neonatologia Flashcards
newbron terminology Live birth Miscarriage (spontaneous abortion) Stillbirth (Fetal death) Infant Newborn Preterm infant Early term infant Full term infant Post term infant Small-for-gestational-age infant (SGA) Appropriate-for-gestational-age infant (AGA) Large-for-gestational-age infant (LGA) Low birth weight Very low birth weight Extremely low birth weight Perinatal period Postpartum period
Live birth Presence of vital signs at birth
Miscarriage (spontaneous abortion) Absence of vital signs, pregnancy loss before the 20th week of gestation and fetal weight less than 500 g
Stillbirth (Fetal death)
No uniform definition: absence of vital signs; most US states report fetal death if pregnancy loss during or after the 20th week of gestation and fetal weight more than 500 g
Infant A child under 1 year of age
Newborn A child under 28 days of age
Preterm infant Live birth between 20 0/7 weeks and 36 6/7 weeks of gestation
Early term infant Live birth between 37 0/7 weeks and 38 6/7 weeks of gestation
Full term infant Live birth between 39 0/7 weeks and 40 6/7 weeks of gestation
Post term infant Live birth later than the 42nd week of gestation
Small-for-gestational-age infant (SGA) Birthweight < 10th percentile
Appropriate-for-gestational-age infant (AGA) Birthweight 10th–90th percentile for gestational age
Large-for-gestational-age infant (LGA) Birthweight > 90th percentile for gestational age
Low birth weight Birthweight < 2,500 g regardless of the gestational age (occurs in early term infants and infants with intrauterine growth restriction; associated with increased mortality, particularly due to sudden infant death syndrome).
Very low birth weight Birthweight between 1,000–1,499 g regardless of the gestational age.
Extremely low birth weight Birthweight < 1,000 g regardless of the gestational age.
Perinatal period The period from the 22nd week of gestation to the 7th day after birth
Postpartum period First 4–6 weeks after birth
Immediate care of the newborn
Apgar score
clear airway secretions; Suction only if necessary
Provide warmth
Clamp and cut the umbilical cord
Apgar score
Apgar score Assessment of 5-minute Apgar score: infants with scores < 7 may require further intervention Reassuring: 7–10 Appearance (skin color) Pulse (heart rate reflex irritability upon tactile stimulation Activity (muscle tone, movement) Respiration
Neonatal resuscitation and risks
Risks:
Maternal factors: very old or very young women, diabetes or hypertension, substance abuse, previous fetal loss
Fetal factors: prematurity, postmaturity, congenital anomalies
Resuscitation steps
pulse oximetry
Positive pressure ventilation with bag mask
Indicated if there is inadequate respiratory effort or a heart rate < 100 bpm
Intubation if pressure ventilation is ineffective or compressions are required
Chest compressions if heart rate is < 60 bpm
IV epinephrine if heart rate < 60 bpm despite adequate ventilation and chest compressions
Preventive measures directly after birth
Ophthalmic antibiotics: to prevent gonococcal conjunctivitis
Vitamin K: to prevent vitamin K deficient bleeding
Assessment of the newborn within the first 24 hours of life
Consequences of intrauterine estrogen exposure
Vital signs
Respiratory rate: 40–60 breaths per minute
Heart rate: 120–160 beats per minute
Urine and meconium
First passage of urine within 24 hours of birth
First passage of meconium; within 48 hours after birth
Losing weight after birth - Loss of up to 7% of birth weight in first five days of life is normal; no specific treatment is required
Newborns normally regain their birth weight by the time they are 10–14 days old.
Consequences of intrauterine estrogen exposure
Breast bud development is normal in newborns, independent of sex.
Newborn girls may have bloody mucoid vaginal discharge.
External signs of maturity
Body hair: lanugo may be present, thinning, or mostly absent
Testicles: descended
Labia: labia minora covered by labia majora
Plantar creases: cover the entire soles of the feet
Neonatal Polycythemia
Pathophysiology
Delayed umbilical cord clamping → erythrocyte transfusion → ↑ circulating red blood mass (HCT)
chronic intrauterine hypoxia; increased intrauterine erythropoiesis; circulating red blood mass (HCT)
Risk factors
LGA; Infants of diabetic mothers; Maternal tobacco use; Delayed umbilical cord clamping;
Clinical features
Respiratory distress; Poor feeding, vomiting; Hypoglycemia; Ruddiness (plethora); irritability; Tremors
Diagnosis: Venous HCT > 65%
Treatment (if symptomatic): IV hydration; partial exchange transfusion (PET)
Complications: Hypoglycemia; Hyperbilirubinemia
Erythema toxicum neonatorum
Definition: self-limiting rash; appears within the first week of life
Etiology: unknown (probable contributing factors: immature sebaceous glands and/or hair follicles)
Clinical features
Small, red macules and papules that progress to pustules with surrounding erythema
Located on trunk and proximal extremities; spares the palms of hands and soles of feet
Diagnosis
clinical appearance of rash
Biopsy or smear of pustula (rarely necessary): ↑ eosinophils
Treatment: observation only
Prognosis: typically resolves without complications within 7–14 days
Congenital dermal melanocytosis (Mongolian spot)
Definition: benign blue-gray pigmented skin lesion Neonatal prevalence: Asian and Native American: 85–100% African American: > 60% Hispanic: 46–70% Pathogenesis: melanocytes migrating from the neural crest to the epidermis during development become entrapped in the dermis Clinical features Blue-gray pigmented macule back; buttocks; flanks Diagnosis clinical appearance It is important to document the diagnosis of Mongolian spots, as they may resemble bruises and lead to false suspicions of child abuse Prognosis: resolves spontaneously
Congenital melanocytic nevi
Clinical features
> 40 cm in size = giant congenital melanocytic nevus
Light to darkly pigmented lesion
increased hair growth
Treatment: surgical excision or laser treatment
Prognosis: Large nevi are at risk of degeneration → frequent follow-up
Infantile hemangioma (strawberry hemangioma)
Definition: benign vascular tumors of infancy
Pathophysiology
Abnormal development of vascular endothelial cells
Rapid proliferation followed by subsequent spontaneous slow involution
Clinical features
Manifests during the first few days to months of life
Progressive presentation; blanching of skin → fine telangiectasias → red painless papule or macule (“strawberry appearance”)
Most commonly on head and neck
Usually solitary lesions
Diagnosis
clinical findings
The differential diagnosis of cherry angioma is found mostly in adults
Treatment
Active non-intervention (monitoring, parental education)
Systemic therapy with propranolol in complicated cases:
Rapidly growing cutaneous hemangiomas
Periorbital hemangioma
Hemangiomas in the airways, gastrointestinal tract, or liver
If unresponsive to medication:
Laser therapy
Resection
Complications
Ulceration
Disfigurement
Prognosis
Spontaneous resolution is common (70% by age 7)
