Neonatology Flashcards
(42 cards)
Major pathophysiology of cause of physiologic nadir of infancy
Fetus’ EPO levels rise, with the highest levels in the final trimester. Erythropoiesis is directly driven by EPO, and as a consequence, a significant portion of the red blood cell mass is produced in the final trimester of pregnancy.
At birth, blood oxygen levels suddenly increase. Renal oxygen tension sensors detect this sudden rise in oxygen levels, and in response, downregulate hypoxia-inducible factors, which in turn, downregulate the production of EPO, resulting in a slowly decreasing hemoglobin for several weeks after birth
- Other causes: shorter lifespan of HbF, iron depletion
When does physiologic nadir of infancy happen and what is the normal Hgb in full term neonates
8-12 weeks
11.0 g/dL
Amniotic Band Syndrome cause and management
Cause: interruption of the normal sequence of development during the third trimester, affects the arms or legs.
Tx: refer to a plastic surgeon for reconstructive surgery.
Contraindications to breastfeeding (maternal infection (5), medication (3) and infant condition (1) )
Untreated Active TB
HIV (in developed countries)
Human T-cell lymphotropic virus tipe I or II
Untreated brucellosis
Ebola
Illicit drug use
Chemotherapy
Radioactive medications
Galactosemia
If neonate has left humeral fracture, what’s the management?
immobilization with elbow in 90 degrees
Management of delivery-related femur fracture
Pavlik harness (optional)
Management of Erb’s palsy
physical therapy
Complications for neonates born to mothers with phenylketonuria
IUGR
microcephaly
Structural cardiac anomalies
Developmental delay
If mother does not have PKU but fetus does, would they have IUGR or other growth restrictions?
NO
Direct hyperbillirubinemia definition in neonate
> 20% of total bilirubin
Direct hyperbillirubinemia and microcephaly
think CMV
Direct hyperbillirubinemia and microcephaly
think CMV
Pathophysiology of physiologic jaundice and when does it happen?
Increased RBC turnover and decreased BUGT activity
Starts 2-4 days after birth, peaks between 4-5 days
If infant has indirect hyperbillirubinemia, is stooling and wetting diapers, mother has A/B or AB blood type, what’s the likely cause?
G6PD
What is hemolytic disease of fetus and newborn?
Maternal Ab against neonate RBC
Usually when neonate have blood type A or B, mother with type O blood
It’s the IgG that crosses placenta and cause hemolysis
usually severe
When does breast milk jaundice occur and what’s the pathophys
7days to 10 weeks
BUGT inhibition
workup of Ischemis perinatal stroke and what artery does it most commonly effect
L MCA
MRI/ head US, echo (congenital heart disease and thrombus in heart)
Coagulation studies:
Protein C activity/ag
Free and total protein S
Fasting homocysteine
Fibrinogen
Plasminogen
Lipoprotein A
Factor VIII
lupus anticoagulant/antiphospholipid Ab
Factor V
Prothrombin
EEG
Mechanism of brachial plexus injury
stretching of nerves
How does transient tachypnea of the newborn happen? (pathophys)
Labor activates Na-K ATPase channels –> clears fluid from alveoli
If infant is born via c- section, this doesnt happen.
Risks for early onset sepsis
Premature birth between 34-36 wks
Post-term >41 weeks
Maternal fever >38
PROM >18h
GBS status
Incidence in hospital EOS
What is a must for newborn discharge?
Newborn Screen
CHD screen (pulse ox)
hearing test
vitals
voided and stooled, nursing
f/u in 48h
Who should not be early discharged (<48h)?
Neonates born to mothers with chronic medical conditions
excessive maternal bleeding
complications from delivery including need for instrument assistance or C-S
CCHD criteria to pass
95%
3 or less difference in RH and foot
Preterm infant born to a febrile mother vaginally through green/brown-stained amniotic fluid, grunting and tachypnic. Likely pathogen?
Listeria
Causes preterm delivery AND green-brown amniotic fluid
Not likely meconium because infant is premature.
