Flashcards in Newborn infant_pre-test Deck (52)
Congenital syphillis presentation
Varied. Many newborns will appear asymptomatic for first few weeks/months. But most untreated infants will develop skin lesions (infiltrative, maculopapular skin peeling rash on face, palms and soles), rhinitis with serous, purulent blood tingied discharge. Other common findings are hepatosplenomegaly, jaundice due to syphilitic hepatitis. LFTs are elevated. Saddle nose due to destrction of bone from syphilitc rhinits. Later manifestation, interstitial keratitis.
Later congenital syphilis presentation
Intersitital keratitis begins in early childhood (6-14 yo), photophobia, corneal haziness, eventual scarring, lacrimation. Hutichison teeth, abnormal enamel, mulberry molars.
Small/IUGR. Affects all organ systems. deafness, Cataracts, micropthalmia, myocarditis, red/purple macular rash (blueberry muffin rash), structural heart defects (PDA, PA stenosis). Labs may show hemolytic anemia with thrombocytopenia, elevated liver functions, pleocytosis in spinal fluid.affected children have poor prognosis.
How do you get congenital HSV
Can happen in utero, intrapartum and postnatally. Infants born vaginally to mom with primary genital herpes infection has highest risk for disease with up to 50% chance of perinatal infection.
Ppt of congenital HSV
Isolated CNS involvement, isolated cutaneous involvement, or systemic generalized infection. Tx is with acyclovir and even with therapy, morbitidy is high in infants with CNS invovlemnt.
Classic triad for toxoplasmosis
hydrocephalus, chorioretinitis and intracranial calcification. May also display sx similar to toher congenital infections - anemia, petechial rash, organomegaly, jaundice and seizures..
Cytomegalic incluion disease findings?
Hepatomegaly, splenomegaly, jaundice, petechiae, purpura and microcephaly, chorioretinitis and intracranial calcifications. More than half present with senorineural hearing loss.
What is the most common cause of congenital infection
CMV infection. Symptomatic congenital disease usually occurs if mom has primary cmv infection during first trimester.
CMV excretion can least for
Months to years
Layers of skull starting from the skin to the meninges
Skin, connective tissue, aponeurotic layer, connective tissue, periosteum, bone, dura, subararachnoid space, leptomeninges
Caput succednaeum, cephalohematoma, subgaleal hemorrhage, subdural hematoma. Describe them (where in the layers do they occur, do they cross midline etc)
Caput succadaneum: soft boggy mass. Right under skin, involves delivery portion of head. Lesion is sometimes ecchymotic and an extend across suture lines. Edema may be pitting and resolves within first few days of life. Cephalohematoma: sub-periosteal and do not cross suture lines. no discoloration fo scap seen. swelling progrsses over first few hours. most resolve within first few weeks/month. Subgaleal/subapnoeurotic hemorrhage will feel like cephalothematoma and crosses midline. can be life threatining if infants lose a lot of blood into this space and can become hypovelemic. subdural hematoma common seen as part of abuse head trauma. occurs when bridge cortical veings that drain the cerebral cortex have been ruptures leading to collection of blood between the dura and cerebral mantle.
What is Alport syndrome
Most common of the hereditary nephritis conditions, frequently ends in ESRD. X linked dominant form of inheritance in 85% of causes, the rest are A/R. all cause hematuria and progressive nephritis. Other findings, deafness, ocular defects.
Coloboma, heart disese, atresia of the choanae, retarded growth and development, genital hypoplasia and ear abnormalities
In what circumstances should an infant get varicella IG?
if mom had onset within 5 days prior to delivery and dx within 2 days post delivery. IVIG not necessary if baby is older than 2 days old because they are not at increased risk compared to older children.
What is the Apt Downey test
Differentiates maternal from fetal hemoglobin in a bloody specimen. Fetal Hg is alkali resistant whreas adult will convert to hematin unpon exposure to alkai.
Drugs contraindicated in breastfeeding
Cyclosporin, lithium antineoplastic, illicit durgs like heroin and cocaine, AMPHETAMINES, ergotamine (used for acute migrain attacks, has biologic role of causing vasoconstriction)
Metabolic patterns in infants born to diabetic moms, in particular glucose, calcium and magnesium?
Hypoglycemic in first 24 hours. In utero exposure to high glucose from mom leads to fetal islet cell hypertrophy, leading to increased insulin production. Abrupt cut off of glucose after birth and high insulin leads to hypoglycemia. Between 48 hours and 96 hours => acheive glycemic control but may now develop hypocalcemia and hypomagnesemia. Hypocalcemia due to delayed PTH syntehsis or responsiveness.
Signs and symptoms of hypocalcemia
Irritability, sweating, tremors, twitches, seizures and arrhythmias.
Evidence of hemolysis in newborns
Even if HCT is normal, nucleated RBCs, elevated retic count, microspherocytes in blood smear is evidence
What is pneumtosis intestinalis. Found in what condition
Distended loops of bowel with air in bowel wall. NEC
How should pneumatosis intestinalis be managed?
Check for free peritonieal air. If none, start systemic abx, monitor lytes and VS closely, perform serial abdominal firlms to evaluate for perforation.
What is an apneic episode
absence of respirations for 20 seconds, may be accompanied by cyanosis and bradycardia. In otherwise well appearing premature infant, this is due to incompletely developed respiratory center.
Most commonly fractured bone during delivery
Presentation of broken clavicle
Pseudoparalysis mimicking erb duchene paralysis
What nerves are effected in Erb Duchene and Klump paralsis
1) 5th and 6th cervical nerves 2) 7th and 8th and first thoracic nerve (can produce horner syndrome)
Sub galeal hemorrhage aka
Subaponeurotic hemorrhage. Below the aponeurotic layer and above periosteum. Crosses midline. Infants can lose a third of their blood into this space and cause hypovolemic shock.
Venous crit of above 65% in neonate
Polycythemia, accompanied by increase in blood viscosity
Manifestations of hyperviscosity syndrome
tremuslousness, jitteriness => seizure due to sludging of blood in cerebral micocirculation or thrombus formation, renal veing thrombois, NEC, tachypnea. Better therapy is partial exhange transfusion with saline or LR not with phlebotomy
What is the mgmt of healthy asymptomatic infants born to HIV+ moms. What tests do they need, if any
No special monitoring or radiographs needed. HIV Elisa antibody test will be positive anyway due to maternal transfer of antibodies. Confirmatory western blot also not helpful.