of NEC.”
“You assisted a delivery of full term baby at NICU. At 15 minutes of life, patient was crying, pink, but blue extremities, good tone, CR more than 100. What will you do first?
A. Do APGAR scoring
B. Dry and do routine newborn care
C. Do Ballards scoring”
B
Case of HIE. Most devastating complication?
Permanent damage to CNS
“Eye screening by paediatrician should be done
A. At birth
B. Before discharge
C. On follow up”
A
“Preterm born at 30 weeks AOG. When is the best time to do ROP screening timing
A. 2 weeks after birth
B. 4 weeks after birth
C. 8 weeks after birth”
B
”"”Prev Ped 2018 p21
Criteria for screening retinopathy of prematurity
1. 32 weeks or younger AOG
2. 1500g or lighter
3. Older than 32 weeks or heavier than 1500g but with stormy medical course at the NICU”””
“Ominous sign of RDS
A. Grunting
B. Respiratory distress
C. Apnea”
C
“Nelson 21st p932
Characteristically, tachypnea, prominent (often audible) expiratory grunting, intercostal and subcostal retractions, nasal flaring, and cyanosis are noted. Breath sounds may be normal or diminished with a harsh tubular quality, and on deep inspiration fine crackles can be heard.
The natural course of untreated RDS is characterized by progressive worsening of cyanosis and dyspnea. If the condition is inadequately treated, blood pressure may fall, cyanosis and pallor increase, and grunting decreases or disappears as the condition worsens.
Apnea and irregular respirations are ominous signs requring immediate intervention. Respiratory failure may occur in infants with rapid progression of the disease. “
“Which of the following ElNC practices encourage early breastfeeding initiation?
A. Immediate & thorough drying of the baby
B. Properly timed cord clamping & cutting
C. First embrace of the mother & baby
D. Non-drug pain relief for the mother before offering anesthesia”
C
”"”Prev Ped 2018 p14
The recommended EINC practice for immediate care of the normal newborn are a series of time-bound interventions at the time of birth that can be enforced immediately in all health care settings. It emphasizes the step by step performance of a sequence of four core actions which are:
- Immediate and thorough drying of the newborn
- Early skin to skin contact between mother and newborn
- Properly timed cord clamping and cutting
- Nonseparation of newborn and mother for early breastfeeding.
These time sensitive interventions should not be pre-empted nor undermined by other interventions. Unnecessary interventions in newborn care include routine separation from the mother, foot printing, appplication of various substances to the cord, and giving pre-lacteals or artificial milk formula or other breast milk substitutes.”””
“After immediate & thorough drying of the newborn, what is the next step in EINC which also contributes to providing heat to the infant?
A. Early skin to skin contact between the mother and baby
B. Proper swaddling of the newborn with clean linen
C. Early bathing of the newborn with warm water
D. Exposure of the newborn to a radiant heat warmer”
A
”"”Prev Ped 2018 p14
The recommended EINC practice for immediate care of the normal newborn are a series of time-bound interventions at the time of birth that can be enforced immediately in all health care settings. It emphasizes the step by step performance of a sequence of four core actions which are:
- Immediate and thorough drying of the newborn
- Early skin to skin contact between mother and newborn
- Properly timed cord clamping and cutting
- Nonseparation of newborn and mother for early breastfeeding.
These time sensitive interventions should not be pre-empted nor undermined by other interventions. Unnecessary interventions in newborn care include routine separation from the mother, foot printing, appplication of various substances to the cord, and giving pre-lacteals or artificial milk formula or other breast milk substitutes.”””
"A newborn was delivered via emergency caesarian section due to fetal distress. At birth, he was noted to be pale, non- reactive to stimuli, with slightly flexed extremities, a HR of 70 beats/ minute, & RR of 40 breaths/ minute. What is his APGAR score? A. 3 B. 4 C. 5 D. 6"
B
"""A - 0 P - 1 G - 0 A - 1 R - 2
= 4
Nelson 21st p872 Table 113.2 Apgar evaluation of newborn infants
Heart rate
0 - absent
1 - below 100
2 - over 100
Respiratory effort
0 - absent
1 - slow, irregular
2 - good, crying
Muscle tone
0 - limp
1 - some flexion of extremities
2 - active motion
Response to catheter in nostril (tested after the oropharynx is clear)
0 - no response
1 - grimace
2 - cough or sneeze
Color
0 - blue, pale
1 - body pink, extremities blue
2 - completely pink
”””
"A term newborn was gasping & apneic at birth, with a HR of 80 beats/ minute. What is the most appropriate intervention within the first minute of life A. Intubate as soon as possible B. Do vigorous stimulation C. Give oxygen support at 5 LPM D. Start positive pressure ventilation"
D
”"”Nelson 21st p926
In term infants after stimulation, if no respirations are noted, or if the heart rate is <100 BPM, PPV should be given through a tightly fitted and appropriately sized bag-mask device. PPV should be initiated at pressures of approximately 20cm H2O at a rate of 40-60 breaths per minute, initially with 21% FiO2 for full term infants.
“””
“What is the most important & effective action in neonatal resuscitation?
A. Perform chest compressions to improve circulation
B. Ventilate the baby’s lungs to prevent respiratory failure
C. Administer fluids for adequate volume requirement
D. Administer epinephrine to prevent cardiac failure”
B
”"”Nelson 21st p926
Failure to initiate or sustain respiratory effort is fairly common at birth, with 5-10% of births requiring some intervention. Infants with primary apnea respond to stimulation by establishing normal breathing. Infants with secondary apnea require some ventilatory assistance in order to establish spontaneous respiratory effort. Secondary apnea usually originates in the CNS as a result of asphyxia or peripherally because of neuromuscular disorders.
The steps in neonatl resuscitation follows the ABCs: anticipate and establish a patent airway by positioning the baby with the head slightly extended, sniffing position, and suctioning if secretions are blocking the airway; B initiae breathing first by using tactile stimulation, followed by PPV with a bag-mask device and ETT insertion should the baby remain apneic or PPV is not achieving effective ventilation; and C, maintain the circulation with chest compressions and medications, if needed. “””
"A 2-day old female, term, delivered via NSD, was discharged on the 36TH hour of life. She was purely breastfed with good suck & activity. However, jaundice was noted on the 30TH hour of life. To assess her transition to life at home & monitor for other problems, she should be brought back to her pediatrician after how many days? A. 1-3 B. 4-6 C. 7-9 D. 10-12"
A
“Prev Ped 2018 p15 Appendix 2. Discharge and followup of healthy term newborns
The Philippine Society of Newborn Medicine lists the following minimum criteria for discharging newborns within 48hrs
- Uncomplicated antepartum, intrapartum, and postpartum courses for both mother and newborn
- Vaginal delivery, singleton, completed 37 weeks AGA
- Normal and stable VS during the preceding 12hrs
- Has urinated and passed at least one stool
- Has documented proper latch, milk transfer, swallowing, infant satiety and absence of nipple discomfort
- Normal PE
- No evidence of significant jaundice in first 24hrs of life
- Educability and ability of parents to care for their child (recognize signs of illness, care of the umbilical cord/skin/genitalia, maternal confidence in feeding her infant and parents’ understanding of the importance of ffup visit or emergency consultation
- Must followup within the next 48hrs”
"The most common causes of readmissions among newborns discharged very early from birthing facilities are hyperbilirubinemia, sepsis, dehydration, and A. Bowel disturbances B. Hepatitis infection C. Ophthalmic ointment reaction D. Missed congenital anomalies"
D
"At what age in weeks is a physiologic decrease in hemoglobin content observed in term infants? A. 1-4 B. 4-8 C. 8-12 D. 12-16"
C
“Nelson 21st p2516
At birth, normal full-term infants have higher hemoglobin (Hb) levels and larger red blood cells (RBCs) than do older children and adults. However, within the 1st wk of life, a progressive decline in Hb level begins and then persists for 6-8 wk. The resulting anemia is known as the physiologic anemia of infancy.”
“Which of the following features is TRUE of breast milk jaundice?
A. It is usually seen within the first week of life.
B. If breastfeeding is continued, the bilirubin levels gradually decreases.
C. If breastfeeding is discontinued, the bilirubin levels falls rapidly but usually returns to high levels with resumption of breastfeeding.
D. There is significant elevation of conjugated bilirubin.”
B
“Breastfeeding jaundice
- 3rd-4th DOL
- Inadequate supply of breastmilk leading to increased enterohepatic circulation
- Tx: Increase breastfeeding to 8-10x/day
Breast milk jaundice
- 1st-2nd week of life
- Glucoronidase in breast milk increases enterohepatic circulation
- Tx: Increase breastfeeding frequency, phototherapy"
"What is the most important neonatal factor predisposing to infection? A. Low birth weight B. Maternal infection C, Septic delivery D. Meconium aspiration"
A
”"”Nelson 21st p1005 HAI
Premature and VLBW infants often have prolonged hospitalizations are are particularly prone to healthcare-acquired infections because of their inefficient innate immunity, deficient skin barriers, presence of indwelling catheters and other devices, and prolonged endotracheal intubation.
Nelson 21st p1012 Perinatal infections
Factors influencing which colonized infants will experience disease are not well understoon, but include prematurity, underlying illness, invasive procedures, inoculum size, virulence of the infecting organism, genetic predisposition, the innate immune system, host response, and transplacental maternal antibodies. “””
"A term infant was born after a normal pregnancy. However, the delivery was complicated by marginal placental separation . On the 12TH hour of life, he passed out bloody meconium although he appeared to be well. Which of the following tests should be prioritized to determine the cause of bleeding? A. Barium enema B. A PT test C. Gastric lavage with normal saline D. Upper GI series"
B
”
Nelson 21st p912
Vomitus containing dark blood is usually a sign of serious illness, but the benign possibility of swallowed maternal blood associated with the delivery process should also be considered. Tests for maternal vs fetal hemoglobin (pt tests) can help discriminate between these possibilities. “
“What is the recommended storage period for breast milk?
A. 4 hours refrigerated at 4 C
B. 24 hours at room temperature of< 25 C
C. 8 days at the freezer compartment of a 2-door refrigerator
D. 6 months at deep freezer with constant temperature of -20 C”
D
”"”Prev Ped 2018 p26
Breastmilk storage period
- Room temperature (<25C) - 4 hours
- Room temperature (>25C) - 1 hour
- Referigerator (4C) - 8 days
- Freezer compartment of a 1 door refrigerator - 2 weeks
- Freezer compartment of a 2 door refrigerator - 3 months
- Deep freezer with a constant temperature -20C - 6 months”””
“Vitamin A has a role in mucosal re-epithelialization in what viral infection?
a. Roseola
b. Rotavirus
c. Varicella
d. HSV”
C
