Peds 7 Flashcards
Asymptomatic newborn with hypoglycemia. What is the treatment?
Enteral feeding, recheck BG measurement in 1 hour
Asymptomatic newborn with hypoglycemia. Had a feeding. Rechecked BG is still < 35mg/dL. What now?
IV glucose
Asymptomatic newborn with hypoglycemia. Had a feeding. Rechecked BG is now > 35mg/dL. What now?
Frequent enteral feeds (every 2-3 hours) should be maintained with preprandial glucose measurements
Symptomatic newborn with hypoglycemia. What is the treatment?
IV infusion of dextrose
Adam is a late preterm, LGA infant of a diabetic mother who presents with tachypnea at two hours of life following C-section delivery through clear amniotic fluid. Exam is significant for normal oxygen saturation, normal and symmetric breath sounds, and mild respiratory distress. What are your top 3 Ddx and what would you order?
Sepsis, RDS, TTN
CBC with differential, Chest x-ray, Continuous pulse oximetry
Newborn
S/s: Exam is significant for normal oxygen saturation, normal and symmetric breath sounds, and mild respiratory distress.
Chest x-ray Impression:
- Significant perihilar streaking: interstitial fluid and engorged lymphatics
- Coarse, fluffy densities that represent fluid-filled alveoli
- Fluid in the pleural space and a small amount of fluid in the fissures on the lateral view
- Normal cardiac size and silhouette
Most likely dx?
Transient tachypnea of newborn (TTN)
Newborn
Chest xray: diffuse reticulogranular appearance of the lung fields (“ground glass appearance”) and air bronchograms
Most likely dx?
Respiratory distress syndrome (RDS)
A 2-hour-old infant is evaluated in the nursery for progressively worsening tachypnea. He was born at 32 weeks gestational age via spontaneous vaginal delivery to a mother with diabetes and negative group B streptococcus status. His Apgar scores were 8 at one minute and 9 at five minutes. On physical examination he is large for gestational age. His vital signs are respiratory rate 75 breaths/minute, temperature 36.5 C (97.7 F), and pulse is 130 beats per minute. His lung exam is remarkable for intercostal and subcostal retractions, grunting, and equal breath sounds. His heart exam reveals normal rhythm, normal S1 and S2, no murmurs, and normal peripheral pulses and capillary refill. Which of the following is the most likely cause of the patient’s condition?
A. Congestive heart failure B. Pneumothorax C. Respiratory distress syndrome D. Sepsis E. Transient tachypnea of the newborn (TTN)
C. Respiratory distress syndrome
Respiratory distress syndrome (RDS) causes tachypnea and is therefore an important consideration in this case. RDS is more common in premature infants. Given his prematurity, an NSVD birth, and few risk factors for sepsis other than prematurity, this infant is likely to have RDS.
A 3-hour-old infant, born by C-section at 36 weeks to a 30-year-old G1P1 with Apgars of 8 and 9 at 1 and 5 minutes, respectively, is found to be tachypneic in the newborn nursery. His mother has a history of type II diabetes that was poorly controlled during her pregnancy. She took prenatal vitamins and no other medications during her pregnancy. Prenatal labs, including GBS, were negative. The mother’s membranes ruptured 9 hours prior to delivery, she was afebrile, and the amniotic fluid had no meconium. On physical exam, the infant is large for gestational age. He has good air movement through the lungs bilaterally, without retractions or nasal flaring. He appears well perfused with a normal cardiac exam. He has decreased muscle tone and a weak suck reflex. Cutaneous blood glucose measurement is 39 mg/dL. What is the most likely diagnosis?
A. Hypoglycemia B. Neonatal sepsis C. Pneumothorax D. Transposition of the great arteries E. Transient tachypnea of the newborn
A. Hypoglycemia
A male infant weighing 3200 grams is born to a G1P1 female at 39 weeks’ gestational age via planned C-section. Maternal PMH is unremarkable, and GBS status is negative. Apgars are 7 and 8 at 1 and 5 minutes of life, respectively. The delivery was uncomplicated, and the infant initially appeared in good condition. However, one hour following delivery the infant develops increasing respiratory distress. Respiratory rate is assessed as 90 breaths/min. All other vital signs are within normal limits. On exam, the infant is acyanotic with rapid respirations and robust capillary refill. Chest x-ray shows bilateral lung fields with the appearance of “a radio-opaque line of fluid in the horizontal fissure of the right lung.” No air bronchograms are noted. What is the most likely etiology of the infant’s respiratory distress?
A. Meconium aspiration
B.Neonatal sepsis
C. Respiratory distress syndrome (RDS)
D. Transient tachypnea of the newborn (TTN)
D. Transient tachypnea of the newborn (TTN)
A one-hour-old newborn male is evaluated in the nursery. He was born to a G2P1 mother at 36 weeks gestation via spontaneous vaginal delivery. The mother did not receive prenatal care because she did not have insurance. She thinks that her water broke about two days ago, but she did not have any contractions after that, so she decided not to come to the hospital. She did not start having contractions until 19 hours before she delivered. No meconium was noted at delivery. The infant did not cry vigorously and was tachypneic and cyanotic. His temperature is 38.1 C (100.5 F). His chest x-ray is normal. Which of the following is the most likely cause of this patient’ symptoms?
A. Hypothermia
B. Meconium aspiration syndrome
C. Pneumothorax
D. Sepsis secondary to prolonged rupture of membranes
E. Transient tachypnea of the newborn (TTN)
D. Sepsis secondary to prolonged rupture of membranes
A 30-minute-old infant is evaluated in the nursery for tachypnea. He was born at 30 5/7 weeks gestation by vaginal delivery. Labor was induced due to severe maternal pre-eclampsia. Mother received no prenatal care. Apgars were 6 and 7 at 1 and 5 minutes, respectively. One dose of betamethasone was given prior to delivery. A chest x-ray reveals decreased lung expansion. Which of the following diagnoses is most consistent with this patient’s presentation?
A. Bronchopulmonary dysplasia (BPD)
B. Meconium aspiration syndrome (MAS)
C. Persistent pulmonary hypertension (PPHN)
D. Respiratory distress syndrome (RDS)
E. Transient tachypnea of the newborn (TTN)
D. Respiratory distress syndrome (RDS)
The baby boy is preterm, and his mother received only one dose of betamethasone, which puts him at increased risk for developing infant RDS, which is caused by insufficient surfactant. His physical exam and chest x-ray findings are consistent with RDS. A reticulogranular or “ground-glass” appearance and bronchograms may be present shortly after birth, but take 12–24 hours to maximally develop if surfactant is not administered.
What newborn characteristics are more commonly seen in RDS vs TTN?
RDS: premature, born NSVD
TTN: term, born C/S, maternal diabetes
What CXR characteristics are more commonly seen in RDS vs TTN?
RDS: diffuse reticulogranular “ground glass” appearance, air bronchograms
TTN: “wet” looking lungs, no consolidation, air bronchograms
What are 6 things late preterm infants are at risk for and you should monitor for?
Hypothermia, hypoglycemia, respiratory distress, apnea, hyperbilirubinemia, feeding difficulty
