The Newborn Flashcards
Neonatology includes caring for the fetus beginning from ___ to ___
20 weeks AOG to 28 days pf postnatal life
Recommended timing of first PNCU
First trimester
Recommended number of PNCU is at least
4
Recommended iron and folate supplementation for pregnant mothers should at least be a duration of
3 months
Recommended mineral supplement for pregnant women to optimize fetal CNS development
Iodine
Pregnant women who work in agriculture are at risk for colonization and infection with
Listeria monocytogenes
Approximately ___% of spontaneous abortuses have congenital defects
20
Congenital anomalies account for more than ___% of fetal deaths
60
Virus implicated in fetal anemia
Parvovirus
Polyhydramnios is defined as
> 2L in the 3rd trimester of AF index >24 cm on UTZ
Oligohydramnios is defined as
<500mL in the 3rd trimester of AF index of <5 cm on UTZ
Indicator of poor perinatal outcome because it is the LATE manifestation of chronic fetal compromise regardless of the etiology
Fetal hydrops
MCC of immune hydrops
Allo-immune hemolysis
Recreational drug shown to cause craniofacial abnormalities, prematurity, withdrawal, and hypertonia in newborns
Toluene (solvent)
Anticonvulsants shown to cause spina bifida and craniofacial defects in the growing fetus
Carbamazepine, Valproate, and Phenytoin
Antimicrobials and their teratogenic effect/s: Chloroquine
Deafness
Antimicrobials and their teratogenic effect/s: Quinine
Thrombocytopenia, deafness
Antimicrobials and their teratogenic effect/s: Streptomycin
Deafness
Antimicrobials and their teratogenic effect/s: Tetracycline
Retarded skeletal growth, cataracts, limb malformation, hypoplasia of enamel
Hormones and their teratogenic effect/s: Danazol
Masculinization of female fetus
Hormones and their teratogenic effect/s: Methyltestosterone
Masculinization of female fetus
Hormones and their teratogenic effect/s: Progesterone
Masculinization of female fetus
Therapeutic drugs and their teratogenic effect/s: Isotretinoin
Facial-ear anomalies, heart disease
Therapeutic drugs and their teratogenic effect/s: Lithium
Ebstein’s anomaly
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
T
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
T
Fetal head compression presents as ___ on FHR monitoring
Early decelerations
T/F Early decelerations are associated with fetal compromise
F
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
48
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
