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Peds > Premature Newborns > Flashcards

Premature Newborns Flashcards

1
Q

What is the second leading cause of infant mortality after congenital abn

A

Prematurity

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2
Q

What is adjusted age

A

Age in months from term due date

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3
Q

What is chronological age

A

Age in months from delivery

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4
Q

Fetal causes of prematurity

A

Fetal distress, multiple gestation, erythroblastosis, non immune hydrous fetalis, congenital anomalies

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5
Q

Maternal causes of prematurity

A

Preeclampsia, chronic medical illness, infection, drug use

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6
Q

Placental causes of prematurity

A

Placental previa or abruption

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7
Q

Uterine causes of prematurity

A

Bicornuate uterus, incompetent cervix, short cervix

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8
Q

What is categorized as a low birth weight infant

A
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9
Q

What classifies a very low birth weight infant

A
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10
Q

What classifies a neonatal death

A

Death within the first month of life

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11
Q

Acute respiratory problems of primis

A

Pulmonary surfactant deficiency

Immature control of respiration (apnea or bradycardia)

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12
Q

Acute cardiac problems in primi

A

Patent ductus arteriosus

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13
Q

Acute GI problems for primis

A

Ability to suck, swallow, breathe in coordination

Impaired substrate absorption

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14
Q

Acute metabolic problems in primi

A

Decreased ability to maintain body temp
Hypoglycemia
Hypocalcemia

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15
Q

Acute neuro problems for primis

A

Immature cerebral vasculature -intraventricular hemorrhage

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16
Q

Acute renal problems for primi

A

Immature renal function

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17
Q

Acute infectious disease

A

Increased susceptibility to infection

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18
Q

What decreases the surface tension of the alveoli during expiration

A

Surfactant

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19
Q

When does surfactant develop

A

Generally with in 72 hours of birth

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20
Q

What is the definition of hyaline membrane disease

A

Deficiency of surfactant leading to greater respiratory effort and/or atelectasis

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21
Q

What causes respiratory failure in hyaline membrane disease

A

Greater expenditure of energy to expand lungs

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22
Q

Bronchopulmonary dysplasia is defined by

A

Oxygen requirement for more than 28 days with sx of lung disease present soon after disease

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23
Q

Treatment of bronchopulmonary dysplasia

A

Bronchodilators, inhaled steroids, diuretics, oxygen, antibiotics

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24
Q

When do most children resolve sx from bronchopulmonary dysplasia

A

2 years

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25
Q

What are children with bronchopulmonary dysplasia more susceptible to

A

Pulmonary infections, respiratory distress, and wheezing

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26
Q

What is the definition of chronic lung disease

A

Respiratory sx, O2 requirement, abn CXR at 36 weeks gestation

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27
Q

Treatment of chronic lung disease in premature infants

A

Diuretics, inhaled steroids, beta2 agonists, systemic steroids

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28
Q

What is persistent pulmonary hypertension

A

Elevated pulmonary vascular resistance –> inadequate pulm blood flow –> right to left shunt of blood

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29
Q

What are potential causes of persistent pulmonary HTN

A

BPD, pneumonia, congenital diaphragmatic hernia

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30
Q

What diagnoses persistent pulm HTN

A

Echocardiogram

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31
Q

How may the infant present with persistent pulm HTN

A

Infant may have low O2 levels and more erratic O2 sats

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32
Q

What is congenital diaphragmatic hernia

A

Hernia toon of abd contents through the diaphragm into the chest cavity

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33
Q

What is the cause of diaphragmatic hernia

A

Failure of the diaphragm to divide chest and abd at 8-10 weeks gestation; mainly left diaphragm

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34
Q

Treatment of congenital diaphragmatic hernia

A

Incubate immediately, NO BMV, NG tube

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35
Q

Sx of congenital diaphragmatic hernia

A

Respiratory distress, scaphoid abd, absent breath sounds in hemithorax, PMI is displaced

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36
Q

GERD sx

A

Postprandial vomiting, irritability, respiratory problems, apnea, bradycardia, feeding difficulty

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37
Q

Treatment of GERD

A

Thickened feeds, posters dial positioning, h2 blockers, PPIs, pro kinetic agents

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38
Q

Necrotizing Enterocolitis is defined as …

A

Acute intestinal necrosis after ischemic injury to bowel and secondary bacterial invasion of intestinal wall

39
Q

What is the likely cause of necrotizing Enterocolitis

A

Perinatal hypoxia

40
Q

What provides the substrate for bacterial overgrowth in necrotizing Enterocolitis

A

Milk

41
Q

Sx of necrotizing Enterocolitis

A

Abd distention, vomiting, increased gastric residuals, heme+ stools, tenderness, temp instability, apnea, bradycardia, decreased UO, poor Q

42
Q

What is the nutritional requirements of a premature infant

A

100-120kcal per day with a gain of 20-30g/day

43
Q

How long in a lifetime do you use the primi growth chart

A

2years of life

44
Q

What is the definition of failure to thrive

A

Premature infant falling behind that of their peers

45
Q

What characterizes HTN of premature infants

A

Increased BP 2 SDs above the mean related to weight and gestational age

46
Q

Sx of HTN in primi

A

Tachypnea, CHF, lethargy, failure to thrive, cardiomegaly, irritability seizure

47
Q

Treatment of HTN

A

Address underlying illness, antiHTNives like enalapril and hydralazine

48
Q

Peri ventricular and intraventricular hemorrhage

A

Ischemia followed by reperfusion injury

49
Q

Rapid deterioration in IVH

A

Coma, hypoventilation, decerebrate posturing, fixed pupils, bulging anterior fontanelle, anemia

50
Q

What diagnoses IVH

A

Ultrasound

51
Q

Common causes of retinopathy

A

Hypoxia, shock, asphyxia

52
Q

Treatment of retinopathy

A

Laser therapy

53
Q

Causes of inguinal hernia

A

Rise in pressure in the abdomen from crying, bowel movements or breathing hard

54
Q

Apnea of prematurity

A

Respiratory pause for 20 secs

55
Q

Treatment of apnea of prematurity

A

Resolves in 34-37 weeks gest, caffeine citrate, theophylline

56
Q

Treatment of u conjugated hyperbilirubinemia

A

Phototherapy, phenobarbital, exchange transfusion

57
Q

Definition of hypoglycemia

A

Less than 45 mg/dl

58
Q

Who is at risk for hypoglycemia

A

Infant of a diabetic mother, insulin producing tumors

59
Q

Tx of hypoglycemia

A

Asymptomatic full term level >20, initiate feeding

Symptomatic or level

60
Q

What are the periods of growth in newborn

A

Intrauterine

Infancy

61
Q

What is intrauterine growth

A

Rapid differentiation, growth and development in embryo, establishment of organ systems, increase in body mass

62
Q

What is infancy growth

A

Continued rapid growth and maturation, esp CNS

Growth determined by genetic background

63
Q

Neonatal growth characteristics

A

1-10 d: decrease 7-10% birth weight, 10-14 d: regain birth weight in normal term, 6 months: double birth weight, 12 months: triple birth weight

64
Q

Two types of intrauterine growth retardation

A

Symmetric and asymmetric

65
Q

What is symmetric intrauterine growth retardation

A

Below 10%, cause is early inhibition of growth in first trimester

66
Q

Asymmetric intrauterine growth retardation

A

Weight

67
Q

Causes of respiratory distress

A

Pulmonary, airway, cardiac, neuro, miscellaneous

68
Q

Common pulmonary causes of respiratory distress

A

Meconium asipration, pneumonia, transient Tachypnea, hyaline membrane disease, pneumothorax

69
Q

Transient Tachypnea of the newborn cause

A

Retained lung fluid associated with C section

70
Q

What is the FiO2 requirement in transient Tachypnea

A

40%

71
Q

What is pneumonia caused by most commonly

A

GBS

72
Q

What is pneumonia associated with

A

Sepsis

73
Q

Treatment of pneumonia

A

10 days IV antibiotics

74
Q

Definition of sepsis

A

A clinical syndrome consisting of bacteremia with systemic signs and symptoms

75
Q

What distinguishes sepsis from bacteremia

A

Sepsis has clinical manifestations

76
Q

Early onset sepsis

A

Within 7 days, source is maternal GU tract

77
Q

Late onset sepsis

A

Onset after 7d in life, infectious source either maternal GU tract, nursery or community, meningitis common

78
Q

Fetal risk factors for sepsis

A

Degree of prematurity and congenital malformation

79
Q

Maternal risk factors for sepsis of newborn

A

Prolonged rupture of membrane am UTI, preterm labor, chorio

80
Q

Signs of severe sepsis

A

Conjugated hyperbilirubinemia, petechiae, seizure, hsm

81
Q

White found level to suspect sepsis

A

0.2

82
Q

Agents that cause sepsis in newborn

A

GBS, E. coli, coag negative staph, S. aureus, listeria, candida

83
Q

Early onset GBS infection

A

First 7 days of life, apnea, Tachypnea, hypoxia, shock, infiltrate on CXR,

84
Q

Late onset GBS

A

1-12 weeks, immune susceptibility, not decreased with maternal prophylaxis

85
Q

Treatment of septic infant

A

PCN + aminoglycoside (ampicillin or gentamicin)

86
Q

How often should a newborn be bathed

A

2-3x weekly, no soap

87
Q

How often and for how long should a newborn wake up each night

A

Every 2 hours for 3-4 months

88
Q

When should immunization so be given in a primi

A

Administer at chronological age not adjusted age, influenza vaccine for >6mos

89
Q

Most common cause of bronchiolitis and pneumonia in infants

A

RSV

90
Q

Dolichocephaly is …

A

When the head is disproportionately long and narrow, premature closure of sagittal suture

91
Q

Laryngomalacia is …

A

Immaturity if the laryngeal cartilages, MC of chronic stridor

92
Q

Subglottic stenosis is…

A

Scarring of subglottic trachea, MCC is long term intubation

93
Q

Definition of a primi

A

Infant born before 37 weeks

Peds (16 decks)

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