Neonatology Flashcards
(26 cards)
How long can breastmilk jaundice last?
persistence of physiologic jaundice in a breast fed neonate past 7 days and can last 2-3 months.
What is breast feeding jaundice?
At the start of life, when breastfeeds do not have a lot of volume.
Other than Valproate, other AED have some (not as dominant) associations with neonate abnormalities including:
Phenobarbital - cardiac, orofacial, and GU anomalies
Gabapentin - limited data (some animal studies show hydroureter & hydronephrosis)
levetiracetam - teratogenic toxicity
Erythromycin ointment is applied infant eyes to prevent
Gonococcal ophthalmia neonatorum (gonorrhea conjunctivitis from vertical transmission)
What is the appropriate management of natal teeth?
Confirm with x-ray that the tooth is supernumerary (meaning no root development or defective root development).
If supernumerary - remove to dec aspiration risk and dec feeding problem
If NOT - don’t extract
Omphalocele vs gastroschisis (anatomy)
Omphalocele - central umbilicus with peritoneal sac (always, sometimes ruptured); associated with other anomalies (40-80%); generally more concerning diagnosis because association with other anomalies
Gastroschisis - lateral to umbilicus (often R) with no peritoneal sac covering; rarely associated with other anomalies (15%)
Lithium is most commonly associated with this anomaly
Ebstein’s anomaly (Tricupsid valve malformed which leads to RA enlargement)
Infant lying on side has a seconds-minutes change in color to reddening on the side she is lying on. With a clear demarcated longitudinal midline and pale on right, or side she upright on. What is this called? Steps in work up?
Harlequin color change, No further evaluation is indicated
What are key risk factors for SIDS?
Maternal smoking during pregnancy –> b/c Smoking in the home?
Is neonatal jaundice an unconjugated hyperbilirubinemia or conjugated?
Unconjugated
Which Type, Type 1 or 2 of Crigler Najjar is correctly? What is the enzyme defect? What is the treatment?
Type 2 is a partial absence of the UGT enzyme activity and can be treated with phenobarbital which increases hepatic glucuronyl transferase activity increasing hepatic uptake of bilirubin (doesn’t increase activity of defective enzyme)
Type 1 is fatal (with age expectancy < teen) – must have continual phototherapy, exchange tranfusions and still universally get kernicterus (bilirubin encephalopathy)
Is the same or a different enzyme implicated in Criggler Najjar Type 1, Type 2, and Gilbert
The same enzyme (UGT activity)
Type 1 - complete absence (deadly)
Type 2 - partial absence
Gilbert - transient decreased activity often brough on by bodily stress like illness
Hemolytic disease of the fetus and newborn (HFDN) is defined as …. and can be caused by what incompatibilities
… Maternal Ab active against RBC antigens oft he infant are passed through the placenta and cause some newborn RBC destruction leading to ‘pathologic jaundice’ … can be caused by Rh(D) antigen or ABO antigen incompatibilities
Name 5 key findings of congenital hypothyroidism on physical exam
UMMPP
Umbilical hernia
Myxedema (aka puffy face)
Macroglossia (protruding tongue),
Pallor
Poor neurodevelopment,
Is Rh antigen or ABO antigen incompatibility more severe in causing pathologic jaundice?
Give an example of each.
Rh > ABO
Rh antigen neg Mom, Rh pos fetus = Rh pos blood passes placenta, Mom makes Rh antibodies because she is negative. She DOES NOT RECEIVE RHOGAM (Anti-D globulin)and then passes Rh antigen over placenta into 2nd fetus.
O mom, A/AB/B fetus = O mom makes anti-A and/or Anti-B antibodies which pass over placenta and attack A/AB/B RBCs and hemolysis occurs.
If neonatal hyperbilirubinemia is conjugated (as opposed to unconjugated), what should be your primary most concerning differential? Work up?
Always pathologic
Think about biliary atresia
Get an Abdominal US / RUQ US to eval liver/gb size, shape, ducts, enlarged hepatic LN? (seen in BA)
A neck mass found in the posterolateral portion of a neonate’s neck and transilluminates is likely a ____.
What other abnormalities are associated with this?
Cystic hygroma.
70% of children with a cystic hygroma have a karyotypic abnormalities (like T21, 13, 18, Turner, or Klinefelter).
Describe POTTER sequence. (Key findings, cause)
Cause: Renal abnormalities (renal cystic disorder like ADPKD or ARPKD, congenital obstructive uropathy, bilateral renal agenesis) or dysplastic disorder –> lead to oligohydramnios or anhydramnios which over time causes
Fetal Compression leading to facial and limb abnormalities
POTTER MNEMONIC:
P: pulmonary hypoplasia (a consequence of…
O: oligohydramnios
T: twisted skin (wrinkly skin)
T: twisted face (Potter facies: low set ears, retrognathia, hypertelorism)
E: extremity deformities (limb deformities: club hands and feet, joint contractures)
R: renal agenesis (bilateral); restricted growth (IUGR) – (the causes is RENAL)
What is the 1st line treatment of neonatal opioid withdrawal syndrome (med and route)?
What Finnegan Neonatal Abstinence scoring system scores trigger treatment?
Oral morphine (or oral methadone)
2 consecutive scores of >8 or 1 of >12
If symptoms persist with opioid involvement, can consider clonidine adjunct.
What has the highest associated risk of DDH?
What are the next risks factors?
Highest: Girls with breech position (12% risk)
Girls with positive family history (4.5%)
Boys with breech position (2.5%)
Boys with positive family history (1%)
Other risk factors: Oligohydramnios has association
Preterm has lower risk (probably because fetus is small)
Identify risk factors for neonatal hypoglycemia
Prematurity (prior to 37 w)
IDM
LGA
SGA
Hypothermia
IEM
Genetic overgrowth syndromes (like beckwith wiedemann)
What is the most common cause of polycythemia?
Hct > 65%. Delayed cord clamping
Usually asx but can develop hypoglycemia, hyperbilirubinemia, poor feeding
What is a significant abnormality that infants of mother’s with SLE are at risk for?
Neonatal Lupus (10% of infants born to mothers w/ anti-SSA/Ro or anti-SSB/La antibodies)
Most serious complication is: 3rd degree AV (complete) heart block
Other signs: periorbital erythema, round pink patches and plaques on face and scalp
Caudal regression syndrome is correlated with what in the mother?
20% of infants with caudal regression syndrome are born to mothers with Type 1 or 2 diabetes.
