perinatal care triggers Flashcards by Billie Roberts

Early first-trimester insults like chromosomal or congenital abnormalities, resulting in global growth delay

this is the primary cause of what?

fetal grwoth restriction (FGR) and IUGR

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what mechanism causes the closure of the PFO

Increased O2 in blood –> increased blood flow in lungs —> increased venous return to LA —> LA pressure increase closes PFO

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what aids babies in learning to regulate their temperature and also helps moms milk production

skin to skin in the golden hour after birth

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what ceases low-resistane circuit in the placenta and also increases systemic BP and relaxes lung vessels for a baby

clamping of the umbilical cord

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Apnea/gasping & HR < 100 BPM indicates what should be done

PPV via BVM at 40-60 breaths per minute

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when do we use MR SOPA

when PPV does not seem to be working properly

while doing MR SOPA place baby on SPO2 moniter and continuous EKG.

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if the heart rate is <60 despite 30s of PPV what is the next step

intubate.

compressions recommended for resuscitation.
3:1 compressions for 90 compressions and 30 breaths.

consider umbilical vein catheterization

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when should epinephrine be considered

if HR <60

(im assuming after youve tried PPV and compressions)

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when should we examine for hypoxic ischemic encephalopathy or therapeutic hypothermia

if a newborn >= 36 weeks received resuscitation

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Delayed resorption of lung fluid leading to pulmonary edema leading to tachypnea

TTN

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CXR shows pleural effusions, perihilar densities with fissure fluids and hyperexpansion of the lungs

TTN

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occurs in teh First 2 hours, lasting up to 72 hours but typically resolving within 12-24 hrs

TTN

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respiratory distress and hypoxia triggered by uterine stress during delivery

meconium aspiration syndrome

(they just get so stressed that they poop everywhere and then inhale it)

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CXR shows bilateral fluffy densities with hyperinflation of the lungs.

MAS

also diagnostic is to see meconium present in amniotic fluid or trachea during intubation

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see meconium present in amniotic fluid or trachea during intubation

MAS

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results in inflammation and surfactant inactivation, atelectasis, rupture of alveoli and V/Q mismatches

progression of MAS

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it is NOT recommended to intubate these patients

MAS

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ground glass opacities on CXR

RDS

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glucocorticoids and postnatal surfactant with ventilation via NCPAP is tx for what

RDS

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MC in GA>34 weeks

PPHN

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associated with MAS, PNA and RDS

PPHN

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this is associated with intrauterine/perinatal asphyxia as well as the exposure of fetus to SSRIs in the 2nd half of pregnancy

PPHN

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presents with meconium staining, respiratory distress, and a possible harsh systolic murmur at the lower left sternal border

PPHN

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echo showing normal anatomy with pulmonary HTN is diagnostic of which disease

PPHN

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use nitric oxide or sildenafil in severe disease

PPHN use ECMO as last resort

use ECMO as last resort for this disease

PPHN

risk factors include maternal exposure to labetalol or terbutaline bronchodilator, LGA, SGA, and maternal diabetes

neonatal hypoglycemia

high risk symptoms for this disease includes floppiness, exaggerated moro reflex, seizures irritability, and more

neonatal hypoglycemia

preterm babies, LGA, SGA and babies with diabetic mothers should all be screened for what

neonatal hypoglycemia

just gonna leave this right here in case anyone wants to look at it

what is pathognomonic of neonatal jandice

jaundice presenting within the first 24 hours of birth.

risk factors includes GA <38wks, albumin <3, hemolytic diseases, sepsis

neurotoxicity due to hyperbilirubinemia

what does TcB have to be for you to suspect jaundice enough to run a TSB

within 3mg/dl of the threshold or >15

What value is used as the definitive test to guide phototherapy and escalation of care decisions in jaundiced babies (including need for exchange transfusion)

TSB

what is a significant conjugated/direct bilirubin in relation to TSB

when conjugated/direct bilirubin exceeds 20% of the TSB

Fasting abd US for biliary atresia or choledochal cyst should be assessed when

when a baby has high bilirubin

caused by poor feeding, Intestinal hypomotility or poor elimination of bilirubin in stool

breastfeeding jaundice

Post 1st week of birth and lasts up to 3 wks, Inhibition of UGT and deconjugation of conjugated bilirubin

breast milk jaundice

what treatment increases an infants neurotoxicity risk factors

phototherapy during treatment of hyperbilirubinemia

feeding is considered the most important first line intervention for what diagnosis

jaundice

IV fluids is NOT recommended in combination with what therapy?

phototherapy

hypertonia of the extensor muscles such as opisthotonus and retrocollis si seen in what phase of neonatal acute bilirubin neurotoxicity

phase 2

When can we D/C phototherapy for hyperbilirubinemia?

TSB < 2 mg/dl below the hour-specific threshold

Venous Hct > 65% at term

polycythemia

Hyperviscosity of blood, resulting in decreased perfusion of the capillary beds.

polycythemia

delayed cord clamping can lead to what problem

benign neonatal polycythemia

CNS: irritability, jittery, seizures, lethargy Cardio: respiratory distress, CHF, PPH (postpartum hemorrhage) GI: emesis, heme-positive stool, distension Renal: Decrease output, rena vein thrombosis Metabolic: Hypoglycemia Heme: Hyperbilirubinemia, thrombocytopenia this is alot but whats it for

benign neonatal polycythemia

Isovolemic partial exchange transfusion with NS to dilute blood but only if pt is symptomatic

benign neonatal polycythemia

amino acidopathy with a deficiency in PAH

PKU

this illness if left untreated leads to permanent brian injury due to accumulation of phe

PKU treat by lifelong restriction of phe by eating phe - free proteins

D10 IVF given to promote anabolic state. consider hemodialysis if elevated ammonia is present.

PKU

Liver dysfunction, jaundice, and coagulopathy E. coli sepsis and cataracts metabolic decompensation of the infant

galactosemia Metabolic decompensation when an infant gets formula with lactose in it.

X linked recessive

G6PD

if you test TRAbs in newborns with hypothyroidism and they are negative, what is the assumption of etiology

I think its inborn error or excess maternal iodine may wanna lok this up becuase im only 86% sure

Protruding abdominal organs without a protective sac, almost always to the right of umbilicus

gastroschisis

Protruding abdominal organs with a protective sac

omphalocele

Usually associated with genetic anomaly/syndrome in 1/2 of cases.

omphalocele

this hernia goes straight through umbilicus

omphalocele

Elevated AFP in mothers blood may suggest what problem (not chromosomal , think physiologic developement)

omphalocele/gastroschisis and NTD

if you underestimate gestational age what lab level will be falsely elevated

AFP

Blind esophageal pouch that does not connect with esophagus/airway or connects both the esophagus and airway later.

esophageal atresia

Baby will be choking, coughing, cyanosis

esophageal atresia

TX: Acutely: suction, elevate head, IV glucose Definitive: Make a fistula to solve problem

esophageal atresia fistula connects esophagus

presents with emesis after birth

upper/proximal intestinal obstruction

presents with abdominal distension, late emesis, late/no stooling in baby

distal/lower intestinal obstruction

dueodenal intestinal atresia is one of the MC intestinal atresias. what is it assocaited with

down syndrome jejunoileal is the other MC cause and its assocaited with CF

risk factors for this is smoking and being a preemie

intestinal atresias

double bubble sign on Xray

duodenal

triple bubble sign on Xray

jejunal atresia

risk factors include inadequate folic acid, maternal DM, maternal Hyperthermia and VPA exposure

neural tube defects

missing part of the brain/skull with inability to control swallowing

ancephaly

tuft of hair on dimple

spina bifida occulta

protrusion of only the meninges

meningocele

protrusion of meninges + the spinal cord

myelomeningocele

Extremely Elevated AChesterase in amniotic fluid can confirm

NTDs

which NTD has normal AFP

spina bifida occulta

Encephalopathy due to hyperbilirubinemia (consequence of untreated jaundice)

kernicterus

perinatal care triggers Flashcards

(78 cards)