Sick Newborns Part 1 Flashcards
What are the primary causes of infant mortality?
PAS
Prematurity
Asphyxia
Sepsis
What should be done if babies are born limp, cyanotic, apneic or pulseless?
Immediate resuscitation before asignment of the 1st minute APGAR score
What is the main goal of resuscitation?
To establish ventilation within the 1st minute of life (first golden minute)
What are indications of Positive pressure ventilation (PPV)
Heart rate <100bpm
Ineffective respiration
Use ECG monitor & pulse oximeter at once resuscitation is required
What should u do if heart rate falls below 60bpm in spite of 30 secs ventilation?
Initiate chest compressions
Do intubation if not yet done
Compression to ventilation ratio: 3:1
Administer 100% oxygen
Continue chest commpressions for 60 secs before re-assessment
What is the heart rate remains <60bpm after CC?
IV epienphrine should be admin
What are things to note once the baby is delivered?
- Note time of birth
- Note if baby is crying or breathing
- Not breathing properly or limp
- Gasping, apneic or HR <100bpm
- Spontaneous but labored breathing
After initial PPV what should be done?
Assess HR
If HR <100bpm -> CC, INC O2 to 10%, Chest rise, perform MR SOPA
If HR <60bpm -> CC 3:1 ratio
If responsive to resuscitation -> post-resuscitation care
What are common causes of common neurologic problems?
Multifactorial
What are common neurologici problems in newborns?
Cranial hemorrhage
Periventricular leukomalacia
Neonatal seizures
Hypoxic ischemic encephalopathy
What are the 2 types of cranial hemorrhage and specific conditions under it?
Extraccranial - Caput succedaneum, Cephalhematoma, Subgaleal hemorrhage
Intracranial - Extradural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage, Intracerebral/Intraventricular hemorrhage
What is the most common and most benign extracranial hemorrhage?
Caput succedaneum
Clin Presentation: diffuse, ecchymotic, edematous swelling of the soft tissues of the scalp
Location: extend across sutures/midlines
What are the clin presentation of Cephalhematoma?
Does not cross sutures/midline (bleeding confined within the subperiosteal area)
What are the clin presentation of Subgaleal hemorrhage?
Blood spreads in the entire skull or even in the SQ tissue of the neck assoc with vacuum delivery
What are managements of Subgaleal hemorrhage?
Volume expanders
Inotropic support
Transfusion for anemia cases
What are the causes of Intracranial hemorrhage?
Birth trauma
Asphyxia
Term infants - subarachnoid hemorrhage (most comon)
Preterm infants - IVH or periventricular hemorrhage
Perinatal arterial ischemic stroke, sinovenou thrombosis, perinatal hemorrhagic stroke and trauma -
What is the most commmon CNS complication of preterm birth?
Intraventricular hemorrhage
What are the sites of bleeding in IVH?
Germinal matrix
Subependymal germinal matrix
Why are preterm infants most susceptible to IVH?
Lack of cerebral flow autoregulation -> pressure passive state exists
What is the most common cause of IVH?
Immatyrity of the germinal matrix of the lateral ventricle
What are the 3 types of clin manifestataions of IVH?
1st = astmptomatic if bleeding is small
2nd: gradual clin deterioration with altered level of consciousness, hypotonia or abnormal eye movements
3rd: sudden and catastrophic deterioration on 2nd-3rd day of life
Full anterior fontanelle with sudden pallor supported by sudden drop in hematocrit (w/ hemodynamic instability, hyperglycemia, acidemia, and hyperkalemia)
How is the Dx of IVH conducted?
Cranial US = screening
IVH grading
What is the IVH grading?
Grade 1 = confined to the GM-subependymal region or <10% of ventricle
Grade 2 = Intraventricular bleeding
Grade 3 = >50% of ventricle is involved
Grade 4 = extension into the parenchyma with ventricular enlargement
What are the characteristics of Periventricular Leukomalacia (PVL)?
Focal necrotic lesions in the periventricular white matter
Risk of PVL INC w/ severe IVH or Ventriculomegaly
What are predisposing factors of PVL?
Prematurity
Dysregulatoin in cerebral blood flow
Maternal-feltal infections
Disturbance in oligodendrocyte precursors for myelination
Factors contributing to the devt of HIE and IVH
What is the clin manifestaion of PVL?
Later infancy = spastic motor deficits
What are the cause sof neonate seizures?
Post asphyxial: hypoxic-ischemic encephalopathy
Posthemorrhage: IVH or subarachnoid hemorrhage
Metabolic disturbances
Imbalance of cerebral excitation & inhibitory pathways
Toxins
Infections
Malformations
Genetic
Trauma
What are the diff types of neonatal seizures?
Subtle seizure (automatism) - most common
Clonic seziures
Tonic seizures
Myoclonic seizures
What pathological condition occurrs where there is no spontaneous breathing or represents irregular breathing after brith?
Perinatal asphyxia
In the timing of injury, when is the most frequent time asphyxial events happen?
Intrapartum = abnormal interruption of umbilical circulation & inadequate placental perfusion
What is the intial response of the organs after asphyxial events?
Diving reflex = there is INC shunting of the cicrculatory system through the ductus venosus, ductus arteriosus and foramen ovale
What are the most targeted organs after asphyxiation?
Renal
CVS
Respi
CNS
What is the pathophysio of Hypoxic ischemic encephalopathy?
Primary energy failure & INC lactic production
What happens during primary energy failure ?
Effects lead to cellular necrosis through impaired cellular integrity -> DEC brain function
WhaT happens in secondary energy failure?
6-48hrs after initial injury
Excitatory occurs when excessive levels of extracellular NT especially glutamate, overstimulate the excitatory receptors
How do u classify if it is a chronic brain injury?
30-60min period of recovery of cellular energy pathways (reperfusion phase)
What are the best prognosis of HIE?
Stage 1 = best outcome; prolonged periods of wakefulness and generalized sympathetic tone
Stage 2 = seizures are common
Stage 3 = worst outcome
What are the initial diagnostic tests done for px?
Chest x-ray
Arterial blood gas
CBC
What is a prominent clin manifestation of ARDS?
Atelectasis = chest xray (GROUND GLASS HAZE IN THE LUNG)
What should be given to prevent preterm birth?
Betamethasone or Dexamethasone (multiple doses are not beneficial)
What are clin features of transient tachypnea of the newborn?
Retained or delayed clearance/resorption of lung fluid
Tachypnea (>60 breaths/min)
Hypoxia
Cyanosis
What are the predisposing factors of Transient Tachypnea of the newborn?
Larger, preterm infants
Twin gestation
Diabetic motehrs
What are causative agents of neonatal pneumonia?
E coli
S aureus
K pneumoniae
What is the tx for neonatal pneumonia?
Ampicillin + Gentamicin
Where does gas exchange occur in pregnant women for babies?
Placenta
What are the causes of pulmonary HTN?
Maladaptation: nromal vasculature but it is vasoconstricted
Maldevelopment: abnormal structure of the pulmonary vasculature bed
What are the common congenital heart diseases?
Ventricular septal defect
Tetralogy of fallot = beyond neonatal period
Transposition of the great arteries = 1st week of life
Hypoplastic left heart syndrome = 1st week of life
What are the causes of cyanosis in CCHD?
Obstruction to the right ventricular inflow or outflow -> intracardiac right to left shunting
Complex anatomic defect - admixture of pulmonary and systemic venous return in the heart
Persistence of fetal pathway
What are the 5Ts, DO, ESP of CCHD?
Truncus arteriosus
TGA
Tricuspid atresia
TOF
Total anomalous pulmonary venou return
Double outlet right ventricle
Ebstein’s anomaly
Single ventricle
Pulmonary atresia
What are the 7 CCHD screening targets?
HLHS
Pulmonary atresia
TOF
TAPVR
TGA
Tricuspid atresia
Truncus arteriosus
What are the diff betw HLHS vs Sepsis?
HLHS - presents after the duct is closed by 48-72 hours & CF to the ER with no murmur
No high risk factors for infection, always consider the dx of HLHS
What are S/Sx of Patent Ductus Arteriosus?
TERM BABIES:
Systolic or machinery murmur w/ bounding pulase
If late, CHF
PRETERM BABIES:
- DEC blood flow to the gut -> Necrotizing enterocolitis, pulmonary hemorrhage, bronchopulmonary dysplasia
What is the most commn life threatenign mergency of GI tract in the newborn period?
Necrotizing enterocolitis -> mucosal/transmural necrosis of the intestine
What are the 3 major risk factors of NEC?
Prematurity
Bacteria colonization of the gut
Formula feeding
What are the clin features of NEC?
2nd or 3rd wk of life
Very low birth weight
Non-specific = lethargy, temp instability
What are the radio findings of NEC?
Pneumatosis intestinalis = air in bowel of mucosa, diagnostic
With portal gas = sign of SEVERE DIS
Pneumoperitoneum = perforation of the bowel
What are the 3 types of meconium diseases?
Meconium plug
Meconium ileus
Meconium peritonitis
What is the indication of Meconium plug?
Hirscprung disease
Presents with: abdominal distention, bilious emesis
What are clin presentation & indications of Meconium ileus?
Clin Pre: Bilious emesis, abdominal distention, no passage of meconium, distal ileum
Abdominal xrays: distended intestinal loops, granular or bubbly
What are clin presentations of meconium peritonitis?
Intestinal performations with meconium spillage in the peritoneal cavity
What are conditions that require surgical intervention of neonates?
Failure to pass meconium within first 24-48hrs of life
Feeding intolerance
Intestinal obstruction
What is the incidence and clnical featres seen in congenital hyperplatic pyloric stenosis?
Male > Female
Blood groups O & B
Non bilious vomitng
Dehydration
Hypochloremic, hypokalemia, metabolic alkalosis
What are diagnostic signs of congenital hyperplastic pyloric stenosis?
Fluoroscopy: Barium-string sign
US: Bull’s or target sign
What are surgical conditions of neonates?
Congenital hyperplastic pyloric stenosis
Esophageal atresia
Duodenal atresia
Hirschprung disease
Omphalocele vs Gastroschisis
What are conditions that are at higher risk of developing duodenal atresia?
Trisomy 21
CHD
Maltrotation
Annlar pancreas
GU
EA`
What are clinical findings of Duodenal atresia?
Utero
- US: polyhydramnios and distended duodenum
Postnatal
- bilious emesis first 24hrs with abdominal distention in upper abdomen & DOUBLE BUBBLE SIGN
What is the most common cause of lower intestinal obstruction in neonates and common segment affected?
Hirschprung disease
Rectosigmoid
What are clinical findigns of Hirschsprung disease?
(-) Meissner’s and Auerbach’s plexuses
Hypertrophied nerve bunes -> HIGH conc of Achesterase
What are the red flags in the neonatal period?
Neonatal intestinal obstructions
Bowel perforation
Delayed passage of meconium
Abdominal distention
Chronic severe constipation
Enterocolitis
What are the diff betw Ompalocele vs Gastroschisis?
Omphalocele - umbilical cord defect (insertion of the distal umbilical cord into the sac)
Gastroschisis - abdominal wall defect (R of umbilical cord)
When is the dx of Gastroschosis done?
20th wk via US -> free-floating bowel loops in the uterine cavity, INC maternal serum AFP
