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Pediatrics > Medical Issues of the Newborn > Flashcards

Medical Issues of the Newborn Flashcards

1
Q

At what times are infants APGAR scores assessed?

A

1 and 5 minutes

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2
Q

What is assessed as part of APGARs?

A

A - activity (muscle tone)
P - pulse
G - grimace (reflex irritability)
A - appearance (skin color)
R - respiration

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3
Q

An APGAR score < 4 indicates what?

A

Resuscitation

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4
Q

What is a normal pulse rate in a full term neonate?

A

110-160 (term neonates when asleep can be 85-90)

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5
Q

What is a normal BP in a neonate?

A

65-85 / 35-55

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6
Q

What is a normal respiratory rate in a neonate?

A

30 - 40

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7
Q

What are the benefits of immediate skin to skin for baby?

A
  • Thermoregulation
  • Glucose regulation
  • Lower/more stable HR
  • Increase oxygenation and decrease apnea
  • Neurobehavioral organization
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8
Q

What interventions are included in “Eyes and Thighs” and should be given by 1 hour of life?

A
  • Erythromycin ophthalmic ointment to prevent neonatal GC conjunctivitis
  • 1 mg IM Vitamin K to prevent vitamin K deficient bleeding
  • Hepatitis B vacine
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9
Q

Is the HBV vaccine effective in preventing perinatal transmission when given within 24 hours of birth?

A

Yes

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10
Q

Who should have glucose screening?

A

Infants at high risk:
- GA < 37 or > 42 weeks
- LGA or SGA
- Infants of diabetic mothers
- Family history of hypoglycemia
- Mothers treated with beta adrenergic or oral hypogycemic agents

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11
Q

Are babies born to diabetic mothers more likely to be hypoglycemic or hyperglycemic?

A

Hypoglycemic

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12
Q

How many hours do newborns sleep per day?

A

16-18 hours/day until 3 months

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13
Q

A newborn typically loses 8-10% of their body weight but should be back to birth weight by when?

A

2 weeks

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14
Q

When should NBS be performed?

A

24-48 hours of life (36 hours ideal)

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15
Q

Can parents refuse NBS?

A

Yes, but must sign refusal form

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16
Q

Hearing implement services should be initiated by what age in those who fail newborn hearing screens?

A

6 months of age is the goal

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17
Q

The goal of newborn hearing screening is to diagnose any hearing abnormality by what age?

A

< 3 months

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18
Q

What is the newborn recommendation for oximetry screening for congenital heart disease?

A

Perform pre-ductal (RIGHT hand) and post-ductal (either foot) saturations between 24-48hrs

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19
Q

Where is the oximeter probe placed to screen pre-ductal saturations?

A

Right hand

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20
Q

What criteria are included in a positive oximetry screen?

A
  • O2 sat < 90% at anytime
  • O2 sat 90-94% in both extremities on 3 seperate measurements
  • O2 sat with >/= absolute difference between right hand and either foot on 3 separate measurements

*each measurement should be separated by one hour

21
Q

What are the risk factors for neonatal sepsis?

A
  • Maternal intrapartum temp >/= 38 C (100.4 F)
  • Membrane rupture of 18 hours
  • Delivery before 37 weeks
  • Chorioamnionitis
  • Maternal GBS colonization
22
Q

The newborn head exam reveals a firm and fluctuant mass, what are you concerned for?

A

Subgaleal hemorrhage

23
Q

Where is the PMI felt in a newborn?

A

Lower left sternal border (RV is dominant)

24
Q

What is the Moro Reflex?

A

Sudden, slight dropping of head from slightly raised supine position: open hands, extension and abduction of arms (and legs), then flexion of arms (and legs) and crying

25
Q

What is the last primitive reflex to disappear in babies?

A

Babinski, usually lasts until about 2 years while all others typically disappear around 6 months

26
Q

What tool is used to predict bilirubin levels in a newborn?

A

Bhutani nomogram

27
Q

What are some hepatocellular diseases that can cause direct (conjugated) hyperbili?

A
  • Hepatitis
  • TPN (cholestasis)
  • Hepatic ischemia
  • Erythroblastosis fetalis
  • Metabolic disorders
28
Q

What is the treatment for hyperbili?

A

Phototherapy

29
Q

Infants with severe hyperbili should receive what treatment?

A

Exchange transfusion

30
Q

What are some causes of peripheral cyanosis?

A
  • Cold exposure
  • Acrocyanosis
  • Shock
  • Sepsis
  • Neonatal polycythemia
31
Q

What are signs of respiratory distress?

A
  • Retractions
  • Grunting
  • Nasal flaring
  • Stridor (laryngeal)
32
Q

What is the initial management for cyanosis?

A
  • IV, O2, Monitor
33
Q

What is the initial work-up for cyanosis in the newborn?

A
  • ABG
  • CBC with diff (low WBC may indicate sepsis)
  • Glucose
  • Blood cultures
  • CXR
  • Echo
34
Q

What are common pulmonary causes of respiratory distress in full-term infants?

A
  • TTN
  • Meconium aspiration
  • PPPHN
35
Q

What is transient tachypnea of the newborn (TTN)?

A

Inadequate clearance of fluid in lungs at birth

36
Q

What are the CXR findings of TTN?

A
  • Increased lung volumes, flat diaphragms, prominant central vascular markings, fluid in the fissures, and possible pleural effusion
37
Q

What is the treatment for TTN?

A

Management is supportive, and typically resolves in 24-72 hours
- O2
- Neutral thermal environment
- Nutrition

38
Q

What is the diagnosis and work-up for Meconium aspiration?

A
  • CXR
  • ABG
  • CBC
  • Blood culture
  • ECHO
39
Q

What are the typical CXR findings of meconium aspiration?

A
  • Initially: streaky densities
  • Progressive changes: hyperinflation and patchy densities
40
Q

What is the management of MAS?

A
  • Maintain oxygenation and ventilation (surfactant, NO, or ECMO maybe needed)
  • Broad spectrum abx
41
Q

How can you definitively diagnose PPHN?

A

ECHO

42
Q

What is the treatment for PPHN?

A
  • Treat underlying condition
  • 100% O2 to reverse vasoconstriction, titrate to pre-ductal sats of 90-95%
  • NO?
  • Consider ECMO
43
Q

True or False: all neonates with fever require a full evaluation for sepsis

A

True

44
Q

How is early onset sepsis defined?

A

First 7 DOL (often beings in-utero)

45
Q

What is the evaluation of early onset sepsis?

A
  • Blood culture
  • LP
  • CBC with Diff, glucose, VBG (lactate)
  • CXR
46
Q

What is the evaluation for late onset sepsis?

A

Same as early onset plus: U/A

47
Q

How is failure to thrive defined?

A
  • Weight that falls or remains below 3rd %ile
  • Weight that decreased 2 major percentile lines on growth chart
  • Weight that is < 80% of the median weight for height
48
Q

What ages is SIDS more common?

A

2-4 months of age

49
Q

A full-term male newborn is brought to the emergency department with signs of respiratory distress shortly after birth. On examination, he appears cyanotic, has nasal flaring, grunting, and subcostal retractions. His mother had an uneventful pregnancy, and prenatal ultrasounds showed no anomalies. What is the most likely diagnosis?

What should be the first line treatment?

A

TTN

Self-limited, Oxygen therapy support with 30-40% FIO2

Pediatrics (16 decks)

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