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Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Describe routine care for a newborn

A

APGAR: Appearence, Pulse, Grimace, Activity, Respiratory

  • Weight, height, head circumference
  • warmed and patted dry
  • topical erythromycin eye drops within 2 hours
  • vitamin K1 injection within 1 hour
  • skin to skin contact
  • Heel prick between 48-72hrs of life: phenylketonuria, galactosemia, congenital hypothyroidism, congenital adrenal hyperplasia, cystic fibrosis, sickle cell, thalassemia
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2
Q

Discuss the presentation and management of erythema toxicum

A
  • is a benign self-limited asymptomatic skin condition occurring after birth and lasting for 2 weeks
  • small erythematous papules, vesicles with surrounding erythematous halo that are transient
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3
Q

List some contraindications to breast feeding

A
  • HIV positive mother
  • HTLV-1 positive mother
  • Herpes lesion of breast
  • Child with galactosemia
  • Mother taking penicillin, anti-metabolite or recreational drugs
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4
Q

Discuss the benefits of breastmilk

A
  • contains many calories, hydration, antimicrobial and immunologic properties
    Colostrum
  • high level of antibodies, low fat and high protein
  • IgA that protects GI tract and increase GI motility
    Mature milk (2-5 days)
  • change according to child needs
  • do not require supplement as long as output is normal for baby
  • recommended for 6 months
  • decreased change of constipation or diarrhea
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5
Q

What are the normal inputs and outputs for a newborn

A
  • Feed every 2-3hrs
  • 6-8 wet diapers
  • Stool every 1-3 days
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6
Q

When should you begin to initiate solid foods

A
  • > 6 months with better head control, can sit up, ability to tell caregiver when full, pick up food and place in mouth
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7
Q

Discuss order of introducing foods

A
  • iron rich foods first
  • add common allergen foods at this time
  • avoid juice, honey and sugary drinks
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8
Q

What are the caloric, vitamin and mineral needs in <1 year old

A

Caloric: 100 kcal/kg/day for first 6 months
Vitamin: 400IU of vitamin D
Minerals:
- Na 3mEq/kg, K 2mEq/kg, Cl 5mEq/kg
- Ca: 210 from 0-6 and then increases as get older
- Iron 1mg/kg

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9
Q

List preventive risk factors of breast feeding for baby and for mom

A 
Baby have lower risk of:
- asthma
- allergy
- diabetes
- obesity
- sudden infant death syndrome
Mother have lower risk of:
- breast cancer
- hypertension
- diabetes
- cardiovascular diseae
- uterine and ovarian cancer
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10
Q

Discuss the differences between a food intolerance and food allergy

A

Food Allergy:
- caused by IgE mediated event to even small amount of food
- diagnosed with skin prick test or history of anaphylaxis
Food Intolerance:
- caused by GI mediated response
- symptoms dependent on frequency and amount of intake
- diagnosed with trial elimination

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11
Q

What qualifies as pre-term?

A

<37 weeks gestation

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12
Q

Discuss pre-term intraventicular hemorrhage

A

Risk:
- vigourous resuscitatin
- pneumothorax
- hypotensive and hypertensive with fluctuating cerebral blood flow
- coagulopathy
Presentation
- begin 8 hours to 3 days of life and majority are asymptomatic
- routine head ultrasound in all infants <32 weeks to diagnose if do not have any neurologic, cardioresp, or metabolic signs
Management
- supportive and follow up

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13
Q

Discuss retinopathy of prematurity

A

Risk: high oxygen exposure at birth
Pathophysiology:
- interruption of growth in developing retinal blood vessels -> early vasoconstriction and obliteration of capillary bed -> neovascularization -> macular edema, tear and retinal detachment
Management:
- crytherapy, laser photocoagulation, anti-VEGF
- surgical vitrectomy or scleral buckle

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14
Q

Discuss apnea of prematurity

A
  • is the cessation of breathing for >20 seconds or shorter respiratory pause with hypoxia and/or bradycardia
    Management:
  • usually resolves on its own
  • environmental temperature control, proper neck positioning
  • oxygenation via nasal prong, CPAP
  • Caffeine to increase ventilatory drive by inhibiting adenosine receptor
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15
Q

Discuss respiratory distress syndrome in a preterm

A 
Risk Factors:
- low birth weight
- maternal diabetes
- C-section without labour
- meconium aspiration
- acidosis, sepsis
Pathophysiology:
- surfactant deficiency -> high alveolar surface tension -> poor lung compliance -> atelectasis -> hypoxia
Presentation:
- respiratory distress that onsets within first few hours and worsens
Investigation
- x-ray: decreased aeration and lung volumes, reticulonodular pattern, atelectasis
Management:
- steroids for prevention
- prophylactic surfactant in <28 week old
- supportive O2
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16
Q

Discuss bronchopulmonary dysplasia for preterm

A
  • is an oxygen requirement for >28days at 30 weeks with abnormal chest x-ray
    Risks
  • prolonged intubation and ventilation with high pressure and oxygen
    Presentation:
  • respiratory distress
  • rales
  • improvement over 2-4 months
    X-ray: lung opacification with hyperinflation
    Treatment:
  • reduce risk factors
  • furosemide, bronchodilators, corticosteroids
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17
Q

Discuss patent ductus arteriosus

A
  • normally closes within first 15 hours of life due to decreased prostoglandins and then anatomically closes within 2-3 weeks of age
    Presentation:
  • poor feeding with increased fatiguability
  • failure to thrive
  • machine like murmur at LUSB
    Investigations:
  • left atrial and ventricular hypertrophy on ECG
  • increased pulmonary vasculature on CXR
    Treatment:
  • PDE2 antagonist in premature (indomethacin)
  • surgical ligation in term or older infants
18
Q

Discuss necrotizing enterocolitis

A 
Risks:
- poor bowel perfusion
- hyperosmolar feeds or formula feeds
- sepsis 
Pathophysiology:
- bowel ischemia -> mucosal damage -> further enteral feeding lead to bacterial proliferation -> bacterial invasion into bowel wall leading to necrosis and perforation 
Presentation:
- feeding intolerance
- increased gastric aspirate or bile 
- blood in stool
- respiratory failure
- temperature instability
Investigations:
- X-ray: pneumatosis intestinalis (intraluminal air), free air, dilated bowel loops
Treatment:
- NPO minimum one week with TPN
- NG tube decompression
- IV fluids
- IV Amp and Gentamycin for 7-10 days
- peritoneal drain if perforation
19
Q

What is small for gestation age

A

Infant weight <10th percentile
Symmetric SGA:
- weight, height and HC <10th percentile
- due to 1st trimester congenital infection, chromosomal abnormality, or severe placental insufficiency
Asymmetric SGA:
- weight is only thing affected
- due to 2nd and 3rd trimester from maternal factors or placental insufficiency

20
Q

Discuss how to differentiate causes of SGA

A 
Maternal Factors:
- malnutrition
- smoking, drug use, alcohol
- vasculopathy
- TORCH
Placental Factors:
- insufficiency
- abruption
Neonatal:
- chromosomal
- multiple gestations
21
Q

List some complications of SGA

A
  • peri-natal: asyphyxiation, meconium aspiration

- metabolic: hypoglycemia, hypothermia, hypocalcemia

22
Q

What is the management of SGA

A
  • antenetal corticosteroids between 24-34 weeks in week before delivery
  • peri-natal: prevent asphyxia by clearing airway
  • prevent hypothermia by drying and warming
  • serial glucose and calcium checks
  • begin feeding
23
Q

What is large for gestational age

A

Weight >90th percentile

  • genetic causes
  • maternal factors: obesity, excessive gestational weight gain, diabetes
  • prolonged gestation
24
Q

List some of the complications of LGA

A
  • increases risk of morbidity and mortality
  • increased birth injury risk
  • respiratory: respiratory distress syndrome, transient tachypnea of the newborn
  • metabolic: hypoglycemia, polycythemia and increased viscosity
  • obesity and diabetes later in life
  • neurodevelopmental disorder
25
Q

Discuss the metabolism of bilirubin

A

Heme oxygenase breaks down RBC into iron, CO, an biliverdin -> biliverdin converted to bilirubin -> bilirubin binds to albumin which transports it to the liver -> conjugated to glucuronic acid by glucuronosyltransferase -> conjugated bilirubin can then be secreted into the bile -> can have enterohepatic circulation as beta-glucuronidase can deconjugate the bilirubin

26
Q

Discuss the causes of hyperbilirubinemia

A

Increased production:
- isoimune-mediated hemolysis: ABO or Rh incompatibility
- RBC membrane defects: herediatroy spherocytosis or elliptocytosis
- Erythrocyte enzymatic defects: G6PD deficiency, pyruvate kinase deficiency
- Sepsis
- Polycythemia
- Cephalohematoma or bruising
Decreased clearance:
- Crigler-Najjar
- Gilbert
- Congenital hypothyroidism or galactosemia
Increased enterohepatic circulation:
- intestinal obstruction
- breast feeding failure
- breast milk jaundice

27
Q

Discuss the presentation of hyperbilirubinemia

A 
Jaundice: progresses cephalocaudal
Acute bilirubin encephalopathy:
- Phase 1: fatigue, mild hypotonia
- Phase 2: febrile and lethargic with poor suck
- Phase 3: apnea, inability to feed, fever, seizures, hypertonicity
Kernicterus: after first year
- cerebral palsy
- hearing loss
28
Q

Discuss the management of hyperbilirubinemia

A
  • Both plotted based on gestational age, risk factors (asphyxia, resp distress, acidosis, sepsis, temperature instability, isoimmune, G6PD) and post-natal age
    Phototherapy:
  • first line and require complete exposure - if severe will not take out to feed
    Exchange transfusion:
29
Q

Discuss the transition of the neonatal blood circulation

A

labour increases catelcholmines which stop pulmonary secretion and increase resorption -> mechanical pressure from birth pushes fluid out -> first breath air displaces fluid and air entry dilate pulmonary blood vessels decreasing resistance -> umbilical vein clamp increases systemic vascular resistance closing right to left shunts

30
Q

Discuss neonatal resuscitation algorithm

A

Good APGAR score can move onto routine care (warmth, clear airway, dry, ongoing evaluation)

  • If not breathing or poor tone in first 30 seconds begin to warm, dry and stimulate with rubbing and toe flicking
  • if no response, if HR below 100, gasping or apnea present begin PPV and Sp02 monitoring
  • if HR below 100 take ventilation steps by intubation, CPAP and high FiO2
  • if HR below 60 than chest compressions with 3 every 2 seconds and 2 breaths with 100% FiO2
  • continue for 15-20 minutes or until resuscitation successful
31
Q

Discuss the causes of neonatal respiratory distress

A
  • CNS (asphyxia encephalopathy)
  • Respiratory (ARDS, TTN, pneumothorax)
  • infection
  • cardiac
32
Q

List the causes of hypoxic ischemic encephalopathy

A 
Maternal Factors:
- impaired oxygenation
- inadequate perfusion: shock, pre-eclampsia, chronic vascular disease
Placental Causes:
- placental abruption
- tight nuchal cord
- cord prolapse
- uterine rupture
Fetal causes:
- hemorrhage, bradycardia or thrombus preventing oxygenation
33
Q

Discuss presentation of neonatal encephalopathy

A
  • poor tone with abnormal posturing and diminished spontaneous movements
  • abnormal level of consciousness
  • absent primitive reflexes
  • low APGAR scores
34
Q

List the common causes of neonatal seizures

A
  • Hypoxic-ischemic encephalopathy
  • intracranial hemorrhage
  • CNS infection (TORCH, meningitis)
  • Metabolic: hypoglycemia, hypocalcemia, hypomagnesemia
35
Q

Discuss the investigations and management for neonatal hypoglycemia

A
  • those with risk factors should have glucose examined from 1 hr of life ever 3-6 hours before feeds for 12 hours
    Treatment:
  • symptomatic hypoglycemia (<2.6): IV dextrose
  • asymptomatic severe (<1.8 at 2hrs or <2 anytime): IV dextrose
  • asymptomatic, mild (1.8-2 at 2 hours or 2-2.5) then re-feed and check in 1 hour
36
Q

Discuss the presentation and red flags for poor feeding in neonates

A
  • lack of interest in feeding or problem with receiving proper amount of nutrition
    Red flags:
  • fever
  • respiratory distress
  • inconsolable crying, irritability, lethargy, decreased LOC
  • failure to thrive
37
Q

Discuss the differential for poor feeding in neonates

A 
Behavioural:
- inappropriate feeding technique
- insufficient lactation
- maternal/infant dysfunction
Interference with Physical Eating
- CP, neuromuscular disorder, hypotonia
- upper airway: nasal obstruction, cleft palate, adenoid hypertrophy
- GERD
- esophageal dysmotility syndrome
Systemic:
- infection
- metabolic
- congenital heart disease 
- vomiting or constipation
38
Q

What is lethargy in neonates?

A

Reduced alertness and awareness due to generalized brain dysfunction

39
Q

Discuss the presentation of cow’s milk protein allergy

A
  • subacute or delayed colitis
  • vomiting
  • diarrhea
  • bloody stool
  • failure to thrive
40
Q

Discuss the three types of non-pathological jaundice and when they most likely appear

A

Physiologic Jaundice:
- Occurs >1 day to 1 week
- Pathophysiology: decreased bilirubin excretion from immature liver and increased enterohepatic circulation.
- also have increased bilirubin production due to increased RBC volume and shorter RBC lifespan
Breastfeeding Jaundice:
- occurs 3-4 days to 10 days
- due to poor milk supply or insufficient feeding resulting in increased enterohepatic circulation and dehydration resulting in greater jaundice
Breastmilk Jaundice
- occurs 1-2 weeks to 1-3 months
- human milk may inhibit enzymes of conjugation

Pediatrics (18 decks)

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