MedU Clipp Cases 7 and 8 Flashcards
(37 cards)
1
Q
(6) Risk Factors for Noenatal Respiratory Distress?
A
- Maternal Diabetes –> RDS
- Prematurity - lack of Surfactant –> RDS
- Maternal Group B Strep (GBS) Infection –> Sepsis
- C-section Delivery –> Transient Tacypnea of Newborn
- Premature Rupture of Membranes > 18 hours (PROM)
- Meconium in the Amniotic Fluid
2
Q
(10) DDx for Tachypnea in Newborn?
A
- Respiratory Distress Syndrome (RDS)
- Transient Tachypnea of Newborn (TTN)
- Pneumothorax
- Hypoglycemia
- Congestive Heart Failure (CHF)
- Neonatal Sepsis
- Congenital Diaphragmatic Hernia
- Coarctation of the Aorta
- Maternal Drug exposure
- Hypothermia
3
Q
What does the APGAR score describe?
A
- Describes the condition of teh newborn infant immediately after birth and is a tool for standardized assessment
- Fetal - to - Neonatal transition
4
Q
What does LGA, AGA, and SGA standfor?
A
- Large for Gestational Age (LGA)
- > 90th % by Birth weight
- Appropriate for Gestational Age (AGA)
- 10th - 90th % by Weight
- Small for Gestational Age (SGA)
- < 10th % by Weight
5
Q
(3) Potential Clinical Problems a/w LGA?
A
- C-section, Vacuum extraction, Forceps and associated complications
- Birthing injuries - Fractured Clavicles, Brachial Plexus injuries, Facial Nerve palsy
- Hypoglycemia, especially a/w Diabetic Mothers
6
Q
(3) Potential Complication of SGA?
A
- Temperature Instability (Hypothermia)
- Inadequate Glycogen Stores (Hypoglycemia)
- Polycythemia and Hyperviscosity
7
Q
Symptoms of
Persistent Pulmonary Hyptertension of the Newborn?
(PPHN)
A
- Tachpnea
- Tachycardia
- Respiratory Distress w/ findings such as Expiratory Grunting and Nasal Flaring
- Generalized Cyanosis
- Low Oxygen Levels, even while recieveing 100% O2
8
Q
(3) Signs of Respiratory Distress in a Newborn?
A
- Tachypnea
- Intercostal and Subcostal Retractions
- Grunting - at the end of Expiration
- Infant attempts to Increase Transpulmonary Pressures
- -> Increase Lung Volumes
- -> Improve Gas exchange
9
Q
Respiratory Conditions for Cyanotic Newborn?
A
- Common
- TTN
- RDS
- Uncommon
- Pneumothorax
- Diaphragmatic Hernia
- Choanal Atresia
- Pulmonary Hypoplasia
- PPHN
10
Q
Cyanotic Congenital Heart Defects?
A
- Common
- Tetralogy of Fallot
- Transposition of the Great Arteries (Diabetic Mom)
- Uncommon
- Truncus arteriosus
- Tricuspid atresia
- Total Anomalous Pulmonary Venous Return
- Pulmonary atresia
11
Q
CNS Conditions of Cyanotic Newborn?
A
- Hypoxic-Ischemic Encephalopathy
- Intraventricular Hemorrhage
- Sepsis / Meningitis
12
Q
Infectious Conditions of a Cyanotic Newborn?
A
- Septic Shock
- Meningitis
13
Q
Other Conditions of Cyanotic Newborn?
A
- Respiratory Depression Secondary to Maternal Medications
- Hypothermia
- Polycythemia / Hyperviscosity Syndrome
14
Q
(8) Studies for the Evaluation of a Cyanotic Newborn?
A
- Arterial Blood Gas
- Blood and CSF cultures
- CBC w/ Differential
- Chest Radiograph
- Echocardiogram
- Oxygen Challenge Test (Hyperoxia Test)
- Physical Examination
- Pulse Oximetry
15
Q
How does Insulin effect the Primary Anabolic
Hormone for Fetal growth?
A
- High lvls of Insuline in 3rd Trimester
- -> Increased growth of Insulin-sensitive Organ Systems
- -> Heart, Liver, and Muscle
- -> and general Fat synthesis and Deposition
- Increased Body Fat, Muscle Mass, Organomegaly
- -> LGA infant
- Insulin-sensitive organs (Brain and Kidney’s)
- -> not effected and have normal size for gestational age
16
Q
(6) Tests for Evaluation of Tachypnea in Newborn?
A
- CBC w/ Differential
- Serum or Plasma Glucose level
- Blood Culture
- CSF for Culture
- Blood gas or Pulse Oximetry Monitoring
- Chest X-ray
17
Q
CXR showing:
“wet” looking lungs
No consolidation
No air Bronchograms
A
Transient Tachypnea of the Newborn
(TTN)
18
Q
CXR showing:
Difuse Reticulogranular Appearance
of the Lung Fields
“Ground Glass Appearance”
Air Bronchograms
A
Respiratory Distress Syndrome
(RDS)
19
Q
CXR showing:
Air-filled loops of Bowel in the Left Side of Chest
Displacement of Heart and Mediastinum
of the Contralateral Side
A
Diaphragmatic Hernia
20
Q
CXR showing:
“Wet” or “not Wet” lungs
No Consolidation
No Air Bronchograms
A
Neonatal Pneumonia
21
Q
Bilirubin pathway in Newborns?
A
- Hemoglobin released from RBCs
- -> converted to Unconjugated bilirubin
- -> insoluble in aqueous solutions
- -> binds to albumin in blood stream
- Liver: Bilirubin extracted by hepatocytes
- -> binds to cytosolic proteins
- -> conjugated w/ glucuronide by Uridine diphosphate glucuronyl transferase (UDPGT)
- Conj. Bilirubin is water soluble and excreted into the Bile and then into the Intestine
22
Q
What is the Enterohepatic cirulation system in Newborns?
A
- Newborns lack the GI flora to metabolize bile, which allows the Beta-glucuronidase present in teh meconium to hydrolyze the conjugated bilirubin back to its uncojugated form
- Unconjugated bilirubin is then reabsorbed into the blood stream where it binds to Albumin
- Newborns absorb significant quantities of Bilirubin through this process.
23
Q
What is Kernicerus?
A
- Term used to describe staining of the Basal Ganglia and Cranial Nerve Nuclei by Bilirubin
- Also, the Clinical condition that results fromt eh toxic effects of High levels of Unconjugated Bilirubin
- Sequelae
- Lose the Suck Reflex
- Become Lethargic
- Develop Hyperirritability and Seizure
- Opisthotonus, rigidity, Oculomotor paralysis, tremors, hearing loss, and ataxia
- Die
*
24
Q
(2) Risk factors for predisposing to Hyperbilirubinemia?
A
- Breastfeeding
- Mediterranean ethnicity
25
Causes of Physiologic Jaundice in Newborns?
* Increased Bilirubin production
* Relative def. of Hepatocyte proteins and UDPGT
* Lack of Intestinal Flora to Metabolize Bile
* High levels of Beta-glucuronidase in Meconium
* Minimal Oral (Enteral) intake in the first 2-4 days of life
- -\> resulting in a slow excretion of Meconium (esp. common w/ breastfed infants)
26
What is the Typical Breastfeeding Pattern?
* Nurses 8 - 12x / 24 hours
* Feedings may initially last up to 60 minutes
* Gradually become shorter in duration
* ~10 - 15 minutes per breast
27
What is G6PD Deficiency?
* X-linked recessive inheritance pattern
* Decreased Bilirubin Conjugation
* Jaundiced w/out anemia
* Decreased conjugation
* Similar to Gilbert's Syndrome
28
Voiding Pattern in Newborns?
* Urination changes in the first days after birth
* Day 3: voiding 3 - 4x / day
* Day 6: voiding 6 - 8x / day
* Urine should be paie yellow
29
Stooling Pattern in Newborns?
* Stooling pattern changes
* Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow
* Day 6 or 7: Most newborns have 3-4 stools per day, although many infnats pass stoll w/ every feeding.
30
What Vitamin Supplementation is req'd for exclusively breastfed babies?
* Vitamin D
* Avoid Rickets - 400 IU of Vitamin D
* Sunlight is req'd to Hydroxylate Vit. D
* Rickets generally appears between 6 and 24 months
* Iron - is req'd for infants after 4 mo. of age
* Fluoride - after 6 mo. of age if water supply lacks
( \< 0.3 ppm)
31
What are (2) common findings that contribute to Hyperbilirubinemia in a Newborn?
* Cephalohematoma
* Does not extend across the suture line
* Blood is reabsorbed
* Bruising - birth trauma
* Broken downa and reabsorbed
32
(3) Risk Factors for Development of Hip Dysplasia?
* Breach Position (30-50% of DDH cases)
* Gender (9:1 Female predominance)
* Family History
33
(12) DDx for Diagnosis of Jaundice in Newborn?
* Breast milk jaundice
* Physiologic jaundice
* Hemolysis
* Hypothyroidism
* Metabolic disease
* Biliary atresia
* Intrinsic Liver disease
* Birth trauma
* Sepsis
* TORCH
* Gilber Syndrome - Glucouronyltransferase enzyme def.
* Crigler-Najjar Syndrome - absence of UDP glucuronosyltransferase 1 family, polypeptide A1
* Type 1: Severe
* Type 2: Mild/Moderate
34
Lab Tests for Neonatal Hyperbilirubinemia?
* Maternal ABO and Rh typing, Isoimmune Antibodies
* Cord blood ABO and Rh typing
* G6PD screen
* Total serum bilirubin (TSB)
* Direct Bilirubin w/ urine dipstick
* CBC or hemoglobin lvl
* Reticulocyte count and Blood Smear
* Neonatal screening
* Newborn Sepsis Tests
* TORCHS congenital Infections
35
(4) Tests for Newborn Sepsis?
* CBC and a Differential Cell count
* C-reactive protein
* Blood cultures
* Lumbar puncture w/ Chemistry and Cultures
36
(8) Signs and Symptoms of Untreated
Congenital Hypothyroidism?
* Prolonged jaundice
* Lethargy
* Large fontanelles
* Macroglossia (enlarged tongue)
* Umbilical hernia
* Constipation
* Abdominal distention
* Severe developmental delay
37
