Neonatology Diseases: Sx, Tx, Dx Flashcards Preview

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Flashcards in Neonatology Diseases: Sx, Tx, Dx Deck (54)
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1

Sturge Weber Syndrome

*Vascular cutaneous malformation w/ trigeminal distribution
*Port wine stain (Facial Angioma)
*Also involves meninges
*Seizures, MR, contralateral hemiparesis *Choroidalangiomas

2

Twin to Twin Transfusion

*15% of monochorionic twins
*S/Sx: Hct difference of ≥15% between twins *Recipient: Polyhydraminos, plethora, ↑Hct, hyperviscosity syndrome, hyperbilirubinemia

3

Polydactyl

*Postaxial (5th finger side)
*Normal occurrence in AA
* Tx: Surgical removal
*Abnormal in whites; Careful cardiac exam
*Preaxial(thumb)
-Abnormal in all races
-Investigate further *Associated w/ Trisomy 13

4

Cleft Lip and Palate

*Complications: Recurrent otitis media, Hearing loss, Speech defects
*Tx: Repair
Lip: 2-3m
Palate: 6mto5y

5

Propanolol (during pregnancy)

* Causes growth retardation, hypoglycemia, apnea
* Decreases ability of asphyxiated newborn to ↑HR/CO

6

Opioid (Narcotics) in Newborn

*Hx of maternal narcotic use
- Demerol for labor pain control
- Heroin
*S/Sx
Lethargic, limp, depressed respirations *Tx
Manage ABCs
Naloxone

7

Subgaleal (or subaponeurotic hemorrhage)

*S/Sx
Similar feel to cephalohematoma (“squishy”), crosses midline (entire scalp),
fluid wave
Rapidly expands
Signs of hypovolemia from hemorrhage
Tachycardia
*Tx
Careful monitoring, transfer to NICU

8

Erb-Duchenne Palsy

o Cervicalnerves5and6
o S/Sx
Unable to abduct, externally rotate, or supinate
Arm will remain internally rotated at side w/ forearm protonated
Won’t move w/ Moro reflex
oMay co exist w/ phrenic nerve palsy (Cervicalnerves3,4,5)
Ipsilateral hemiparesis of the diaphragm
Asymmetry on inspiration when it doesn’t flatten
“See Saw”
Typically resolves on own

9

Clavicle Fracture

o Initial presentation may be pseudoparalysis Refusal to move arm
Mimics Erb-Duchenne
o Dx
Can be identified at birth by crepitus
Those not discovered in newborn present later with a callus formation
o Tx
Reassurance

10

Hypothermic Infant

o Interaction will ↑ metabolic rate and subsequently ↑ RR to maintain O2
Metabolic acidosis
Become tachypenic
o Tx
Warmer

11

Bleeding in Newborn

o W/ hematemesis or melena first establish source
- Maternal vs. Fetal
- Apt-Downey test: Fetal Hb is alkali resistant

12

Breast Feeding Contradindications

o Active TB, HIV
o Medications
Antineoplastic, lithium, cyclosporine, illicit drugs, amphetamines, ergotamines,
and bromocriptine (↓ lactation)
Most ABx safe (except Tetracyclines)
o Galactosemia

13

Acrocyanosis

o W/ Cutis Marmorata (mottling of the skin w/ venous predominance) Vasomotor instability

14

Milia

o Small cysts around the pilosebaceous follicles
White papules surrounding the nose Disappear in 1st weeks

15

Pustular Melanosis

o Benign transient rash characterized by small dry superficial vesicles over a dark base o Blacks
o Differentiate from HSV or Bacterial (ex. Impetigo)
o Lesions are filled w/ eosinophils

16

Erythema Toxicum Neonatorum

o Benign rash in first 72h
o Erythematous macules, papules, & pustules (flea bite like)
-On trunks & extremities
- Not palms/soles
o Lesions are filled w/ eosinophils

17

Nevus Simplex (Salmon Patch or Telangiectastic Nevus)

o Most common vascular lesion of infancy
o Pink macular lesion on nape of neck (stork bite), upper eyelids, galbella, or nasolabial
folds

18

Nevus Flammeus (Port Wine Stain)

o Capillary hemangioma over face or trunk
o Those over CN V-1 (Trigeminal) may be associated w/ intracranial or spinal vascular
malformations, seizures, & intracranial calcifications
- Sturge-Weber Syndrome

19

Neonatal Acne

1-2w after birth (not present @ birth)

20

Caput Succedaneum

o Diffuse edema of soft tissue of the scalp that crosses sutures & midline
o Can sometimes be ecchymotoic

21

Cephalohematomas

o Subperiosteal hemorrhages secondary to birth trauma, confined by sutures (bc
subperiosteal)
o No ecchymosis discoloration
o Usually parietal or occipital bones

22

Craniosynostosis

o Premature skull fusion
Abnormal shape

23

Macroglossia

o Beckwith-Wiedeman Syndrome
Hemihypertrophy, visceromegaly, macroglossia
o HoThyroidism

24

Midline clefts or Masses

o Goiter
Secondary to maternal antithyroid meds or maternal thyroid stimulating Auto
Ab

25

Neonatal Torticollis

o Asymmetric shortening of SCM
o Causes
Fixed position in utero
Postnatal hematoma

26

Periodic Breathing

o Normal in preterms
Irregular breathing w/ short apenic bursts ≤5 to 10s

27

Umbilicus

o 2 arteries, 1 vein
1 artery suggests renal malformation

28

Diastasis Recti

o Separation of the rectus abdominis @ midline
o Benign

29

Umbilical Hernia

o Soft swelling beneath umbilicus
o May protrude during crying
o Most close spontaneously

30

Persistent Urachus

o Urine draining from bladder to umbilicus

31

Hydrometrocolpos

o Cysts between the labia
Caused by an imperforate hymen and collection of secretions behind

32

Male Genitalia
- Hypospadias
- Epispadias
- Hydrocele
- Cryptorchidism

o Hypospadias
Urethral Meatus Ventral
Not associated w/ ↑ incidence of urinary malformations o Epispadia
Urethral Meatus Dorsal
Often associated w/ bladder extrophy
Protrusion of bladder from abdominal wall, w/ exposure of its mucosa
Extremities
o Hydrocele
Scrotal swelling
Fluid in tunica vaginalis Resolve spontaneously
o Cryptorchidism
Surgery should not take place

33

Absence/ Hypoplasia of Radia

o TAR Syndrome (thrombocytopenia, absent radii), Fanconi Anemia, Holt-Oram
Syndrome

34

Edema of Feet w/ Hypoplastic Nails

Turner Syndrome & Noonan Syndrome

35

Rocker Bottom Feet

Trisomy 18

36

Post-Term

o Placental insufficiency
Intrauterine asphyxia, meconium aspiration, polycythemia

37

Small for Gestational Age (SGA)

o Complications
Hypoxemia, perinatal asphyxia, hypocalcemia, Hypomagnesaemia
Floppy
Polycythemia (>65% Hct)
From ↑ erythropoietin in response to hypoxia
↑ blood viscosity; “hyperviscositysyndrome” ; Jittery, seizures
Changes in cerebral blood flow Renal V. thrombosis
NEC
o Tx
- Partialexchangefusion
o Hypothermia
From ↓ability to thermoregulate from ↓ subq fat
o Hypoglycemia
From ↓ glycogen stores
Manage w/ early and frequent feeds
o Associated w/ higher incidence of major congenital abnormalities

38

Large for Gestational Age

o Causes
Diabetes, Beckwith-Wiedmann Syndrome, Prader-Willi Syndrome, Nesidioblastosis (diffuse proliferation of pancreatic islet cells)

39

Cyanosis

o Related to the amount of unoxygenated Hb
>3 arterial or >5 capillary
o Causes
-5 T’s of Cyanotic CHD, Polycythemia, intraventricular hemorrhage, hypoglycemia, hypocalcemia, hypothermia, HoThyroidism
o 100%O2Test
-w/ Cyanotic Heart Disease (slight ↑)
Those w/ ↓ Pulmonary blood flow (ex. TOF) will only have slight ↑ in PaO2 (10-15 mmHg)
-w/ Normal or ↑ Pulmonary blood (ex. Truncus Arterious), PaO2 will ↑ ≥15-20 mmHg, but not close to 150mmHG total
-w/ Lung Disease
PaO2 will ↑ a lot (≥150 mmHg)
Except w/ Persistent Pulmonary HTN of NewBorn
May have a large R→L shunt through PFO or PDA
PaO2 will not ↑ ≥10-15 mmHg

40

Respiratory Distress Syndrome, RDS (Hyaline Membrane Disease or Surfactant deficiency
Syndrome)


o Sufficient surfactant @ 30-32w
RDS more likely/severe 28d Need supplemental O2 for >28d
Characteristic CXR
Retinopathy of prematurity

41

Term infant w/ Respiratory Distress

o Persistent Pulmonary HTN (PPHN)
Especially w/ C section
o Meconium Aspiration Syndrome (MAS)
Especially post term

42

Persistent Pulmonary HTN (PPHN)

o Any condition other than CHD w/ low blood flow to the lungs after birth
o Causes
Perinatal asphyxia
Can result in ↑ pulmonary pressure while the systemic BP falls
o Causes a persistent R to L shunt across PDA or PFO Results in PPHN
MAS (meconium aspiration syndrome)
Any cause of fetal stress o ↑PVR
R→L Shunt through PFO or PDA o Cyanosis from Respiratory Failure
o Pre and Post Ductal PO2 differences
o CXR
?
o Echo
Rule out CHD, assess shunt
o Tx
O2
Important b/c hypoxemia is a potent vasoconstrictor (want to ↓PVR)
NO

43

Meconium Aspiration Syndrome (MAS)

o Respiratory distress in term or post term newborn
o “PeaSoup” or Meconium stained amniotic fluid
o Meconium (first stools)
Can be passed as result of distress (e.g. hypoxemia)
o CXR
↑ Lung Vol, diffuse patchy atelectasis, parenchymal infiltrates alternating w/ hyperinflation
Possible pneumothorax
Diminished breath sounds on side
Loss of lung markings on CXR
o Endotracheal Suction after whole body is delivered (not intrapartum or after head only)

44

Apnea of Prematurity

o Respiratory pause >20s
o Caused by immature respiratory center
o Or pause of any length if accompanied by bradycardia/cyanosis or O2 desat
o Types
Central
-Absent chest wall movement & no airflow
Apnea secondary to Obstruction
-Chest wall movement w/out airflow
Won’t show as apnea on home monitors
o Tx
Maintain neutral temp environment & Stimulation Respiratory stim med
Caffeine or Theophylline

45

Neonatal Jaundice

o Visible jaundice in neonate TB >5 o Peak
Term: Day 3-4
Preterm: Day 5-7 o Evaluate always if
Jaundice in .5/hour
Suggestive of hemolysis o DirectHyperbiliEval
Hepatic US (Choledochal Cyst), Serology (Hepatitis), Radio isotope scan for hepatobilliary tree (biliary atresia), sepsis
o Tx
Phototherapy
Exchange transfusion for rapid rises in TB from hemolysis or extremely high TB
Complications: coagulopathy (bleeding)
o Complications
Indirect crosses BBB
Acute Bilirubin encephalopathy
o High pitched cry, lethargy, poor feeding, hypotonia
Localizes in Basal Ganglia & Hippocampus

46

Heroin Withdrawal

o Jitteriness, hyperreflexia, irritability, tremulousness/tremors, feeding intolerance
o High pitched cry

47

Esophageal Atresia w/ Transesophageal Fistula (TEF)

o Often associated w/ Polyhydramnios
o Copious oropharyngeal secretions
↑ risk of aspiration, choking, or pneumonia feeding attempted o Associatedmalformations
CHD, anorectal, renal, skeletal, or the VACTERL Association CH5 III.A.8
o Evaluation
Insert oral gastric tube until resistance

48

Omphalocele

o Centrally
Through umbilicus o True hernia sac
Covered w/ peritoneal sac
But not w/ skin like in an umbilical hernia (which can resolve on own, usually
protrudes w/ crying)
o Frequent association w/ other congenital malformations (heart, kidney)
CHD
TOF & ASD
Beckwith-Wiedemann Syndrome
Exophthalmos, macroglossia, gigantism, hyperinsulinemia,
hypoglycemia, midline defects (eg. Omphalocele)
o Dx: Polyhydramnios on US
90% diagnosed Prenataly (so usually pt. w/ no prenatal care)
o Tx
Surgery

49

Gastroschisis

o Fissure of abdominal wall located right paraumbilical area (nonmidline)
Umbilicus looks normal
o Not true hernia sac
No peritoneal sac covering
o No association w/other malformations
o Increased risk of damage to bowel from exposure to amniotic fluid
o Tx
Immediately wrap in sterile saline dressings and cover in plastic
Surgery

50

Intestinal Obstruction

o Meconiumileus
Wrap in sterile wet gauze
CF
Air remains trapped in meconium giving it a soap bubble appearance on XR

51

Hypoglycemia

o Glc

52

Infants of Diabetic Mothers

o Large bc of ↑ body fat and visceromegaly Liver, adrenals, heart
o Typically LGA, but can be SGA if mother has serious DM w/ vascular complications causing placental insufficiency
o Complications
Hypoglycemia (typically 1st 24h), polycythemia, hypocalcemia (typically 48-
96h), hypomagnesaemia Hypertrophic Cardiomyopathy, PPHN, RDS, renal vein thrombosis
Hypocalcemia presents w/ twitching/tremors, seizures, arrhythmias o Tx:IVCalciumGluconate
Malformations
Structural heart, CNS, Musculoskeletal, Hypoplastic Left Colon, Caudal
Regression Syndrome (hypoplasia of the sacrum and LE)

53

Polycythemia

o Hct>65%
o Causes
↑ Erythropoietin in response to placental insufficiency, fetal hypoxia, ↑
placental transfusion from delayed cord clamping
o Tx
Partial Exchange Transfusion
Blood is removed and then replaced w/ same volume of plasma (normal saline)

54

Choanal Atresia

o S/Sx
Trouble breathing when sleeping or eating
Improved breathing w/ crying o Dx
Unable to pass NG tube
Lack of fogging on a cold metal instrument under the nares
o CHARGE association
Coloboma
Absence or defect of ocular tissue
o Usually the retina
o Impaired vision
Heart disease (TOF)
Atresia of the choanae
Retarded growth and development
Genital hypoplasia
Ear abnormalities (cup ears & hearing loss)