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Pre-term Infants Flashcards

(106 cards)

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1
Q

Esophageal Atresia

A

Loss of connection between upper and lower esophageal pouch and stomach

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2
Q

Gastroschisis

A

Sac absent, defect to right of umbilicus, exposed to amniotic fluid

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3
Q

Omphalocele

A

Sac present, associated anomalies common, at umbilicus, normal GI function

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4
Q

Congenital Intestinal Obstruction examples

A

atresia, malrotation, vulvulus

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5
Q

What is atresia?

A

Lack of bowel continuity, ischemia during development

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6
Q

What is a vulvulus?

A

An abnormal twisting of a portion of the intestine that can inhibit blood flow

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7
Q

Which intestinal atresia is most common?

A

jejuno-ileal atresia

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8
Q

Which bowel length has the highest outcomes?

A

> 15 cm small bowel with ileocecal valve, or 40 cm small bowel without ileocecal valve

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9
Q

Ductus Arteriosis

A

normal part of fetal artery connections used to divert blood from lungs- closes soon after birth

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10
Q

Complications of VSD

A

Blood supply from each side mixes, L side works harder to pump to lungs and enlarges, damaging vessels and causing pulmonary HTN

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11
Q

Complications of ASD

A

Diverts blood away from lungs, can result in pulmonary HTN and damaged vessels

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12
Q

Patent Ductus Arteriosis complications

A

Excess blood to lungs which strains lungs/heart, causes congestion, high BP, pulmonary hypertension

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13
Q

Pulmonary Stenosis definition

A

narrowing of pulmonary valve

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14
Q

Pulmonary Stenosis complications

A

R ventricle works harder and enlarges, weakening it

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15
Q

Tetrology of Fallot Definition

A

VSD, PS, displacement of aorta, R ventricular hypertrophy

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16
Q

TOF complications

A

PS decreases oxygenated blood, aortic displacement sends both oxygenated and deoxygenated blood to body

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17
Q

Coarctation of Aorta Definition

A

Narrowing of aorta between branches resulting in poor blood flow to extremities

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18
Q

Coarctation of Aorta Complications

A

Increased BP in heart, arms and head

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19
Q

Transposition of the Great Arteries types

A

Dextro-TGA, Levo-TGA

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20
Q

Dextro-TGA definition

A

Position/function of aorta/PA reversed- aorta delivers oxygen poor blood to body, PA delivers O2 rich blood to lungs

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21
Q

Levo-TGA definition

A

Position/function of arteries reversed, but ventricles are also reversed- functional but can lead to R ventricular decline

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22
Q

Aortic Stenosis definition

A

Aortic valve narrows, preventing normal flow of blood from L ventricle to aorta. Pressure in L ventricle increases and muscle thickens

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23
Q

What can cause pallor?

A

shock, asphyxia, PDA

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24
Q

What causes plethora (redness)?

A

overoxygenated

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25
What causes central cyanosis?
low oxygen saturation
26
What causes acrocyanosis (blue extremeties)?
cold, hypovolemia
27
What causes mottling?
cold stress, hypovolemia, sepsis
28
What causes edema?
overhydration, protein deficiency
29
What causes face/sacral edema?
Elevated R heart pressure
30
How is GERD diagnosed in pre-term infants?
Dual 24 hr probe, intraluminal impedance
31
Diagnosis of GERD is made with which indicators?
period of time esophagus is exposed to pH <4- 11% is abnormal
32
Why does Simply Thick increase changes of NEC development?
Bacterial metabolism of Simply Thick leads to accumulation of SFA and mucosal injury
33
Use of PPI in pre-term infants can lead to what?
PNA, gastroenteritis, NEC, candidemia
34
Why can fundoplication lead to retching?
osmolarity of feeds, high bolus volumes, overfeeding
35
What is bilirubin?
A product of heme metabolism
36
What is unconjugated bilirubin?
bound to albumin, transported to liver
37
What is conjugated bilirubin?
within hepatocytes and excreted within bile or resorbed from stool via enterohepatic circulation
38
What is omegaven?
IV Lipid with omega-3 effective in reducing cholestasis
39
What is SMOF lipid?
soy, MCT, olive oil, and fish oil
40
Primary risk factors for NEC
low gestational age, IUGR, abnormal fetal blood flow
41
Possible complications of Neonatal Abstinence Syndrome
preterm birth, SGA, hospitalization, feeding problems
42
What is inborn errors of metabolism?
Absent or malfunctioning enzyme/cofactor leads to deficiency or accumulation of metabolite
43
What is PKU
Mutation in PAH gene- converts phenylalanine to tyrosine
44
What is secondary PKU?
genetic defect that affects BH4 synthesis, which is a necessary cofactor for conversion
45
What is Galactosemia?
body cannot break down galactose
46
What is MSUD?
prevents metabolism of BCAA
47
What is anencephaly?
Failure of brain development in first month
48
What is Encephalocele?
lesions on brain tissue that protrude from skull
49
What is Myelomeningocele?
malformation of spinal cord- spina bifida is an example
50
Neonatal encephalopathy manifestations
seizures, respiratory distress, reduced tone
51
Hypoxic-ischemic encephalopathy
impaired cerebral blood flow caused by an event like placenta previa or shoulder dystonia
52
Growth implications of Cornelia DeLange
small stature, growth delay
53
Growth implications of Marfan Syndrome
connective tissue disorder, tall and thin, heart murmurs
54
Growth implications of Prader Willi
Constantly eats, never full
55
Growth implications of Rubinstein-Taybi
short stature, learning disability
56
Growth implications of Turner Syndrome
short stature, heart defects
57
Growth implications of William's Syndrome
broad, "elfin" features
58
Which infants are at higher risk for renal complications?
<36 weeks GA
59
Definition of AKI
Rapid decline in kidney function resulting in inability to maintain fluid and electrolyte homeostasis
60
Definition on nephrocalcinosis
calcium salt deposition in renal parenchyma
61
Implications of hypertension
irritability, lethargy, poor feeding, cardiopulmonary and neurologic symptoms
62
CKD definition
anticipated, long term impaired or decreased kidney function
63
Prerenal kidney injury
caused by inadequate renal perfusion related to impaired renal function with immaturity
64
Intrinsic kidney injury
tubular necrosis d/t ischemia
65
Examples of nephrotoxic meds
acyclovir, NSAIDS, ACE inhibitors, aminoglycosides, vancomycin, radiocontrast agents
66
Postrenal kidney injury
cause by obstruction
67
What causes renal hypertension?
renovascular disease progressively narrows veins/arteries
68
Examples of renal congenital anomalies
hydronephrosis, renal agenesis, renal dysplasia
69
Hydronephrosis
swelling of kidney d/t inability to excrete urine
70
renal agenesis
1 or both kidneys fail to develop in utero
71
Renal dysplasia
Renal tubules don't fully develop, urine collects in kidneys due to inability to flow through immature tubules
72
Examples of inherited renal disorders
autosomal dominant and autosomal recessive
73
What is autosomal dominant polycystic KD
development of cysts in both kidneys, reducing kidney function and requiring transplant
74
What is autosomal recessive polycystic KD
enlarged kidney with multiple cysts
75
What is hematuria indicative of for nephro
renal disease including tubular nectrosis, venous thrombosis or UTI
76
What is proteinuria indicative of?
renal disease like acute tubular necrosis, dehydration
77
What is elevated urine pH indicative of?
>5.3 with low serum bicarb indicative of distal renal tubular acidosis
78
What is GFR?
rate at which kidneys filter blood
79
When does GFR increase?
with gestational age and increase in renal blood flow
80
What is the cause of respiratory disease in preterm infants?
immaturity of lung tissue structure and function, causing respiratory distress and bronchopulmonary dysplasia
81
What is transient tachypnea?
Fluid in lungs at birth, doesn't clear/resorb quickly. resolves in 24-48 hrs
82
persistent pulmonary hypertension caused
underdevelopment of lung tissue, pulmonary vasculature can't handle normal blood flow
83
What is meconium aspiration syndrome?
fetal GI contents trigger immune system when present in lung tissue, causing inflammation
84
Definition of intestinal failure
need for PN for >60 days due to intestinal disease, dysfunction or resection
85
Most common reasons for SBS in NICU
NEC, Congenital malformations, volvulus
86
What does the stomach secrete?
intrinsic factor, HCl, pepsin
87
What does the duodenum absorb?
Glucose, water soluble vitamins, Fe, Ca, Mg
88
What does Jejunum secrete?
secretin, CCK
89
What does jejunum absorb?
amino acids, fat
90
What does ileum secrete?
Enteroglucagon
91
What does ileum absorb?
zinc, phos, bile acid, bile salt, B12, cholesterol
92
What does the colon secrete?
K, HCO3
93
What does the colon absorb?
Water, Na, Oxalate
94
What does low urine sodium suggest?
Renal conservation- <25 mEq/L associated with poor growth
95
What does BUN measure?
Adquacy of enteral protein provision in normal renal function
96
What are 2 markers of copper status?
Serum copper or ceruloplasmin
97
What does ceruloplasmin do?
iron metabolism and HgB synthesis
98
Implications of copper deficiency
neurtopenia, impaired iron absorption, anemia, bone fractures
99
What does plasma citrulline indicate?
correlates with residual small bowel length and enterocyte mass. Levels >15 may indicate higher probability of weaning from PN
100
What weight is considered Low Body weight?
<2.5 kg
101
What weight is considered very low body weight?
<1.5 kg
102
What weight is considered extremely low body weight?
<1 kg
103
How is BPD diagnosed?
abnormal CXR, supplemental O2 on DOL 28
104
How is FTT diagnosed?
WFA <5th percentile WFL/WFH <5th percentile Growth decreased 2 percentiles Growth decreased 2 SD over 3-6 mo
105
What is the definition of short bowel syndrome?
40-60% of small intestine resected, resulting in significant malabsorption
106
What is intestinal bacterial overgrowth
excessive bacteria from colon migrate to small intestine

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