Neonate Flashcards
1
Q
small white rash on erythematous base
erythema toxicum contains
A
eosinophils
2
Q
vesicopustular eruption
pusutular melanosis contains
A
PMNs or neutrophils
3
Q
hard palate beside raphe accumulation of epithelial cells
A
epstein pearls
4
Q
solid flank mass
hematuria
hypertension
thrombocytopenia
A
renal vein thrombosis
5
Q
urine output in neonates
A
void by 12 hrs
about 95% preterm and term void in 24 hours
6
Q
meconium passage
A
usually 12 hours
99% of term and 95% preterm pass by 48 hrs
7
Q
t or f
apgar used to predict neuro outcome
A
false
8
Q
convection
A
heat energy to cooler surroundings
9
Q
conduction
A
heat to colder materials touching baby
10
Q
radiation
A
infant to other nearby cooler object
11
Q
evaporation
A
skin and lungs
12
Q
nursery temp at
A
22-26 degrees celsius
13
Q
vernix shed in
A
2-3 days
14
Q
advantage circumcision
A
decrease: phimosis uti penile cancer std hiv
15
Q
most accurate measure AOG in utz first trimester
A
crown rump length
16
Q
most accurate measure AOG in utz up to 30wks
A
biparietal diameter
17
Q
most common cause of fetal distress
A
uteroplacental insufficiency
18
Q
uteroplacental insufficiency
manifests as
A
iugr
fetal hypoxia
increased vascular resistance of fetal vessels
mixed respiratory and metabolic acidosis
19
Q
components of bpp
A
heart rate movement tone breathing amniotic fluid volume
20
Q
high risk for fetal alcohol syndrome if
A
> 7drinks per week
or >3drinks at a time
21
Q
lecithin: sphingomyelin ratio indicative of lung maturity
A
2:1
22
Q
oligohydramnios
A
Amniotic fluid leak/rupture of membranes Intrauterine growth restriction Fetal anomalies Twin–twin transfusion (donor) Renal agenesis (Potter syndrome) Urethral atresia Prune-belly syndrome Pulmonary hypoplasia Amnion nodosum Indomethacin Angiotensin-converting enzyme
23
Q
polyhydramnios
A
Anencephaly Hydrocephaly Tracheoesophageal fistula Duodenal atresia Spina bifida Cleft lip or palate Cystic adenomatoid lung malformation Diaphragmatic hernia
Syndromes: Achondroplasia Klippel-Feil Trisomy 18 Trisomy 21 TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus, herpes simplex) Hydrops fetalis Multiple congenital anomalies
24
Q
Accutane (isotretinoin)
A
Facial-ear anomalies, heart disease, CNS anomalies
25
Alcohol
Congenital cardiac, CNS, limb anomalies; IUGR; developmental delay; attention deficits; autism
26
Amphetamines
Congenital heart disease, IUGR, withdrawal
27
Angiotensin-converting enzyme inhibitors
| and angiotensin receptor antagonists
Oligohydramnios, IUGR, renal failure, Potter-like syndrome
28
Azathioprine
Abortion
29
Carbamazepine
Spina bifida, possible neurodevelopmental delay
30
Carbon monoxide
Cerebral atrophy, microcephaly, seizures
31
Chloroquine
Deafness
32
Cigarette smoking
LBW for gestational age
33
Cocaine/crack
Microcephaly, LBW, IUGR, behavioral disturbances
34
Danazol
Virilization
35
Lithium
Ebstein anomaly, macrosomia
36
Methyl mercury
Minamata disease, microcephaly, deafness, blindness, mental retardation
37
Misoprostol
Arthrogryposis, cranial neuropathies (Möbius syndrome), equinovarus
38
Mycophenolate mofetil
Craniofacial, limb, cardiovascular, CNS anomalies
39
Penicillamine
Cutis laxa syndrome
40
Phenytoin
Congenital anomalies, IUGR, neuroblastoma, bleeding (vitamin K deficiency)
41
Prednisone
Oral clefts
42
Quinine
Abortion, thrombocytopenia, deafness
43
Selective serotonin reuptake inhibitors
Small increased risk of congenital anomalies, persistent pulmonary hypertension of newborn
44
Statins
IUGR, limb deficiencies, VACTERAL
45
Stilbestrol (diethylstilbestrol [DES])
Vaginal adenocarcinoma in adolescence
46
Streptomycin
Deafness
47
Tetracycline
Retarded skeletal growth, pigmentation of teeth, hypoplasia of enamel, cataract, limb
malformations
48
Thalidomide
Phocomelia, deafness, other malformations
49
Toluene (solvent abuse)
Craniofacial abnormalities, prematurity, withdrawal symptoms, hypertonia
50
Topiramate
Cleft lip
51
Valproate
CNS (spina bifida), facial and cardiac anomalies, limb defects, impaired neurologic function, autism
spectrum disorder
52
Vitamin D
Supravalvular aortic stenosis, hypercalcemia
53
Warfarin (Coumadin)
Fetal bleeding and death, hypoplastic nasal structures
54
Phenobarbital—
bleeding diathesis (vitamin K deficiency), possible long-term reduction in IQ, sedation
55
Dexamethasone—
periventricular leukomalacia
56
amnion nodosum (granules in amnion) and oligohydramnios assoc with
pulmonary hypoplasia and renal agenesis
57
fetal transfusion syndrome
difference 5g/dL
| >20% weight difference
58
Symmetric iugr
```
Earlier onset
Chromosomal
Genetic
Teratogen
Malformation
Infection
Severe hypertension
```
59
Asymmetric iugr
Late onset
Preserve Doppler waveform in carotids
Poor maternal nutrition
Preeclampsia, chronic hypertension
60
Insensible water loss <1000g infant
2-3 ml/kg/hr
61
Insensible water loss 2000-2500g infant
0.6 - 0.7 ml/kg/hr
62
Parental nutrition requirements
2.5-3.5 g/dL amino acids
10-15 g/dL glucose
2.2 kcal/mL intralipid
63
Calorie intake >100kcal per kg per 24 hr
Gain 15g /kg/24 hours
| Positive nitrogen balance 150-200mg.kg.24hrs
64
Tip of not should be
2.5cm or 1 inch from lower end of stomach
65
Swelling that crosses suture lines
Caput succedaneum
66
Subperiosteal bleeding
| Limited to one bone
Cephalhematoma
67
Collection of blood under aponeurosis
Usually in vacuum
Ruptured emissary veins
Subgaleal hematoma
68
Tears in tentorium cerebelli
Subdural hemorrhage
69
IVH found in
Gelatinous subependymal germinal matrix
70
Predisposing factors for IVH include
prematurity, RDS, hypoxicischemic or hypotensive injury, reperfusion injury of damaged vessels, increased or decreased cerebral blood flow, reduced vascular integrity, increased venous pressure, pneumothorax, thrombocytopenia, hypervolemia, and hypertension.
71
Ventriculomegaly is defined as
mild (0.5-1 cm dilation), moderate (1.0-1.5 cm dilation), or severe (>1.5 cm dilation).
72
Cutz to screen for ivh
For <1000g highest risk
<32 weeks aog
Done within first 3-7 days of life
73
Repeat cutz to check for PVL
36-40 weeks aog
| Cystic lesion 2-4 weeks after
74
Target Temp therapeutic hypothermia
33.5 first six hours
| For 72 hours
75
Poor prognosis HIE
pH <6.7
Apgar scores of 0-3 at 5 min, high base deficit (>20-25 mmol/L), decerebrate posture, severe basal ganglia–thalamic lesions, persistence of severe HIE at 72 hr, and lack of spontaneous activity are also at increased risk for death or impairment.
76
Brain death HIE
coma unresponsive to pain, auditory, or visual stimulation; apnea with Pco2 rising from 40 to >60 mm Hg without ventilatory support; and absence of brainstem reflexes (pupillary, oculocephalic, oculovestibular, corneal, gag, sucking)
Persistent for 2 days in term, 3 days preterm
77
Typical spinal cord injuries at birth
level of the 4th cervical vertebra with cephalic presentations and the lower cervical–upper thoracic vertebrae with breech presentations
78
First thoracic root injured especially sympathetic
Paralyzed hand
Ptosis
Miosis
Horner syndrome
79
Which paralysis has better prognosis
| Upper or lower part of arm
Upper part of arm
80
Nerve injury edema and heals spontaneously
Neuropraxia
81
Nerve injury with intact myelination sheath but nerve fiber disrupted
Axonotmesis
82
Nerve injury total disruption or root avulsion
Neurotmesis
83
Lung catecholamines for transition to neonatal life
Vasopressin
Prolactin
Glucocorticoids
84
risk for RDS
```
premature
maternal diabetes
multiple births
cs
precipitous delivery
asphyxia
cold stress
maternal hx of prev babies
```
85
RDS causes
dec lung compliance
insuff alveolar ventilation
small tidal vol
inc dead space
86
indication for ventilation and surfactant
on CPAP 40-70% o2 but still with sats <85%
87
contraindication to indomethacin
```
plt <50, 000
bleeding
oliguria up 1cc/kg/hr
nec
intestinal perforation
crea >1.8 mg/dL
```
88
four histo stages of bpd
1. acute lung injury
2. exudative bronchiolitis
3. proliferative bronchiolitis
4. obliterative fibroproliferative bronchiolitis
89
oxygenation index formula
= MAP x Fio2 x 100/ PaO2
90
mean airway pressure
[(PIP - PEEP) x. RR x IT / 60 ] + PEEP
91
OI >40
mortality >80%
92
ECMO not used for
high risk of IVH
<2kg
<34 weeks
93
anteromedial CDH
morgagni
94
posterolateral CDH
bochdaleck
95
poor prognosis CDH
lung head ratio <1
(good prognosis if >1.4)
presence of liver in thoracic cavity
96
paraesophageal hernia
gastroesophageal junction is in normal place
97
air on xray
15-30 mins in jejenum
2-3 hrs ileum
3 hrs colon
98
absence of rectal gas by __ hrs is abnormal
24hrs
99
xray meconium ileus
loops may vary in width
| bubbly granular appearance in severe cases
100
tx meconium ileus or plug
gastrografin enema
101
triad of NEC
1. ischemia
2. enteral nutrition
3. bacterial translocation
102
pathogens recovered NEC
```
e coli
klebsiella
clostridium perfringens
staph epidermidis
astrovirus
norovirus
roatvirus
```
103
indication of surgery for nec
pneumoperitoneum
| postive culture on paracentesis
104
relative indication for nec
failure of med tx
single fixed bowel loop
ab wall erythema
palpable mass
105
mechanism of hyperbil
1. increased liver load
2. reduced activity of transferase enzyme
3. competes or blocks transferase enzyme
4. decreased bili uptake in liver
106
jaundice in indirect hyperbil
bright yellow
107
jaundice in direct hyperbil
green or muddy yellow
108
value of bilis on pe
face 5mg/dL
mid ab 15
soles 20
109
autosomal recessive
high unconjugated bili
nonhemolytic
crigler najjar
110
physiologic jaundice
2-3 days seen
<5mg/dl rise per day
<12 terms (or 10-14mg/dl in preterms)
decreases to <2mg/dl on day 5-7
direct bili <2mg/dL always
111
syndrome with inactivity of bilirubin glucoronyl transferase
gilbert syndrome
112
phototherapy contraindicated in
porphyria
113
physiologic anemia
```
TERM 8-12wks (11g/dL)
PRETERM 6wks (7-10g/dL)
```
114
test to determine fetal cells in maternal blood
kleihauer betke test
115
delayed clamping causes
increase 20-40ml blood
| 30-35mg of iron
116
rh (-) mom should have igG of D antigen measured at
12-16wks
28-32wks
36wks
117
```
diarrhea
rash
hepatitis
eosinophilia
after blood transfusion
```
graft versus host disease
118
prevention of rh sensitization
Rhogam within 72 hours of delivery of rh + baby, ectopic, ab trauma in pregnancy, amniocentesis, abortion, chorionic villous sampling
may be given 28-32 weeks and then at birth
119
neonatal RBC
decreased deformability and filterability
120
fetal hemoglobin is __ resistant
alkali
APT TEST`
121
result apt test
yellow brown color -> MATERNAL
| pink color -> BABY
122
normal cord length
55cm
123
long cord
>70cm
124
intrauterine transplacental infection
```
syphilis
cmv
rubella
toxoplasmosis
parvovirus b19
varicella
```
125
intrapartum infection
```
hiv
hsv
hepa b
hepa c
tb
```
126
common cause of nosoc infection
```
coagulase neg staph
e coli
klebsiella
enterobacter
citrobacter
pseudomonas
serratioa
enterococci
satph aures
candida
```
127
congenital pneumonia
cmv
rubella
treponema pallidum
128
pneumonia during labor and delivery
```
gbs
gram - enteric
listeria
mycoplasma
chlamydia
cmv
hsv
candida
```
129
neonatal meningitis pathogen
```
gbs
e coli
listeria
strep pneumoniae
hib
staph
kleb
enterobacter
pseudomonas
treponema pallidum
TB
```
130
most important neonatal actor predisposing to infection is
prematurity
| low birth weight
131
risk factors for nosoc infection
prematurity,
low birthweight,
invasive procedures,
indwelling vascular catheters,
parenteral nutrition with lipid emulsions,
endotracheal tubes,
ventricular shunts,
alterations in the skin and/or mucous membrane barriers,
frequent use of broad-spectrum antibiotics,
and prolonged hospitalization
132
most frequent nosoc
coagulase neg staph
133
sirs
any 2:
1. fever or hypothermia
2. tachycardia/bradycardia
3. tachypnea/bradypnea
4. abnormal WBC
134
ecthyma gangrenosum
pseudomonas
135
small salmon pink papules
listeria monocytogenes
136
bleuberry muffin
cmv
rubella
parvovirus
137
common cause of death neonatal tetanus
aspiration pneumonia
138
normal csf in infants 1 mo old
protein 84 +- 45 mg/dL
glucose 46 +- 10 mg/dL
leukocyte 11 +- 10
PMNs 2.2 +- 3.8%
139
initial empiric
ampicillin + aminoglycoside (gentamicin) or cefotax
140
nosoc NICU empiric
ampicillin +
| oxacillin/nafcillin OR vancomycin
141
empiric gram negative
ampicillin
| + aminoglycoside or 3rd gen ceph
142
listeria tx
ampicillin
143
GBS tx
penicillin
144
enterococci tx
penicillin (or ampicillin or pipericillin)
| and aminoglycoside
145
duration bloodstream infection
7-10 days
| or 5-7 days after clinical response
146
nosocomial pneumonia
methicillin/vancomycin + aminoglycoside/3rdgen ceph
147
chlamydia trachomatis pneumonia
erythromycin
or
cotrimoxazole
148
u. urealyticum infection
erythromycin
149
duration gram neg meningitis
21 days or
| 14 days after sterilization of CSF
150
b fragilis infection
metronidazole
151
Intrauterine growth
| restriction
CMV, Plasmodium, rubella,
toxoplasmosis, Treponema
pallidum, Trypanosoma cruzi, VZV
152
Cataracts
Rubella
153
Cardiac defects
Rubella
154
Hydrocephalus
HSV, lymphocytic choriomeningitis
| virus, rubella, toxoplasmosis
155
Intracranial calcification
CMV, HIV, toxoplasmosis, T. cruzi
156
Limb hypoplasia
VZV
157
Microcephaly
CMV, HSV, rubella, toxoplasmosis
158
Microphthalmos
CMV, rubella, toxoplasmosis
159
Carditis
Coxsackieviruses, rubella, T. cruzi
160
Encephalitis
CMV, enteroviruses, HSV, rubella,
| toxoplasmosis, T. cruzi, T. pallidum
161
Hepatosplenomegaly
CMV, enteroviruses, HIV, HSV,
Plasmodium, rubella, T. cruzi,
T. pallidum
162
Hydrops
Parvovirus, T. pallidum,
| toxoplasmosis
163
Petechiae, purpura
CMV, enteroviruses, rubella, T. cruzi
164
Pneumonitis
CMV, enteroviruses, HSV, measles,
rubella, toxoplasmosis, T. pallidum,
VZV
165
Retinitis
CMV, HSV, lymphocytic
choriomeningitis virus, rubella,
toxoplasmosis, T. pallidum, West
Nile virus
166
Skin lesions
Enteroviruses, HSV, measles, rubella,
| T. pallidum, VZV
167
Thrombocytopenia
CMV, enteroviruses, HIV, HSV,
| rubella, toxoplasmosis, T. pallidum
168
Deafness
CMV, rubella, toxoplasmosis
169
Convulsions
CMV, enteroviruses, rubella,
| toxoplasmosis
170
ADE Oxygen
Retinopathy of prematurity,
| bronchopulmonary dysplasia
171
ADE
| Chloramphenicol
Gray baby syndrome—shock, bone
| marrow suppression
172
ADE
| NaHCO3
Intraventricular hemorrhage
173
ADE
| Amphotericin
Anuric renal failure, hypokalemia,
| hypomagnesemia
174
ADE
| Indomethacin
Oliguria, hyponatremia, intestinal
| perforation
175
ADE
| Tetracycline
Enamel hypoplasia
176
ADE
| Calcium salts
Subcutaneous necrosis
177
ADE
| Prostaglandins
Seizures, diarrhea, apnea, hyperostosis,
| pyloric stenosis
178
ADE
| Dexamethasone
Gastrointestinal bleeding, hypertension,
infection, hyperglycemia,
cardiomyopathy, reduced growth
179
ADE
| Iodine antiseptics
Hypothyroidism, goiter
180
ADE
| Erythromycin
Pyloric stenosis
181
```
hie location?
Stupor or coma
Seizures
Hypotonia
Oculomotor abnormalities
Suck/swallow abnormalities
```
Selective neuronal
| necrosis
182
hie location?
Proximal limb weakness
Upper extremities affected more
than lower extremities
Parasagittal injury
183
hie location?
Unilateral findings
Seizures common and typically focal
Focal ischemic
| necrosis
184
hie location?
Bilateral and symmetric weakness in
lower extremities
More common in preterm infants
Periventricular injury
