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Pediatrics > The Perinatal Period > Flashcards

The Perinatal Period Flashcards

1
Q

Gestational period:

  1. Preterm gestation?
  2. Term gestation?
  3. Post term gestation?
A
  1. Preterm gestation: less than 37 weeks
  2. Term gestation: 37 to 42 weeks
  3. Post-term gestation: >42 weeks
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2
Q
  1. What is the neonatal period?
  2. Perinatal period?
A
  1. First 28 days (4 weeks) of life (+ preterm time period)
  2. from 20 weeks gestation to one month after birth
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3
Q

Fetal-Neonate Transition includes what? 4

A
  1. Cardiovascular Transition
  2. Respiratory Transition
  3. Temperature Maintenance
  4. Growth Transition
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4
Q

What is richer in oxygen… the umbilical arteries, or the umbilical vein?

A

the umbilical vein is richer in oxygen

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5
Q

What are the three shunts in the fetus?

A
  1. Ductus venosus
  2. Ductus arteriosus
  3. Foramen ovale
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6
Q

Describe where each of the following is:

  1. Ductus venosus
  2. Ductus arteriosus
  3. Foramen ovale
A
  1. connects umbilical vein to inferior vena cava
  2. a channel of communication between the main pulmonary artery and the aorta
  3. opening between the two atria of the fetal heart
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7
Q

Describe the function of each of the following:

  1. Ductus venosus
  2. Ductus arteriosus
  3. Foramen ovale
A
  1. Ductus venosus: allows oxygenated blood directly from mom to enter circulation (bypasses liver) via inferior vena cava
  2. Ductus arteriosus: allows majority of blood which would enter pulmonary vasculature to bypass directly to the aorta (so what about those lungs then?)
  3. Foramen ovale: allows oxygenated blood from mom which enters right atrium to be channeled directly to left atrium (right to left shunting) and then onto the left ventricle, aorta, and system
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8
Q

So what happens to those shunts with birth? Describe the pulmonary and vascular resistance in the following situations:

  1. In utero?
  2. At birth?
A

In utero:

  1. Systemic vascular resistance low
  2. Pulmonary vascular resistance high

At birth:

  1. Increased systemic vascular resistance
  2. Decreased pulmonary vascular resistance
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9
Q

What does this shift do in vascular and pulmonary pressure at birth cause? 2

A

This increases left atrial pressure which

  1. closes the foramen ovale and
  2. eliminates right to left shunting
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10
Q

What closes the ductus arteriosus?

A

Extremely sensitive to the oxygen content of the blood —At birth increased oxygen initiates constriction and subsequent closure

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11
Q
  1. When does the ductus venosus disappear?
  2. What does it become?
A
  1. Disappears within 2 weeks after birth
  2. Becomes ligamentum venosum
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12
Q
  1. What is the last system to fully mature in utero?
  2. When does this start to develop?
A
  1. The last system to fully mature in utero is the pulmonary system:
  2. Third trimester (28-40 weeks gestation):
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13
Q
  1. When is surfactant produced?
  2. What is its function?
  3. Surfactant production is usually sufficient by when?
A
  1. Surfactant starts being produced
  2. Surfactant reduces surface tension and stabilizes alveoli
  3. Surfactant production is usually sufficient by 34 weeks gestation
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14
Q
  1. Describe the temperature maintance in babies?
  2. So what should we do immediately after birth? 2
A
  1. Heat regulation not well developed (and why would it be?… baby’s been in a spa with tight temp regulation for the last 9 months!) Sensitive to excess heat loss and heat retention (hypo-/hyperthermia)

2.

  • Dry the infant
  • Provide radiant heat (& during PE!)
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15
Q
  1. Describe the growth transition in the first few days of birth?
  2. What does this consist of? 2
A
  1. Weight loss of 5-10% is normal in first week after birth

2.

  • Predominantly loss of extracellular water
  • Inadequate nutritional intake
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16
Q

Describe the acclimation phase of growth transition back to normal weight:

  1. Timeline?
  2. What improves?
A
  1. Most newborns back to birth weight by 2 weeks of age
  2. -Feeding improves -Growth accelerates
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17
Q

Describe the APGAR scoring system

  1. Acitivity?
  2. Pulse?
  3. Grimace?
  4. Appearance (skin color)?
  5. Respiration?
A

See picture

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18
Q

Important basic principles: Neonatal Resuscitation

4

A
  1. Oxygen! Oxygen! Oxygen!
  2. Bulb Suctioning, particularly if meconium stained amniotic fluid
  3. Stimulation** (induces sympathoadrenal-mediated increases in respiratory and cardiac performance)
  4. Drying and warming for maintenance of thermoneutrality (so neonate can expend energy elsewhere)
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19
Q

Babies born with these conditions appear completely normal, thus why we screen!

Commonly screened conditions include: 5

When do these disorders usually develop?

A
  1. Phenylketonuria (PKU)
  2. Galactosemia
  3. Hemoglobinopathies
  4. Hypothyroidism–symptoms
  5. Hearing screening

Disorders usually only develop after baby has been feeding for 2-3 days. When are mom and child usually discharged?

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20
Q

Which of the following babies would be considered full term?

  1. Billy born at 26 3/7 weeks gestation
  2. Tommy born at 34 5/7 weeks gestation
  3. Bobby born at 37 1/7 weeks gestation
  4. Frodo born at 42 2/7
A

4

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21
Q
  1. Small for gestational age (SGA)?
  2. Appropriate for gestational age (AGA)?
  3. Large for gestational age (LGA)? (what is this called)
  4. (most common cause of macrosomia?)
A
  1. less than 10th percentile on growth chart vs. Intrauterine growth retardation (IUGR)
  2. Between 10th and 90th percentile on growth chart
  3. Above the 90th percentile for weight on growth chart

fetal macrosomia

  1. Genstational diabetes
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22
Q

Using the chart to the left, tell me if a baby born at 38 4/7 who weighed 4000g would be LGA, AGA, or SGA?

A
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23
Q

IUGR Concepts

Important distinction is whether the growth restriction is symmetric or asymmetric

  1. SGA symmetric causes? 3
  2. Asymmetric? 3
  3. Describe how asymmetric is different than symmetric?
A

Symmetric:

Infant can be SGA due to genetics and is normal but small

–Symmetric implies event in EARLY pregnancy such as

1.

  • chromosomal abnormalities,
  • drug or alcohol use, or
  • congenital viral infections
    2. Asymmetric

Asymmetric implies problem LATE in pregnancy such as

  • pregnancy-induced hypertension,
  • pre-eclampsia or
  • placental insufficiency

3.

ONLY THE WEIGHT at or below 10th percentile

Head is normal size, body is smaller

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24
Q

Which do you think is associated with a better prognosis for development… symmetric or asymmetric?

A

asymmetric

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25
Q

Causes of LGA? 2

Normal varients? 4

A
  1. Infant of a diabetic mother (IDM)
  2. Erythroblastosis fetalis (Hydrops)

Normal variants:

  1. Genetic predisposition
  2. Male fetus
  3. Post-dates gestation
  4. Multiparity (this does NOT mean twins)
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26
Q

Why is the infant of a diabetic mother:

  1. Usually large for gestational age?
  2. At risk for hypoglycemia?
A
  1. more calories in the form of glucose
  2. Used to getting all that sugar from the mother and when they are born they arent able to get it. Their insulin is high in the womb and they dont get that glucose levels when they are born so it drops because of excess insulin
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27
Q

IDM (Hypoglycemia)

  1. ***All LGA infants should be screened for hypoglycemia while in the hospital—hypoglycemia can occur within _____of birth
  2. At 3 hours of life normal-term babies blood glucose stabilizes at_______ mg/dL
  3. Concentrations below ______mg/dL after the first few hours of life should be considered abnormal
  4. Heel stick to screen, if low or borderline, need what?
A
  1. 3 hrs
  2. 50-80
  3. 40-45
  4. direct measurement of blood (more reliable)
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28
Q

IDM (Hypoglycemia)

1. management? 1

  1. Signs? (are nonspecific and may be subtle) 4
A
  1. Continued surveillance until full enteral feedings without IV supplementation for 24-hour period
  2. Signs are nonspecific and may be subtle:
    - Lethargy, poor feeding
    - Irritability, tremulousness, jitteriness
    - Apnea, and
    - seizures
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29
Q

IDM (Hypoglycemia)

  1. Treatment? 2
  2. Prognosis? 1
  3. IUGR infants can also have hypoglycemia: due to?
A

1.

  • Intravenous glucose- Dose depends on level of hypoglycemia and whether there are symptoms
  • If infant is alert and vigorous and only mildly hypoglycemic, may just feed and monitor carefully
    2. Prognosis usually excellent if therapy prompt
    3. reduced glucose stores
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30
Q

**Before we begin, always remember that hypoxemia and acidosis contribute to what?

A

pulmonary vasoconstriction (Increased pulmonary vascular resistance!)

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31
Q

Respiratory Distress Syndrome (RDS):

  1. What is last to fully mature?
  2. Epithelial cells in the alveoli called Alveolar type II cells produce what?
  3. Surfactant lowers what?
  4. Surfactant deficiency leads to what?
  5. Uncommon at ____weeks’ gestation and beyond
  6. 70% chance of RDS at _____weeks gestation
A
  1. Pulmonary system
  2. produce surfactant
  3. surface tension
  4. markedly decreased lung compliance (alveoli collapse without its presence)
  5. 37
  6. 28-30
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32
Q

RDS

Signs include (within 6 hours after birth): 5

Chest xray findings? 2

A
  1. Tachypnea (What’s normal- 160)
  2. Retractions
  3. Nasal flaring
  4. Grunting
  5. Cyanosis

Chest x-ray:

  1. Reticulogranular (“ground glass”) pattern
  2. Air bronchograms
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33
Q

Respiratory Disorders

DDx?

6

A
  1. Sepsis
  2. Pneumonia
  3. Pneumothorax
  4. Mass-occupying lesions in the chest (stomach)
  5. Polycythemia
  6. Transient tachypnea of the newborn
34
Q

Management of RDS:

4 (whats most important)

A
  1. Oxygen therapy with monitoring of blood gases
  2. Continuous positive airway pressure (CPAP)
  3. Mechanical ventilation (if needed)
  4. Artificial surfactant replacement***
35
Q

Meconium Aspiration Syndrome(MAS):

  1. Staining of amniotic fluid with meconium in association with what?
  2. More common the longer the gestation. Whats the theory behind this?
  3. What kind of disease is this?
  4. Most common with what? 2
  5. Signs include? 5
A
  1. Respiratory distress
  2. theory is that fetal distress leads to meconium passage in utero followed by aspiration from gasping
  3. Obstructive disease**
  4. Most common with postmaturity and fetal distress
  5. Signs include
    - grunting,
    - nasal flaring,
    - retractions,
    - marked tachypnea, and
    - varying degrees of cyanosis (sound familiar?)
36
Q

MAS respiratory disorder:

  1. Chest xray reveals?
  2. Frequently seen complications? 3
  3. What do ABGs lead to? 2
A
  1. Chest x-ray reveals fluffy infiltrates with alternating areas of lucency

2.

  • Pneumothorax or
  • pneumomediastinum and
  • hyperinflation with flattening of diaphragm also frequently seen
    3. ABGs reveal
  • hypoxemia (low O2) and
  • hypercarbia (high CO2)
37
Q

Management: of MAS

5

A
  1. Suctioning of nose and oropharynx after delivery of head should always be done by obstetrician when meconium staining is present (gentle bulb suctioning)
  2. Chest physiotherapy
  3. Oxygen therapy with monitoring of blood gases
  4. CPAP or mechanical ventilation
  5. Routine administration of antibiotics because of possible occurrence of secondary bacterial pneumonia
38
Q
  1. Persistent Pulmonary HTN of Newborn (PPHN): AKA?
  2. PP?
  3. Caused by?
  4. Can be idiopathic or secondary to what? 4
  5. What can demonstrate right to left shunting pattern and rule out any structural heart defects?
A
  1. Also known as persistent fetal circulation
  2. Right to left shunting of desaturated blood through fetal pathways (patent foramen ovale [PFO] or patent ductus arteriosus [PDA]) in structurally normal heart
  3. Caused by sustained elevation in pulmonary vascular resistance

4.

  • RDS,
  • congenital diaphragmatic hernia,
  • hyperviscosity,
  • sepsis
    5. Echocardiography with color flow doppler
39
Q

Respiratory Disorders

Transient Tachypnea of the Newborn (TTN):

  1. What is the problem?
  2. Distress starts at what time?
  3. Requires what treatment?
  4. Occurs in what population of infants?
  5. Chest xray findings?
  6. Resolution?
A
  1. Retained fetal lung fluid
  2. Distress typically from birth
  3. Requires mild to moderate oxygen (25-50%)
  4. Often occurs in term or near-term infants
  5. Chest x-ray shows perihilar streaking and fluid in interlobar fissures
  6. Resolution usually occurs within 12-24 hours
40
Q
  1. What is jaundice caused by?
  2. Describe the production and conjugation of bilirubin that causes this?
  3. Conjugated where?
  4. Excreted where? 2
  5. Any process that causes excess destruction of RBCs or interferes w/ bile excretion can cause?
A
  1. Jaundice is caused by excessive levels of bilirubin in the blood stream
  2. Production:
    - Bilirubin is produced from RBCs destroyed in the liver and spleen
    - It is unconjugated and binds to albumin and is transported to the liver

Excretion:

  1. Conjugated in the liver

4.

  • Excreted in the bile
  • Eliminated in the urine and feces
    5. hyperbilirubinemia
41
Q

Describe Bilirubin Metabolism?

A

See picture

42
Q
  1. Why We Care About Jaundice?
A

Unconjugated [indirect] bilirubin is neurotoxic:

Bilirubin induced neurologic dysfunction (BIND)

43
Q

Acute bilirubin encephalopathy [early signs of toxicity]:

  1. Occurs when?
  2. Chracterized by? 2
  3. Can be reversed unless what happens?
A

1, Neurological changes occur in the first postnatal weeks

  1. Characterized by hypotonia and seizures
  2. Can be reversed unless levels of bilirubin remain elevated
44
Q
  1. What is Kernicterus?
  2. Develops when?
A
  1. Chronic and permanent sequelae of BIND
  2. Develops during the first year of life
45
Q

We treat to prevent neurotoxicity—Kernicterus

  1. Occurs when unconjugated bilirubin, normally tightly bound to albumin, reaches what?
  2. The unconjugated bilirubin exceeds what?
  3. How is it neurotoxic?
A
  1. High levels
  2. the binding capacity of albumin
  3. It crosses blood-brain barrier to damage cells of the brain
46
Q

In full term newborns:

  1. Kernicterus can occur when unconjugated bilirubin levels are above what levels?
  2. Occurs at lower levels with who?
  3. What does treatment depend on?
A
  1. 20-25 mg/dL
  2. Occurs at lower levels with premature infants
  3. Treatment depends on circumstance and rate of bilirubin increase
47
Q

Mechanisms leading to Physiologic Jaundice

3 ways

A
  1. Bilirubin production is higher:
  2. Bilirubin clearance by the liver is decreased due to a decrease in an enzyme—UGT1A1
  3. Increased enterohepatic circulation:
48
Q

Describe the mechanisms to jaundice and why they occur:

  1. Bilirubin production is higher: 3
  2. . Increased enterohepatic circulation: 3
A

Bilirubin production is higher:

  1. Newborns have a higher HCT (normal—50-60%)
  2. Fetal RBCs have a shorter life span
  3. There is a greater turnover of RBCs

Increased enterohepatic circulation:

  1. Conjugated bilirubin (cannot be reabsorbed) reaches the infant’s gut
  2. Beta-glucuronidase in the infant’s gut acts on the bilirubin to make it unconjugated and then it is reabsorbed into the circulation again
  3. The infant gut has few bacteria in it to counter the effects of the Beta-glucuronidase (YET!)
49
Q

Physiologic jaundice of newborn

  1. Begins when?
  2. Peaks at what levels and when?
  3. Returns to normal when?
  4. Progression pattern?
  5. Premature infants may take _____days to reach peak bilirubin levels, and these peaks may be______that observed among full-term infants
A
  1. Begins after 24 hours of life
  2. Peaks at a level of 12-15mg/dL of indirect (unconjugated) bilirubin at around 3 days of life
  3. Returns to normal by days 10-12
  4. Progresses cephalocaudally (head to toe)
  5. 4-5, twice
50
Q

At what serum bilirubin level does jaundice appear?

A
  1. Total bilirubin levels of 3-5

This includes the indirect and direct bilirubin

51
Q

The difference between direct and indirect bilirubin?

A

Direct bilirubin has been conjugated (water soluble) by the liver

Indirect bilirubin is not conjugated (NOT water soluble)

52
Q
  1. In an infant with physiologic jaundice, what bilirubin is high?
  2. What kind of disease is this?
A
  1. it is the INDIRECT bilirubin that is high because the liver is immature and CANNOT conjugate the bilirubin
  2. In obstructive diseases it is the direct bilirubin that is elevated
53
Q

What other history should we get for jaundice?

3

A
  1. Breastfeeding habits include every three hours vigorously for ten minutes on each breast, sometimes he’ll go four hours between feeds.
  2. Four to five wet diapers a day, three to four stools per day, which are greenish and soft
  3. No known family hx of liver disease, hematologic disease, or genetic disorders. No one at home is ill.
54
Q
  1. What is the indirect Coombs test?
  2. Patient’s serum is incubated w/ RBCs w/ what?
  3. If there are antibodies present in serum they will do what?
  4. A positive test results in what?
A
  1. Tests for presence of blood type antibodies in serum
  2. known antigenic markers
  3. bind to RBCs
  4. agglutination of the RBCs
55
Q

Describe agglutination in the indirect coombs test

A

see picture

56
Q

Exaggerated physiologic hyperbilirubinemia or breast feeding jaundice:

  1. Jaundice often exaggerated by what?
  2. There is usually what associated with it?
  3. Newborns should feed at a minimum every _____?
  4. Produce ____wet diapers per day
  5. ____stools a day
A
  1. the milk takes longer to come in
  2. mild dehydration
  3. 2-3 hours
  4. 6-8
  5. 5-6
57
Q

Treatment of Exaggerated physiologic hyperbilirubinemia or breastfeeding jaundice?

3

A
  1. Frequent feeding and adequate hydration

Depending on total serum bilirubin level

  1. Consider phototherapy (converts unconjugated bilirubin into water-soluble forms that can be excreted without conjugation in liver)
  2. Exchange transfusion if needed (VERY RARELY needed)
58
Q

Treatment of Jaundice

2

A

Phototherapy and exchange transfusion

59
Q

Phototherapy:

  1. Describe the process?
  2. The light converts bilirubin to ________which is excreted in the bile and urine**
  3. Risks include what? 4
  4. Monitor what? 4
A
  1. Use of a blue light of a particular wave length with as much skin exposed as possible—eyes covered
  2. lumirubin

3.

  • retinal degeneration,
  • dehydration,
  • hyperthermia and
  • at times rashes

4.

  • temp,
  • hydration status,
  • total bilirubin levels, &
  • time of exposure
60
Q
  1. When do we use exchange transfusion for jaundice?
  2. What kind of blood do we use?
A
  1. Used when phototherapy fails or an infant shows signs of bilirubin-induced signs of neurologic-dysfunction (BIND), including “acute-bilirubin encephalopathy” (reversible) and kernicterus (irreversible)

Rarely used

  1. Irradiated blood is used to reduce the risk of graft vs. host disease
61
Q

Describe the phototherapy guidelines 3 and associated risk factors 8?

A

See picture

62
Q

Differentiating Physiologic from Pathologic Jaundice

2

A
  1. Exaggerated physiologic jaundice occurs at serum bilirubin levels between 7 and 17mg/dL
  2. Levels above 17 in full-term infants are NOT considered physiologic and require further investigation
63
Q

Other incidences where jaundice is NOT considered physiologic:

3

A
  1. ***Onset in the first 24 hours
  2. Rate of increase of serum bilirubin exceeds 0.5mg/dL/h
  3. Conjugated serum bilirubin exceeds 10% of total bilirubin or 2mg/dL (what kind of disease would this suggest? Obstructive)
64
Q

Other Causes of Jaundice in the Newborn

3

A
  1. Increased Production:
  2. Decreased Clearance:
  3. Increased Enterohepatic Circulation:
65
Q

Reasons for increased production of bili leading to jaundice? 5

Descreased clearance etiologies? 2

Increased Enterohepatic Circulation? 3

A

Increased Production:

  1. Hemolytic disease—ABO or Rh incompatibilities
  2. Inherited RBC membrane defects
  3. G6PD, etc.
  4. Sepsis causes hemolysis
  5. Increased RBC breakdown: (Cephalohematoma and Polycythemia)

Decreased Clearance:

  1. Inherited liver defects
  2. Such as Gilbert syndrome

Increased Enterohepatic Circulation:

  1. Human milk jaundice
  2. Breast milk jaundice
  3. Impaired intestinal motility
66
Q

Describe Caput succedaneum 7 and cephal haematoma 7

A

See picture

67
Q

ABO and Rh hemolytic disease: ABO hemolytic disease:

  1. Occurs in what situations?
  2. PP? 2
  3. Prognosis?
  4. Can accompany any pregnancy where mom is type what?
  5. Symptoms can appear when?
  6. May develop significant anemia over first several weeks, may need to be what?
A
  1. Occurs in context of mom having type O blood and baby having type A or B

2.

  • Preformed maternal anti-A or anti-B antibodies can passively cross the placenta late in pregnancy or during delivery
  • The antibodies attack A or B antigen on fetal RBCs
    3. Disease usually is not severe
    4. type O
    5. Symptoms can appear in first 24 hours
    6. need to be transfused at a few weeks of age
68
Q

Rh hemolytic disease:

  1. Compare it to ABO?
  2. Same process that occurs with ABO incompatibility but with what?
  3. Can be more severe with each pregnancy. Why?
  4. Can accompany any pregnancy where mom has what blood?
  5. Symtpoms when?
A
  1. much less common but more severe
  2. Same process that occurs with ABO incompatibility but with antibodies directed against Rh protein
  3. They continue to make more antibodies
  4. Can accompany any pregnancy where mom has Rh negative blood!
  5. Symptoms in first 24 hours
69
Q
  1. What is the proper term for Rh hemoytic disease?
  2. What can this be prevented by? and what is it classified as?
  3. When is it administered?
A
  1. Proper term is Rh isoimmunization
  2. Usually can be prevented by administering Rhogam, an immune globulin
  3. Administered to any Rh-negative woman after any invasive procedure during pregnancy as well as after any miscarriage, abortion, or delivery of an Rh-positive infant
70
Q

Erythroblastosis fetalis (hydrops fetalis):

  1. Who does this occur in?
  2. Often results in what?
  3. Less severe cases result in what?
A
  1. Occurs in severe cases, especially in Rh-negative women who have NOT received appropriate care with Rhogam previously
  2. Often results in fetal or neonatal death without appropriate prenatal intervention
  3. Less severe cases result in hemolysis, with resultant hyperbilirubinemia and anemia
71
Q

Rh Hemolytic Disease

Treatment:

  1. When diagnosised prenatally?
  2. Following therapy?
  3. Ongoing what will occur until maternal antibody is gone?
  4. Infants should be carefully followed for _______to ensure they do not become anemic enough to warrant further transfusions
A
  1. When diagnosed prenatally, transfusion of fetus with Rh-negative cells is done
  2. Following delivery, phototherapy is started immediately with exchange transfusion as necessary
  3. Ongoing hemolysis will occur until maternal antibody gone
  4. 2 months
72
Q
  1. What is human milk jaundice?

2, Etiology?

  1. Lasts how long? and what is the prognosis?
  2. Peaks when?
  3. Treatment?
  4. Describe nursing levels during this time?
A
  1. Prolonged unconjugated hyperbilirubinemia:

Uncommon syndrome

  1. Etiology unclear, may be associated with beta-glucuronidase, an enzyme found in breast milk
  2. Lasts 3 weeks to 3 months in thriving infant without evidence of hemolysis or other disease
  3. Peaks at 10-15 days of age, with max bilirubin level of 10-30mg/dL
  4. Treatment:

Nursing is interrupted for 24-48 hours

  1. Bilirubin level falls quickly and will not rebound to the same level when nursing is resumed
73
Q
  1. When does breastfeeding jaundice usually occur? 2
  2. What does this result in?
  3. Risk factors? 6
A

1.

  • Usually occurs when breastfeeding is difficult:
  • Occurs within the first week of life
    2. This results in slower bilirubin excretion and increased enterohepatic circulation
    3. Risk factors:
  • Inadequate education from clinicians and lactation consultants
  • Inadequate documentation of latching on by infant
  • Inadequate recording of urine output and stool pattern changes
  • Mother and infant breast feeding complications***
  • Short hospital stays
  • First time mothers
74
Q

Breast Milk Jaundice

Treatment?

2

A

Treatment:

Education, education, education

  1. Supplemental feeding with pumped breast milk or formula for adequate hydration and reversal of hypovolemia if necessary
  2. Phototherapy if necessary

Prevention!!!

75
Q

Clinical Tips for the Jaundiced Newborn

  1. Jaundice usually progresses from where to where?
  2. Total serum bilirubin (TSB) level can be estimated by the degree of what?
A
  1. Head to toe
  2. caudal extension:

Face, 5mg/dL

Upper chest, 10mg/dL

Abdomen, 12mg/dL

Palms and soles, >15mg/dL

76
Q

At what point will they need phototherapy?

A

See picture

77
Q

Clinical Tips for the Jaundiced Newborn!

5

A
  1. Jaundice seen in the first 24 hours (usually caused by hemolysis—medical emergency!)
  2. TB greater than the 95th percentile
  3. Rate of TB rise greater than 0.2 mg/dL per hour
  4. Jaundice in a newborn greater than 2 weeks of age
  5. Direct (conjugated) bilirubin concentration >1 mg/dL if the TB < 5 mg/dL or more than 20% of TB is direct w/ TB > 5 mg/dL (suggests cholestasis)
78
Q

Common Etiologies of Unconjugated Hyperbilirubeinemia

  1. WIth hemolysis? 2
  2. Without hemolysis? 6
A

With Hemolysis:

  1. Blood group incompatibility—ABO, Rh, Kell, Duffy
  2. Sepsis

Without Hemolysis:

  1. Physiologic jaundice
  2. Human Milk jaundice
  3. Breast milk jaundice
  4. Internal hemorrhage
  5. Polycythemia
  6. Infant of diabetic mother
79
Q
  1. What is Sudden Infant Death Syndrome (SIDS)?
  2. Peak incidence?
  3. Risk factors include?
A

1, Unexplained death < 1 year of age

  1. Peaks between 2-4 months of age
  2. Risk factors include:
    - Sleeping position
    - Bottle feeding
    - Maternal smoking (prenatal and postnatal)
    - Infant overheating
80
Q

Pertinent Points

  1. Full term pregnancy is defined as?
  2. Fetal circulation is designed to do what?
  3. What is the key to neonatal resuscitation?
  4. When is surfactant production sufficient by?
A
  1. Full term is 37-42 weeks gestation

2.

-maximize oxygenation from an outside source,

you must understand the physiology to understand potential problems clinically thereafter

  1. Oxygen is the key to neonatal resuscitation
  2. Surfactant production usually sufficient by 34 weeks gestation
81
Q

1. As far as growth restriction, if WHAT, usually the baby has a positive prognosis?

2. The WHAT of the baby will have a significant impact on your thought processes for why a newborn may have respiratory problems?

3. Jaundice appearing in the first 24 hours is NOT what?

4. Indirect bilirubin usually indicates a ____liver problem while direct usually indicates a ____liver problem

5. We treat jaundice when necessary to prevent what?

Use your nomograms, they are extremely helpful!

A
  1. brain is the right size

2. gestational age

3. physiologic

4. pre-, post-

5. neurotoxic problems**

Pediatrics (18 decks)

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