Pre-term Infants Flashcards
Esophageal Atresia
Loss of connection between upper and lower esophageal pouch and stomach
Gastroschisis
Sac absent, defect to right of umbilicus, exposed to amniotic fluid
Omphalocele
Sac present, associated anomalies common, at umbilicus, normal GI function
Congenital Intestinal Obstruction examples
atresia, malrotation, vulvulus
What is atresia?
Lack of bowel continuity, ischemia during development
What is a vulvulus?
An abnormal twisting of a portion of the intestine that can inhibit blood flow
Which intestinal atresia is most common?
jejuno-ileal atresia
Which bowel length has the highest outcomes?
> 15 cm small bowel with ileocecal valve, or 40 cm small bowel without ileocecal valve
Ductus Arteriosis
normal part of fetal artery connections used to divert blood from lungs- closes soon after birth
Complications of VSD
Blood supply from each side mixes, L side works harder to pump to lungs and enlarges, damaging vessels and causing pulmonary HTN
Complications of ASD
Diverts blood away from lungs, can result in pulmonary HTN and damaged vessels
Patent Ductus Arteriosis complications
Excess blood to lungs which strains lungs/heart, causes congestion, high BP, pulmonary hypertension
Pulmonary Stenosis definition
narrowing of pulmonary valve
Pulmonary Stenosis complications
R ventricle works harder and enlarges, weakening it
Tetrology of Fallot Definition
VSD, PS, displacement of aorta, R ventricular hypertrophy
TOF complications
PS decreases oxygenated blood, aortic displacement sends both oxygenated and deoxygenated blood to body
Coarctation of Aorta Definition
Narrowing of aorta between branches resulting in poor blood flow to extremities
Coarctation of Aorta Complications
Increased BP in heart, arms and head
Transposition of the Great Arteries types
Dextro-TGA, Levo-TGA
Dextro-TGA definition
Position/function of aorta/PA reversed- aorta delivers oxygen poor blood to body, PA delivers O2 rich blood to lungs
Levo-TGA definition
Position/function of arteries reversed, but ventricles are also reversed- functional but can lead to R ventricular decline
Aortic Stenosis definition
Aortic valve narrows, preventing normal flow of blood from L ventricle to aorta. Pressure in L ventricle increases and muscle thickens
What can cause pallor?
shock, asphyxia, PDA
What causes plethora (redness)?
overoxygenated
What causes central cyanosis?
low oxygen saturation
What causes acrocyanosis (blue extremeties)?
cold, hypovolemia
What causes mottling?
cold stress, hypovolemia, sepsis
What causes edema?
overhydration, protein deficiency
What causes face/sacral edema?
Elevated R heart pressure
How is GERD diagnosed in pre-term infants?
Dual 24 hr probe, intraluminal impedance
Diagnosis of GERD is made with which indicators?
period of time esophagus is exposed to pH <4- 11% is abnormal
Why does Simply Thick increase changes of NEC development?
Bacterial metabolism of Simply Thick leads to accumulation of SFA and mucosal injury
Use of PPI in pre-term infants can lead to what?
PNA, gastroenteritis, NEC, candidemia
Why can fundoplication lead to retching?
osmolarity of feeds, high bolus volumes, overfeeding
What is bilirubin?
A product of heme metabolism
What is unconjugated bilirubin?
bound to albumin, transported to liver
What is conjugated bilirubin?
within hepatocytes and excreted within bile or resorbed from stool via enterohepatic circulation
What is omegaven?
IV Lipid with omega-3 effective in reducing cholestasis
What is SMOF lipid?
soy, MCT, olive oil, and fish oil
Primary risk factors for NEC
low gestational age, IUGR, abnormal fetal blood flow
Possible complications of Neonatal Abstinence Syndrome
preterm birth, SGA, hospitalization, feeding problems
What is inborn errors of metabolism?
Absent or malfunctioning enzyme/cofactor leads to deficiency or accumulation of metabolite
What is PKU
Mutation in PAH gene- converts phenylalanine to tyrosine
What is secondary PKU?
genetic defect that affects BH4 synthesis, which is a necessary cofactor for conversion
What is Galactosemia?
body cannot break down galactose
What is MSUD?
prevents metabolism of BCAA
What is anencephaly?
Failure of brain development in first month
What is Encephalocele?
lesions on brain tissue that protrude from skull
What is Myelomeningocele?
malformation of spinal cord- spina bifida is an example
Neonatal encephalopathy manifestations
seizures, respiratory distress, reduced tone
Hypoxic-ischemic encephalopathy
impaired cerebral blood flow caused by an event like placenta previa or shoulder dystonia
Growth implications of Cornelia DeLange
small stature, growth delay
Growth implications of Marfan Syndrome
connective tissue disorder, tall and thin, heart murmurs
Growth implications of Prader Willi
Constantly eats, never full
Growth implications of Rubinstein-Taybi
short stature, learning disability
Growth implications of Turner Syndrome
short stature, heart defects
Growth implications of William’s Syndrome
broad, “elfin” features
Which infants are at higher risk for renal complications?
<36 weeks GA
Definition of AKI
Rapid decline in kidney function resulting in inability to maintain fluid and electrolyte homeostasis
Definition on nephrocalcinosis
calcium salt deposition in renal parenchyma
Implications of hypertension
irritability, lethargy, poor feeding, cardiopulmonary and neurologic symptoms
CKD definition
anticipated, long term impaired or decreased kidney function
Prerenal kidney injury
caused by inadequate renal perfusion related to impaired renal function with immaturity
Intrinsic kidney injury
tubular necrosis d/t ischemia
Examples of nephrotoxic meds
acyclovir, NSAIDS, ACE inhibitors, aminoglycosides, vancomycin, radiocontrast agents
Postrenal kidney injury
cause by obstruction
What causes renal hypertension?
renovascular disease progressively narrows veins/arteries
Examples of renal congenital anomalies
hydronephrosis, renal agenesis, renal dysplasia
Hydronephrosis
swelling of kidney d/t inability to excrete urine
renal agenesis
1 or both kidneys fail to develop in utero
Renal dysplasia
Renal tubules don’t fully develop, urine collects in kidneys due to inability to flow through immature tubules
Examples of inherited renal disorders
autosomal dominant and autosomal recessive
What is autosomal dominant polycystic KD
development of cysts in both kidneys, reducing kidney function and requiring transplant
What is autosomal recessive polycystic KD
enlarged kidney with multiple cysts
What is hematuria indicative of for nephro
renal disease including tubular nectrosis, venous thrombosis or UTI
What is proteinuria indicative of?
renal disease like acute tubular necrosis, dehydration
What is elevated urine pH indicative of?
> 5.3 with low serum bicarb indicative of distal renal tubular acidosis
What is GFR?
rate at which kidneys filter blood
When does GFR increase?
with gestational age and increase in renal blood flow
What is the cause of respiratory disease in preterm infants?
immaturity of lung tissue structure and function, causing respiratory distress and bronchopulmonary dysplasia
What is transient tachypnea?
Fluid in lungs at birth, doesn’t clear/resorb quickly. resolves in 24-48 hrs
persistent pulmonary hypertension caused
underdevelopment of lung tissue, pulmonary vasculature can’t handle normal blood flow
What is meconium aspiration syndrome?
fetal GI contents trigger immune system when present in lung tissue, causing inflammation
Definition of intestinal failure
need for PN for >60 days due to intestinal disease, dysfunction or resection
Most common reasons for SBS in NICU
NEC, Congenital malformations, volvulus
What does the stomach secrete?
intrinsic factor, HCl, pepsin
What does the duodenum absorb?
Glucose, water soluble vitamins, Fe, Ca, Mg
What does Jejunum secrete?
secretin, CCK
What does jejunum absorb?
amino acids, fat
What does ileum secrete?
Enteroglucagon
What does ileum absorb?
zinc, phos, bile acid, bile salt, B12, cholesterol
What does the colon secrete?
K, HCO3
What does the colon absorb?
Water, Na, Oxalate
What does low urine sodium suggest?
Renal conservation- <25 mEq/L associated with poor growth
What does BUN measure?
Adquacy of enteral protein provision in normal renal function
What are 2 markers of copper status?
Serum copper or ceruloplasmin
What does ceruloplasmin do?
iron metabolism and HgB synthesis
Implications of copper deficiency
neurtopenia, impaired iron absorption, anemia, bone fractures
What does plasma citrulline indicate?
correlates with residual small bowel length and enterocyte mass. Levels >15 may indicate higher probability of weaning from PN
What weight is considered Low Body weight?
<2.5 kg
What weight is considered very low body weight?
<1.5 kg
What weight is considered extremely low body weight?
<1 kg
How is BPD diagnosed?
abnormal CXR, supplemental O2 on DOL 28
How is FTT diagnosed?
WFA <5th percentile
WFL/WFH <5th percentile
Growth decreased 2 percentiles
Growth decreased 2 SD over 3-6 mo
What is the definition of short bowel syndrome?
40-60% of small intestine resected, resulting in significant malabsorption
What is intestinal bacterial overgrowth
excessive bacteria from colon migrate to small intestine
