Neonate Flashcards
(221 cards)
1
Q
TORCH definition
A
Pregnacy Hx/Congenital Infections Toxoplasmosis Other Rubella CMV HSV
Other - GBS, HIV, HVB, B19, GC TB
2
Q
Definition of perinatal/neonatal mortaility
A
Fetal death 20w EGA - 28D post delivery
3
Q
Definition of premature birth
A
Birth <38wk (pre-term infant)
4
Q
MC factors to Perinatal mortality
A
Congenital anomalies and prematurity
5
Q
Reasons for fetal demise (in utero)
A
Intrauterine asphyxia
Multiple gestation
Intrauterine infection
Placental insufficiency
6
Q
Preterm - perinatal mortality reasons
A
RDS
Immaturity
Intraventricular hemorrhage
Necrotizing enterocolitis
7
Q
Term infant - perinatal mortality
A
Birth asphyxia
Congenital anomalies
Infection
8
Q
RFs for low birth weights?
A
Black - (doubles risk)
<16 or >35yo
Common sense items
9
Q
Causes of neonatal asphyxia
A
D/O of respiratory drive
CNS depression
Occlusions of up/low AW
Extreme prematurity
10
Q
During AW positioning ensure not to?
A
Hyperextend neck too much
11
Q
Neonatal Intubation intervention if?
A
No chest rise w/ BVM
No IV route of Rx admin established
Preferred if transporting
12
Q
3 methods of O2 administration
A
Blow by
BVM (PPV)
Intubation
13
Q
2 techniques of Chest compressions? Preferred method?
A
Two thumb - preferred
Two fingers
14
Q
Purpose of Ductus arteriosus? And how it works?
A
Blood bypasses lungs via R-vent to descending aorta
15
Q
Is PDA patent at birth?
A
Yes
16
Q
When does the PDA typically close?
A
24-48hrs
17
Q
What patient population typically has a PDA that fails to close?
A
Preterm infants
18
Q
What can occur if PDA remains patent and nev er closes?
A
Heart failure
19
Q
In what situation would a HCP leave a PDA open?
A
Cyanotic heart disease
20
Q
Neonatal resuscitation medications
A
O2
IV fluids
Epinephrine
Narcan (PRN)
21
Q
Neonatal resuscitation - epinephrine Route/dosing/purpose.
A
1:10k IV or Inhaled ETT for Asystole or bradycardia
22
Q
When is F-hgb fully replaced by adult Hgb?
A
3-6mo
23
Q
Which has a higher affinity for O2 - F-hgb vs Adult Hgb?
A
F-Hgb
24
Q
NL Neonatal physiological shunts
A
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
25
Purpose of Ductus Venosus?
Shunts fresh O2 from Placenta to IVC bypassing Liver
26
Bypasses what?
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
Ductus Venosus - past liver
Ductus Arteriosus - past lungs 85%
Foramen Ovale - past lungs
27
Closes when?
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
Ductus Venosus - Mins after birth
Ductus Arteriosus - w/in 1-2D
Foramen Ovale - 1st fetal breath
28
How can you prevent GC conjunctivitis w/ a newborn in a nursery setting?
Erythromycin - Ophthalmic ointment (Better than AgNO3)
29
What are screenings/shots/labs of newborn in nursery setting?
Hearing
HVB
Genetic/metabolic - PKU/TSH/CF/SCA
Vit K
30
Purpose of vitamin K?
PVT Vit K deficiency (Hemorrhagic disease of the newborn (HDN)).
31
Appearance of HDN (S/S)?
Generalized ecchymosis
GI bleeding
Bleeding from umibilical stump or circumcision
32
What two supplementations are required if breast feeding?
Iron and Vit D
33
When is Iron supplementation required for breast feeding infants?
At 4 months (until child is eating sufficent iron in diet)
34
IF giving formula for diet what must you supplement with?
Vit D (Iron is added to formula)
35
What is the dosage/day for Vit D and iron?
Vit D - 400IU/day
| Iron - 1mg/kg/day (Max 15mg)
36
Severe Vit D deficiency will result in?
Rickets
37
Childhood Rickets presents as?
```
Thickening at wrist and ankles
Rachitic Rosary
Enlarged anterior fontanelle
Bow legs or knocked knees
Craniotabes
```
38
How can you estimate gestational age?
Using the Ballard score (Physical and neurological characteristics score added)
39
Purpose of Ballard score is to?
Identify abnormal growth patterns
Predict neonatal complications
Estimate GA
40
Small for EGA is what percentile?
<10%
41
Large for EGA is what percentile?
>90%
42
SGA is also known as?
Intrauterine growth restriction
43
SGA is associated w/?
Increased risk of...
- temperature instability
- perinatal asphyxia
- hypoglycemia
- polycythemia
- pulmonary hemorrhage
44
LGA is associated with?
Maternal DM
| Neonatal hypoglycemia
45
Post-term delivery is also known as how many weeks?
>42
46
Ballard score maturity rating? Baseline? Increments?
40=40 baseline
| Every 5 point change = 2wk change
47
Scaphoid abdomen may indicate?
Diaphragmatic hernia
48
NL umbilical cord anatomy?
3 vessels ( 2 arteries and 1 venous)
49
Barlows maneuver checks for? Performed how
Congenital hip dysplasia-
Adduct w/ Downward force to dislocate hip
50
Ortalani maneuver checks for? Performed how?
Congenital hip dysplasia - clunks when hip relocates back into acetabulum
ABduct with lateral pressure over greater trochanter
51
Barlows/Ortalini reqs what to indicate congenital hip dysplasia?
Multiple F/U visits that have reproducible clunks
52
Congenital hip dysplasia can lead to?
Pathological changes
- Flattening acetabulum
- Muscle contractures limiting motion
- Joint Capsule tightening
53
Congenital hip dysplasia MCs?
Left hip 3x
| Female 9x
54
Congenital hip dysplasia risk factors?
Breech presentation
1st born child
Oligohydraminos
Tight swaddling
55
Positive Barlows/ortalini reflex to?
Ultrasound of hips for congenital hip dysplasia after 6wks of age to avoid NL laxity confusion.
56
Congenital hip dysplasia TXT?
```
Refer to PEDs ortho -
Pavlics Harness (up to 6mo)
Abduction orthosis
Closed reduction w/ hip spica cast
Open reduction
```
57
Newborn Back ABNL findings?
Lumbosacral hair tuft = spina bifida
Gluteal fold dimples (sacral dimples)
58
Rooting reflex is gone by?
4-6mo
59
Fencer reflex is gone by?
3mo
60
Moro reflex is gone by?
6mo
61
Grasp reflex is gone by?
6mo
62
Placing reflex is gone by?
4-6mo
63
Galant reflex is gone by?
4mo
64
Babinski reflex is gone by?
12-18mo
65
Which reflex is a “true reflex”
Sucking reflex
66
Umbilical cord w/ 2 vessels should cause you to...?
Perform a more detailed exam
67
Enlarged anterior fontanelle >5cm may suggests?
Hypothyroidism
68
Closed sutures/fontanelles is also known as?
Carniosynostosis
69
ABNL red reflex that is white is AKA?
White reflex (Leukokoria)
70
White eye reflex is associated w/?
Cataracts
Ocular tumors
Severe chorioretinitis
Immature retinas
71
Neck cysts per location will indicate?
Anterior midline on neck?
Anterior SCM?
Posterior SCM?
Anterior midline on neck? - Thyroid disorder
Anterior SCM? - Brachial cleft cysts
Posterior SCM? - Cystic hygroma
72
Will murmurs be initially heard upon newborn exam auscultation?
Maybe - (Maybe not!)
73
Single second heart sound may indicate?
Cyanotic heart disease
74
What are the pathological Murmurs?
Holosystolic, continuous harsh murmur
Grade 3 or higher
All diastolic murmurs
75
Hepatomegaly may indicate?
Left sided heart failure
76
When does the umbilical cord typically fall off?
At 3-4weeks post delivery
77
Is jaundice abnormal or normal w/in the 1st 24hr?
Abnormal
78
Overriding sutures are?
When sutures overlap creating a ridge palpable on exam
79
NL eye alignment of a infant usually occurs at?
4mo
80
Strabismus is?
Eyes not aligned properly - ABNL light reflex
81
Pseudostrabismus is?
Eyes aligned - NL light reflex, +- epicanthal folds
82
Epicanthal folds are notable w/ what population?
Asians and downs
83
Newborn gum/palate NL 2 benign findings? Resolves w/in?
Epstein pearls and Bohn nodules - Resolves w/in 1st few wks
84
Epstein Pearls are?
Gum/palate - Keratin cysts (Benign) (looks like teeth)
85
Bohn Nodules are?
Salivary tissue (Benign) (looks like teeth)
86
Desquamation of newborn epithelial occurs when?
24-48hrs
87
Vernix Caseosa is?
Chalky-white to gray mix of Epithelial, Sebum, Keratin common in preterm infants
88
Milia is?
<2mm White smooth papules on face and scalp from trapped keratin occluding pores that resolves 1st few wks
89
Milia Rubra is?
- Overheating/febrile infants that present w/ Erythematous 1-3mm papules
- "heat rash"
- does not involve follicles
90
Monglolian spots are?
Blue to black pigmented maclues that fade over several years of life.
91
Cafe-Au-Lait spots are?
Light to dark sharply defined macules.
92
When does Cafe-Au-Lait spots require further eval?
>= 6 spots
>5mm diameter
Not confined to a segmental region
93
What are Cafe-au-Lait spots ass/w?
Neurofibromatosis
94
Nevus Simplex is AKA?
Salmon Patch
95
Nevus Simplex locations?
Stork Bite - Nape of neck
| Forehead or eyelids - Angel kiss
96
Is nevus simplex Benign or concerning?
Benign
97
Nevus Fameus is AKA?
Port Wine Stain
98
Nevus Fameus pathogenesis?
Malformation of capillary bed
99
Nevus Fameus is ass/w?
Sturge-Weber Syndrome on face in the trigeminal nerve distribution.
100
Difference between Nevus Fameus/simplex
Simplex - Transient and Benign (symmetrical) light pigmentation
Fameus - Persistent through life (Asymmetrical) darker pigmentation
101
Erythema Toxicum Neonatorum is?
Pustules w/ erythematous base located on trunk/back that contain EOS
102
When does Erythema Toxium Neonatorum Begin/Resolve?
Starts 24-48hrs of life
| Resolves w/in 14d
103
Neonatal acne pathogenesis?
Exposure to maternal estrogen
104
Neonatal acne is?
Self limiting pustules appearing w/in birth to 1st few weeks of life found on cheecks and scalp.
105
Cutis Marmorata AKA?
Mottling
106
Cutis Marmorata pathogenesis?
Physiologic response to cold
107
Cutis Marmorata resolves when?
As neonate ages or exposed to warmth
108
Persistent Cutis Marmorata may be ass/w?
Hypothyroidism,
Vascular malformation,
Congenital conditions
109
Cradle Cap is AKA?
Seborrheic Dermatitis
110
Cradle cap may be first sign of?
Atopic Dermatitis
111
TXT for severe cradle cap?
Mineral oil
Emollient (white petrolatum)
Medicated shampoo w/ soft brush to remove scales.
112
Cradle cap can take how long to resolve?
Months
113
Umbilical Granuloma is? And TXT how?
Friable red papule - TXT w/ silver nitrate
114
DDx to consider w/ umbilical granuloma?
Urachus - (W/ intermittent urinary discharge)
Meckles diverticulum
Persistent Vitelline duct - (Malodorous discharge)
Umbilical polyp - (W/ sticky surface due to mucus)
Talc Granulomas _ ( Use of talc on umbilical)
115
Metatarsus adductus is?
Medial deviation of mid and forefoot
116
To Dx metatarsus adductus?
Mid line heel bisector - line goes between 2 and 3 toes
| V-finger test - should not gap at 5th Metatarsal
117
Txt of Metatarsus adductus?
Conservative management or if severe serial casting
118
Clubfoot is AKA?
Talipes equinovarus
119
Clubfoot is classified as either?
Extrinsic (supple)
| Intrinsic (rigid)
120
Clubfoot anatomical position is?
Inversion, adduction, plantar flexion
121
Extrinsic clubfoot is due to?
Uterine molding
122
Intrinsic clubfoot is due to?
Idiopathic abnormal bone structure
123
Key differences between intrinsic vs extrinsic clubfoot?
Extrinsic - able to reduce
| Intrinsic - not able to reduce
124
TXT for clubfoot
Serial casting - if intrinsic many need surgery to correct bone ABNLs
125
Spina bifida is AKA?
Cleft Spine
126
Spina bifida is?
Lumbosacral neural tube defect of spinal cord or meninges
127
DX for spina bifida usually occurs when? And how?
2nd trimester
| Fetal U/S and Alpha fetoprotein
128
Alpha fetoprotein is?
Protein secreted from fetal yolk sac, GI tract, and liver into mothers serum.
129
Low vs High results of Alpha fetoprotein indicate?
High - neural tube defects (Spina bifida)
| Low - Aneuloploidy (Trisomy's 18, 13 and downs)
130
Quad test components?
Alpha fetoprotein
Unconjugated Estriol
Inhibin A
HCG
131
Spina bifida occulta is def? AKA?
Rachischisis - minor defect (hair tuft) w/out neuro S/S
132
Spina bifida occulta requires a eval for? to avoid what?
A connecting sinus - to avoid meningitis.
133
Meningo-cele def?
Meninges herniates (w/out spinal cord protrusion)
134
Meningo-myelocele def?
Meninges and spinal cord herniates
135
Myeloschisis def?
Open skin w/ exposed spinal cord
136
Spina bifida TXT is?
Neurosurgery
137
Neuro tube defect prevention in pregnancy?
Folate
138
Delivery w/ physicians forceps may result in what condition?
Facial nerve palsy (CN VII)
139
Erb-Duchenne palsy affects what spinal cord level?
C5-6 (phrenic nerve lesions w/in brachial plexus)
140
Erb-Duchenne palsy may be due to?
Shoulder dystocia
141
Erb-Duchenne palsy is AKA?
Waiters tip palsy
142
Erb-Duchenne palsy affects what reflexes?
Grasp reflex - present
| Biceps reflex - absent
143
Erb-Duchenne palsy TXT?
PT and close observation > SL resolves
144
Brachial plexus lesions?
Erb-Duchenne Palsy (MC - 90%) or Klumpke Palsy (<1%)
145
Klumpke Palsy affects what spinal cord level?
C8-T1
146
Klumpke Palsy is AKA?
Claw hand
147
Klumpke Palsy affects what reflexes?
Grasp reflex -
| Bicep reflex -
148
Klumpke Palsy is ass/w what other condition?
Horners syndrome ipsilaterally
149
Differences between Klumpke Palsy VS Erb-Duchenne palsy
Klumpke "Claw hand" - (C8-T1, Reflex Grasp - absent/bicep present)
VS
Erb-Duchenne " Waiter-tip" - (C5-6, Reflex Grasp - present/bicep absent)
150
Hydrocephalus def?
Increased CSF volume
151
Types of Hydrocephalus?
1. Communicating (w/ subarachnoid)
| 2. Non-communicating (Obstructed)
152
TXT for hydrocephalus?
Ventriculoperitoneal shunt
153
Key hydrocephalus S/S presentations?
Papilledema
Setting Sun Gaze
Lower extremity Spasticity
Bulging fontanelle
154
Highest incidence of neonatal sepsis? Term vs Preterm?
Preterm 1:250
155
Biggest RFs of neonatal sepsis?
Prematurity x6
Prolonged ruptured membranes >24hrs
GBS
156
Classifications of neonatal sepsis? Timeframe?
Early (0-7d) and Late onset (8-28d)
157
S/S of "early" onset neonatal sepsis
Rapid onset of - Fever, Hypothermia, Hypotonia, Resp distress(pneumonia)
158
S/S of "late" onset neonatal sepsis
Insidious onset of - Fever, lethargy, seizure, increased direct bili, bulging fontanelle, poor muscle tone.
159
Which classification is more likely associated w/ late onset neonatal sepsis?
Late onset neonatal sepsis
160
Organisms associated w/ EARLY onset neonatal sepsis?
```
#1 - GBS
E. Coli
Klebsiella
L. Mono
Salmonella
Mycoplasmas
```
161
Organisms associated w/ LATE onset neonatal sepsis?
```
H. Influenzae
Staph
HSV, CMV
Enterovirus
S. Pneumoniae
N. Meningitidis
```
162
Eval components for Neonatal sepsis evaluation?
```
CBC
Bld Cx X2
UA/Cx
Blood glucose
CXR
CSF
```
163
Neonatal Sepsis Rx TXT? If + Meningitis? If + HSV?
```
IV Ampicillin AND Gentamicin
OR
IV Ampicillin AND Cefotaxime
as soon as labs are drawn and continue until...
NEG Cxs
(+- Vancomycin if meningitis present)
(Acyclovir if HSV present)
```
164
How long does Rx TXT go on for Neonatal sepsis and if meningitis is associated?
Sepsis only -14D
| Sepsis w/ Meningitis - 21D (+- Add Vancomycin)
165
TXT HSV w/ what Rx?
Acyclovir
166
GBS positive mother requirements per what 3 steps?
1. Neonate S/S of sepsis/infection? Empiricly TXT/Eval
2. <35wks EGA? 48hr hold/limited eval
3. Did mom receive 2 doses of ABX?
- - Y-48h observe w/out txt - No-48h hold/limited eval
167
At a minimum how long do you hold a baby born to GBS positive mother?
48h
168
What is a sign of neonatal respiratory distress?
Grunting or subtle soft meowing
169
Respiratory distress syndrome is AKA?
Hyaline membrane disease
170
RDS pathophys?
Insufficient surfactant synth by type II pneumatocytes.
171
EGA cutoff RDS is commonly seen?
<34w
172
What is the physiological outcome to lungs from RDS?
End-Expiration atelectasis
173
RDS CXR will appear?
Bilateral, Ground glass appearance
174
Prior to birth what will help prevent RDS occuring in neonate?
CCS given to mom 32-34wks
175
TXT for RDS after birth?
Intubate - vent w/ artificial surfactant via ET tube.
176
Complications of RDS?
Persistent PDA
PTX
Bronchopulm dysplasia
Retinopathy of prematurity
177
What is PDA typically noticed?
2-4d of life
178
PDA can lead to what complications?
Pulmonary edema and hepatomegaly
179
TXT of PDA?
Restrict fluids
Diuretics (lessen burden)
Indomethacin or Ibuprofen - closes PDA
180
Symptomatic pneumothorax TXT?
Chest tube
181
Bronchopulm dysplasia pathophys?
Damage to lungs caused by mechanical ventilation and long-term oxygen (O2 toxicity/barotrauma)
182
Retinopathy of prematurity pathophys?
O2 toxicity on developing retinal blood vessels
183
Apnea of prematurity causes?
MC - Central - Phrenic nerve not stimulated by Medulla/Pons
| Periph - Malformation/positioning causes AW obstruct
184
TXT of Apnea of prematurity?
o2,
Stimulants - caffeine or theophylline
Transfusions for anemia
185
Tracheomalacia pathophys? Worse w/?
Weak/floppy cartilage or tracheal wall causing collapse of trachea.
Worse w/ coughing, crying, feeding, URI
186
Breath sounds ass/w Tracheomalacia?
+- high pitched rattling/noisy breath sound
187
What is Meconium aspiration syndrome?
Respiratory distress
Pneumonia/Pneumonitis
Pneumothorax
188
Nonvigorous child w/ suspected meconium aspiration requires what TXT?
Intubation and suction (if this fails)
| BVM w/ PPV
189
How does Meconium aspiration syndrome occur?
Meconium is mixed w/in amniotic fluid
190
CXR of Meconium aspiration syndrome neonates look like?
Coarse irregular infilitrates
191
Transient tachy-P is defined as?
Retained amniotic fluid causes mild hypoxia then tachy-P shortly after birth.
192
When does Transient tachy-P of neonate resolve typically?
In 24h
193
CXR of a neonate w/ Transient tachy-P appears?
Fluid in fissures (distinct linear marking between lobes)
194
Transient tachy-P occurs in what kind of neonates MCLY? Why these neonates?
C- Section or LGA (large gestational age).
| - Due to the lack of squeeze during delivery to force fluid out of lungs
195
MC cause of a serious neonatal anemia?
Hemolytic Dz of newborn (ABO/Rh/antigen incompatibilities)
196
Why do all newborns have Jaundice?
Elevated bilirubin from
- Increased RBC mass turnover
- Insufficient hepatic clearance
- Decreased gut motility/excretion
197
Hyperbilirubinemia is defined as what lab result?
>5mg/dL
198
MC cause of neonatal jaundice is?
Hemolytic dz of newborn
199
Normal physiologic causes of neonatal jaundice?
Breastfeeding jaundice
| Breast milk jaundice
200
Difference between Breastfeeding jaundice vs Breast milk jaundice?
- Breastfeeding jaundice - 1st wk of life - Insufficent milk synth by mom/intake by baby > Baby retains bilirubin due to decreased gut motility
- Breast milk jaundice - After 1st wk of life lasting 1-2w - Milk has a factor or enzyme that inhibits bilirubin conjugation or causes increases bilirubin absorption on intestines.
201
How does jaundice begin and progress?
Mucosa/sclera of head then skin head > toe
202
What physical evidence suggests concern that jaundice is bad?
Yellow skin at/below umbilicus
203
NL bilirubin levels for a full term infant? Breastfed infant?
Bili <13 on day 3
or
Up to 17 if breastfed
204
NL bilirubin levels for a pre-term infant?
Bili <15 on day 5
205
Pathologic bilirubin lab values?
>13 on 1st day of life in term infant
Bilirubin rate rises >0.5/h OR >5/d
Jaundice starts w/in 24h of life
206
Severe signs of neonatal jaundice?
Hepatosplenomegaly AND anemia
207
Jaundice on 1st day of life is NL physiologic or pathologic?
Always pathologic
208
Breast feeding jaundice typically occurs in what type of moms?
1st baby Moms
209
Breastmilk jaundice physiology?
Fatty acids from milk displaces Bili from ALB = unconjugated w/out hemolysis
210
1st > 2nd place jaundice will show on the body
1st - Under tongue
| 2nd - Sclera
211
Coomb's test in the eval of neonatal jaundice will detect?
ABO incompatiability due to ABs attached to fetal RBCs
212
Kernicterus is AKA?
Bilirubin Encephalopathy
213
Pathophys of Kernicterus?
Lipid soluble unconjugated (indirect) Bili deposits in brain cells and is toxic to CNS
214
Kernicterus will occur if bili value is?
Bili > 20-25 or less if comorbid conditions are present
215
Early S/S of Kernicterus?
Lethargy, Hypotonia, poor Moro's, vomiting, high-pitched cry.
216
Early S/S of Kernicterus typically occur when?
4th day of life
217
Late S/S of Kernicterus
Fontanelle bulge
Opisthotonic posture (arched back)
Fever, seizure
Upward gaze is paralyzed in position
218
TXT of (mild,mod,severe) neonatal Jaundice
Mild - lifestyle (sun exposure, increase/improve feeding)
Mod - Phototherapy
Severe - Transfuse
219
Transfusion of neonate w/ severe jaundice occurs if?
Indirect bili =20 or more for infants w/ hemolysis and >2kg
| Indirect bili >25 in asymptomatic infants w/ physiologic jaundice
220
SEs of phototherapy?
Diarrhea/gas, temperature instability, bonding w/ mom
Asthma - long term
DM1 - long term
221
Follow up times post discharge of neonate w/ jaundice?
Discharge before 24hr life - F/U in 3d
Discharge between 24-48h of life - F/U in 4d
Discharge between 48-72h of life - F/U in 5d
