perinatal period Flashcards
(63 cards)
1
Q
umbilical vessels have how many veins and arteries
A
1 vein 2 arteries
oxygen rich is in the vein
2
Q
consequence if PDA does not close
A
pulmonary edema
3
Q
2 ways to medically close PDA
A
- ibuprofen or acetaminophen
- severe– ligation or device closure
4
Q
2 ways to medically close PDA
A
- ibuprofen or acetaminophen
- severe– ligation or device closure
5
Q
by ____ week, breast fed babies should be back to their birth weight
A
2nd
6
Q
staff can do this to allow for continued blood flow from the placenta to the baby during delivery
A
delayed cord clamping
7
Q
effects of umbilical cord clamping
A
increases systemic vasc. resistance leading to DV constriction
8
Q
very preterm week range
A
week 20 to 32
9
Q
moderate preterm range
A
week 32 to 34
10
Q
late preterm range
A
34 - 37 week
11
Q
increases end-expiratory lung volume
A
grunting
12
Q
tx for apnea d/t prematurity
A
caffeine
13
Q
tx for asphyxia d/t placental abruption or umbilical cord compression
A
therapeutic hypothermia
14
Q
3 causes of apnea
A
prematurity
asphyxia
infection
15
Q
first ____ days of life is considered neonate
A
28
16
Q
most important part of neonatal resuscitation
A
ventilation
17
Q
breath:compression ratio in neonatal resus
A
3:1
18
Q
normal temp for neonatal
A
97.7-99.5
19
Q
Below the 10th percentile for weight causing thermoregulation issues & hypoglycemia
A
small for gestational age (SGA)
20
Q
Feed Baby! Dextrose gel, D10 Bolus followed by infusion
A
tx for SGA
21
Q
Above the 90th percentile
most commonly seen in infants of diabetic moms
A
LGA
22
Q
normal sugar for babies
A
45-90 mg/dL
23
Q
- RDS, PDA
- necrotizing enterocolitis (NEC)
- intraventricular hemorrhage (IVH)
A
prematurity conditions
24
Q
exclusively in preterm infants; air within wall of the bowel; can progress very fast and cause death
A
necrotizing enterocolities (NEC)
25
tx for NEC
no feeding for 14 days, surgery
26
no good way of preventing it; typically happens within first 72 hrs of premature birth
intraventricular hemorrhage (IVH)
27
Qualitative or quantitative surfactant deficiency
respiratory distress syndrome
28
premature white male
c-section
Gestational Diabetes
Multiple Gestation Pregnancy
fam hx
| these are risk factors for?
respiratory distress syndrome
29
3 ways to manage respiratory distress syndrome
* maternal steroids in moms w/ preeclampsia or preterm labor
* respiratory support
* surfactant right away
30
first intestinal discharge of newborn; contains epithelial cells, fetal hair, mucus, bile
meconium
31
Intrauterine stress may cause passage of meconium in amniotic fluid before delivery; fetus aspirates it during gasping in response to hypoxia or hypercapnia
meconium aspiration syndrome (MAS)
32
airway obstruction--> trapped air--> hyperinflammation--> chemical pneumonitis--> inactivation of surfactant production and activity
pathophys of MAS
33
3 ways to manage MAS
resp support PRN
maybe surfactant
abx for 48hrs incase they get pneumonia
34
* Failure to achieve or sustain the normal decrease in pulmonary vascular resistance at birth, causing Profound cyanosis
* In conjunction with lung parenchymal dz or systemic illness but can be idiopathic
persistent pulmonary HTN of newborn (PPHN)
35
* breathing fast but doesn't need resp. support & eating well
* caused by Delayed resorption of fetal lung fluid by the pulmonary lymphatic system
transient tachypnea of the newborn (TTN)
36
in addition to starburst pattern of white lines shooting from center on CXR, what else confirms diagnosis of TTN
quick resolution in 24 hrs
37
venous HgB of less than 13.3 g/dl indicates what
baby anemia
38
most common type of anemia in babies
hemorrhagic
39
* Immune hemolysis
* Sepsis
* Congenital erythrocyte defect: metabolic enzyme deficiency, thalassemia, hemoglobinopathies
* Systemic diseases: galactosemia
| these cause what type of anemia
hemolytic anemia
40
* Congenital: Diamond-Blackfan syndrome (congenital hypoplastic anemia) congenital leukemia
* Acquired: rubella, syphilis infections; aplastic crisis/anemia
| these cause what type of anemia
hypoplastic
41
Venous Hgb >20g/dL (Hct >68%) indicates what
polycythemia
42
* Rarely occurs in premature newborns
* Associated with IDM
* Increased incidence of jaundice
polycythemia
43
what is the tx for polycythemia and when do you tx it
* partial to double volume exchange transfusion
* tx only if sx and only on central Hgb results
44
list some sx of polycythemia (9)
lethargy, hypotonia, irritability, jitteriness, weak suck, vomiting, seizures, tremulousness, apnea, desaturation
45
2 ways to manage neonatal jaundice
* blue light phototherapy (oxidizes bilirubin)
* exchange transfusion if 1+ neurotoxicity risk factor
46
* Initially reversible neurologic sequelae of untreated indirect hyperbilirubinemia that precedes the development of the most devastating complication, kernicterus
acute bilirubin encephalopathy
47
* Initial phase: lethargy, hypotonia, poor suck
* Progresses: moderate stupor, irritability, increased tone, arching, fever
* Next stage: deep stupor, coma, increased tone, inability to feed, seizures
| these describe the phases of what
acute bilirubin encephalopathy
(note that it goes from hypotonia to hyper tonia)
48
* jaundice that starts **after** 24hrs of life, peaks around 3 days of life (5 days in premature)
* tends to progress from head to toe
| jaundice WITHIN first 24 hrs is pathologic
exaggerated physiologic jaundice
49
* Prolonged indirect hyperbilirubinemia that can last up to 3 weeks to months with no evidence of hemolysis or incompatibility d/t breast milk
breast milk jaundice
50
* **IgG antibodies cross the placenta and bind to and destroy RBCs**
* Fetal sensitization (positive direct Coombs) occurs only in 3-4%
* Risk factors present in 12-15% of pregnancies
ABO incompatibilty
51
Accounts for 2/3 observed cases of hemolytic disease of the newborn but symptomatic dz occurs in less than 1%
ABO incompatibility
52
jaundice **in** first 24 hrs; usually mild anemia
ABO incompatibility
53
3 ways to tx ABO incompatibility
* phototherapy
* rare-- exchange transfusion
* rare-- IVIG
| prognosis is excellent
54
* Incompatibility between Rh(-) mothers previously sensitized to Rh (D) antigen, and her Rh (+) fetus
* IgG cross the placenta and destroy RBCs of infants with a Rh-antigen
Rh isoimmunization
55
when is RhoGAM prophylaxis given to prevent maternal immune system to the Rh antigen
28 weeks gestation
56
Rh isoimmunization vs ABO incompatibility-- which is more common and which is more severe
* ABO is more common
* Rh is more severe
57
sx of jaundice in first 24hrs, anemia, **hydrops fetalis**
| what is the condition
RH isoimmunization
58
3 ways to manage Rho antepartum
* RhoGAM
* intrauterine transfusion
* IVIG
59
3 ways to manage Rho postpartum (for baby)
* phototherapy
* exchange transfusion
* IVIG
60
bilirubin that binds to albumin for transport in blood and its able to cross BBB and cause issues
indirect/unconjugated bilirubin
61
bilirubin that is conjugated into water-soluble molecule in liver and gets excreted
Direct/conjugated bilirubin
62
* Choreoathetoid cerebral palsy
* High-frequency sensorineural hearing loss
* Palsy of vertical gaze
* Dental enamel hypoplasia
* Cognitive deficits can be severe
* Mortality as high as 10%
kernicterus implications
63
consequence of untreated severe hyperbilirubinemia
kernicterus
