universal: - TSB before discharge / 72h - blood type & screen - baby blood type - G6PD if ethnic group (consider) If severe/treating: - DAT (coombs) - CBC + diff - smear & retics - unconj + conj serum bili - G6PD - if asian or severe - consider septic w/u (eg if WBC off, etc) Note: also do DAT if high-intermed risk and mom is group O

Neonatal Flashcards by Erica S

Gastroschisis Description

defect in anterior abdo wall lateral to umbilicus

herniated intestine /w no covering/sac

no associated abnormalities

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omphalocele

incomplete closure of ant abdo wall

herniated bowel, stomach, liver, spleen in peritoneal sac

often other abnormalities

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NRP algorithim

dry, stimulate, clear secretions (30secs)

if apnea, gasping or HR < 100: PPV, SpO2 monitor, +/- ECG

HR < 100? Check chest movement, correct PPV. ETT or LMA if needed.

then if HR <60, ETT. Compressions. 100% O2. ECG monitor.

HR still <60, IV epi

HR persistently <60, consider hypovolemia or pneumothorax

if labored breathing or persistent cyanosis only: position + clear airway, supplemental O2 PRN. Consider CPAP.

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Preductal SpO2 targets in newborn resusc

1min - 60-65%
2min - 65-70%
3 min - 70-75%
4 min - 75-80%
5 min - 80 - 85%
10 min - 85-95%

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changes at birth in circulation

hypoxia –> breath

breathing/O2 –> lower pulm resistance, increased pulm blood flow

loss of placental circulation –> increased systemic vascular resistance, closing FO + DA

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prematurity acute + chronic morbidity

acute:

CNS: asphyxia, IVH, seizures, periventricular leukomalacia
Resp: RDS, apnea of prematurity (monitoring until 5-8d without apnea)
CVS: PDA
GI: feeding intolerance, NEC
ID: sepsis
Derm: temp instability

chronic:

HEENT: ROP, hearing impairment
Resp: CLD
CNS: behavioural, LDs, CP, cognitive, seizures

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management of late preterm infants (34+)

<35 need NICU, otherwise may not

observe - temp, jaundice, BG, car seat test

careful monitor feeding, weight gain until consistent

risk of readmission

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kernicterus diagnosis

only dx on histology (see in basal ganglia)

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acute bilirubin encephalopathy diagnosis

= clinical diagnosis

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physiologic causes of jaundice

breast feeding jaundice (=not getting enough)

breast milk jaundice (getting enough but reacting to a component)

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Pathologic causes of Jaundice

Unconjugated/indirect

hemolytic: ABO incompatible, fragmentation, spherocytosis/elliptocytosis, G6PD def, PKD, alpha thalassemia
others: cephalohematoma, bruising, craig najar syndrome, gilberts, sepsis, hypothyroidism

Conjugated/direct

biliary atresia
choledocal cysts
infections: sepsis, viral, TORCH, UTI
metabolic: galactosemia, A1AT def, hypothyroidism
long term TPN
idiopathic neonatal hepatitis

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Jaundice work up

universal:

TSB before discharge / 72h
blood type & screen
baby blood type
G6PD if ethnic group (consider)

If severe/treating:

DAT (coombs)
CBC + diff
smear & retics
unconj + conj serum bili
G6PD - if asian or severe
consider septic w/u (eg if WBC off, etc)

Note: also do DAT if high-intermed risk and mom is group O

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Jaundice likely pathologic if

jaundice at <24hr
bili rises rapidly or very high
persists beyond 2 weeks
conjugated hyperbilirubinemia (does not cause kernicterus or respond to phototherapy – but must workup!)

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treatment for hyperbilirubinemia

phototherapy (blanket, light)

- if severe, IVIG, partial exchange transfusion

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how to dx hyperbilirubinemia

use nomogram of total bili to decide if phototherapy
if no tx, then use 2nd nomogram to determine risk zone + follow-up needed
RFs = iso immune hemolytic dx, G6PD, asphyxia, resp distress, lethargy, temp instability, sepsis, acidosis

lines: 38+well, 35-38 + wll or term /w RFs, 35-38 with RFs

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signs of kernicterus

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hypertonia, arcing, retrocolis, fever, opthisthotonos, high pitched cry

tx of kernicterus

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exchange transfusion

risk factors for neonatal sepsis

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ROM > 18hr
intrapartum fever
maternal GBS
prev infant with GBS
chorioamnionitis
prematurity
perinatal asphyxia

micro-organisms for neonatal sepsis

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GBS
E coli
Strep Viridans
Strep pneumo
enterobacter
S aureus
H flu
HSV
enteroviruses

presentation of neonatal sepsis

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non-specific/subtle
poor feeding
lethargy
vomiting
resp distress/grunting/apnea
temp instability
low tone
tachycardia
fever or hypothermia
seizures
petechiae

full septic workup

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CBC
blood cultures
urinalysis + culture
LP - CSF anlalysis, culture, viral PCR
\+/- CXR, stool testing

when to do a workup for sepsis

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unwell - full w/u

well and multiple RF or chorio: do CBC after 4 hrs

one RF: observe for 24hr, +/- CBC

empiric antibiotics for neonatal sepsis

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ampicillin + gent or cefotaxime

add vanco if >30d, if ?meningitis, or if lines in

add acyclovir if ?HSV

Ddx for neonatal resp distreass

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most common:

transient tachypnea of newborn
respiratory distress syndrome
meconium aspiration syndrome

less common:

infection (pneumonia, sepsis)
persistent pulmonary HTN
pneumothorax, effusion, lung hemorrhage

investigation for neonatal resp distress

CBC, lytes, BG, blood gas, blood cultures LP if ?sepsis, meningitis CXR echo (esp if severe hypoxemia or ?PPHN) ECG pre and post ductal sats (PPHN)

Transient tachypnea of Newborn description, dx, treatment

"wet lungs" RF: CS, macrosomia, maternal DM CXR: parenchymal infiltrates, wet silhouette, intralobal fluid tx: give O2 PRN

Respiratory Distress Syndrome

not enough surfactant RF: male, maternal DM, preterm tachypnea, hypoxia, cyanosis CXR: homogenous infiltrates, air bronchograms, small volumes tx: resusc, O2, ventilate, give surfactant

mec aspiration syndrome

post-term, SGA patchy atelectatsis, consolidation resusc, O2, ventilate, surfactant if severe, abx until cultures back (b/c looks like pneumonia)

neonatal hypoglycemia cut off

<2.6

neonatal hypoglycemia causes

endocrine: persistent hyperinsulinemic hypoglycemia of infancy, diabetic mom, LGA, other rare things ``` perinatal stress sepsis RDS prematurity PPHN rare inborn errors of metabolism ```

work-up for persistent hypoglycemia / requiring lots of glucose

"critical labs" - PG - blood gas - insulin level - GH - cortisol - FFA - beta-hydroxybutarate - acyclcarnitinse - total and free carnitine - serum amino acids - ammonia - lactate - c-peptide - urine: ketones, glucose, organic acids, reducing substrates

management of neonatal hypoglycemia

LGA + IDM: monitor from 2h life to 12hrs. SGA + premies until 36hrs. monitor PG q3-4h before feeds, then before every 2nd or 3rd feed after 48h PG < 1.8 at 2h of life despite one feed or <2.0 after any feed: IV dextrose 2.0-2.6 (or 1.8-2 in first 2h): feed. If repeatedly <2.6, IV dextrose <2.6 and unwell: IV dextrose

IV fluid choice for neonatal hypoglycemia

start with D10, can go up to D12

developmental dysplasia of the hip risk factors

breech, family hx, female

hip dysplasia mangement

positive exam <2wks - ortho referral equivocal exam 2wks+: US or ortho referral tx = pavlik harness (abduction brace)

Apgar score

2 for each category: ``` appearance / color pulse (absent, <100, >100) grimace (floppy, weak, vigorous) activity (active, flexed, absent) resp (absent, slow, vigorous) ```

Neonatal Flashcards

(36 cards)