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Peds: Growth and Development > Problems Common to the Newborn > Flashcards

Problems Common to the Newborn Flashcards

1
Q

What are the common newborn problems?

A
  1. Hypoglycemia
  2. Neonatal Jaundice
  3. Respiratory Distress of Newborn
    A. Hyaline Membrane Disease
    B. Most common cause
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2
Q

What are the general characteristics of hypoglycemia in infants?

A
  1. Defined as blood glucose less than 40-45
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3
Q

What is the pathophys of hypoglycemia in infants?

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

What are the sxs of hypoglycemia in infants?

A 
Asymptomatic 
Poor feeding
Lethargy
Tremulousness
Irritability
Apnea
Seizures
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5
Q

What are the dx studies for hypoglycemic infants?

A
  1. Heel blood tested w/glucometer
  2. Abnormal results should be confirmed w/ serum blood glucose
  3. Normal glucose level is 50-80 mg/dL @ 3 hrs of age
  4. Abnormal level is glucose
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6
Q

What are the rx for hypoglycemic infants?

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

What is the pathophys of infant jaundice?

A
  1. Newborns produce bilirubin 2X the rate as adults
    A. Due to polycythemia & ↑ RBC turnover
    B. ↓ to adult level w/in 10-14 days after birth
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8
Q

What is the normal physiology of bilirubin

A

1/ Bilirubin is final product of heme degradation

  1. Insoluble in plasma & requires protein binding w/ albumin
  2. After conjugation in liver, it’s excreted in bile
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9
Q

What is level of bilirubin can cause neonatal jaundice?

A
  1. Total serum bilirubin > 5 mg/dL

2. Typically results from deposition of unconjugated bilirubin pigment in the skin & mucus membranes

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10
Q

When is neonatal jaundice pathologic?

A
  1. Presents w/in 1st 24 hrs after birth
  2. Total serum bilirubin rises by > 5 mg/dL per day
  3. > 17 mg/dL
  4. (+) signs & sx’s suggestive of serious illness
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11
Q

What are the most common causes of neonatal jaundice in the first wk of life?

A 
1. Physiologic
A. Appears after 24 hr
B. Peaks @ 3-5 days
2. Prematurity
A. Appears w/in 24 hr of birth
3. Breast feeding problems
A. Appears 2nd – 3rd day of life
B. ↓ volume & frequency of feedings → dehydration & delayed passage of meconium
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12
Q

What can cause an overproduction of bilirubin and elevated reticulocyte count?

A
  1. Hemolysis 2° to blood group sensitizations
  2. Hemolysis 2° to congenital hemolytic anemia
  3. Hemolysis 2° to sepsis
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13
Q

Hemolysis 2° to blood group sensitizations is asst w/?

A
  1. (+) Coombs test
    A. ABO incompatibility
    B. Rh incompatibility
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14
Q

Hemolysis 2° to congenital hemolytic anemia is asst w/?

A
  1. (-) Coombs test
    A. Hereditary spherocytosis
    B. G6PD deficiency
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15
Q

What can cause jaundice with a decreased rate of conjugation and a normal reticulocyte count?

A
  1. Physiologic jaundice 2° to ABO incompatibility

2. Bilirubin increases by

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16
Q

What may be seen on the pe of an infant with jaundice?

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
17
Q

What dx studies are ordered for an infant w/ jaundice?

A 
1.CBC: Anemia
A. 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
18
Q

What complications can arise from jaundice and elevated bilirubin?

A
  1. Kernicterus
    A. Abnormal accumulation of bile pigment in the brain & other nerve tissue
    B. Leads to encephalopathy
    C. Bilirubin > 20-25 mg/dL
19
Q

What are the early sxs of bilirubin toxicity?

A
  1. lethargy
  2. poor feeding
  3. high pitched cry
  4. hypotonia
20
Q

What are the late sxs of bilirubin toxicity?

A
  1. irritability
  2. Opisthotonos
  3. Seizures
  4. Apnea
  5. hypertonia
  6. fever
21
Q

What are the chronic sxs of bilirubin toxicity?

A
  1. Cerebral palsy
  2. Highfrequency hearing loss
  3. Paralysis of upward gaze
  4. Dental dysplasia
  5. Mild mental retardation
22
Q

How is rh incompatibility treated?

A

Transfusion

Phototherapy

23
Q

How is hereditary sphereocytosis treated?

A

Phototherapy

24
Q

How is G6PD treated?

A

Phototherapy

25
Q

How is physiologic jaundice treated?

A

1.Usually resolves w/out intervention if bili 10 mg/dL or not decreasing

26
Q

How is breast feeding jaundice treated?

A
  1. Supplement w/ formula

2. Phototherapy if bili > 10 mg/dL

27
Q

Describe phototherapy treatment?

A
  1. Blue wavelengths of light alter unconjugated bilirubin in the skin
    A. Bilirubin is converted to less toxic water-soluble photo-isomers that are excreted in bile & urine w/out conjugation
28
Q

When is phototherapy instituted?

A
  1. Phototherapy instituted when the total serum bilirubin level is:
    A. ≥ 15 mg/dL if 25-48 hours old
    B. 18 mg/dL if 49-72 hours old
    C. 20 mg/dL if > 72 hours old
29
Q

When is phototherapy discontinued?

A

D/C when total serum bilirubin level less than 15

30
Q

What are the pulmonary causes of respiratory distress in infants?

A
  1. Chonal atresia
  2. Transient tachypnea of newborn
    A. Resolves in 24 hr
  3. Fluid aspiration
    A. Blood or meconium
  4. Hyaline membrane disease
31
Q

What is hyaline membrane disease?

A
  1. Most common cause of resp distress in preterm infant
  2. Deficiency of lung surfactant
    A. Poorly developed pneumocytes cause low surfactant production needed to keep alveoli open
32
Q

What are the cardiovascular causes of respiratory distress in infants?

A 
1. Cyanotic lesions
A. Tetralogy of Fallot
B. Tranposition of great arteries
2. Mild cyanosis
A. Hypoplastic left heart syndrome
B. Coarctation of aorta
33
Q

What are the non pulmonary/cardiovascular causes of respiratory distress in infants?

A 
1. Hyperthermia or hypothermia
A. Premature infants
2. Intrauterine exposure to cocaine
3. Metabolic acidosis
4. Hemorrhage or asphyxia resulting in damage to CNS
A. Traumatic delivery
34
Q

What may be seen on the pe of an infant with respiratory distress?

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
35
Q

What are the dx studies for an infant with respiratory distress?

A
  1. CXR
  2. Pulse oximetry
  3. ABG
  4. CBC & blood cultures
    A. If sepsis suspected
  5. CMP
  6. ECHO
36
Q

What are the Classic CXR results in hyaline membrane disease?

A

Air bronchograms, diffuse atelectasis causing ground glass appearance, & doming of diaphragm

37
Q

How is an infant with respiratory distress managed?

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

Peds: Growth and Development (13 decks)

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