The Newborn Flashcards by CM A

Neonatology includes caring for the fetus beginning from ___ to ___

20 weeks AOG to 28 days pf postnatal life

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Recommended timing of first PNCU

First trimester

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Recommended number of PNCU is at least

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Recommended iron and folate supplementation for pregnant mothers should at least be a duration of

3 months

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Recommended mineral supplement for pregnant women to optimize fetal CNS development

Iodine

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Pregnant women who work in agriculture are at risk for colonization and infection with

Listeria monocytogenes

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Approximately ___% of spontaneous abortuses have congenital defects

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Congenital anomalies account for more than ___% of fetal deaths

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Virus implicated in fetal anemia

Parvovirus

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Polyhydramnios is defined as

> 2L in the 3rd trimester of AF index >24 cm on UTZ

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Oligohydramnios is defined as

<500mL in the 3rd trimester of AF index of <5 cm on UTZ

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Indicator of poor perinatal outcome because it is the LATE manifestation of chronic fetal compromise regardless of the etiology

Fetal hydrops

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MCC of immune hydrops

Allo-immune hemolysis

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Recreational drug shown to cause craniofacial abnormalities, prematurity, withdrawal, and hypertonia in newborns

Toluene (solvent)

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Anticonvulsants shown to cause spina bifida and craniofacial defects in the growing fetus

Carbamazepine, Valproate, and Phenytoin

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Antimicrobials and their teratogenic effect/s: Chloroquine

Deafness

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Antimicrobials and their teratogenic effect/s: Quinine

Thrombocytopenia, deafness

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Antimicrobials and their teratogenic effect/s: Streptomycin

Deafness

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Antimicrobials and their teratogenic effect/s: Tetracycline

Retarded skeletal growth, cataracts, limb malformation, hypoplasia of enamel

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Hormones and their teratogenic effect/s: Danazol

Masculinization of female fetus

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Hormones and their teratogenic effect/s: Methyltestosterone

Masculinization of female fetus

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Hormones and their teratogenic effect/s: Progesterone

Masculinization of female fetus

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Therapeutic drugs and their teratogenic effect/s: Isotretinoin

Facial-ear anomalies, heart disease

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Therapeutic drugs and their teratogenic effect/s: Lithium

Ebstein’s anomaly

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Therapeutic drugs and their teratogenic effect/s: Misoprostol

Arthrogryposis, equinovarus, Möbius syndrome

Therapeutic drugs and their teratogenic effect/s: Prednisone

Oral clefts

Therapeutic drugs and their teratogenic effect/s: Vitamin D

Supravalvular aortic stenosis, hypocalcemia

Therapeutic drugs and their teratogenic effect/s: Warfarin

Hypoplastic nasal structures

Environmental chemicals and their teratogenic effects: Methyl mercury

Minamata disease, microcephaly, deafness, blindness, mental retardation

Environmental chemicals and their teratogenic effects: Pthalates

Reduced masculinization of male fetus

Neonatal effects of commonly used medications: Magnesium sulfate

Respiratory depression, meconium plug, hypotonia

Neonatal effects of commonly used medications: Oxytocin

Hyponatremia, hyperbiblirubinemia

Limited data show that exposure of human fetuses to large doses of radiation ____ mrad causes microcephaly, mental, and intrauterine retardation

20,000-50,000

The recommended occupational limit of exposure to radiation from all sources is ___ mrad for the entire 40 weeks of pregnancy

500

T/F Mothers with PKU (unabble to metabolize phenylalanine) should regulate dietary intake of the amino acid to provide this to the fetus

The CRL, when taken between 8-12 weeks AOG is within ___ days of the actual AOG

5-7

A reactive NST is defined as

2 accelarations of 15 bpm from baseline got at least 15 sec in a 20-minute observation period

Normal Biophysical profile score

8-10

Components of a BPP

BM TAN: Breathing, movement, tone, amniotic fluid, NST

Principal active component of surfactant

Lecithin

Amniotic fluid L/S ratio of ___ is a good indicator of lung maturity with 98% accuracy

≥2

AF L/S ratio of ___ is needed to assure fetal lung maturity if mothers have diabetes or Rh isoimmunization

≥3

Normal fetal heart rate

110-160

Severe fetal bradycardia is defined as

<90/min

Fetal tachycardia is defined as

>160/min

Normal fetal heart rate variability

>6 beats/min of beat-to-beat variability

T/F Accelerations on FHR monitoring are indicative of fetal well-being

Fetal head compression presents as ___ on FHR monitoring

Early decelerations

T/F Early decelerations are associated with fetal compromise

Variable decelerations on FHR monitoring are usually due to

Umbilical cord compression

Variable decelerations are considered severe if

HR decreases to <60 bpm, ≥60 bpm from baseline, or lasts <60 seconds

Variable decelerations with beat-to-beat variability suggest

Fetal compensation

Late decelerations with beat-to-beat variability suggests

A sudden insult to a fetus that is able to compensate physiologically

Late decelerations with decreased or absent beat-to-beat variability indicates

Fetal hypoxia from uteroplacental insufficiency

Measurement of maternal AFP to screen for fetal disease is done when

Early 2nd trimester

High MSAP detects

90% of NTDs, gastroschisis, omphaloceles, congenital nephrosis, multiple gestations

Elevated MSAP in a structurally-normal fetus is a risk for fetal morbidity because

It reflects placental micr-abruptions or breaching of maternao-fetal barrier

Low MSAP is associated with

Incorrect GA estimates, IUGR, Trisomy 21 and 18

Triple test for Down Syndrome consists of ___ and is done in the 2nd trimester

BUM: MSAP, β-hcg, unconjugated estriol

Quadruple test for Down Syndrome includes ___ on top of the ones done in Triple test and increases sensitivity

Inhibin A

Combined test done in the first trimester for Down Syndrome consists of

PAPP, free β-hcg, fetal UTZ to look for nuchal translucency + Quadruple test in the 2nd trimester

Definitive antenatal diagnostic test for Down Syndrome

Fetal karyotype in the 2nd trimester

Amniocentesis is best done when

Mid-2nd trimester

Effect of oxygen from the first breath to the lungs

Pulmonary vasodilation --> decrease in pulmonary vascular resistance

T/F Foramen ovale remains open longer than the ductus arteriosus

T, BUT without flow

An APGAR score of ___ at 5 minutes is considered normal

8-10

If the APGAR score is less than ___ at the 5th minute of life, an extended score every ___ min is assigned until a score of ___ is reached

7, 5, 7

T/F Majority of children with CP in later childhood have been found to have normal APGAR scores at birth

T, 2/3

T/F A relatively low APGAR score does not necessarily indicate asphyxia in a preterm neonate

T, especially those born <28 weeks AOG

Newborn deaths account for ___% of under-5 mortality rate

MC among the primary causes of death in the neonate

Prematurity/LBW

About half of newborn deaths take place when

First 48 hours of life

Complications that can be prevented by discontinuing routine suctioning of the airways in newborns

Apnea, bradycardia, infection

Newborn's temp should be maintained between

36.5-37.5

Measures done in the DR to prevent heat loss: Via evaporation

Immediate drying

Measures done in the DR to prevent heat loss: Via conduction

Place baby on a warm surface or skin-to-skin contact with the mother

Measures done in the DR to prevent heat loss: Via convection

Draught of cold air should be avoided

Measures done in the DR to prevent heat loss: Via radiation

Maintain a warm environment of 25-28C

Measures done in the DR to prevent heat loss: Via convection

Turning the air conditioner or fans off

Immediate and thorough drying should be done for how long

At least 30 seconds

Benefits of the vernix

Thermal protection and infection prevention

Benefits of delayed cord clamping

1) Decreases severity of physiologic anemia 2) Increases venous hct 3) Decreases incidence of IVH in the preterm 4) Increases stores of iron

Delayed cord clamping is defined as

Clamping between 1-3 minutes of life or until cord pulsations can longer be appreciated