S12C111 - Neonatal emergencies

Question 1

Normal Feeding

Answer 1

• 2-4oz q2-4h if formula, for first week of life

- BF babes feed q1-3h

Question 2

Weight gain/loss neonate

Answer 2

• may lose up to 10% of BW in first 3-7d of life

- gain 20-30g/d for first 3mo and 15-20g/d over next several months

Question 3

Colic

Answer 3

• 3h of crying/d, for 3d/wk, over 3wk period
• crying, flushed face, circumoral pallor, tense abdo, drawn up legs, cold feet, clenched fists
• may begin after 1w of life, usually doesn’t last past 3-4mo of age
• tx suggestions: feed more frequently, pacifier, car ride, remove cow milk from diet

Question 4

Stork bite

Answer 4

• nevus flammeus
• macular, salmon pink
• nape of neck or glabellar region (those on neck may persist, those on face fade)

Question 5

Mongolian spot

Answer 5

• dark blue-black macular patches
• lumbar/sacral areas
• usually darker pigmented babies

Question 6

Erythema toxicum

Answer 6

• small erythematous or yellow papules/pustules over face, trunk, extremities
• distinguised from staph/strep infxn b/c NOT tender, no warmth and no induration

Question 7

Neonatal acne

Answer 7

• related to transplacental hormones

- small papules/pustules on face, upper trunk, appear at 2nd/3rd wk of life and resolve w/o tx

Question 8

Apnea defn

Answer 8

-

Question 9

Ddx: blood in diaper

Answer 9

• urine crystals
• w/d bleed in females
• fissure
• blood in maternal milk (do kleihauer-betke test)
• coagulopathy
• Nec
• allergic/infxs colitis
• congenital defects
• cow’s milk allergy

Question 10

constipation

Answer 10

• neonates: think meconium ileus, cystic fibrosis, hirschsprung dz, hypothyroid, anal stenosis
• infants: occult dysraphism (neurogenic bowel/bladder)

Question 11

Jaundice

Answer 11

• hemolysis d/t ABO, Rh incompatibility
• congenital infxn (ToRCHS)
• excessive bruising from birth trauma
• acquired infection (Sepsis, pna)

Question 12

Jaundice: 2-3d after birth

Answer 12

-physiologic

Question 13

Jaundice: 3d-1w

Answer 13

• acquired infxn (sepsis, UTI…)
• congenital decrease in glucuronyl transferase (Gilbert, crigler-najjar)
• ToRCHS

Question 14

Jaundice: >1w

Answer 14

• breast milk jaundice (substances in breast milk inhibit glucoronyl transferase)
• acquired infection
• biliary atresia
• congenital/acquired hepatitis
• RBC membrane defect (sickle cell, spherocytosis, elliptocytosis
• RBC enzyme defect (G6PD)
• hemolysis d/t drugs
• endocrine d/o (hypothroid)
• metabolic d/o (Galactosemia, fructosemia)
• pyloric stenosis

Question 15

Neonatal sepsis: Abx

Answer 15

• cefotaxime plus ampicillin plus acyclovir
• gentamicin covers gm-
• cefotaxime give gm- and + coverage

Question 16

Meningitis organisms:

Answer 16

Neonates: listeria, GBS, e coli

>3mo: strep pneumo (if not vaccinated), n. meningitidis, staph aureus