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Flashcards in neonatology Deck (85):
1

NB resucitation: Apnea or HR<100

Provide positive-pressure ventilation

2

NB resuscitation: HR<60 after PPV

continue PPV; start chest compressions

3

NB resuscitation: HR<60 after compressions

administer epi IV or ET

4

APGAR score: HR<100; blue; grimacing; limp; slow irregular RR

APGAR=3

5

order of disappearance in a sick baby

color; respiration; muscle tone; reflex; cardiac rate

6

order of appearance in a resuscitated baby

cardiac rate; color; respiration; reflex; muscle tone

7

essential intrapartum newborn care

dry the baby; delayed cord clamping; early skin-to-skin contact; delayed washing; non separation of mother and NB

8

NB Care

Erythromycin 0.5% ointment or Tetracyline 1%; Vit K 1mg IM; Hep B; BCG

9

NB Screening test

Congenital Hypothyroidism; CAH; Galactosemia; G6PD; PKU; done at 48hrs old RA9288

10

when to repeat NBS?

if blood collected <24hrs old; repeat at 2weeks old

11

normal BW and BL; delayed physical; mental; and sexual dvt; sluggish; feeding difficulties; hyponatremia; edema of scrotum/genitals; prolonged physiologic jaundice

Congenital Hypothyroidism

12

deficiency of 21hydroxylase; vomiting; failure to thrive; normal at birth; signs of sexual and somatic precocity

CAH

13

feeding intolerance; vomiting; jaundice; convulsions; lethargy; hypotonia; MR

Galactosemia

14

episodic/chronic hemolytic anemia; symptoms develop 1-2days after exposure to substance with oxidant properties; Heinz bodies; reticulocytosis; jaundice; ARF

G6PD

15

substances implicated in G6PD

sulfonamides; nalidix acid; nitrofurantoin; chloramphenicol; antimalarials; vit K analogs; ASA; benzene; naphthalene

16

enzyme deficient in PKU

phenylalanine HYDROXYLASE

17

most common manifestation of PKU without treatment

developmental delay

18

unpleasant musty odor; severe vomiting; hypertonic; hyperactive DTR's; seizures in infant

PKU

19

defective enzyme in Maple Syrup urine dse causing buildup of leucine; isoleucine; and valine

alpha ketoacid dehydrogenase

20

flat blue gray with well-define margins in NB

mongolian spot

21

small papules or pustules on an erythematous base filled with eosinophils

erythema toxicum

22

small inclusions cysts; pearly white; usually on the face

milia

23

lacy pattern on the skin similar to cobblestones; vasomotor response to cold stress

cutis mamorata

24

open and closed comedones from circulating androgens

neonatal acne

25

subperiosteal bleed due to birth trauma; does NOT cross suture lines

cephalhematoma

26

swelling of the scalp due to birth trauma; involves the presenting part; CROSSES suture lines

caput succedaneum

27

arm adducted; pronated; and internally rotated; (C5-C6 involvent); if with C4 involvement there is ipsilateral diaphragmatic paralysis

Erb-Duchenne palsy

28

claw hand; (C8-T1 involvement; if with T1 sympathetic fibers involvent: Horner Syndrome)

Klumpke palsy

29

reflex present at 4-6mos of life; arms adduct and extend; hands open; legs flex when loweing the entire body abruptly while the baby is supine and head; back; and legs supported

Moro reflex

30

most commonly fractured bone during delivery

clavicle

31

defect in the lid (small notch to a large cleft)

coloboma

32

incomplete closure of branchial clefts

branchial cleft cyst

33

cystic dilatation of thyroglossal duct remnants; seen in the midline

thyroglossal duct cyst

34

incomplete closure of the umbilical ring; associated with diastasis recti

umbilical hernia

35

herniation of peritoneum and abdominal contents at the base of the umbilicus; with sac

omphalocele

36

herniation without a sac; defect lateral to the umbilius

gastroschisis

37

urethral opening on the dorsal penis

epispadia

38

urethral opening on the ventral penis; more common

hypospadia

39

accumulation of fluid in the tunica vaginalis; resolves by 12mos old

hydrocele

40

timing of surgery in undescended testes

not later than 9-15mos old(majority descends in the first 3mos; if not; it will remain undescended)

41

aka IUGR;BW<3rd percentile

SGA

42

symmetric IUGR;earlier onset

associated with dse seriously affects fetal cell number like chromosomal; genetic malformation; teratogenc; infectious; severe maternal HTN

43

assymetric IUGR;late onset

associated with poor maternal nutrition or late onset/exacerbation of maternal vascular dse

44

hypoglycemic; plethora; increase risk of: RDS; congenital heard dse; lumbosacral agenesis; hyperbilirubinemia

LGA

45

increased surface tension causes alveolar collpase and V/Q mismatch and hypoia; seen in preterms

RDS I

46

term; delivered by C-section; resolves in 4-5days; overaeration and flat diaphragm

Transient Tachypnea of the newbord (RDS II)

47

causes pulmonary hypoplasia; scaphoid abdomen; bowel sounds heard over the chest

diaphragmatic hernia

48

most common cause of persistent pulmonary hypertension of the newborn

meconium aspiration syndrome

49

presents after 48th hr of life; TB increases not > 5mg/dL/day; TB peaks at 14-15 mg/dL; DB<10% of TB

Physiologic jaundice

50

presents in the 1st 24 hrs of lfe; TB increases by >0.5 mg/dL/hr; TB increases to >15mg/dL; DB>10% of TB

Pathologic jaundice

51

onset at 3-4DOL; 13% of breastfed infants; accentuated unconjugated hyperbilirubinemia; decreased milk intake; reduced caloric intake; few days duration

breastfeeding jaundice

52

onset after 7th DOL; increased B1 in 2% of breastfed infants; presence of glucoronidase in some breast milk

breast milk jaundice

53

how to reduce incidence of breastfeeding jaundice

frequent breastfeeding(>10/24hrs); rooming-in with night feeding; discouraging D5% or water supplementation; ongoing lactation support

54

lab test requested for indirect hyperbilirubinemia in NB

Coomb's test

55

(+) Coomb's test in indirect hyperbilirubinemia

Isoimmunization (Rh/ABO incompatibility)

56

(-) Coomb's test with increased Hb in indirect hyperbilirubinemia

polycythemia; twin-twin/ maternal-fetal transfusion; IDM

57

intrahepatic causes of direct hyperbilirubinemia

sepsis/TORCHS; prolonged TPN; hypothyroidism; galactosemia; cystic fibrosis; alpha-1-antitrypsin deficiency

58

extrahepatic causes of direct hyperbilirubinemia

choledochal cyst; biliary atresia

59

most common cause of hemolytic disease in the NB; most cases are mild; jaundice; mild hepatosplenomegaly; phototherapy is benificial

ABO incompatibility

60

rarely occurs in the 1st pregnancy due to too late for the mother to become sensitized and transmit antibody to her infant before delivery

Rh incompatibility

61

(-) Coomb's test with normal/decreased Hb and normal reticulocyte counts in indirect hyperbilirubinemia

enclosed hemorrhage;increased enterohepatic circulation;decreased calories(breastfeeding jaundice);disorders of conjugation(breastmilk jaundice)

62

(-) Coomb's test with normal/decreased Hb and increased reticulocyte count in indirect hyperbilirubinemia

with characteristic rbc morpholgy(spherocytosis;elliptocytosis); with noncharacteristic RBC morphology(G6PD deficiency; purvate kinase deficiency)

63

early sepsis

birth to 7th day of life

64

late sepsis

8th to 28day of life

65

risk factors for developing neonatal sepsis

maternal infection during pregnancy; PPROM(18hrs); prematurity(MC predisposing factor for infxn)

66

common organisms implicated in sepsis

GBS; E. coli; Listeria monocytogenes; HSV; enteroviruses

67

gold standard in the diagnosis of neonatal sepsis

blood and urine cultures

68

Tx for neonatal sepsis

ampicillin + 3rd gen cephalosporin or aminoglycoside; supportive

69

infection from ingestion of infected raw meat; handling cat feces

Toxoplasmosis

70

classic triad of toxoplasmosis

HYDROCEPHALUS; chorioretinitis; intracranial calcifications

71

Tx for Toxoplasmosis

Pyremethamine and sulfonamide

72

IUGR; cataracts; congenital heart dse(PDA); MR< deafness; blueberry muffin

Rubella

73

most common congenital infection

CMV

74

may cause chorioretinitis; microcephaly; periventricular calcifications

CMV

75

Tx for CMV

Ganciclovir

76

Tx for HSV

Acyclovir; deliver by C-section if with active lesions

77

maculopapular rash; snuffles; periostitis of long bones; hepatosplenomegaly

early stage(<2 yrs) syphilis

78

Hutchinson teeth; saddle nose

Late stage(>2yrs) syphilis

79

Tc for syphilis

Penicillin

80

most common life threatening emergency of the GIT in neonates

NEC

81

location of NEC

distal ileum and proximal colon

82

greatest risk factor in developing NEC

prematurity

83

initially presents as abdominal distention; gastric retention; lethargy; temperature instability; bloody stools in 25% of patients; progresses to bowel perforation; peritonitis; SIRS; shock; death

NEC

84

AXR finding in NEC

pneumatosis intestinalis

85

indications for surgery in NEC

evidence of perforation; failure of medical mgt; single fixed bowel loop on Xray; abdominal wall erythema; palpable mass