Theory 5a2 Flashcards by Klaren Voon

Neonatal hypoglycemia

Blood glucose level below__milligrams per deciliter in term infants and below__milligram per deciliter in preterm infants

Below
40 mg/dL in term infants
30 mg/dL in preterm infants

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This is when Blood glucose level falls below 40 milligrams per deciliter in term infants and below 30 milligram per deciliter in preterm infants

Neonatal hypoglycemia

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Neonatal hypoglycemia

This is common in patients with:

Preterm infant
Small for gestational age infants
Large for gestational age infants
Infant of diabetic mothers

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What are the two types of hypoglycemia?

Reactive hypoglycemia/postprandial hypoglycemia

Fasting hypoglycemia/postabsorptive hypoglycemia

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Neonatal hypoglycemia

What is the primary energy source of the brain?

Glucose

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Neonatal hypoglycemia

In the utero, the fetus receives a glucose from maternal circulation via the __

Placenta

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Neonatal hypoglycemia

After birth glucose homeostasis depends on these two process

Glycogen stores and gluconeogenesis

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Neonatal hypoglycemia
True or false

Hypoglycemia occur when the glucose utilization exceeds production

True

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Neonatal hypoglycemia

Give me the four risk factors

Prematurity
Inadequate glycogen stores
Perinatal stress
Excessive insulin production (hyperinsulinism)

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Neonatal hypoglycemia
Types of hypoglycemia

This refers to low blood sugar that occur after a meal, usually within four hours after eating

Reactive hypoglycemia, or postprandial hypoglycemia

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Neonatal hypoglycemia
Types of hypoglycemia

This occurs when both glucagon and epinephrine are deficient, but not when either glucagon or epinephrine alone is deficient and insulin is present

Fasting hypoglycemia, or post-absorptive hypoglycemia

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This occurs when the blood glucose level of the infant is >125 mg/dL in preterm infants and >150 mg/dL in term infants

Neonatal hyperglycemia

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Neonatal hyperglycemia

Blood glucose level
__In pre-term infants
__In term infants

> 125 mg/dL in preterm infants and >150 mg/dL in term infants

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Neonatal hyperglycemia
True or false

Hypoglycemia is often asymptomatic and is frequently diagnosed on routine screening of an infant at risk

True

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Where does the word hyperglycemia derive from?

Derived from the Greek term

Hyper (high)
Glykys (sweet/sugar)
Haima (blood)

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Neonatal hyperglycemia
True or false

This is more common than hypoglycemia

False

it is less common than hypoglycemia

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Where is hyperglycemia typically seen in preterm infants and neonates

When they receive IV glucose therapy

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Hypoglycemia
In what way do you diagnose the infant?

Heel stick blood glucose monitoring

Confirming plasma glucose testing

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Hyperglycemia
In what way do you diagnose the infant?

Heel stick blood glucose monitoring
Serum insulin levels
Urine glucose testing

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This refers the condition of surfactant deficiency and physiological immaturity of the thorax

Respiratory distress syndrome (RDS)

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What is the principle cost of Respiratory distress syndrome (RDS)?

Low level or absence of surfactant

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Respiratory distress syndrome (RDS)

What normally lines the alveola and reduce surface tension to keep the alveola from collapsing on expiration

Phospholipid

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Respiratory distress syndrome (RDS)

This is the presence of air in the plural cavity of the lungs, causing pain and difficulty in breathing

Pneumothorax

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Respiratory distress syndrome (RDS)
True or false

Male babies are more susceptible in contracting RDS

True
Androgens induce a delayed maturation of lecithin compound of surfactant

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Respiratory distress syndrome (RDS) Diagnostic testing This is used as a severity of the respiratory distress in newborns and preterm infants without respiratory support. It evaluate five parameters of work of breathing and assigned an overall score with a patient breathing comfortably with a zero and a patient in severe respiratory distress with a ten

Silverman Anderson retraction score

Respiratory distress syndrome (RDS) Silverman Anderson retraction score What does it mean when the score is 0 to 3?

Mild respiratory distress

Respiratory distress syndrome (RDS) Silverman Anderson retraction score What does it mean when the score is 4 to 6?

Moderate respiratory distress

Respiratory distress syndrome (RDS) Silverman Anderson retraction score What does it mean when the score is >6?

Impending respiratory failure

Respiratory distress syndrome (RDS) Silverman Anderson retraction score What does it mean when the score is 10?

Severe respiratory distress

Respiratory distress syndrome (RDS) What are the two under medical management?

Oxygen administration and ventilation

Respiratory distress syndrome (RDS) pharmacologic management This is a important vascular dilator. This helps oxygenate a newborn lungs.

Nitric oxide

Respiratory distress syndrome (RDS) Pharmacology management This type of therapy enhances pulmonary maturity before delivery of the baby

Steroid therapy

Respiratory distress syndrome (RDS) Pharmacology management This should be immediately done after birth and is administered in an endotracheal tube by a syringe or a catheter It is important that the baby is tipped into an upright position, following administration

Surfactant replacement

Respiratory distress syndrome (RDS) Pharmacology management Surfactant replacement True or false The infant airways is not suction for as long as possible, after administration of surfactant

True

Respiratory distress syndrome (RDS) Surgical management This manager, severe hypoxemia of newborns. This was primarily used as a main state of therapy for RDS, but is now rarely needed because of surfactant lavage

Extracorporeal membrane oxygenation

This is the newborn’s first poop. This sticky thick, dark green poop is made up of cell proteins, fat and intestinal secretions like bile.

Meconium

Meconium aspiration syndrome True or false Some babies passed meconium was still in the womb

True

This syndrome is evidenced by troubled breathing in a newborn who has aspirated a dark, green sterile fecal material called meconium into the lungs before or around the time of birth

Meconium aspiration syndrome

How and when does meconium aspiration happen in a baby?

Me aspiration happens when a baby is stressed and gasps while still in the womb

Meconium aspiration syndrome Medical interventions This can be used to dilute the amount of meconium in the amniotic fluid and has shown to improve the outcomes for newborn with meconium situations where perinatal observation is limited

Amnioinfusion

This is seen in preterm infants and characterized by poses in breathing lasting >20 seconds It results from an immature central respiratory control system, and under developed airway reflex

Apnea of prematurity (AOP)

Apnea of prematurity (AOP) This is characterized by passing and breathing lasting. How many seconds?

Lasting more than or equal to 20 seconds

Apnea of prematurity (AOP) As often associated with

Bradycardia Desaturation (low oxygen level) Cyanosis

Apnea of prematurity (AOP) True or false In utero fetal breathing is irregular

True It is irregular and dependent on brainstem, maturity

Apnea of prematurity (AOP) What are the three types of apnea?

Central apnea Obstructive apnea Mixed apnea

Apnea of prematurity (AOP) Types of apnea This is the absence of respiratory effort due to immature, brain, stem control

Central Apia

Apnea of prematurity (AOP) Types of apnea Airflow obstruction due to upper airway collapse despite respiratory effort

Obstructive apnea

Apnea of prematurity (AOP) Types of apnea Combination of central and obstructive apnea most common type and preterm infants

Mixed apnea

Apnea of prematurity (AOP) Pharmacological intervention This is frequently used in reducing the frequency of primary apnea Ricardia episodes in neonates as well as functioning as a CNS stimulant to breathing

Caffeine citrate

Apna of prematurity (AOP) Pharmacological intervention This is an alternative if caffeine is unavailable, it increases tidal volume and has minimal effect on respiratory frequency

Theophylline

This is a type of chronic lung disease that affects babies most commonly in those who are born prematurely and require oxygen therapy. Babies aren’t born with the condition when a baby has been on oxygen or breathing machine for a long time this can happen. This can cause inflammation as well as scarring in the lungs.

Bronchopulmonary dysplasia

And this this is the lungs and airways are damaged, causing tissue destruction in the tiny air sacks of the lungs. This causes damage to the current developing alveoli.

Bronchopulmonary dysplasia

Bronchopulmonary dysplasia What are the two pharmacological interventions?

Corticosteroids Bronchodilators through nebulizer

This is a genetic disorder affecting the exocrine glands leading to abnormally, thick mucus production

Cystic fibrosis (CF)

Cystic fibrosis (CF) This primarily impacts these systems

Respiratory Gastrointestinal Reproductive

Cystic fibrosis (CF) This is a genetic disorder affecting what type of glands?

Exocrine glands

Cystic fibrosis (CF) True or false It is an autosomal recessive disorder

True

Cystic fibrosis (CF) This is caused by a mutation in what gene

Cystic fibrosis transmembrane conductane regulator gene (CFTR)

Cystic fibrosis (CF) Defective CFTR protein leads to what?

Decrease chloride secretion Increase sodium absorption

Cystic fibrosis (CF) What happens to the gastrointestinal system?

-Meconium ileus in newborn -Pancreatic insufficiency -Malabsorptive fats, proteins and fat soluble, vitamin -Failure to thrive despite a good appetite -Distended abdomen rectal prolapse

Cystic fibrosis (CF) What happens in the male reproductive system?

95% infertility due to absence of vas differens

Cystic fibrosis (CF) What happens in the female reproductive system?

Thick cervical mucus can reduce fertility

Cystic fibrosis (CF) True or false Your skin will taste salty

True Due to excessive sodium chloride loss and sweat

Cystic fibrosis (CF) What does the gold standard of diagnosing cystic fibrosis

Sweat chloride test

Cystic fibrosis (CF) Sweat chlorine test If Chloride concentration is ___mEq/L it confirms cystic fibrosis

>60 mEq/L confirms cystic fibrosis

Cystic fibrosis (CF) This type of diagnosis measures immuno reactive trypsinogen level levels

Newborn screening

Cystic fibrosis (CF) This type of diagnosis identifies CFTR mutations

Genetic testing

Apnea of prematurity This diagnosis tracks apnea events HR and SPO2

Continuous cardio, respiratory monitoring

Apnea of prematurity This diagnosis evaluate respiratory patterns and persistent places this is a comprehensive test used to diagnose sleep disorder it records brain waves the oxygen level in the blood heart rate and breathing as well as eye movements

Polysomnography

Apnea of prematurity This diagnosis assesses for acidosis or hypoxia

Blood gas analysis

Apnea of prematurity This diagnosis rules out sepsis if apnea is prolonged or worsening

Infection screening

Cystic fibrosis (CF) What are the Four treatment and management?

Respiratory care Gastrointestinal and nutritional support Infection control CFDR modulator therapy

Cystic fibrosis (CF) This type of CFDR modulator therapy improve CFTR function

Ivacaftor (kalydeco)

Cystic fibrosis (CF) This type of CFDR modulator therapy helps protein function properly

Lumancaftor-Ivacaftor (Orkambi)

Meconium aspiration syndrome What is the gold standard diagnosis?

Echocardiography

Meconium aspiration syndrome This type of diagnosis shows right to left shunting through the ductus arteriosus or the foramen ovale it detects elevated pulmonary pressures

Echocardiography

This is a serious neonatal condition in which the pulmonary arteries remain constricted after birth leading to high pulmonary vascular resistance resulting in rate the left chanting of blood and severe hypoxemia despite oxygen therapy

Persistent, pulmonary hypertension of the newborn

Persistent pulmonary hypertension of the newborn (PPHN) This prevents normal transition from __ to __ circulation

Transition from fetal to neonatal circulation

Persistent pulmonary hypertension of the newborn (PPHN) True or false This results in right to left shunting of the blood

True

What are the two types of Persistent pulmonary hypertension of the newborn (PPHN)?

Primary Persistent pulmonary hypertension of the newborn (PPHN) Secondary Persistent pulmonary hypertension of the newborn (PPHN)

Persistent pulmonary hypertension of the newborn (PPHN) Which type is this? Occurs when the pulmonary vessels failed to relax and open with initial respiration of birth

Primary Persistent pulmonary hypertension of the newborn (PPHN)

Persistent pulmonary hypertension of the newborn (PPHN) Which type is this? Results from hypoxic stress that increase PVR and causes a return to fetal cardiac pulmonary circulation

Secondary Persistent pulmonary hypertension of the newborn (PPHN)

Persistent pulmonary hypertension of the newborn (PPHN) What are the risk factors?

Pre-term or poster birth Maternal NSAID use Intrauterine growth restriction Delayed resuscitation at birth

This is a condition where a newborn has low red blood cell count, hemoglobin or hematocrit level levels leading to poor oxygen delivery to tissues

Neonatal anemia

Neonatal anemia Treatment and management What do you do in mild cases?

- Monitor and support nutrition (iron EPO for prematurity) - Hydration

Neonatal anemia Treatment and management What do you do for severe blood loss?

- Blood transfusion - partial exchange transfusion (symptomatic, or HCT > 70%)

Neonatal anemia Treatment and management What do you do when homolysis occurs?

Phototherapy or exchange transfusion

Neonatal anemia Treatment and management What do you do if infections occur?

Antibiotics

Neonatal anemia Types of anemia It is a hypochromic microcytic type of anemia, resulting from an adequate iron supplementation chronic blood loss in men and older women who have ulcers CGI two more and younger women with heavy menstruation

Iron deficiency anemia

Neonatal anemia Types of anemia This is caused by damage to the hematopoietic stem cell and the bone marrow. This causes a depression of all blood element elements, pancytopenia, anemia, leukopenia, and thrombocytopenia.

Aplastic anemia

Neonatal anemia Type of anemia This is caused by faulty absorption of vitamin B12 from the G.I. tract, which is required in the production of red blood cells

Pernicious anemia

This is when the hematocrit exceeds 65% or hemoglobin is abnormally high This results in thickened blood (hyperviscosity) reduced oxygen delivery and increased risk of complications

Polycythemia

Polycythemia True or false This results in thickened blood

True Hyperviscosity

Polycythemia What are the three causes?

Increased fetal erythropoiesis (excess RBC production) Fetal maternal blood transfer imbalances Genetic and other causes

Polycythemia Give me the percentage of hematocrit

Hematocrit exceeds 65%

This is also called the hemorrhagic decease of the newborn This is a bleeding disorder in unit units due to low vitamin K levels

Vitamin K deficiency bleeding (VKDB)

Vitamin K deficiency bleeding (VKDB) True or false This leads to impaired clotting, factor activation

True

Vitamin K deficiency bleeding (VKDB) What are the three types of VKDB?

Early VKDB within the first 24 hours Classic VKDB 2 to 7 days Late VKDB 1 to 12 weeks after birth

Vitamin K deficiency bleeding (VKDB) Types of VKDB Rare but severe often associated with maternal medications like anticonvulsant or warfarin Bleeding is in the brain, abdomen or skin

Early VKDB

Vitamin K deficiency bleeding (VKDB) When does early VKDB usually occur?

Within 24 hours after birth

Vitamin K deficiency bleeding (VKDB) Types of VKDB Most common type bleeding sites are umbilical, circumcision site, gastrointestinal, track, and skin bruising

Classic VKDB

Vitamin K deficiency bleeding (VKDB) When does classic VKDB usually occur?

2 to 7 days after birth

Vitamin K deficiency bleeding (VKDB) Types of VKDB Seen and exclusively breast-fed infants who did not receive vitamin K at birth Bleeding sites are usually in the brain, skin and G.I. tract Severe and life-threatening

Late VKDB

Vitamin K deficiency bleeding (VKDB) When does late VKDB usually occur?

1 to 12 weeks after birth

Vitamin K deficiency bleeding (VKDB) True or false Platelet count is normal

True Not a platelet disorder

Vitamin K deficiency bleeding (VKDB) What is the prevention and treatment?

Vitamin K injection at birth Oral vitamin vitamin K

Vitamin K deficiency bleeding (VKDB) How many milligrams of vitamin K is given at birth?

1 mg IM vitamin K

Vitamin K deficiency bleeding (VKDB) This type of treatment requires multiple doses to be effective and a less reliable than IM injection

Oral vitamin K

This is a disorder involving immature, retinal vasculature. It is a condition seen in infants of low birth weight with progressive and excessive neovascularization.

Retinopathy of prematurity

Retinopathy of prematurity What can cause Retinopathy of prematurity?

Premature birth can Increase oxygen level and damage capillaries

Retinopathy of prematurity What are the five stages of retinopathy?

1. A demarcation line separates the a vascular retina interiorly from the vascularized retina posteriorly. 2. A ridge formed from the demarcation line with the height and width occupies volume and extends beyond the plane of retina. 3. A ridge with extraretinal fibrovascular proliferation 4. Partial retinal detachment. 5. Total retinal detachment.

Retinopathy of prematurity These are white pupils

Leukocoria

Retinopathy of prematurity These are abnormal eye movements

Nystagmus

Retinopathy of prematurity These are crossed eyes

Strabismus

Retinopathy of prematurity Severe nearsightedness

Myopia

Retinopathy of prematurity What is This medical management This involves placing a silicon based band around the eye and tightening it. It’s reason is to keep the vitreous gel from pulling on the scar tissue and allows the retainer to flatten back down onto the wall of the eye

Sclera buckle

Retinopathy of prematurity What does the surgical management? Use of extreme cold to freeze and remove abnormal tissue they should be done under general anesthesia

Cryotherapy

Retinopathy of prematurity What surgical therapy is this? It is used to focus the laser light into the retina. It uses light, the great thermal burn on the retinal tissue.

Indirect laser photocoagulation

Retinopathy of prematurity What surgical management is this? An eye surgery to treat various problems with the retina and vitreous this involves removing the vitreous and replacing it with saline solution after the vitreous has been removed The scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall

Vitrectomy

This type of brain injury or reperfusion injury is the most common cause of neurologic impairment in term and preterm infants. That brain damage is usually a result from a fixture before during or after delivery.

Hypoxic ischemic brain injury

Hypoxic ischemic brain injury This is defined as below normal levels of oxygen in your blood specifically in the arteries

Hypoxemia

Hypoxic ischemic brain injury This is a condition where a part of your body is not getting enough blood

Ischemia

Hypoxic ischemic brain injury What are the three classifications?

Mild HIE Moderate HIE Severe HIE

Hypoxic ischemic brain injury Types of HIE Less than 5% of the infants will have a severe handicap

Mild HIE

Hypoxic ischemic brain injury Types of HIE More than 75% of the infants will have a severe handicap or potentially die early in life

Severe HIE

Hypoxic ischemic brain injury What are the three risk assessment?

Preeclampsia Lung malformation or respiratory distress Cardiac arrest

Hypoxic ischemic brain injury What is the major intervention in the management of hypoxic ischemic brain injury?

Immediate cooling

Hypoxic ischemic brain injury Types of HIE 25% to 75% of the infants will have a severe handicap or potentially die in early life

Moderate HIE

This is a hemorrhage or bleeding that can occur within the brain or in the space between the brain and the skull were the accumulation of blood may causes brain damage by increasing pressure on the brain tissue

Intracranial hemorrhage

Intracranial hemorrhage True or false It is usually asymptomatic

True If left untreated, it can be life-threatening

Intracranial hemorrhage How can this be detected?

CT scan

Intracranial hemorrhage What are the two types?

Extra Axial Intra Axial

Intracranial hemorrhage What are the three types of extra axial hemorrhage?

Subarachnoid Subdural Epidural

Intracranial hemorrhage What is the example under intra axial hemorrhage?

Intracerebral

Intracranial hemorrhage Types of hemorrhage This is the accumulation of blood between the skull and Dura matter when the skull fracture stairs and underlying blood vessel

Epidural hemorrhage

Intracranial hemorrhage Types of hemorrhage What usually causes an epidural hemorrhage?

Most commonly the result of severe head injury, such as motorcycle or snowboarding accident

Intracranial hemorrhage Types of hemorrhage True or false Epidural hemorrhage is four times more likely to occur in males than females

True

Intracranial hemorrhage Types of hemorrhage Epidural hemorrhage What are under the Cushing triad, which is a late sign of impending means them herniation

Hypertension Bradycardia Respiratory depression

Intracranial hemorrhage Types of hemorrhage This is bleeding in the space between the Dura motor and the arachnoid membrane

Subdural hemorrhage

Intracranial hemorrhage Subdural hemorrhage True or false This is more common in term

True

Intracranial hemorrhage Types of hemorrhage How does subdural hemorrhage usually occur in neonates?

It is a consequence of labor and delivery

Intracranial hemorrhage Types of hemorrhage True or false Subdural hemorrhage is the most dangerous type

True As the blood quickly pull within the subdural space causing rapid pressure in the brain

Intracranial hemorrhage Types of hemorrhage This refers to bleeding at the space between the arachnoid membrane and the PIA matter

Subarachnoid hemorrhage

Intracranial hemorrhage Types of hemorrhage What is the most common type of intracranial hemorrhage?

Subarachnoid hemorrhage

Intracranial hemorrhage Subarachnoid hemorrhage True or false This is more common in pre-term

True

Intracranial hemorrhage Types of hemorrhage What is the leading cause of subarachnoid hemorrhage?

Rupture of abnormal bulge and a blood vessel or aneurysm in your brain About 85% of cases

Intracranial hemorrhage Types of hemorrhage This is bleeding inside of the brain

Intercerebral hemorrhage

Intracranial hemorrhage Types of hemorrhage True or false Intercerebral hemorrhage is the most common type of intracranial hemorrhage

False It is the second most common type

Intracranial hemorrhage Intracerebral hemorrhage True or false This is more common in preterm

True

These are the most common and distinct clinical manifestations of neurological dysfunction in newborn infants

Neonatal seizures

This is defined as a paxoxysmal alteration in neurological function, such as motor, behavioral or autonomic function

Seizure

Neonatal seizures Types of seizures This is especially common in pre-term and term infants This is the most common type of seizure

Subtle seizure

Neonatal seizures Types of seizures Subtle seizure constitutes how many percent of all seizures?

50% of all seizures

Neonatal seizures Types of seizures This type prefers to sustain flexion or extension of Axial or appendicular muscle group

Tonic seizures

Neonatal seizures Types of seizures True or false Tonic seizures, primarily found in preterm

True

Neonatal seizures Types of seizures Or tonic seizures associated with EEG changes

No, EEG changes

Neonatal seizures Types of seizures These are muscle group movements that are rhythmic. They have both fast and slow components a frequency of 1 to 3 jerks per second.

Clonic seizures

Neonatal seizures Types of seizures True or false Clonic seizures are primarily preterm

False they are primarily term

Neonatal seizures Types of seizures Chronic seizures are frequently associated with EEG changes

Yes, they are

Neonatal seizures Types of seizures How many jerks per second does a clonic seizure usually have

1 to 3 jerks

Neonatal seizures Types of seizures This manifest as a single or multiple fast jerks of the upper or lower limbs, and are usually distinguished from chronic movements by their faster, speed and lack of slow return and preference for flexor muscle groups

Myoclonic seizures

Neonatal seizures Types of seizures Myoclonic seizures commonly see changes on EEGs

Yes, they do include birth, suppression pattern, focal, sharp waves

Neonatal seizures This surgical management removes a small area of the brain tissue that causes seizures

Focal resection

Neonatal seizures This type of surgical management is a procedure where the disease half of the brain is removed or partially removed from the normal hemisphere. This is one of the most effective procedures of stopping seizures and carefully selected patients.

Cerebral hemispherectomy

What are the clotting factors of vitamin K deficiency bleeding?

2,7,9,10

Latino Patsy of prematurity occur mainly in infants with Weeks grams

Middle of 32 weeks and 1500 g

Theory 5a2 Flashcards

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