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56 Cards in this Set
- Front
- Back
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Newborn vs Infant
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Less than one month vs Less than a year
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Premature, Mature, Post Mature
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<37 weeks
37-42 >42 |
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SGA - small for gestational age
AGA LGA |
<10th percentile
10th - 90th percentile >90th percentile |
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What is a low birth weight ? When do you see this ?
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Below 2500g. (1st percentile)
In premature infants and SGA newborns |
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Immature neonate
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Below 1000g. Extremely low birthweight ELBW
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Ways in which neonates are classified ?
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LGA, SGA or AGA with premature, mature or postmature
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Neonate is above the growth chart, and therefore requires immediate C section at 32 weeks. What is the classifiecation
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Premature LGA
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Top 3 differentials for neonate death in industrialized nations
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1.Birth defects
2.Low birth weight : SGA and prematurity 3. SIDS |
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How do you takcle LBW ?
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Prenatal care
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Major risk factors for prematurity
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5 factors !!!!
1. Placenta, Uterine and Cervic abn 2. Multiple gestations 3. Fetal disease 4. PROM 5. Infection leading to sick fetus |
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SGA reasons :
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FETAL GROWTH RESTRICTION
Fetal disorders Placental disorders Maternal disorder |
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What are the fetal disorders that can cause SGA ?
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Well there are two types -
1. Intrinsic - These can include chromosomal abnormalities(TRIPLOIDY AND TRISOMY) and congenital anomalies 2. Extrinsic - These are extenral agents, like a TORCH infection or drugs/toxin or radiation |
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What anatomical association do fetal disorders usually have ?
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No sparing of the brain
- SYMMETRIC or proportionate growth retardation - decreased: ht, wt & head circumference* |
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Placental disorders
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Uteroplacental insufficiency
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W.r.t Placental disorders
1. When is the period of most susceptibility ? 2.Comment on growth 3. Name 6 disorders that can cause this |
1. THIRD trimester
2. Baby has ASYMMETRIC growth retardation, however the brain is SPARED, and normal 3.Vacular disorder, placenta, previa, placenta abruptia, placenta infection, pulmonary thrombosis and infarction and multiple gestations leading to abnormal flow |
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Maternal disorders causing FGR
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Vascular
Drugs Malnutrition |
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What would you expect in a neonate born to an Aftrican american mother with chronic HTN, SCD, toxemia of pregnancy due to abuse of narcotics drugs etc ?
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Fetal growth restriction, which would be the cause of SGA and
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APGAR in newborn. Do you want this low or high /
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High score = better prognosis.
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Small premie has
- Tachypnea - Nasal flaring & intercostal retractions & grunting (dyspnea) - +/- Pallor - mottled skin - +/- Cyanosis What disorder is this ? |
Respiratory distress syndrome.
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What are the PULMONARY Ddx for RDS ?
realize there could be other causes like CNS, CHD, severe anemia,Anatomic problems, Metabolic problems |
1.Hyaline Membrane disease- generalized atelectasis
2.Meconium aspiration 3.Bacterial pneumonia 4.Pneuomothorax 5.Transient tachypnea - wet lung 6.Pulmonary hemorrhage 7.Diaphragmatic hernia 8.Pulmonary hypoplasia |
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CXR shows ground glass appearance of lung fields . What does this suggest is going on in the lungs ?
What is it shows air bronchograms ? |
Atelectasis
These are seen when air stands out against the collapsed atelectatic parenchyma |
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Pathophys behind meconium ?
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Meconium is the babies poop. This can be ingested in utero, and when the baby is born the meconium slips into the lungs causing an obstruction or chemical pneumonitis
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Newborn presents with tachypnea, pallor, cyanosis, and dyspnea. Comment on the possible pathophys in the lungs and clinical presentation
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Respiratory distress with fine rale
CXR would show ground glass appearance - showing atelectasis |
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How is this treated these days ?
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Artifical surfactant
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What is the physiology behind surfactant and how it affects prematurity
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Well Well Well, in premature infants, there is a surfactant deficiency. This can cause hypoxia and hypercapnia, due to the collapse of alveoli in the lungs. This metabolic and respiratory acidosis causes endothelium and epithelial damage, leading to leakage of plasma into the lungs. This exudate consists of fibrin and necrotic cells, and is called fibrinoid necrosis and causes the HYALINE MEMBRANES. And the formation of hyaline membranes leads to increased diffusion gradient and this has a POSITIVE FEEDBACK on the acidosis, which in turn feeds back on the SURFACTANT deficiency
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How is hyaline membrane dx treated ?
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Artifical surfactant
Mechanical ventilation - pressure - oxygen |
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So you diagnosed this tachypneic newborn with hyaline membrane disease after noticing fibrinoid necrosis on the slide and metabolic acidosis, and decided to treat with mechanical ventilation of 40 atm o2, and the newborn just tanks. What happened ?
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There could be two explanations
1. Oxygen toxicity - due to high oxygen concenttration or high pressure which damages the lung 2.Lung damage from intersitital emphysema pneumothorax bronchopulmonary dysplasia |
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So the tech accidently set the oxygen pressure at 500atm, instead of 100atm. What just happened ?
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An interstitial emphysema( Escape of air from the alveoli into the interstices of the lung, commonly due to trauma or violent cough.) and pneumothorax
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What about bronchopulmonary dysplasia in the past
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- A form of chronic lung disease
- Resulted from mechanical ventilation of premies - Required chr. O2 therapy - Pathology: changes AIRWAY CHANGES, FIBROSIS - Uncommon today because of improvements in ventilation management (surfactant; lower pressure) |
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What is its pathophys currently ?
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Now BPD is used in ELBW with little or no lung disease at birth. However there is a progressive disease that develops due to arrested lung development - alveolar hypoplasia.
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So how would you treat the above ?
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Chronic O2 therapy, however if this therapy lasted more than a year, then it has a poor prognosis
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What causes retrolental fibroplasia ?
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Oxygen toxicity (high IFio2) also called retinopathy of prematurity
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Since treatment of RDS with artifical surfactant and better oxygen ventilatiors, what are some of the newer probelms seen ?
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PDA
Interventricular hemorrhage necrotizing enterocolitis |
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Baby on aritifical surfactants presents with labored breathing, and neurological deficits and later died. What is the problem ?
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Interventricular hemorrhage. - This is hemorrhage into the periventricular area and brain tissue due to the rupture of germinal matrix vessels causing herniation and death
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So an investigation was set up to determine why there was tonsillar herniation, and it was found that hemorrhage occured. So what exactly damaged those germinal matrix vessels ?
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Vessel injuries are caused by
Hypoxia Hypotension (ischemia) Reperfusion (oxidative stress) Hypertension (mechanical stress) Incr. venous pressure (mechanical stress) |
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Newborn who was on a ventilator presented with neurological deficitys like a decreased Moro reflex, lethargy , somnolence, bulging fontanella, pallor, shock from blood loss, decreased muscle findings, apnea and seizures
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IVH !
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Features of IVH ?
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Aboev
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What else causes a bulging fontanelle ?
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Meningitis
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Major complications of IVH?
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ICP
Hydrocephalus Destructed cortical tissue Periventricular Leukomalacia - loss of white matter. Not specific for IVH |
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Newborn on a ventilator presents with necrotizing enterocolitis ? Pathphys ?
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Ischemic injury to the bowel !
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Newborn on respirator presents with bloody stools abdominal distention, circulatory collapse, gas within intestinal walls - pneumatosis instestinalis. DDx ?
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NEC...r/o IVH or sepsis
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Pathophysiology of NEC
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Generalized or local ischemia damaged the mucosal barrier. Thus upon feeding the newborn, there is a compromise in the structure and there is mucosal infection with gut flora leading to further loss of mucosal barrier and sepsis, shock and death
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So if you were to do an US on a newborn with NEC. Where would you look ? If this was a chronic conditions, what would you expect to see ?
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Terminal ileum, cecum and right colon.
Strictures of the colon from healing. aka FIbrosis |
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Upon biopsy of a newborn with the presentation of NEC, you find submucosal or subserosal gas filled cysts. What is this condition called ?
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Pneumatosis intestinalis
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What are the infections affecting new borns ?
TORCH AND SLAVE infections |
Yeah, TORCH are similar presentations
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Neonate presents with fever, encephalitis, chorioretinitis, HSM, pneumonitis, myocarditis, hemolytic anemia, vesicular or hemorrhagic skin lesions
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Definitely an intrauterine infection !
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Which bacteria cause infecton in newborns. Early onset (<7 days) and late onset (7days - 3months)
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Early - Group B streptococcus, and Ecoli
Late - Group B strep, Listeria monocytogenes and Candida Albicans |
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A 3 month old presents with sepsis, pneumonia, meningitis and soft tissue infections. How would you calssify this ?
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A post natal infection
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Newborn in RESPIRATORY distress, seizures, hypotension, COLD, with meningitis, pneumonia and bone and soft tissue dmaage
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SEPSIS !! RUN !!
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Hah ! So you treated the kid, now you are asked to determine what caused this sepsis or infection ?
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1. Aspirated Meconium (chemical pneumonitis)
2. Intrauterine infection 3. Mucosal perforation - NEC 4. Iatrogenic |
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They ask you to figure out what bacteria it was ?
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Well, since its a new born its either Group B streptocci or Ecoli
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How would you differentiate a GBS penumonia infection from HMD ?
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Well since its an infxn, you can expect an inflammatory response in the interstitum and membranes.
By about half a day, the lungs show infiltrates of neutrophils |
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Metabolic problems affecting new borns?
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Hypoglycemia
Hypocalcemia Unconjugated hyperbilirubinemia - deficiency of UDP glucouronyl transferase that causes unconjugated hyperbilirubinemia ( a risk for kernicterus) |
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What is hydrops fetalis
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Edema fluid present in the fetus
Distribution: generalized versus localized - Localized - Generalized: +/-evidence of CHF, pulmonary edema, anasarca, pleural effusion, ascites |
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What test detects it ?
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Prenatal ultrasound
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Oops lost all the typed up cards. Read page 221 and 222.
Understand Peristence of Fetal circulation and the complications you an see from Diabetes |
OKAYYYY
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