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Flashcards in Neonatology Deck (56)
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1

Assessment of Fetal Maturation

New Ballard Score→ takes into account Physical Maturity Signs such as→ skin, lanugo (fine, soft hair on newborn), plantar surface, breast, eye/ear, genitals→ added up, total score should correlate to weeks of age.

2

Major Reason for Large Neonatal size (Infants large for gestational Age-IGA

infant of DM mother. Mother’s blood sugar is high and crosses placenta, baby releases insulin as a result→ insulin is a growth hormone= large baby

3

Reasons for Small gestational age (SGA)

• Asymmetrical→ placental insufficiency (maternal vascular dz—HTN), poor weight gain during pregnancy, multiple gestations
• Symmetrical→ protoplasm was effected→ drugs, alcohol, chromosomal abnormalities, infections

4

Apgar Score

asses condition of new born at birth, has best predictability for neurologic injury at 10 min
activity, pulse, grimace, appearance, resp

5

Newborn Reflexes

check to see that reflex is present and if it is asymmetrical→ sucking, rooting (head turns to focal stimulus), traction, palmar grasp, DTR, moro/startle, tonic neck

6

Contraindications for early newborn discharge

jaundice@ 24 hr, risk of infection, reason to believe child will withdraw, cleft lips, less than 38 wks, less than 6lb, not feeding, multiple births

7

Acute Bilirubin Encephalopathy

• SX→ lethargy, poor feeding, irritability, arching neck, apnea, seizures

8

Chronic Bilirubin Encephalopathy

• Extrapyramidal movement disorder, gaze problems, hearing probs, dysplasia of enamel

9

Hypoglycemia

<45mg/dl→ stressed infants at risk
• SX→ lethargy, poor feeding, irritability, seizures
• Mother is DM, baby’s BS rises, insulin is released→ birth, insulin still being released→ BS crashes
• Reduced fetal hyperinsulemia
• TX→ feed if 20-45 w/no sx
o If under 45 w/sx= give D10W (bolus then infusion)
o If under 20 → give D10W (bolus then infusion)

10

Respiratory Distress

tachypnea over 60, retractions, cyanosis
• Can be pulmonary, sepsis, cardio.
• Should get CXR, ABG/CBG

11

Neonatal Murmurs

if present at birth= valvular.
• Turbulent blood flow, change in vascularity, change in how fast blood goes across a valve, neonates are changing so rapidly
• After 24 hrs if murmur present→ BP in R arm and LE (looking for coarctation of aorta)
• D/C new born with F/U
• If NB isn’t feeding well and/or cyanotic→ could be CHF

12

Birth Trauma

difficult delivery
• Often larger birth weight, abnormal presenting position
• Soft tissue, bruising, fractures, cervical plexus palsies, intracranial hemorrhage, subglial hemorrhage, caput, cephalohematoma, subgleal

13

Infants of mothers who abuse drugs

• Coke & meth→IUGR, premature delivery, withdrawal (irritability)
• Opiods→hyperactivity, hypertonicity, tremors, seizures, GI probs, nasal stuffiness, sneezing, IUGR
• Tobacco→ IUGR

14

Birth Asphyxia

become hypoxic, become bradycardic
• D/T→ acute interruption of umbilical blood flow, maternal hypotension/hypoxia, chronic placental insufficiency

15

Monochorial Twins

monozygous, same sex, diamniotic/monoamniotic→ risk of twin-twin transfusion= congential abnormalities, CP. One could steal all the food and hemoglobin from the other

16

Dichorial Twins

can be same sacks or different sacks, same or different sex, not at risk for transfusions syndrome

17

Complications of multiple births

IUGR, twin-twin transfusion, CP, birth weights that are significantly different, preterm delivery, extra amniotic fluid (polyhydramnios), premature rupture of membranes, abnormal fetal presentations, prolapsed umbilical cord

18

Apnea of Prematurity

no breath for 20 seconds
• Could be temp related (heat, cold), vagal response to feeding tube, GERD, pulm dz, PDA, hypoglycemia, infection, intracranial hemorrhage (scan head if you can’t figure out why they are apneic), seizures, drugs

19

RSD Type 1

surfactant deficiency in alveoli (either didn’t produce or inactivated d/t protein leak)
• CXR→ reticulogranular pattern (ground glass)
• TX→ antenatal corticosteroids, early intubation and surfactant→ proph in infants less than 27 weeks

20

Transient Tachypnea of Newborn (RDS type 2)

• Often associated with c section, TX w/02 support
• On CXR will see interstitial edema, pleural effusions

21

Patent Ductus Arteriosus

presents on 3-7 days
• SX→ respiratory distress
• Tx→ medical ligation→ indomethacin
o Surgical

22

Bronchopulmonary Dysplasia

common in premies that required mechanical ventilation
• Pathology→ inflammation→hypercellularity→fibrosis
• Change in lung tissue from injury that occurs→ the damaged tissue is often replaced by new lung that does not have fibrosis→ as they get older so they tend to outgrow it
• On CXR→ see large cysts, not homogenous ground glass
• Tx→ surfactant use (early) glucocorticoid can help wean from ventilator, diuretics

23

Necrotizing Enterocolitis (NEC)

often premies w/sepsis getting gastric feeds presenting w/bloody stool, distension, penumatosis intestinalis (air developing in the gut wall).
• Often in premies under 4 lbs, and full term babies w/polycythemia
• Etiology→ can be d/t infection, immunological immaturity

24

Necrotizing Enterocolitis (NEC) treatment

• Treatment→ NG tube, maintain ventilation/oxygenation, IV fluids (to replace third spaced fluids). Often need TPN.
o Surgery if perf, fixed dilated loop of bowel, abd wall cellulitis
o ABX→ broad spectrum

25

Anemia in Preterm Infants

Sx→ poor feeding, lethargy, increased HR, poor weight gain, periodic breathing
• Sx present when hct is <20%
• Tx→ erythropoietin

26

Intraventricular Hemorrhage

bleeding MC occurs in subependymal germinal matrix right along lateral ventricles. Hemonculus→ legs close to ventricles, so when ventricles dilate there is problem with the legs
MC in infants w/low gestational age (<26 wks)

27

Intraventricular Hemorrhage Sx and Dx

• Sx→ hypostension, metabolic acidosis, altered neurologic status,
• Dx→ routine ultrasound if born before 32 weeks (US of anterior fontanelle)

28

Retinopathy of Prematurity (ROP)

happens when pre mature retinal is not completely vascularized, triggered by insulin like growth factors
• abnormal vascularization can occur→ fibrovascular tissue in vitreous is associated w/inflammation, scarring, retinal folds/detachment

29

Acyanotic Congenital Heart Lesions

Most are left-sided outflow obstruction
• Cant deliver enough flow to tissue, large heart, pulm edema, L→ shunting (sx don’t occur until pulm resistance goes up and you’re shunting more back over)
• Clinical sx start @ 3-4 weeks
• CXR= large heart
• EKG= Diagnostic

30

Treatment of Cyanotic & Acyanotic Lesions

Supportive (IV glucose, O2, vent)
• Prostaglandin E1 (maintain ductal patency) and improves systemic perfusion for left sided outflow tract obstruction
• Surgery & cardiac cath
• Prognosis depends on lesions, and complications from surgery