Newborn - General

Question 1

Erythromycin ointment prevents opthalmia neonatorium due to which sexually transmitted infection?

Answer 1

Gonorrhea, but not chlamydia.

Question 2

What is the treatment for opthalmia neonatorium secondary to N. gonorrhea?

Answer 2

A single dose of ceftriaxone

Question 3

Which newborns require empiric antibiotic treatment for sepsis?

Answer 3

1. Those with signs and symptoms of sepsis.
2. Those born to mother with known or suspected chorioamnionitis.

Question 4

Which term newborns require a full 48 hours of observation after delivery?

Answer 4

Well appearing infants born to GBS+ mothers who were not adequately prophylaxed. (Some algorithms permit observation of infants born to mothers with fevers or suspected chorioamnionitis as well.)

Question 5

How can the probability of vertical transmission of chlamydia trachomatis be minimized?

Answer 5

1. Treatment of mother (with Azithromycin, as doxycycline is contraindicated in pregnancy).
2. C-section without rupture of membranes.

Question 6

What maternal medications are associated with vitamin k deficiency bleeding in the neonatal period?

Answer 6

Carbamazepime
Phenytoin
Isoniazid
Rifampin

Question 7

What is the GOAL glucose level in the first 24 hours of life and the second 48 hours of life?

Answer 7

45-50mg/dl
50-60mg/dl

Question 8

IV dextrose is indicated in any symptomatic newborn with a blood sugar below what threshold?

Answer 8

40 mg / dl (and any newborn with a blood sugar below 25 whether symptomatic or not)

Question 9

What is the empiric treatment for presumed GBS related early onset sepsis?

Answer 9

0-7 days: Amp + Gent
7-28 days: Amp + ceftazidime
>28 days: ceftriaxone
** > 8 days, add vancomycin if meningitis or critically ill **

Question 10

What is the duration of treatment for GBS related early onset sepsis?

Answer 10

10 days (bacteremia)
14 days (meningitis)

Question 11

What are the three ways of diagnosing chorioamnionitis?

Answer 11

1. Amniotic fluid gram stain
2. Intrapartum fever > 39.0
3. Intrapartum fever 38.0 - 39.0 + one of leukocytosis, purulent discharge, or fetal tachycardia

Question 12

Which infants are at increased risk of hyperbilirubinemia?

Answer 12

1. GA < 38 weeks
2. LGA born to mother with gestational diabetes
3. Hematoma
4. Down syndrome
5. Positive family history
6. Inherited enzyme or RBC membrane defect.

Question 13

Which infants are at increased risk of neurotoxicity from hyperbilirubinemia?

Answer 13

1. Albumin < 3.0 (if measured)
2. Isoimmune or other hemolytic condition
3. Sepsis
4. Clinical instability

NOTE: While < 38 weeks gestation is a risk factor, the curves in the 2022 guidelines are stratified by gestational age, so gestational age is not used to determine high risk vs. low risk. Under the old guidelines, infants that were < 38 weeks gestation would use the medium or high risk curves (depending on presence or absence of other risk factors).

Question 14

What is the definition of Late Preterm?

Answer 14

Gestational age of 34/0 to 36/6

Question 15

What endocrine disorder is associated with hyperbilirubinemia?

Answer 15

Hypothyroidism

Question 16

When does chlamydial pneumonia typically occur in infants and what is the treatment?

Answer 16

2-19 weeks of life
Azithromycin x 3 days (same as for conjunctivitis)

Question 17

What is the prophylaxis for infants born to mothers with active gonorrhea infection?
Chlamydia infection?

Answer 17

1. Ceftriaxone 25-50 mg/kg x 1
2. Nothing (treat mother during pregnancy if possible, otherwise deliver via c-section).

Question 18

What is the treatment for neonatal gonorrhea?

Answer 18

Ceftriaxone or cefotaxime, 7 days (14 days for meningitis).

Question 19

What are the criteria for a Brief Resolved Unexplained Event to be classified as Low Risk?

Answer 19

1. Born at 32 weeks GA or later
2. Present GA 45 weeks or greater.
3. 60 - 365 days old
4. No CPR by a trained medical professional
5. Event lasted < 1 minute
6. First event
7. Negative PE, history, PMH, social history, and family history (e.g. no family history of unexplained death at a young age or sibling who died as an infant).

Question 20

What are the three criteria indicating that a newborn infant does not require resuscitative maneuvers following birth?

Answer 20

1. Term?
2. Good tone?
3. Breathing or crying?

Question 21

You are handed a blue, flaccid 34 week GA infant at delivery. You dry and stimulate the baby, position the infant in the sniffing position, and suction a small amount of amniotic fluid out of the oropharynx. What are indications to proceed to positive pressure ventilation?

Answer 21

1. Apnea or gasping
2. HR < 100

Question 22

You are handed a blue, flaccid 34 week GA infant at delivery. You dry and stimulate the baby, position the infant in the sniffing position, and suction a small amount of amniotic fluid out of the oropharynx. You palpate at the umbilical cord stump and find the heart rate is 60. You initiate PPV. How long should you perform PPV before rechecking HR?

Answer 22

30 seconds. During that time ensure adequate chest rise and troubleshoot if inadequate chest rise.

Question 23

You have been resuscitating a newborn infant with PPV. After 30 seconds you recheck the heart rate. It is 75. What is the next step?

Answer 23

Continue PPV, ensuring adequate chest rise. Titrate FiO2 to acheive saturation targets.

Question 24

You have been resuscitating a newborn infant with PPV. After 30 seconds you recheck the heart rate. It is 45. What is the next step?

Answer 24

1. Intubation or laryngeal mask
2. Chest compressions
3. Insert UVC

Question 25

You have been resuscitating a newborn infant who is now intubated and you have been performing chest compressions for 60 seconds. You check HR and it is 35. What is the next step?

Answer 25

Epinephrine (0.02 mg/kg IV or 0.1 mg/kg ET, which is equivalent to 0.2ml/kg or 1ml/kg, respectively) every 3-5 minutes. Continue compressions, consider fluid bolus, consider pneumothorax.

Question 26

What is the initial FiO2 for neonatal resuscitation?

Answer 26

35 weeks GA or older: 21% Less than 35 weeks GA: 21-30% (So, basically, you can just start with 21% and titrate up to achieve saturation goals).

Question 27

What is the goal pulse oximetry saturation for a newborn infant in the first 10 minutes post delivery?

Answer 27

55% + (5 x age in minutes) So... 1 min: 60-65 2 min: 65-70 3 min: 70-75 4 min: 75-80 5 min: 80-85 10 min: 85-95

Question 28

What initial PIP and PEEP is suggested for neonatal resuscitation?

Answer 28

PIP: 20cm H2O PEEP: 5cm H2O

Question 29

What are the steps to trouble shoot ventilation during neonatal resuscitation?

Answer 29

Mask Adjustment Reposition (try again) Suction Open mouth (try again) Pressure increase Alternative airway

Question 30

How long does it typically take an infant to regain birthweight?

Answer 30

Up to two weeks

Question 31

You are caring for a 3 month old breast fed infant who presents with complaint of blood tinged stool. The infant is feeding well without vomiting. Physical exam is completely reassuring. Vital signs are normal. The ER checked some labs and they are all normal. You suspect milk protein allergy. What are your treatment options?

Answer 31

1. Elimination of all milk products from maternal diet (possible followed by elimination of all soy products). 2. Transition to an extensively hydrolyzed (alimentum, nutramigen) or amino acid (Elecare, Neocate) formula. Note that many patients with milk protein allergy are also allergic to soy products.

Question 32

What are the clinical features of fetal alcohol syndrome?

Answer 32

1. Facial - Short palpebral fissures - Smooth filtrum - Thin upper lip 2. Growth retardation 3. CNS - Structural abnormalities - Seizures - Microcephaly - Neurological deficits 4. Neurobehavioral deficits - Developmental delay - Learning disabilities - Attention / regulation deficits (Diagnosis requires all 4 features, including at least 2 facial features)

Question 33

What is the definition of adequate intrapartum antibiotic prophylaxis for group B strep?

Answer 33

Penicillin, ampicillin, or cefazolin at least 4 hours prior to delivery. Vancomycin or clindamyin (depending on susceptibility testing) may be used for women with severe penicillin allergies. While this will reduce risk, vancomycin and clindamycin are NOT considered "adequate prophylaxis" regardless of susceptibility testing.

Question 34

For whom is intrapartum antibiotic prophylaxis for group B strep indicated?

Answer 34

1. Group B bacteriuria during current pregnancy. 2. Positive rectovaginal swab (recommended at 36-37 weeks) 3. History of previous infant with GBS disease 4. Labor or PROM prior to 37 weeks 5. Unknown GBS status and intrapartum fever or ROM > 18 hours. 6. Unknown GBS and history of prior colonization (at least consider in these patients)

Question 35

What are the criteria for discharging a newborn infant prior to 48 hours of observation?

Answer 35

1. At least 37/0 weeks gestation and normal physical exam. 2. Any GBS related evaluation and observation is complete. 3. Normal vitals for past 12 hours 4. Successfully fed at least twice, stooled at least once and urinating regularly. 5. Anticipatory education complete 6. Hyperbilirubinemia risk stratification complete and any needed follow up arranged. 7. Newborn screening complete. 8. Maternal labs available and do not identify risk factors. 9. Follow up with PCP arranged within 48 hours (possible 72 hours)