Fetus and Newborn

Question 1

Which race has the highest infant mortality rate?

Answer 1

African Americans

Question 2

Which specific groups have the highest mortality rate?

Answer 2

• Caucasian infants <500 grams
• Male infants have higher mortality rates than female infants
• Prenatal care delayed until after first trimester is associated with higher infant mortality

Question 3

What is the leading cause of infant mortality?

Answer 3

Congenital malformation is leading cause of infant death in the US

25% of infant mortality

Question 4

Intrauterine Growth Restriction

Answer 4

less than 5th percentile of growth for gestational age

Question 5

What is the most common umbilical cord abnormality?

Answer 5

The most common umbilical abnormality is having 1 artery

40% of these infants will die or have a major congenital abnormality such as trisomy 18

Obtain renal ultrasound on all infants with single umbilical artery

Question 6

Placental Accreta

Answer 6

abnormally deep attachment of the placenta, through the endometrium and into the myometrium

Increase risk in females who have an uterus that lacks normal membranes secondary to previous trauma such as:

• curettage
• myomectomy
• C-Section

Question 7

Placental Percreta

Answer 7

The placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall).

This variant can lead to the placenta attaching to other organs such as the rectum or bladder

Most severe form

Question 8

Placental Abruption

Answer 8

the placental lining separates from the uterus of the mother causing hemorrhage

Question 9

Chorangioma

Answer 9

non-neoplastic, hamartoma-like growth in the placenta consisting of blood vessels

arises from fetal circulation, may become large and interfere with fetal circulation causing heart failure and hydrops

Question 10

Monozygomatic Twins

Dichromic twins

Answer 10

Monochromic membranes form identical twins, one ovum divides into two

Dichromic twins are fraternal twins with two placentas

Question 11

When does prenatal screening for GBS occur?

Answer 11

Do prenatal screening for vaginal and rectal GBS of all pregnant women between 35-37 weeks gestation, valid for 5 weeks

Give antibiotics prophylaxis (penicillin/Ampicillin) in:

• women who delivered a previous infant with GBS disease whether currently colonized or not
• Women with GBS bactriuria during any trimester of current pregnancy
• Women who are GS positive at 35-37 weeks
• Women in labor who have unknown GBS status who delivery at less than 37 week gestation, fever, rupture of membranes for >18hrs

Question 12

Preterm labor

Answer 12

less than 37 weeks gestation

Question 13

Preterm Rupture of Membranes

Answer 13

rupture of the membrane of the amniotic sac and chorion more than one hour before the onset of labor

Attempt to keep baby until 34 weeks of gestational age even if fetal lungs are mature unless there is an infection

Question 14

HELLP syndrome

Answer 14

• hemolysis
• elevated liver enzymes
• low platelet count

Get positive D-dimer test

Question 15

Complications of Maternal Diabeties

Answer 15

Get glucose levels under control before conception

Defects include:

• sacral agenesis
• situs abnormalities
• holprosencepaly
• congenital heart disease
• microcolon

Electrolyte abnormalities include:

• QT interval prolongation
• Hypocalcaemia
• hypomagnesaemia
• hypophosphatemia

Question 16

Nonstress testing

Answer 16

detects the fetal heart rate fetal movement and uterine activity by external methods

a reactive test is 2 accelerations of the fetal heart rate in 20 minutes. This is associated with fetal survival of 99% for another week

A non reactive test is associated with poor fetal outcome in 20% of cases, continue with biophysical profile

Question 17

Biophysical profile

Answer 17

• fetal movement
• tone
• reactivity
• breathing
• amniotic fluid volume

Question 18

Nonreassuring fetal heart recordings

Answer 18

In infant with nonreassuring patterns on FHR recordings perform:

• fetal scalp stimulation
• pH measurement (normal >7.25, if <7.20, immediately deliver)

Persistent tachycardia greater than 180 beats per minute and maternal fever is chorioamnionitis

Fetal bradycardia is baseline heart rate of less than 120 beats per minute

Question 19

A) Early decels

B) Late decels

C) Variable decels

Answer 19

A) Early decels are due to fetal head compression during uterine contraction, normal

B) Late decels are usually at the beginning or after the peak of the uterine contraction with return of the fetal heart rate after the contraction has ended. Potentially ominous, uteroplacental insufficiency

C) Variable decels have variable recovery period, may be due to hypoxia

Question 20

Size of Endotracheal tube based on weight

Length of Endotracheal tube based on weight

Answer 20

Size of ET tube:

<1.5kg: 2.5 mm tube diameter

1.5-2/5kg: 3mm in diameter

>2.5kg 3.5mm tube diameter

Length of tubes:

1kg: 7cm
2kg: 8cm
3kg: 9cm
4kg: 10cm

Question 21

Epinephrine

Answer 21

Epinephrine:

• stimulates the alpha adrenergic receptors
• enhances cardiac contractility
• constricts peripheral circulation beta adrenergic effects on the receptors in the heart
• increase rate and effectiveness of cardiac contraction

Question 22

Crouzons

Answer 22

multiple sutures fuse prematurely

cause craniosynostosis

see increase bone density along the suture

maxillary hypoplasia

Question 23

Caput Succedaneum

Answer 23

edema crosses suture lines and the midline of the skull

Caput is external the periosteum

Question 24

Cephalohematoma

Answer 24

collection of blood under the peristeum of the outer surface of the skull

Due to rupture of blood vessels, will not cross suture lines

Question 25

Subgaleal Hemorrhage

Answer 25

bleeding from beneath the scalp Firm, fluctuant swelling over the scalp that extends to the neck or in front of the ears

Question 26

Erb’s paralysis

Answer 26

damage to the upper part of the brachial plexus in the 5th and 6th cervical roots Palpate for ipsilateral clavicle fractures Waiter’s tip sign

Question 27

Klumpke Paralysis

Answer 27

involve the 7th and 8th cervical roots and 1st thoracic component of the brachial plexus claw like posturing of the hand Less likely to improve spontaneously

Question 28

Horner’s Syndrome

Answer 28

ptosis miosis anhidrosis delayed pigmentation of the iris due to injury to the sympathic fibers of T1

Question 29

What cardiac abnormality is associated with maternal SLE?

Answer 29

Maternal SLE is associated with an infant with heart block

Question 30

What condition is suspected if there is a difference between upper extermity and lower extremity blood pressures?

Answer 30

Coarctation upper extremity blood pressure is greater than 20 in the upper extremities than the lower extremities

Question 31

What is an abnormal penile length for a newborn?

Answer 31

Penile length less than 2.5cm is abnormal and needs endocrine workup

Question 32

What disease is suspected in an infant who fails to pass meconium in the first 48 hours of life?

Answer 32

Failure to pass meconium stool may be associated with Hirsch sprung disease Complication of Hirsch sprung disease is toxic mega colon

Question 33

Teratoma

Answer 33

Tumor of spine at birth is a teratoma

Question 34

Who is at risk for congenital hip dysplasia?

Answer 34

* all daughters of affected mothers with developmental dysplasia of the hip * Females in breech position

Question 35

Hyaline membrane disease

Answer 35

due to lack of surfactant and lack of development of alveoli at risk if less than 28 weeks gestational age mature levels of surfactant found in infants greater than 35 weeks gestational age Prophylaxes infants less than 28 weeks gestation with surfactant therapy Lecithin makes 65% of surfactant and surfactant is stored in Type II alveolar cells Chest X Ray shows ground glass haziness

Question 36

Persistent Pulmonary Hypertension of the Newborn

Answer 36

syndrome due to: * meconium aspiration * infection * hyaline membrane disease * sepsis

Question 37

Meconium Aspiration

Answer 37

During first hour after birth, infants are hypoxemic with metabolic acidosis Commonly see pneumothoraxes and pneumomediastinum Use of prophylactic antibiotics have not been shown to improve outcomes and increases risk of developing resistant organism Patchy infiltrates on the Chest X Ray

Question 38

Interstitial Pulmonary fibrosis/Wilson-Mikity Syndrome

Answer 38

seen in infants without a history of hyaline membrane disease who are less than 32 weeks of age with a birth weight of less than 1,500 grams Gradual onset over the first month of life Chest X Ray: bilateral reticular infiltrates with development of multi-cystic lesions

Question 39

Group B Streptococcus Pneumonia

Answer 39

infection with GBS early onset is less than 7 days of life and is most common late onset is 4 weeks of age See severe leukopenia and thrombocytopenia with abnormal PT/PTT

Question 40

Patent ductus arteriosus

Answer 40

Patenet ductus arteriosus is seen commonly in premature infants. Ductus normally closes within 10-15 hours of birth * continuous machinery like murmur * Best heard below the left Clavicle * worsening respiratory status * bounding peripheral pulses * a wide pulse pressure Side effect of indomethacin: oliguria and dilutional hyponatremia and intestinal perforation. Do not use indomethacin if there is: * NEC * serum creatinine is greater than 1.6 * decrease urine output of less than 1ml/kg * bleeding * platelets less than 50,000

Question 41

Meconium Plugs

Answer 41

Meconium plugs are more common in infants with: * small left colon syndrome * cystic fibrosis * hypothyroidism * Hirsprung * maternal drug abuse * magnesium sulfate therapy for preeclampsia

Question 42

Meconium ileus

Answer 42

lower intestinal obstruction from impaction of meconium the abdomen is “doughy” because the bowel loops are filled with meconium instead of air

Question 43

Necrotizing Enterocoliits

Answer 43

mainly a disease of preterm infants the distal ileum and proximal colon are more commonly affected Generally presents in the first 2 weeks of life but may occur up tot 3 months of age See pneumatosis intestinalis: gas accumulation in the submucosa of the bowel wall or air in the hepatic portal system Start antibiotics of ampicillin with gentamicin

Question 44

Erythroblastosis fetalis

Answer 44

hemolytic disease of the newborn occurs when maternal antibodies are active against RBC antigens of the infants resulting in increased RBC destruction The baby may become pancytopenia Give anti D globulin during her third trimester and again during delivery of D positive infant at each pregnancy