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Gen Med: Peds > Problems Common to Newborn > Flashcards

Problems Common to Newborn Flashcards

1
Q

What is the most common cause of Respiratory Distress of a newborn?

A

Hyaline Membrane Disease

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2
Q

Hypoglycemia: General Characteristics

A

Defined as blood glucose

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3
Q

Hypoglycemia: Pathophysiology

A

Infant does not have sufficient glycogen stores in muscle or liver nor sufficient fat for release of fatty acids for energy

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4
Q

Hypoglycemia: Signs & Sx’s

A 
Asymptomatic 
Poor feeding
Lethargy
Tremulousness
Irritability
Apnea
Seizures
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5
Q

Hypoglycemia: Diagnostic Studies

A

Heel blood tested w/glucometer

Abnormal results should be confirmed w/ serum blood glucose

Normal glucose level is 50-80 mg/dL @ 3 hrs of age

Abnormal level is glucose

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6
Q

Hypoglycemia: Treatment

A
  • Bolus of dextrose & water (D10W) & IV glucose as needed
  • Continue to monitor
  • Usually resolves by day 5
  • Failure to resolve should prompt investigation for less likely causes
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7
Q

Neonatal Jaundice: Bilirubin Pathophysiology

A
  1. Bilirubin is final product of heme degradation
  2. Insoluble in plasma & requires protein binding w/ albumin
  3. After conjugation in liver, it’s excreted in bile
  4. Newborns produce bilirubin 2X the rate as adults
    - Due to polycythemia & ↑ RBC turnover
    - ↓ to adult level w/in 10-14 days after birth
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8
Q

Neonatal Jaundice: General Characteristics

A
  • Total serum bilirubin > 5 mg/dL
  • Typically results from deposition of unconjugated bilirubin pigment in the skin & mucus membranes

Pathologic if:

  • Presents w/in 1st 24 hrs after birth
  • Total serum bilirubin rises by > 5 mg/dL per day
  • > 17 mg/dL
  • (+) signs & sx’s suggestive of serious illness

> 65% of infants have bilirubin level > 5 mg/dL in first week of life

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9
Q

Neonatal Jaundice: Most common causes

A
  1. Physiologic
    - Appears after 24 hr
    - Peaks @ 3-5 days
  2. Prematurity
    - Appears w/in 24 hr of birth
  3. Breast feeding
    - Appears 2nd – 3rd day of life
    - ↓ volume & frequency of feedings → dehydration & delayed passage of meconium
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10
Q

Neonatal Jaundice: Etiology

A
  1. Overproduction of bilirubin
    a. Elevated reticulocyte count
    - Hemolysis 2° to blood group sensitizations
    - (+) Coombs test
    - ABO incompatibility
    - Rh incompatibility
    b. Hemolysis 2° to congenital hemolytic anemia
    - (-) Coombs test
    - Hereditary spherocytosis
    - G6PD deficiency
    c. Hemolysis 2° to sepsis
  2. Decreased rate of conjugation
    a. Normal reticulocyte count
    - Physiologic jaundice 2° to ABO incompatibility
    - Bilirubin increases by
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11
Q

Neonatal Jaundice: Physical Exam

A
  1. Jaundice begins @ head
    a. Extends to chest & extremities as bilirubin increases
  2. Scleral icterus & jaundiced oral mucosa help distinguish jaundice in dark skinned infants
  3. Splenomegaly may be present in hereditary spherocytosis
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12
Q

Neonatal Jaundice: Diagnostic Studies

A
  1. CBC
    a. Anemia
    - Monitor H&H if acute hemolysis
  2. Peripheral smear
    a. Poikilocytosis, schistocytes, nucleated RBC’s
  3. Bili – total, direct, indirect
  4. Retic count
  5. Coombs test
  6. G6PD test
    a. African, Asian or Mediterranean descent
  7. Septic work-up if indicated
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13
Q

Neonatal Jaundice: Complications

A
  1. Kernicterus
    - Abnormal accumulation of bile pigment in the brain & other nerve tissue
    - Leads to encephalopathy
    - Bilirubin > 20-25 mg/dL
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14
Q

Early Effects of Bilirubin Toxicity

A

Lethargy
Poor Feeding
High-pitched cry
Hypotonia

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15
Q

Late Effects of Bilirubin Toxicity

A 
Irritability
Opisthotonos
Seizures
Apnea
Hypertonia
Fever
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16
Q

Chronic Effects of Bilirubin Toxicity

A 
Cerebral Palsy
High Frequency hearing loss
Paralysis of upward gaze
Dental dysplasia
Mild mental retardation
17
Q

Neonatal Jaundice: Treatment

A
  1. Rh incompatibility
    - Transfusion
    - Phototherapy
  2. Hereditary spherocytosis
    - Phototherapy
  3. G6PD deficiency
    - Phototherapy
  4. Physiologic jaundice
    - Usually resolves w/out intervention if bili 10 mg/dL or not decreasing)
  5. Breast feeding jaundice
    - Supplement w/ formula
    - Phototherapy if bili > 10 mg/dL
18
Q

What is phototherapy treatment (for neonatal jaundice)?

A
  1. Blue wavelengths of light alter unconjugated bilirubin in the skin
    - Bilirubin is converted to less toxic water-soluble photo-isomers that are excreted in bile & urine w/out conjugation

-Phototherapy instituted when the total serum bilirubin level is:
≥ 15 mg/dL if 25-48 hours old
18 mg/dL if 49-72 hours old
20 mg/dL if > 72 hours old

  1. D/C when total serum bilirubin level
19
Q

Respiratory Distress in the Newborn: Etiology

A
  1. Pulmonary causes
    a. Chonal atresia
    b. Transient tachypnea of newborn
    -Resolves in 24 hr
    c. Fluid aspiration
    -Blood or meconium
    d. Hyaline membrane disease
    -Most common cause of resp distress in preterm infant
    -Deficiency of lung surfactant -
    Poorly developed pneumocytes cause low surfactant production needed to keep alveoli open
  2. Cardiovascular causes
    a. Cyanotic lesions
    - Tetralogy of Fallot
    - Tranposition of great arteries
    b. Mild cyanosis
    - Hypoplastic left heart syndrome
    - Coarctation of aorta
  3. Other common causes
    a. Hyperthermia or hypothermia
    - Premature infants
    b. Intrauterine exposure to cocaine
    c. Metabolic acidosis
    d. Hemorrhage or asphyxia resulting in damage to CNS
    - Traumatic delivery
20
Q

Respiratory Distress in the Newborn: Physical Exam

A
  1. Cyanosis
    a. If improves w/ oxygen, suspect pulmonary or non-cardiac cause
  2. RR > 60 breaths/min
  3. Grunting
    a. Usually occurs w/ nasal flaring, intercostal & sternal retractions
21
Q

Respiratory Distress in the Newborn: Diagnostic Studies

A
  1. CXR
    a. Air bronchograms, diffuse atelectasis causing ground glass appearance, & doming of diaphragm
    - Classic CXR in hyaline membrane disease
  2. Pulse oximetry
  3. ABG
  4. CBC & blood cultures
    a. If sepsis suspected
  5. CMP
  6. ECHO
22
Q

Respiratory Distress in the Newborn: Treatment

A
  1. Supplemental oxygen
  2. Administration of exogenous surfactants
  3. Intubation & mechanical ventilation if necessary
    a. Recommended treatment for hyaline membrane disease
  4. Determine underlying cause & treat appropriately

Gen Med: Peds (6 decks)

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