Neo Flashcards
(174 cards)
1
Q
what are the clinical manifestations of Fetal alcohol syndrome
A
growth failure
CNS abnormalities
cognitive defects
behavioral problems
2
Q
head compression
A
early deceleration
3
Q
cord compression; variable shape, abrupt onset
A
Variable deceleration
4
Q
fetal hypoxemia, maternal hypotension
A
Late deceleration
5
Q
Auscultation of fetal heart sounds
A
16-18 weeks
6
Q
perception of fetal movements
A
18-20 weeks
7
Q
Contraindications to breastfeeding
A
Galactosemia, MSUD, PKU HIV, Human T-cell lymphocytic virus 1 & 2 Active TB Herpes virus lesions on breast Radioactive substances
8
Q
failure of closure of allantoic duct
A
Persistent urachus
tx: immediate surgical repair
9
Q
most common defects associated with Beckwith-Wiedemann Syndrome
A
omphalocele, wilms tumor, macrosomia, hypoglycemia
10
Q
polyhdramnios
A
> 2000ml in 3rd trimester, >24cm
11
Q
Oligogydramnios
A
<500ml, <5cm
12
Q
most accurate assessment of gestational age by 1st trimester
A
crown rump length
13
Q
target plasma glucose
A
> or = 45mg/dl
14
Q
hypoglycemia in infants
A
<40mg/dl
15
Q
when is treatment indicated for asymptomatic patients with hypoglycemia
A
<30mg/dl
16
Q
when should IV glucose be given?
A
persistent hypoglycemia <25mg/dl (1st 4 hours) and <35mg/dl (4-24 hours)
Give IV glucose (2ml/kg) 10% glucose
17
Q
infant with hypoglycemia unable to tolerate oral feeding
A
IV rate 4-8 mg/kg/min
18
Q
Neonatal tetanus
A
ability to suck at birth and 1st few days then inability to suck between 3-10 days; difficulty swallowing, spasm, stiffness, seizure and death
19
Q
most important neonatal factor predisposing to infection
A
prematurity or low birth weight
20
Q
most frequent neonatal hospital acquired infection
A
coagulase negative staphylococci
21
Q
SIRS in neonates clinical manifestations
A
temperature instability
respiratory dysfunction
cardiac dysfunction
perfusion abnormalities
22
Q
common cause of infection in neonatal period
A
GBS, E. coli, HSV, CMV, VZV, RSV, Entero, Candida
23
Q
transferred across placenta
A
IgG
24
Q
not transferred across placenta
A
IgA, IgE, IgM, IgD
25
Absoulte and relative contraindications to breastfeeding
HIV: risk must be weighed versus risk of transmitting virus to body
TB infection: contraindicated until completion of 2 weeks treatment
Varicella zoster: no direct contact to active lesions; should receive immunoglobulin
CMV: may be found in milk of mothers
Hep B: give immunoglobulin and vaccine
Hep C: not contraindicated
Alcohol: limit to 0.5g/kg/day equivalent to 2 cans of beer, 2 glasses of wine
Cigarette smoking: discouraged but not contraindicated
Chemo, radiopharmaceutical: generally contraindicated
26
what is the whey:casein ratio in infant formula
18:82 to 60:40
27
predominant whey in cow's milk
B-globulin
28
predominant whey in breastmilk/human milk
alpha lactalbumin
29
principles of weaning
begin at 6 months of age
at proper age, encourage cup rather than bottle
Introduce 1 new food at a time
energy density should exceed breastmilk
Iron-containing foods
Zinc intake fold be encouraged
phytate intake should be low
Breastmilk should be continued until 12months
give no more than 24oz/day of cow's milk
Fluids other breastmilk should be discouraged
Give no more than 4-6oz/day of 100% fruit juice
no sugar sweetened beverages
30
IVH occurs in
gelatinous subependymal germinal matrix
31
PVH occurs in
injury to corticospinal tracts in white matter
| clinically asymptomatic until neurologic sequelae becomes apparent
32
IVH grading of hemorrhage: bleeding isolated to subependymal area
Grade 1 IVH
33
IVH grading of hemorrhage:bleeding within ventricle without dilation
Grade 2 IVH
34
IVH grading of hemorrhage:ventricular dilation
Grade 3 IVH
35
IVH grading of hemorrhage: IVH and parenchymal hemorrhage
Grade 4 IVH
36
what is the pathophysiology of HIE?
hypoxia/ischemia --> anaerobic metabolism --> inc lactate and inorganic phosphates
Glutamate accumulates in damaged tissue
prompting NMDA, AMPA, Kainate receptors
inc permeability to Na and Ca
intracellular accumulation of Na, Ca --> cytotoxic edema and neuronal death
37
treatment for HIE
hypothermia (within 6hr)
high dose erythropoietin
Sz (1st line): Phenobarbital 20mg/kg
Refractory: levetiracetam (preferred)
38
"whipple's triad"
plasma concentration of <60mg/dl
concurrent CNS or cathecolamine based symptom
resolution of symptoms when glucose restored to normal
39
Phenylalanine
deficiency of phenylalanine hydroxylase (PAH) or its cofactor tetrahydrobiopterin (Bh4) --> accumulation of phenylalanine in body fluids and brain
severe deficiency >20mg/dl
milder between 10-20mg/dl
40
major organ damaged in PKU
brain
41
mousey or musty odor
PKU
42
manifestations of PKU
neurologic: seizures, spasticity, hypereflexia and tremors
EEG abnormalities
Non-PKU hyperphenylalanemia: >2mg/dl less than 20mg/dl; do not produce phenylketones
43
treatment of PKU
low phenylalanine diet
| maintain levels at 2-6mg/dl throughout life
44
Maternal PKU
high risk of having offspring with intellectual disability, microcephaly, growth retardation, congenital malformations, CHD
45
patient is normal at birth then symptoms appear at 1st year; severe pain in the legs, associated with extensor hypertonia of neck and trunk
tyrosine
46
treatment for Tyrosinemia
Nitisone
| titrated to the lowest most effective dose 20-40umol/L
47
ocular manifestations, skin lesions, intellectual disabilit
Tyrosenemia Type 2
48
What is the new BPD?
disease of infants born <1000g who were born at <28wks AOG; no lung disease at birth but with progressive respiratory symptoms after 1st week
49
Definition of BPD in <32 weeks
36 weeks PNA or discharge home treatment with >21% O2 for 28 days plus:
Mild: breathing room air at 36 weeks PNA or discharge home
Moderate: <30% O2 at 36 weeks or discharge
Severe: >30% need O2 at 36 weeks AOG
50
Definition of BPD >32 weeks
>21 days to <56 postnatal age or discharge home. Treatment with 21% O2 for 28 days plus:
Mild: breathing room air by 56 days or discharge home
Moderate: <30% O2 at 56 days or discharge
Severe: >30% need O2 at 56 postnatal age
51
What are the chest xray findings in RDS?
air bronchograms
low lung volume
diffuse, fine, reticular granularity of parenchyma
52
What are the xray findings in TTN?
early onset tachypnea
clear breath sounds
chest xray: prominent perihilar pulmonary vascular markings, fluid in intralobar tissues
small pleural effusions
53
what are the chest xray fndings in BPD?
fine, diffuse interstitial opacities; wandering atelectasis
| severe: increase O2, frank cystic changes or pneumatoceles
54
What are the chest xray findings in Meconium aspiration syndrome
patchy infiltrates
flattening of the diaphragm
coarse streaking of both lung fields
increase AP diameter
55
most frequently involved part in NEC?
distal part of ileum
| proximal segment of colon
56
clinical features of kernicterus
```
Phase 1 (1-2 days): poor suck, stupor, hypotonia, seizures
Phase 2: hypertonia of extensor muscles, opisthotonus, retrocolis, fever
Phase 3 (after 1st week): hypertonia
```
57
crosses suture lines
caput seccedaneum
58
fluid filled mass; doest not cross suture lines; not present at birth
Cephalhematoma
59
not restricted by boundaries; larger and more diffuse; requires prompt recognition
subgaleal hemorrhage
60
assymetric skull and face with ear malalignment
Deformational plagiocephaly
61
premature fusion of sutures
Cranial synostosis
62
EINC steps
1. Immediate and thorough drying
2. skin to skin contact
3. properly timed corn clamping
4. nonseparation of baby to mother
63
most frequent pathogenic bacteria to colonize umbilical cord
Staphylococcus aureus
64
recommended for infants born outside birthing centers
topical chlorhexidine
65
bright yellow or orange jaundice
Indirect bilirubin
66
Greening/ muddy yellow jaundice
DIrect bilirubin
67
estimate of bilirubin levels
face: 5mg/dl
mid abdomen: 15mg/dl
soles: 20mg/dl
68
pathologic causes of hyperbilirubinemia
erythroblastosis fetalis
conceled hemorrhage
sepsis or congenital infections
69
deposition of unconjugated bilirubin (Indirect) in basal ganglia and brainstem nuclei
Kernicterus/bilirubin encephalopathy
70
What is the problem in ABO incompatibility?
mother is type O, baby is non type O
| occurs during 1st pregnancy
71
positive DAT and positive Indirect antiglobulin test (IAT)
HDFN
72
in patients with jaundice, what do we request?
obtain blood type of mother and baby
CBC with PBS
Coombs/DAT
reticulocyte count
73
eyrthroblastosis fetalis
HDFN
74
rarely occurs during 1st pregnancy
| transfusion of RH+ blood into Rh negative mother
Rh incompatibility
75
CHARGE syndrome is associated with
Choanal atresia
76
Meconium ileus is associated with
Cystic fibrosis
77
Term neonate will develop jaundice if bilirubin level is
5mg/dl
78
Antiviral agent of choice for Influenza A infection
Oseltamivir
79
Most serious complication of 3 day measles
Encephalitis
80
Most important and effective action in neonatal resuscitation is
Ventilate the baby’s lungs
81
“Vigorous” is defined as
Strong respiratory efforts
Good muscle tone
HR >100bpm
82
Indications for PPV
Apnea/gasping
HR <100
Persistent cebtral cyanosis despite 100% free-flow oxygen
83
Imitate vertical lines
24 months
84
Draw circle
30 months
85
extremely premature infants should be scored within
12 hours of life
86
Full term infants are scored as early as possible and may be reliably scored within ____ hours of life
72 hours of life
87
Neurologic maturity
```
Posture
Square window
arm recoil
popliteal angle
scarf sign
heel to ear
```
88
chart used for premature infants
Fenton Chart
89
low birth weight
<2500g
90
very low birth weight
<1500g
91
extremely low birth weight
<1000g
92
SGA
below 10th percentile
93
AGA
between 10th to 90th percentile
94
LGA
above 90th percentile
95
lanugo hair in term infants are called
vellus hair
96
flat, blu-gray with well defined margins usually over the buttocks and back
Mongolian spots
97
benign, small papules or pustules on an erythematous base usually 1-3 days after birth and persist for 1 week; filled with eosinophils
Erythema toxicum
98
small inclusion cysts; pearly white usually on the face
Milia
99
lacy pattern on the skin similar to cobblestones
cutis marmorata
100
epithelial cells on the hard palate
Epstein pearls
101
inability to pass a feeding tube through the nares
Choanal atresia
102
PMI in newborns
4th left intercostal space just medial to midclavicular line
103
herniation of abdominal contents onto base of umbilical cord, abdominal contents covered by a protective membrane
Omphalocele
104
laterally located full thickness abdominal wall defect; extruded intestine not covered by membrane
Gastroschisis
*usually located on the right side
105
voiding must be within
24 hours
106
urethral orifice located on the glans or ventral surfaces of the shaft
hypospadia
107
caudal curvature of penis
chordee
108
affected in Erb-Duchenne palsy
C5-C6; upper trunk
*arm adducted and pronated and forearm internally rotated; absent biceps reflex and Moro reflex on the affected side
109
affected in Klumpke paralysis
C7-C8, T1, lower trunk
* claw hand: paralyzed, no wrist movement, absent grasp reflex
* if no involvement of t1 sympathetic fibers: Horner syndrome
110
age of disappearance:
| rooting reflex
1 month
111
age of disappearance:
| palmar grasp
2-3 months
112
age of disappearance:placing or stepping reflex
4-5 months
113
age of disappearance:
| Moro reflex
5-6 months
114
age of disappearance:
| tonic neck reflex (Fencing)
6-7 months
115
age of disappearance:
| plantar grasp reflex
7-9 months
116
benefits of early skin to skin contact:
BLEST
```
Breastfeeding success
Lymphoid tissue system stimulation
exposure to maternal skin flora
sugar
thermoregulation
```
117
Newborn screening is done at
after 24 hours of life but not later than 3 days of age
118
for preterm infants: ideal time for NBS is at
5-7 days old
119
if newborn is place in NICU, when can we do NBS
7 days old
can be done until 1 month in very sick babies
120
Amino acid disorders
```
Homocystinuria
Hypermethionemia
Adenosine transferase deficiency
MSUD
PKU
Tyrosinemia Type I, II and III
```
121
Fatty acid disorders
Carnitine palmioyltransferase
Long chain Hydroxyacyl-Coa
medium and very long chain acyl coa
trifunctional protein deficiency
122
organic acids
```
glutaric acidemia type 1
Isovaleric acidemia
methylmalonic acidemia
multiple carboxylase deficiency
proprionic acidemia
```
123
The universal Newborn Screening and Intervention Act of 2009
RA 9709
124
Infants born in hospitals should be screened within
first 3 months
125
if hearing loss detected, audiologic evaluation should be made before
6 months
126
most important question to ask during delivery of baby
"Is the baby apneic/gasping or limp?"
127
Steps in Newborn Resuscitation
Birth
Immediate and thorough drying
apnea/gasping or limp?
if yes --> call for help, change wet linen, clamp and cut cord, transfer to warmer, position airway, clear secretions if needed
PPV
SpO2
Apnea/gasping; HR <100
if yes --> ventilation corrective steps
intubate if needed
HR <60bpm?
If yes, Intubate if not yet done; PPV & chest compressions, 100% O2, Consider UVC insertion
HR <60bpm?
If yes, IV epinephrine, consider hypovolemia, consider pneumothorax
128
ventilation corrective steps
```
mask readjustment
reposition airway
suction mouth and nose
open mouth
pressure increase
airway alternative
```
129
dose of epinephrine in newborn resuscitation
0. 1 to 0.3 ml/kg of 1:10,000 via umbilical vein or
| 0. 5 to 1ml/kg of 1:10,000 via ET
130
foremilk
watery
| high lactose and high protein
131
hindmilk
creamy with high fat (5x fat content)
132
what is released during first 0-7 days of breastfeeding?
colostrum
* protein rich
* high concentration of secretory IgA and protective factors: lactoferrin and lysozyme
* contains Vitamin A, E, K and growth factors
* low levels of fat and carbohydrates
133
what is transitional milk?
between colostrum and mature milk
| rising levels of macronutrients
134
what is mature milk?
day 10-14
| same as colostrum content + high fat and lactose
135
what is involutionary milk?
produced when breastfeeding frequency decreases
reverts to being more like colostrum with high concentration of immune factors
low content of water, fat and lactose
136
what are curds and whey?
curds- semi-soli fraction which settles when milk is clotted; made from casein proteins
Whey: clear fluid that remains
137
human milk casein:whey ratio
low casein:whey ratio
10: 90 early milk
40: 60 mature milk
50: 50 in late lactation
138
composition of breastmilk vs formula:
| protection against specific antigens
Maternal secretory IgA
| in BM only
139
composition of breastmilk vs formula:
| for phagocytosis of pathogens
Maternal WBC
| in BM only
140
composition of breastmilk vs formula:
| lysis of bacteria
Lysozyme
| in BM only
141
composition of breastmilk vs formula:
| inhibits binding of pathogens to host cells and cause lysis of enveloped pathogens
milk lipids
| in BM; less effective in formula
142
composition of breastmilk vs formula:
| inhibits pathogen binding
Oligosaccharides
143
composition of breastmilk vs formula:
| wide range of synergistic protective factors
lactoferrin
144
a newborn was noted to have bloody stool;
| what test can we request to differentiate it from maternal blood?
APT test; positive if blood is due to GI or pulmonary bleeding
negative: swallowed blood
145
cyanosis with feeding
esophageal atresia
146
cyanosis that disappears with crying
choanal atresia
147
hyperalertness, normal muscle tone, weak suck, low threshold Moro, mydriasis, absence of seizures
Sarnat Stage 1 (Mild) HIE
148
lethargic or obtunded, mild hypotonia, weak or absent suck, weak Moro, miosis and focal or multifocal seizures
Sarnat Stage 2 (moderate) HIE
149
stuporous, flaccid muscle tone, intermittent decerebration, absent suck, absent Moro, poor pupillary light response
Sarnat Stage 3 (Severe) HIE
150
initial drug of choice in HIE
Phenobarbital
Phenytoin
Diazepam
Others: correct underlying etiology, trial of Pyridoxine B6 50-100mg IV push with EEG monitoring
therapeutic hypothermia
150
initial drug of choice in HIE
Phenobarbital
Phenytoin
Diazepam
Others: correct underlying etiology, trial of Pyridoxine B6 50-100mg IV push with EEG monitoring
therapeutic hypothermia
151
always pathologic, does not cross blood brain barrier
Congugated bilirubin; Direct (B2)
152
congugated bilirubin is considered elevated if it is:
>1mg/dl for total bilirubin levels <5mg/fl or
| 20% of the total bilirubin for total bilirubin levels >5mg/dl
153
congugated bilirubin is considered elevated if it is:
>1mg/dl for total bilirubin levels <5mg/fl or
| 20% of the total bilirubin for total bilirubin levels >5mg/dl
154
lipid soluble; may cross the blood brain barrier; bound to albumin
Unconjugated bilirubin; Indirect
| B1
155
Coomb's positive
ABO/RH incompatibility
156
most common cause of hemolytic disease in the newborn
ABO incompatibility
157
recommended distance between infant and light source in phototheraphy
20 cm
158
pathophysiology of ROP
```
early vasoconstriction and obliteration of capillary network in response to high oxygen concentrations
progressive neovascularization
retinal edema
retinal hemorrhages
fibrosis and traction
eventual detachment of retina
```
159
treatment of choice for ROP
laser photocoagulation
160
asymmetric IUGR
* weight affected more than length
* due to poor maternal nutrition
* fetus affected late in the gestation
* good catch up growth
161
symmetric IUGR
* weight, length and head circumference equally affected
* genetic and metabolic conditions
* fetus affected early in gestation usually <18 weeks
* high mortality and morbidity
* poor outcome
162
most common perinatal respiratory disorder
TTN
163
barrel chest due to increased AP diameter
TTN
164
"fuzzy vessels"
sunburst pattern
peripheral air trapping
TTN
165
also known as persistent fetal circulation
Persistent pulmonary hypertension (PPHN)
166
4 clinical criteria of HIE
1. acidosis, pH <7 umbilical cord
2. APGAR 0-3, >5mins
3. Neurologic outcome
4. Multiorgan system dysfunction
167
most common cause of aneuploidy
meiotic nondisjunction
168
most common form aneuploidy
Trisomy
169
genetic cause of moderate intellectual disability
Trisomy 21
170
most common autosomal aneuploidy in spontaneous abortion
Trisomy 16
171
most common cause of oligohydramnios
rupture of membranes
172
most common cause of hemolytic disease of newborn
ABO incompatibility
173
most common eye disease of newborn
Ophthalmia neonatorum
