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CSP > Pre-term Infants > Flashcards

Pre-term Infants Flashcards

1
Q

Esophageal Atresia

A

Loss of connection between upper and lower esophageal pouch and stomach

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2
Q

Gastroschisis

A

Sac absent, defect to right of umbilicus, exposed to amniotic fluid

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3
Q

Omphalocele

A

Sac present, associated anomalies common, at umbilicus, normal GI function

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4
Q

Congenital Intestinal Obstruction examples

A

atresia, malrotation, vulvulus

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5
Q

What is atresia?

A

Lack of bowel continuity, ischemia during development

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6
Q

What is a vulvulus?

A

An abnormal twisting of a portion of the intestine that can inhibit blood flow

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7
Q

Which intestinal atresia is most common?

A

jejuno-ileal atresia

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8
Q

Which bowel length has the highest outcomes?

A

> 15 cm small bowel with ileocecal valve, or 40 cm small bowel without ileocecal valve

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9
Q

Ductus Arteriosis

A

normal part of fetal artery connections used to divert blood from lungs- closes soon after birth

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10
Q

Complications of VSD

A

Blood supply from each side mixes, L side works harder to pump to lungs and enlarges, damaging vessels and causing pulmonary HTN

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11
Q

Complications of ASD

A

Diverts blood away from lungs, can result in pulmonary HTN and damaged vessels

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12
Q

Patent Ductus Arteriosis complications

A

Excess blood to lungs which strains lungs/heart, causes congestion, high BP, pulmonary hypertension

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13
Q

Pulmonary Stenosis definition

A

narrowing of pulmonary valve

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14
Q

Pulmonary Stenosis complications

A

R ventricle works harder and enlarges, weakening it

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15
Q

Tetrology of Fallot Definition

A

VSD, PS, displacement of aorta, R ventricular hypertrophy

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16
Q

TOF complications

A

PS decreases oxygenated blood, aortic displacement sends both oxygenated and deoxygenated blood to body

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17
Q

Coarctation of Aorta Definition

A

Narrowing of aorta between branches resulting in poor blood flow to extremities

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18
Q

Coarctation of Aorta Complications

A

Increased BP in heart, arms and head

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19
Q

Transposition of the Great Arteries types

A

Dextro-TGA, Levo-TGA

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20
Q

Dextro-TGA definition

A

Position/function of aorta/PA reversed- aorta delivers oxygen poor blood to body, PA delivers O2 rich blood to lungs

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21
Q

Levo-TGA definition

A

Position/function of arteries reversed, but ventricles are also reversed- functional but can lead to R ventricular decline

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22
Q

Aortic Stenosis definition

A

Aortic valve narrows, preventing normal flow of blood from L ventricle to aorta. Pressure in L ventricle increases and muscle thickens

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23
Q

What can cause pallor?

A

shock, asphyxia, PDA

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24
Q

What causes plethora (redness)?

A

overoxygenated

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25
Q

What causes central cyanosis?

A

low oxygen saturation

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26
Q

What causes acrocyanosis (blue extremeties)?

A

cold, hypovolemia

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27
Q

What causes mottling?

A

cold stress, hypovolemia, sepsis

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28
Q

What causes edema?

A

overhydration, protein deficiency

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29
Q

What causes face/sacral edema?

A

Elevated R heart pressure

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30
Q

How is GERD diagnosed in pre-term infants?

A

Dual 24 hr probe, intraluminal impedance

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31
Q

Diagnosis of GERD is made with which indicators?

A

period of time esophagus is exposed to pH <4- 11% is abnormal

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32
Q

Why does Simply Thick increase changes of NEC development?

A

Bacterial metabolism of Simply Thick leads to accumulation of SFA and mucosal injury

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33
Q

Use of PPI in pre-term infants can lead to what?

A

PNA, gastroenteritis, NEC, candidemia

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34
Q

Why can fundoplication lead to retching?

A

osmolarity of feeds, high bolus volumes, overfeeding

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35
Q

What is bilirubin?

A

A product of heme metabolism

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36
Q

What is unconjugated bilirubin?

A

bound to albumin, transported to liver

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37
Q

What is conjugated bilirubin?

A

within hepatocytes and excreted within bile or resorbed from stool via enterohepatic circulation

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38
Q

What is omegaven?

A

IV Lipid with omega-3 effective in reducing cholestasis

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39
Q

What is SMOF lipid?

A

soy, MCT, olive oil, and fish oil

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40
Q

Primary risk factors for NEC

A

low gestational age, IUGR, abnormal fetal blood flow

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41
Q

Possible complications of Neonatal Abstinence Syndrome

A

preterm birth, SGA, hospitalization, feeding problems

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42
Q

What is inborn errors of metabolism?

A

Absent or malfunctioning enzyme/cofactor leads to deficiency or accumulation of metabolite

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43
Q

What is PKU

A

Mutation in PAH gene- converts phenylalanine to tyrosine

44
Q

What is secondary PKU?

A

genetic defect that affects BH4 synthesis, which is a necessary cofactor for conversion

45
Q

What is Galactosemia?

A

body cannot break down galactose

46
Q

What is MSUD?

A

prevents metabolism of BCAA

47
Q

What is anencephaly?

A

Failure of brain development in first month

48
Q

What is Encephalocele?

A

lesions on brain tissue that protrude from skull

49
Q

What is Myelomeningocele?

A

malformation of spinal cord- spina bifida is an example

50
Q

Neonatal encephalopathy manifestations

A

seizures, respiratory distress, reduced tone

51
Q

Hypoxic-ischemic encephalopathy

A

impaired cerebral blood flow caused by an event like placenta previa or shoulder dystonia

52
Q

Growth implications of Cornelia DeLange

A

small stature, growth delay

53
Q

Growth implications of Marfan Syndrome

A

connective tissue disorder, tall and thin, heart murmurs

54
Q

Growth implications of Prader Willi

A

Constantly eats, never full

55
Q

Growth implications of Rubinstein-Taybi

A

short stature, learning disability

56
Q

Growth implications of Turner Syndrome

A

short stature, heart defects

57
Q

Growth implications of William’s Syndrome

A

broad, “elfin” features

58
Q

Which infants are at higher risk for renal complications?

A

<36 weeks GA

59
Q

Definition of AKI

A

Rapid decline in kidney function resulting in inability to maintain fluid and electrolyte homeostasis

60
Q

Definition on nephrocalcinosis

A

calcium salt deposition in renal parenchyma

61
Q

Implications of hypertension

A

irritability, lethargy, poor feeding, cardiopulmonary and neurologic symptoms

62
Q

CKD definition

A

anticipated, long term impaired or decreased kidney function

63
Q

Prerenal kidney injury

A

caused by inadequate renal perfusion related to impaired renal function with immaturity

64
Q

Intrinsic kidney injury

A

tubular necrosis d/t ischemia

65
Q

Examples of nephrotoxic meds

A

acyclovir, NSAIDS, ACE inhibitors, aminoglycosides, vancomycin, radiocontrast agents

66
Q

Postrenal kidney injury

A

cause by obstruction

67
Q

What causes renal hypertension?

A

renovascular disease progressively narrows veins/arteries

68
Q

Examples of renal congenital anomalies

A

hydronephrosis, renal agenesis, renal dysplasia

69
Q

Hydronephrosis

A

swelling of kidney d/t inability to excrete urine

70
Q

renal agenesis

A

1 or both kidneys fail to develop in utero

71
Q

Renal dysplasia

A

Renal tubules don’t fully develop, urine collects in kidneys due to inability to flow through immature tubules

72
Q

Examples of inherited renal disorders

A

autosomal dominant and autosomal recessive

73
Q

What is autosomal dominant polycystic KD

A

development of cysts in both kidneys, reducing kidney function and requiring transplant

74
Q

What is autosomal recessive polycystic KD

A

enlarged kidney with multiple cysts

75
Q

What is hematuria indicative of for nephro

A

renal disease including tubular nectrosis, venous thrombosis or UTI

76
Q

What is proteinuria indicative of?

A

renal disease like acute tubular necrosis, dehydration

77
Q

What is elevated urine pH indicative of?

A

> 5.3 with low serum bicarb indicative of distal renal tubular acidosis

78
Q

What is GFR?

A

rate at which kidneys filter blood

79
Q

When does GFR increase?

A

with gestational age and increase in renal blood flow

80
Q

What is the cause of respiratory disease in preterm infants?

A

immaturity of lung tissue structure and function, causing respiratory distress and bronchopulmonary dysplasia

81
Q

What is transient tachypnea?

A

Fluid in lungs at birth, doesn’t clear/resorb quickly. resolves in 24-48 hrs

82
Q

persistent pulmonary hypertension caused

A

underdevelopment of lung tissue, pulmonary vasculature can’t handle normal blood flow

83
Q

What is meconium aspiration syndrome?

A

fetal GI contents trigger immune system when present in lung tissue, causing inflammation

84
Q

Definition of intestinal failure

A

need for PN for >60 days due to intestinal disease, dysfunction or resection

85
Q

Most common reasons for SBS in NICU

A

NEC, Congenital malformations, volvulus

86
Q

What does the stomach secrete?

A

intrinsic factor, HCl, pepsin

87
Q

What does the duodenum absorb?

A

Glucose, water soluble vitamins, Fe, Ca, Mg

88
Q

What does Jejunum secrete?

A

secretin, CCK

89
Q

What does jejunum absorb?

A

amino acids, fat

90
Q

What does ileum secrete?

A

Enteroglucagon

91
Q

What does ileum absorb?

A

zinc, phos, bile acid, bile salt, B12, cholesterol

92
Q

What does the colon secrete?

A

K, HCO3

93
Q

What does the colon absorb?

A

Water, Na, Oxalate

94
Q

What does low urine sodium suggest?

A

Renal conservation- <25 mEq/L associated with poor growth

95
Q

What does BUN measure?

A

Adquacy of enteral protein provision in normal renal function

96
Q

What are 2 markers of copper status?

A

Serum copper or ceruloplasmin

97
Q

What does ceruloplasmin do?

A

iron metabolism and HgB synthesis

98
Q

Implications of copper deficiency

A

neurtopenia, impaired iron absorption, anemia, bone fractures

99
Q

What does plasma citrulline indicate?

A

correlates with residual small bowel length and enterocyte mass. Levels >15 may indicate higher probability of weaning from PN

100
Q

What weight is considered Low Body weight?

A

<2.5 kg

101
Q

What weight is considered very low body weight?

A

<1.5 kg

102
Q

What weight is considered extremely low body weight?

A

<1 kg

103
Q

How is BPD diagnosed?

A

abnormal CXR, supplemental O2 on DOL 28

104
Q

How is FTT diagnosed?

A

WFA <5th percentile
WFL/WFH <5th percentile
Growth decreased 2 percentiles
Growth decreased 2 SD over 3-6 mo

105
Q

What is the definition of short bowel syndrome?

A

40-60% of small intestine resected, resulting in significant malabsorption

106
Q

What is intestinal bacterial overgrowth

A

excessive bacteria from colon migrate to small intestine

CSP (5 decks)

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