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PEDIA2 > Sick Newborns Part 1 > Flashcards

Sick Newborns Part 1 Flashcards

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1
Q

What are the primary causes of infant mortality?

A

PAS
Prematurity
Asphyxia
Sepsis

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2
Q

What should be done if babies are born limp, cyanotic, apneic or pulseless?

A

Immediate resuscitation before asignment of the 1st minute APGAR score

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3
Q

What is the main goal of resuscitation?

A

To establish ventilation within the 1st minute of life (first golden minute)

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4
Q

What are indications of Positive pressure ventilation (PPV)

A

Heart rate <100bpm
Ineffective respiration

Use ECG monitor & pulse oximeter at once resuscitation is required

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5
Q

What should u do if heart rate falls below 60bpm in spite of 30 secs ventilation?

A

Initiate chest compressions
Do intubation if not yet done
Compression to ventilation ratio: 3:1
Administer 100% oxygen

Continue chest commpressions for 60 secs before re-assessment

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6
Q

What is the heart rate remains <60bpm after CC?

A

IV epienphrine should be admin

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7
Q

What are things to note once the baby is delivered?

A
  1. Note time of birth
  2. Note if baby is crying or breathing
  3. Not breathing properly or limp
  4. Gasping, apneic or HR <100bpm
  5. Spontaneous but labored breathing
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8
Q

After initial PPV what should be done?

A

Assess HR
If HR <100bpm -> CC, INC O2 to 10%, Chest rise, perform MR SOPA
If HR <60bpm -> CC 3:1 ratio
If responsive to resuscitation -> post-resuscitation care

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9
Q

What are common causes of common neurologic problems?

A

Multifactorial

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10
Q

What are common neurologici problems in newborns?

A

Cranial hemorrhage
Periventricular leukomalacia
Neonatal seizures
Hypoxic ischemic encephalopathy

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11
Q

What are the 2 types of cranial hemorrhage and specific conditions under it?

A

Extraccranial - Caput succedaneum, Cephalhematoma, Subgaleal hemorrhage

Intracranial - Extradural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage, Intracerebral/Intraventricular hemorrhage

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12
Q

What is the most common and most benign extracranial hemorrhage?

A

Caput succedaneum
Clin Presentation: diffuse, ecchymotic, edematous swelling of the soft tissues of the scalp
Location: extend across sutures/midlines

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13
Q

What are the clin presentation of Cephalhematoma?

A

Does not cross sutures/midline (bleeding confined within the subperiosteal area)

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14
Q

What are the clin presentation of Subgaleal hemorrhage?

A

Blood spreads in the entire skull or even in the SQ tissue of the neck assoc with vacuum delivery

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15
Q

What are managements of Subgaleal hemorrhage?

A

Volume expanders
Inotropic support
Transfusion for anemia cases

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16
Q

What are the causes of Intracranial hemorrhage?

A

Birth trauma
Asphyxia
Term infants - subarachnoid hemorrhage (most comon)
Preterm infants - IVH or periventricular hemorrhage
Perinatal arterial ischemic stroke, sinovenou thrombosis, perinatal hemorrhagic stroke and trauma -

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17
Q

What is the most commmon CNS complication of preterm birth?

A

Intraventricular hemorrhage

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18
Q

What are the sites of bleeding in IVH?

A

Germinal matrix
Subependymal germinal matrix

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19
Q

Why are preterm infants most susceptible to IVH?

A

Lack of cerebral flow autoregulation -> pressure passive state exists

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20
Q

What is the most common cause of IVH?

A

Immatyrity of the germinal matrix of the lateral ventricle

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21
Q

What are the 3 types of clin manifestataions of IVH?

A

1st = astmptomatic if bleeding is small
2nd: gradual clin deterioration with altered level of consciousness, hypotonia or abnormal eye movements
3rd: sudden and catastrophic deterioration on 2nd-3rd day of life

Full anterior fontanelle with sudden pallor supported by sudden drop in hematocrit (w/ hemodynamic instability, hyperglycemia, acidemia, and hyperkalemia)

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22
Q

How is the Dx of IVH conducted?

A

Cranial US = screening
IVH grading

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23
Q

What is the IVH grading?

A

Grade 1 = confined to the GM-subependymal region or <10% of ventricle
Grade 2 = Intraventricular bleeding
Grade 3 = >50% of ventricle is involved
Grade 4 = extension into the parenchyma with ventricular enlargement

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24
Q

What are the characteristics of Periventricular Leukomalacia (PVL)?

A

Focal necrotic lesions in the periventricular white matter

Risk of PVL INC w/ severe IVH or Ventriculomegaly

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25
What are predisposing factors of PVL?
Prematurity Dysregulatoin in cerebral blood flow Maternal-feltal infections Disturbance in oligodendrocyte precursors for myelination Factors contributing to the devt of HIE and IVH
26
What is the clin manifestaion of PVL?
Later infancy = spastic motor deficits
27
What are the cause sof neonate seizures?
Post asphyxial: hypoxic-ischemic encephalopathy Posthemorrhage: IVH or subarachnoid hemorrhage Metabolic disturbances Imbalance of cerebral excitation & inhibitory pathways Toxins Infections Malformations Genetic Trauma
28
What are the diff types of neonatal seizures?
Subtle seizure (automatism) - most common Clonic seziures Tonic seizures Myoclonic seizures
29
What pathological condition occurrs where there is no spontaneous breathing or represents irregular breathing after brith?
Perinatal asphyxia
30
In the timing of injury, when is the most frequent time asphyxial events happen?
Intrapartum = abnormal interruption of umbilical circulation & inadequate placental perfusion
31
What is the intial response of the organs after asphyxial events?
Diving reflex = there is INC shunting of the cicrculatory system through the ductus venosus, ductus arteriosus and foramen ovale
32
What are the most targeted organs after asphyxiation?
Renal CVS Respi CNS
33
What is the pathophysio of Hypoxic ischemic encephalopathy?
Primary energy failure & INC lactic production
34
What happens during primary energy failure ?
Effects lead to cellular necrosis through impaired cellular integrity -> DEC brain function
35
WhaT happens in secondary energy failure?
6-48hrs after initial injury Excitatory occurs when excessive levels of extracellular NT especially glutamate, overstimulate the excitatory receptors
36
How do u classify if it is a chronic brain injury?
30-60min period of recovery of cellular energy pathways (reperfusion phase)
37
What are the best prognosis of HIE?
Stage 1 = best outcome; prolonged periods of wakefulness and generalized sympathetic tone Stage 2 = seizures are common Stage 3 = worst outcome
38
What are the initial diagnostic tests done for px?
Chest x-ray Arterial blood gas CBC
39
What is a prominent clin manifestation of ARDS?
Atelectasis = chest xray (GROUND GLASS HAZE IN THE LUNG)
40
What should be given to prevent preterm birth?
Betamethasone or Dexamethasone (multiple doses are not beneficial)
41
What are clin features of transient tachypnea of the newborn?
Retained or delayed clearance/resorption of lung fluid Tachypnea (>60 breaths/min) Hypoxia Cyanosis
42
What are the predisposing factors of Transient Tachypnea of the newborn?
Larger, preterm infants Twin gestation Diabetic motehrs
43
What are causative agents of neonatal pneumonia?
E coli S aureus K pneumoniae
44
What is the tx for neonatal pneumonia?
Ampicillin + Gentamicin
45
Where does gas exchange occur in pregnant women for babies?
Placenta
46
What are the causes of pulmonary HTN?
Maladaptation: nromal vasculature but it is vasoconstricted Maldevelopment: abnormal structure of the pulmonary vasculature bed
47
What are the common congenital heart diseases?
Ventricular septal defect Tetralogy of fallot = beyond neonatal period Transposition of the great arteries = 1st week of life Hypoplastic left heart syndrome = 1st week of life
48
What are the causes of cyanosis in CCHD?
Obstruction to the right ventricular inflow or outflow -> intracardiac right to left shunting Complex anatomic defect - admixture of pulmonary and systemic venous return in the heart Persistence of fetal pathway
49
What are the 5Ts, DO, ESP of CCHD?
Truncus arteriosus TGA Tricuspid atresia TOF Total anomalous pulmonary venou return Double outlet right ventricle Ebstein’s anomaly Single ventricle Pulmonary atresia
50
What are the 7 CCHD screening targets?
HLHS Pulmonary atresia TOF TAPVR TGA Tricuspid atresia Truncus arteriosus
51
What are the diff betw HLHS vs Sepsis?
HLHS - presents after the duct is closed by 48-72 hours & CF to the ER with no murmur No high risk factors for infection, always consider the dx of HLHS
52
What are S/Sx of Patent Ductus Arteriosus?
TERM BABIES: Systolic or machinery murmur w/ bounding pulase If late, CHF PRETERM BABIES: - DEC blood flow to the gut -> Necrotizing enterocolitis, pulmonary hemorrhage, bronchopulmonary dysplasia
53
What is the most commn life threatenign mergency of GI tract in the newborn period?
Necrotizing enterocolitis -> mucosal/transmural necrosis of the intestine
54
What are the 3 major risk factors of NEC?
Prematurity Bacteria colonization of the gut Formula feeding
55
What are the clin features of NEC?
2nd or 3rd wk of life Very low birth weight Non-specific = lethargy, temp instability
56
What are the radio findings of NEC?
Pneumatosis intestinalis = air in bowel of mucosa, diagnostic With portal gas = sign of SEVERE DIS Pneumoperitoneum = perforation of the bowel
57
What are the 3 types of meconium diseases?
Meconium plug Meconium ileus Meconium peritonitis
58
What is the indication of Meconium plug?
Hirscprung disease Presents with: abdominal distention, bilious emesis
59
What are clin presentation & indications of Meconium ileus?
Clin Pre: Bilious emesis, abdominal distention, no passage of meconium, distal ileum Abdominal xrays: distended intestinal loops, granular or bubbly
60
What are clin presentations of meconium peritonitis?
Intestinal performations with meconium spillage in the peritoneal cavity
61
What are conditions that require surgical intervention of neonates?
Failure to pass meconium within first 24-48hrs of life Feeding intolerance Intestinal obstruction
62
What is the incidence and clnical featres seen in congenital hyperplatic pyloric stenosis?
Male > Female Blood groups O & B Non bilious vomitng Dehydration Hypochloremic, hypokalemia, metabolic alkalosis
63
What are diagnostic signs of congenital hyperplastic pyloric stenosis?
Fluoroscopy: Barium-string sign US: Bull’s or target sign
64
What are surgical conditions of neonates?
Congenital hyperplastic pyloric stenosis Esophageal atresia Duodenal atresia Hirschprung disease Omphalocele vs Gastroschisis
65
What are conditions that are at higher risk of developing duodenal atresia?
Trisomy 21 CHD Maltrotation Annlar pancreas GU EA`
66
What are clinical findings of Duodenal atresia?
Utero - US: polyhydramnios and distended duodenum Postnatal - bilious emesis first 24hrs with abdominal distention in upper abdomen & DOUBLE BUBBLE SIGN
67
What is the most common cause of lower intestinal obstruction in neonates and common segment affected?
Hirschprung disease Rectosigmoid
68
What are clinical findigns of Hirschsprung disease?
(-) Meissner’s and Auerbach’s plexuses Hypertrophied nerve bunes -> HIGH conc of Achesterase
69
What are the red flags in the neonatal period?
Neonatal intestinal obstructions Bowel perforation Delayed passage of meconium Abdominal distention Chronic severe constipation Enterocolitis
70
What are the diff betw Ompalocele vs Gastroschisis?
Omphalocele - umbilical cord defect (insertion of the distal umbilical cord into the sac) Gastroschisis - abdominal wall defect (R of umbilical cord)
71
When is the dx of Gastroschosis done?
20th wk via US -> free-floating bowel loops in the uterine cavity, INC maternal serum AFP

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