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Flashcards in Neonatology 2 Deck (26):
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Causes of cyanosis in newborns?

1. Pulmonary (pneumothorax)
2. Cardiac (5Ts – tetralogy of flow, transposition of great vessels, truncus arteriosus, tricuspid atresia, TAPVR)
3. Hematologic (polycythemia)
4. Metabolic (hypoglycemia, hypocalcemia, hypothyroid, hypothermia)

1

Neonate with cyanosis – test and interpretation?

Hundred percent oxygen test
If PaO2 increases less then 15, reduced pulmonary bloodflow (tetralogy of fallout or right to left shunt)

If PaO2 increases but levels less than 150, normal/increased pulmonary bloodflow (truncus arteriosus)

If PaO2 goes over 150, lung disease

2

Most common pulmonary causes of respiratory distress?

1. Respiratory distress syndrome (surfactant deficiency syndrome)
2. Meconium aspiration syndrome
3. Persistent pulmonary hypertension

3

Indicators of fetal lung maturity?

Lecithin: sphingomyelin ratio greater than 2:1 and presence of phosphatidylglycerol

4

X-ray findings of respiratory distress syndrome? Management?

Groundglass and air bronco grams

Supplemental oxygen, CPAP, exogenous surfactant

5

Broncopulmonary dysplasia? Criteria?

Progressive pathologic changes in immature long

1. Mechanical ventilation during first two weeks
2. Respiratory compromise persisting beyond 28 days
3. Needs supplemental oxygen beyond 28 days
4. Characteristic CXR

6

Persistent pulmonary hypertension of the newborn? Most common causes? Pathophys? Clinical features? Evaluation? Management?

Any condition other then congenital heart disease that reduces blood flow to the lungs

Most common causes: perinatal asphyxia and meconium aspiration syndrome

Right to left shunt

PaO2 is significantly decreased

Decreased pulmonary vascular markings on CXR and echo findings

Oxygen, mechanical ventilation, extracorporeal membrane oxygenation, inhaled nitric oxide

7

Meconium aspiration syndrome? Clinical features? Evaluation? Management?

Green amniotic fluid and respiratory failure

CXR shows increased lung volume with diffuse patchy pneumothorax

Suctioning, oxygen, ECMO

8

Apnea prematurity? Categories?

Respiratory pause without airflow lasting more than 15 seconds OR pause of any duration with bradycardia and cyanosis

1. Central – complete cessation of chest wall movement
2. Secondary to airway obstruction – chest wall movements without airflow
3. Mixed – central and obstructive apnea (most frequent type)

9

Idiopathic apnea of prematurity – clinical features? Management?

24 hours after birth and resolves by post conceptional age of 33-42 weeks

Maintain thermal environment, respiratory stimulants (caffeine, theophylline), ventilation/CPAP

10

Jaundice in newborns – when visible?

serum bilirubin >5 mg/dL

11

Physiologic jaundice? Causes? Peak bilirubin concentrations and timing in term infants? In preterm infants?

Self-limited indirect hyperbilirubinemia that resolves within the first week of life

Increased bilirubin load or delayed activity of hepatic enzyme glucoronyl transferase

5-16 peaking around 3 days of life; peaks in 5-7 days in preterm infants and takes two weeks before decreasing

12

Non-physiologic jaundice? Types?

Jaundice secondary to pathophysiologic cause

Direct versus direct (direct is always pathologic)

13

Causes of indirect hyperbilirubinemia?

1. Breast-feeding jaundice – increased bilirubin in the first week of life due to sub optimal milk intake (decreased milk intake needs to decrease passage of stool and decreased excretion of bilirubin)

2. Breast milk jaundice – due to high levels of beta-glucoronidase and high lipase in milk. Peaks in second/third weeks of life

14

Differential for indirect hyperbilirubinemia?

1. Physiologic jaundice
2. Breast-feeding jaundice
3. Breast milk jaundice
4. Sepsis
5. Inborn errors of metabolism (hypothyroidism)
5. Inherited disorders bilirubin uptake (Gilberts, Criggler-Najjar)
7. Increased red blood cell (trauma)
8. Hemolysis (spherocytosis, Elliptocytosis, pyruvate kinase deficiency)
9. Upper G.I. obstruction

15

Differential for direct hyperbilirubinemia?

1. Obstructive jaundice due to choledochal cyst or biliary atresia
2. Sepsis
3. Neonatal hepatitis
4. Metabolic (galactosemia, fructose intolerance, alpha-1 anti-trypsin, tyrosinemia)
5. Cholestasis due to PTN
6. Cystic fibrosis

16

Treatment of indirect bilirubinemia? Treatment if due to hemolytic disease? ?

Photo therapy

Exchange transfusion

17

Complications of insufficiently treated indirect Bilirubinemia?

Indirect bilirubin can pass through blood brain barrier and localize to basal ganglia/hippocampus


Causes choreoathetoid cerebral palsy, hearing loss, seizures, oculomotor paralysis

18

Congenital diaphragmatic hernia? Clinical features? Evaluation? Management?

Herniation of abdominal contents into thorax impairing lung maturation

Scaphoid abdomen, respiratory insufficiency, bowel sounds heard in chest

Ultrasound is in utero, CXR shows absence of diaphragmatic dome/no gas in abdomen/mediastinal shift to contralateral side/bowel loops in thorax

Hundred percent oxygen and correction of acidosis. Do not use BVM because it may increase compression of long

19

Meconium ileus? Clinical features? Diagnosis? Management?

Manifestation of cystic fibrosis resulting in abnormal accumulation of intestinal secretions

Abdominal distention, vomiting, no passage of meconium

Abdominal radiographs show minimal air fluid levels, soap bubble sign.

Enemas to relieve the obstruction

20

Most common cause of obstruction in neonatal period?

Intestinal atresia

21

Hirshsprung disease? Clinical features? Diagnosis? Management?

Congenital aganglionic bowel disease caused by lack of caudal migration of ganglion cells from Neural crest

Constipation, vomiting, abdominal distention

Rectal biopsy

Resection of affected segment

22

Necrotizing enterocolitis? Clinical Features? Diagnosis? Management?

Abdominal distention/tenderness, bilious aspirate, bloody stools, abdominal erythema, metabolic acidosis

Radiographs shows air fluid levels, thickened bowels, Air in bowel wall

Medical treatment (bowl rest) or surgical (resection of necrotic bowel)

23

Hypoglycemia – criteria in newborns? Causes? Clinical features?

Glucose <40

Insulin excess (diabetic mothers, nesidioblastosis - islet cell hyperplasia)

Diminished glucose production (intrauterine growth retardation with limited hepatic glycogen stores, galactosemia, fructose intolerance, aminoacidopathies)

24

Infants with diabetic mothers – alterations in metabolic processes? Clinical features? Complications?

Increased hepatic glucose uptake, glycogen synthesis, lipogenesis, protein synthesis

Increased by fat and visceromegaly, increased skeleton length but small head/face

Congenital heart disease, small left colon syndrome (decreased caliber left colon)

25

polycythemia – definition? Causes? Clinical features? Management?

Hematocrit >65

Placental insufficiency leading to depot secretion, hypoxemia, deleted cord clamping

Poor perfusion, cyanosis, poor feeding, seizures

Partial Exchange transfusion