Newborn Flashcards

Question

Infant of Diabetic Mother - Neonatal findings: - Hypoglycemia - Macrosomia/LGA - SGA/IUGR - Prematurity - Electrolyte abnormalities - Hypo___ - Hypo___ - Unconjugated hyperbilirubinemia - Polycythemia/plethora - Hypertrophic cardiomyopathy - ______ or one/both ventricular walls. Rarely, will lead to heart failure. Some will need tx with Beta blocker - RDS. Insulin blocks precursor of surfactant. - Small ___ syndrome. Resolves spontaneously after a few days. - The increased risk of congenital anomalies in IDMs is likely due to poor diabetes control BEFORE conception and during early pregnancy, when fetal organogenesis is occurring. Therefore it is highly recommended that diabetes be well-controlled PRIOR TO and throughout pregnancy. - Findings for infants of mothers with pregestational diabetes (onset before pregnancy) - Congenital anomalies occurs 2-4x more frequently in IDM with preconception glucose - Cleft palate, vertebral, intestinal, anencephaly, spina bifida, GI atresia, situs inversus, and urinary tract anomalies - _____ - Increased risk of _____

Answer 1

Infant of Diabetic Mother - Neonatal findings: - Hypoglycemia - Macrosomia/LGA - SGA/IUGR - Prematurity - Electrolyte abnormalities - Hypocalcemia - Hypomagnesemia - Unconjugated hyperbilirubinemia - Polycythemia/plethora - Hypertrophic cardiomyopathy - inter ventricular septum or one/both ventricular walls. Rarely, will lead to heart failure. Some will need tx with Beta blocker - RDS. Insulin blocks precursor of surfactant. - Small left colon syndrome. Resolves spontaneously after a few days. - Infant of mothers with gestational diabetes only are at increase risk for morbidities except for congenital anomalies and future obesity/diabetes. - The increased risk of congenital anomalies in IDMs is likely due to poor diabetes control BEFORE conception and during early pregnancy, when fetal organogenesis is occurring. Therefore it is highly recommended that diabetes be well-controlled PRIOR TO and throughout pregnancy. - Findings for infants of mothers with pregestational diabetes (onset before pregnancy) - Congenital anomalies occurs 2-4x more frequently in IDM with preconception glucose - Cleft palate, vertebral, intestinal, anencephaly, spina bifida, GI atresia, situs inversus, and urinary tract anomalies - Caudal regression syndrome / Lumbosacral dysgenesis - Increased risk of obesity and diabetes later in life

Answer 2

GBS Prophylaxis - Indications for intrapartum antibiotic prophylaxis: - Prior infant with neonatal GBS infection. - GBS bacteriuria or GBS UTI during current pregnancy (regardless of tx) - GBS-positive rectal or vaginal culture during the current pregnancy - Unknown GBS status PLUS any of the following - <37 weeks gestation - Intrapartum fever - ROM for >18 hours - Intrapartum NAAT positive for GBS

Answer 3

Management of infants born to mothers requiring GBS pix: - Symptomatic for signs of sepsis: Work-up (CBC, blood culture, CXR, lumbar puncture) and start antibiotic therapy Asymptomatic 1) <37 weeks gestation or ROM >18 hours: - Adequate abx: Observe for 48 hours - Inadequate abx: Blood culture, CBC, observe for 48 hours and do full sepsis workup if indicated 2) Full term >37 weeks AND ROM <18 hrs - Adequate intrapartum antibiotic tx for GBS (ampicillin, penicillin, or cefazolin): Meet early discharge criteria at 24 hours with follow-up in 48h - Inadequate antibiotics: Observation for 48 hrs and do full sepsis workup if indicated

Answer 4

Polycythemia - Hematocrit >65% from free flowing venous sample - Polycythemia can lead to hyper viscosity which can lead to decreased oxygenation or organs - Pt: >70% are asymptomatic. Plethora, irritability, jitteriness, apnea, seizures - The most common lab abnormality is hypoglycemia. - Tx: - Asymptomatic with Hct 65-70%: Close monitoring for hydration, hypoglycemia, and hyperbilirubinemia - Symptomatic or Hct >70%: IVF or partial exchange transfusion

Answer 5

Diaphragmatic hernia - Dx: Typically prenatal US. CXR will demonstrate abdominal viscera in chest cavity and elevation of hemidiaphragm - Management: 1) Intubation for resp distress, ventilation (AVOID bag mask ventilation), and NG suction. 2) Surgical repair. ECMO may be needed. - Prognosis is dependent on severity of pulmonary hypoplasia - For repaired congenital diaphragmatic hernia, the most likely complication is recurrent herniation

Answer 6

Transient Tachypnea of Newborn - RF: C-section - CXR: Prominent pulmonary/perihilar markings, fluid in the fissures - Tx: Resolve within 12-24 hours

Answer 7

Respiratory Distress Syndrome - RF: - Incidence increases with decreasing gestational age - Surfactant production begins 32-34 weeks gestation and usually reaches sufficient quantities by 36 weeks. - As gestational age increases, more surfactant is synthesized and stored in type 2 alveolar cells. Mature levels of pulmonary surfactant are usually present at >35 weeks. - Infants born at <28 weeks of gestation whose mothers have not received glucocorticoid tx are at high risk of RDS. - Infant of diabetic mother, male sex, caucasian race - Predict which infant will develop RDS by measuring the lecithin/sphingomyelin (L/R) ratio in amniotic fluid. L/S >2 predicts mature surfactant function. - RDS causes a mixed metabolic acidosis and respiratory acidosis - CXR shows 1) poor lung expansion 2) fine ground glass haziness 3) air bronchograms (atelectasis) - Appears identical to CXR for pneumonia caused by GBS. For this reason, newborns with RDS with RF for infection should be tx with antimicrobial therapy - Tx: Oxygen support - Intratracheal surfactant within 30-60 mins after delivery - Criteria for surfactant therapy: Clinical and radiographic diagnosis of RDS in an infant who requires >30% FiO2 to maintain a PaO2 >80mmHg. - Ppx: Maternal steroids within 7 days of delivery reduces risk of RDS. Recommended at 23-34 weeks

Answer 8

Persistent pulmonary hypertension of newborn - Hypoxemia refractory to oxygen administration - Pt: - Tachypnea with cyanosis is the most common feature - Greater oxygen saturation in the upper body compared to the lower body is classic. - Typical cardiac findings: - Prominent precordial pulse - Tricuspid regurgitation murmur (harsh systolic murmur at the L lower sternal border) - Loud narrowly split 2nd heart sound (P2) - In some infants, oxygen requirements vary widely bc resistance oscillates - Tx: Treat underlying etiology - Correct hypoxia, acidosis, and hypotension until pulmonary vascular resistance falls - Inhaled NO reduces the need for ECMO. However, NO has rare complication of methemoglobinemia. Therefore, periodically track methemoglobin levels during NO therapy.

Answer 9

Bronchopulmonary Dysplasia - long term consequence of RDS - Generally develops in infants <30 weeks - Definitions: Respiratory support needed at either 36 weeks gestation (if born before 32 WGA) or at 56 days gestational age (if born after 32 WGA). - Infants requiring oxygen >21% for at least first 28 DOL PLUS one of the following A) - Gestational age <32 weeks - Mild: Breathing room air at 36 weeks PMA or discharge, whichever comes first - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first - Severe: Need for >30% and/or PPV/NCPAP at 36 weeks PMA or discharge, whichever comes first B) - Gestational age >32 weeks - Mild: Breathing room air by 56 days postnatal age or discharge, whichever comes first - Moderate: Need for <30% oxygen and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first - Severe: Need for >30% and/or PPV/NCPAP at 56 days postnatal age or discharge, whichever comes first - Labs: Compensated respiratory acidosis - Tx: Oxygen - Surfactant - For moderate-severe, chronic use of thiazide diuretics in combination with spironolactone - Bronchodilatory therapy - RSV ppx

Answer 10

Retinopathy of Prematurity - Screening: - All infants with BW <1500g or a gestational age <30 weeks - Infants with complicated clinical course - Screening - Infants 22 - 26+6 weeks are initially screened at 31 weeks. All other infants (>27 weeks) should be screened at 4 chronological weeks (DOL 28) after birth

Answer 11

IVH - Head US indications: <32 weeks OR <1500g OR clinically indicated. Perform at 7 days postnatally. May need HUS at 1mo as clinically indicated. - Intraventricular hemorrhage is characterized by the extent of the hemorrhage - Grade 1: Involves only the germinal matrix only - Grade 2: Involves the lateral ventricles without ventricular dilation - Grade 3: Involves at least 50% of the lateral ventricles with associated ventricular dilation - Grade 4: Involves periventricular brain parenchyma - IVH of any grade is a RF closely associated with neurodevelopment impairment

Answer 12

NEC - Pt: Abdominal distention appears first - Stages: - Stage IA (suspected NEC): Nonspecific systemic signs and mild abdominal signs - Stage IIA (proven NEC, mildly ill): Worsening abdominal, systemic, and radiographic findings - Stage IIIA (advanced NEC, severely ill with intact bowel): Advancement to signs of sepsis, acute abdomen - XR shows - Pneumatosis intestinalis (air in submucosa wall of bowel. “Double line” or “train track”) - Classic and pathognomonic finding on films - Air in the hepatic portal system is also pathognomonic for NEC. May show portal venous gas - Pneumoperitoneum/free air secondary to bowel perforation. - “Football sign” on supine radiograph- large radiolucent area in the central abdomen with demarcation of the falciform ligament - Sentinel loops (loops of bowel that remain in a fixed position) are suggestive of necrotic bowel and/or peritonitis. - Tx: - NPO, bowel rest, NG tube decompression, TPN, blood cultures - IV abx - Vancomycin, gentamicin, metronidazole OR - Vancomycin, gentamicin, and piperacillin-tazobactam - Isolate from others in NICU - Surgery consult

Answer 13

Toxoplasmosis - Pt: - Triad of hydrocephalus, chorioretinitis, and cerebral calcifications (throughout corteX or CircuMVent) - Isolated ocular toxoplasmosis: Characteristic retinal lesions (white focal retinitis with overlying vitreous inflammation) - Dx: Anti-toxoplasma IgM and IgA are most reliable markers - Tx of the mother can begin during if the diagnosis is made. - If the infection occurs in weeks 7-34 of gestation, you can give spiramycin 1g q8h (not licensed in US, available through CDC). - If fetal infection is excluded, continue spiramycin until term. - If you confirm infection of the fetus, switch therapy to pyrimethamine, sulfadiazine, and leucovorin (which is folinic acid, not folic acid). The congenitally infected child must receive 12 mo of therapy. - If the maternal infection occurs after 34 weeks of gestation, the 3-drug regimen can be used. - After delivery, continue treating the infant even if there are no clinical signs/symptoms. - Continue combination of pyrimethamine, sulfadiazine, and folinic acid (leucovorin).

Answer 14

Congenital Rubella - Path: Togavirus - Trimester of infection has important prognostic predictors: - 1st trimester: 90% fetal infection risk - Pt: - Triad: Cataracts (or glaucoma), congenital heart defects (PDA), sensorineural loss (deafness, damage to organ of Corti) - Thrombocytopenic purpura aka blueberry muffin (also seen in cmv) - Radiolucencies in the long bone metaphysis - Higher risk of DM1 - Rare complication of progressive rubella panencephalitis, which is a severe progressive neurologic deterioration that begins in the 2nd decade of life. - Tx: Supportive

Answer 15

Cytomegalovirus - Pt: - MOST COMMON cause of congenital sensorineural hearing loss; most common long-term sequela of CMV - Blueberry muffin rash (as in rubella) - Microcephaly - Chorioretinitis - Periventricular intracerebral calcifications (CMV will “CircuMVent” the ventricles) - Tx: - Treatment with antiviral agents is NOT recommended for neonates with ASYMPTOMATIC congenital CMV infection. - For symptomatic infants, start tx with ganciclovir or valganciclovir in the 1st month of life. - Oral valganciclovir (16mg/kg/dose administered twice daily) for 6 months is recommended for term neonates with symptomatic congenital CMV infection with and without CNS disease; therapy must be started by 4 weeks of age. - Adverse effects of valganciclovir therapy include significant neutropenia (in 20% of infants) and hepatoxicity. - IV ganciclovir may be considered in neonates with symptomatic congenital CMV infection who have necrotizing enterocolitis or other intestinal problems limiting their ability to absorb oral medication. - Studies have shown that 6mg/kg dose IV for 6 weeks in newborns with severe CMV and neurologic improvement showed protection against hearing loss and head circumference growth in the first 6-12mo of life - Significant myelosuppression (in 66% of infants) is a major concern with IV ganciclovir therapy

Answer 16

Parvovirus B19 | - Pt: Hydrops fetalis, aplastic crisis

Answer 17

Varicella - Varicella infection during the 1st trimester (8-20 weeks gestation) results in a risk of fetal abnormalities in about 1-2% of births. Short limbs, small eyes. - Limb reduction defects can occur if the infection occurs prior to, or during, limb bud formation. - Microphthalmia, cataracts - Infants born to mothers who develop varicella from 5 days before delivery to 2 days after delivery are at risk of severe neonatal varicella - Tx: IV acyclovir

Answer 18

Neonatal HSV - Risk of transmission is far greater with primary HSV infection as compared with reactivation of previous infection. - Pt: - SEM: Skin, eye, and mouth disease (45% of cases) - Localized CNS disease with or without skin lesions (30% of cases): Seizures, lethargy, mouth - Disseminated disease (25% of cases): Multiple organ systems - Sepsis, hepatitis, coagulopathy, DIC, encephalitis/CNS - Dx: - Surface swabs by culture/PCR - LP - Tx: - Suspected or confirmed HSV must receive IV acyclovir (60mg/kg/d in 3 divided doses) - For 14 days for SEM disease - For 21 days for CNS or disseminated disease - (Nephropathy as a result of tubular precipitation of acyclovir can occur with IV administration, not oral. It is more common with rapid infusion and in patients with dehydration.) - Following completion of IV acyclovir, all infants with neonatal HSV infection must receive oral acyclovir suppression therapy for 6 months. - Infants must be closely monitored with serial blood cell counts for neutropenia while receiving acyclovir suppressive therapy. - Should have absolute neutrophil counts assessed at 2 and 4 weeks after starting treatment and then monthly since at risk for neutropenia/myelosuppression

Answer 19

Congenital Syphilis - Pt: - Early congenital syphilis (<2yo) - Snuffles / copious purulent rhinorrhea - Pseudoparalysis of extremity secondary to osteochondritis or periostitis - Skin rash of vesicular/desquamation of hands/feet - Late congenital syphilis (>2yo) - Hutchinson triad: - Hutchinson teeth (peg/barrel incisors) - Sensorineural hearing loss - Interstitial keratitis - Mulberry molars - Saddle nose (destruction of septum) - Saber shins (anterior bowing of tibia) - Eyes (interstitial keratitis), clutter joints (painless arthritis of knees) - Dx: - Non-treponemal testing: RPR, VDRL - Treponemal testing: FTA-ABS - Tx: Penicillin G

Answer 20

Hyperthermia | - Increases risk of neural tube defects

Answer 21

Valproic acid | - Neural tube defects. Craniofacial and digital complications

Answer 22

Phenytoin - Fetal hydantoin syndrome: growth deficiency, craniofacial defects, abnormal/retarded growth and development, and hypo plastic phalanges/nails - P: cleft Palate - H: small Head, Hypoplastic face, Heart defects - N: hypoplastic Nails/digits, Neurologic defects

Answer 23

Carbamazepine | - Risk of spina bifida

Answer 24

Lithium | - Ebstein’s anomaly - atrialization of RV. Can develop into WPW

Answer 25

Thalidomide | - Originally antinausea drug. Limb defects

Answer 26

Methotrexate | - Craniosynostosis, craniofacial abnormalities, limb defects

Answer 27

ACE Inhibitors | - Renal dysgenesis, oligohydramnios, skull ossification defects

Answer 28

DES | - Vaginal adenocarcinoma

Answer 29

Retinoids - Malformations: Microcephalic, facial palsies, microbial, external auditory canal anomalies, cardiovascular defects, thymic hypoplasia, GU anomalies

Answer 30

Streptomycin | - Hearing loss

Answer 31

Tetracycline | - Discoloration of fetal teeth

Answer 32

Warfarin | - Fetal warfarin syndrome: Nasal hypoplasia, stippled epiphyses

Answer 33

SSRIs - Can present with NAS - Increase the risk persistent pulmonary HTN

Answer 34

Cocaine - Increase risk of miscarriage, stillbirth, premature delivery, placental abruptions, intracranial hemorrhage - Infant: jitteriness, excessive sucking, hyperactive Moro reflex, irritable, muscle rigidity

Answer 35

Tobacco - Low birth weight, SGA - Miscarriage, prematurity, stillbirth

Answer 36

Neonatal Abstinence Syndrome - Tachypnea, diarrhea, hypertonia, high pitched cry, tremors/jitteriness, irritability, sleep problems/restlessness, fever, nasal flaring, vomiting, poor feeding, seizures, autonomic symptoms

Answer 37

Fetal Alcohol Syndrome - Most common cause of intellectual disability - Dx: 3 cardinal features along with substantiated maternal alcohol use: - 1) Abnormal facial features. Must have 2 of the following - Hypoplastic nasal root - Short upturned nose - Hypoplastic or absent philtrum - Thin upper lip - Midface hypoplasia - 2) Pre of postnatal growth deficiency. Must have 1 of the following - Weight <10%ile - Microcephalic - Length/Height ratio <10%ile - 3) Cognitive abnormalities: must have 1 developmental or learning problem

Answer 38

Endotracheal intubation for pediatrics - Size (mm) - Uncuffed: tube = (age/4) + 4 - Cuffed: tube = (age/4) + 3.5 - Depth: - Child <1 year: Depth of intubation cm = weight/2 + 8 - Child >1 year: Depth of intubation cm = age/2 + 13

Answer 39

Monozygotic “identical” twins - Most commonly monochorionic/diamniotic - Monoamniotic/monochorionic (single placenta) - share same amniotic sac/cavity; highest risk of cord entanglement Dizygotic “fraternal” twins - Diamniotic and dichorionic (separate placentas) - Dizygotic twins are no more similar than nontwin siblings

Newborn Flashcards

(63 cards)