Mcphs Problems Of The Neonate

Front 1

What is considered to be the neonatal period?

Back 1

The first 28 days of life

Front 2

What is the period from birth to six days considered to be?

Back 2

Early neonatal period

Front 3

What is the period after birth 7 through 27/28 days of age (first lunar month)?

Back 3

Late neonatal period

Front 4

Newborns produce bilirubin at a rate of approximately ?

Back 4

6-8mg per kg per day

Front 5

Bilirubin production typically declines to the adult level within

Back 5

10-14 days

Front 6

Water soluble bilirubin is?

Back 6

BC = conjugated or Direct bilirubin it is Water soluble

Front 7

diazo reagent + blood specimen =

Back 7

Azobilirubin = Direct Bilirubin

Front 8

This bilirubin is not water soluble?

Back 8

BU = unconjugated or indirect bilirubin is NOT water soluble
Reaction: Reacts more slowly. Still binds with diazo reagent and forms azobilirubin but needs Ethanol therefore the measurement of this bilirubin is “indirect”.

Front 9

Indirect bilirubin =

Back 9

Total bilirubin – Direct bilirubin

Front 10

Total Bilirubiin =

Back 10

BU (end conjugated bilirubin) + BC

Front 11

refers to the neurologic consequences of the deposition of unconjugated bilirubin in brain tissue.

This can cause Subsequent damage and scarring of the basal ganglia and brain-stem nuclei may occur.

Back 11

Kernicterus

Front 12

Physiologic jaundice of the newborn is a result of ?

Back 12

the immature liver's lacking sufficient conjugating enzymes.

Front 13

The newborn's inability to conjugate bilirubin results in?

Back 13

high circulating blood levels of unconjugated bilirubin, which, if untreated, passes through the blood-brain barrier.

Front 14

Indirect bilirubin is calculated from the?

Back 14

total and direct bilirubin.

Front 15

Bilirubin levels can be decreased by exposing newborns to?

Back 15

ultraviolet light.

Front 16

Infants without identified risk factors rarely have total serum bilirubin levels above ?

Back 16

12 mg per dL (205 µmol per L).

Front 17

What level is the bilirubin in a newborn if it is visible in the skin?

Back 17

>5mg/dl

Front 18

What are the levels of biliribun when visible at the following locations?

Face
Upper trunk
Lower trunk & thighs
Arms and lower legs
Palms & soles

Back 18

Face 4-8
Upper trunk 5-12
Lower trunk & thighs 8-16
Arms and lower legs 11-18
Palms & soles > 15

Front 19

Appears after 24 hours
Maximum intensity by 4th-5th day in term & 7th day in preterm
Serum level less than 15 mg / dl
Clinically not detectable after 14 days
Disappears without any treatment

Back 19

Physiological Jaundice

Front 20

Why does physiologic jaundice develop?

Back 20

Increased bilirubin load
Defective uptake from plasma
Defective conjugation
Decreased excretion
Increased entero-hepatic circulation

Front 21

Appears within 24 hours of age
Increase of bilirubin > 5 mg / dl / day
Serum bilirubin > 15 mg / dl
Jaundice persisting after 14 days
Stool clay / white colored and urine staining clothes yellow
Direct bilirubin> 2 mg / dl

Back 21

Pathological Jaundice

Front 22

Causes for jaundice Appearing within 24 hours of age

Back 22

Hemolytic disease of NB : Rh, ABO
Infections: TORCH, malaria, bacterial
G6PD deficiency

Front 23

Causes of jaundice Appearing between 24-72 hours of life

Back 23

Physiological
Sepsis
Polycythemia
Concealed hemorrhage
Intraventricular hemorrhage
Increased entero-hepatic circulation

Front 24

Causes of jaundice after 72 hours of age

Back 24

Sepsis
Cephalhaematoma
Neonatal hepatitis
Extra-hepatic biliary atresia
Breast milk jaundice
Metabolic disorders

Front 25

RISK FACTORS FOR JAUNDICE:

J
A
U
N
D
I
C
E

Back 25

J - jaundice within first 24 hrs of life
A - a sibling who was jaundiced as neonate
U - unrecognized hemolysis
N – non-optimal sucking/nursing
D - deficiency of G6PD
I - infection
C – cephalhematoma /bruising
E - East Asian/North Indian

Front 26

What are common causes of jaundice?

Back 26

Exaggerated physiological
Blood group incompatibility – ABO,Rh
G6PD deficiency
Bruising and cephalhematoma
Intrauterine and postnatal infections
Breast milk jaundice

Front 27

Calorie deprivations
Decreased volume and frequency of feedings = mild dehydration and delayed passage of meconium
BF babies 3-6 x more likely to experience moderate jaundice (Total serum bilirubin level above 12 mg/dL) or severe jaundice (Total serum bilirubin level above 15 mg/dL)

Back 27

Early onset breastfeeding jaundice

Front 28

Causes not entirely understood. May be that some substances in maternal milk may inhibit normal bilirubin metabolism.

May substitute formula if serum bilirubin goes up; after 48 hours of formula substitution breastfeeding can be resumed if bilirubin level declines rapidly (indicating BF jaundice).

Back 28

Late-Onset Breast Milk Jaundice

Front 29

What is the approach to a jaundice baby?

Back 29

Ascertain birth weight, gestation and postnatal age
Ask when jaundice was first noticed
Assess clinical condition (well or ill)
Decide whether jaundice is physiological or pathological
Look for evidence of kernicterus* in deeply jaundiced NB

*Lethargy and poor feeding, poor or absent Moro's, opisthotonus or convulsions

Front 30

What is the workup for a jaundice baby?

Back 30

Maternal & perinatal history
Physical examination
Laboratory tests (must in all)*
Total & direct bilirubin*
Blood group and Rh for mother and baby*
Hematocrit, retic count and peripheral smear*
Sepsis screen
Liver and thyroid function
TORCH titers, liver scan when conjugated hyperbilirubinemia

Front 31

What is the management for a jaundice baby?

Back 31

Rationale: reduce level of serum bilirubin and prevent bilirubin toxicity
Prevention of hyperbilirubinemia: early feeds, adequate hydration
Reduction of bilirubin levels: phototherapy, exchange transfusion, drugs

Front 32

Native bilirubin that is insoluble is exosed to what in order to create soluble photo isomers of bilirubin?

Back 32

450-460nm of light

Front 33

How do you perform phototherapy?

Back 33

Perform hand wash
Place baby naked in cradle or incubator
Fix eye shades
Keep baby at least 45 cm from lights, if using closer monitor temperature of baby
Start phototherapy

Front 34

What are six important things to know with phototherapy?

Back 34

Frequent extra breast feeding every 2 hourly
Turn baby after each feed
Temperature record 2 to 4 hourly
Weight record- daily
Monitor urine frequency
Monitor bilirubin level

Front 35

What are the side effects of phototherapy?

Back 35

Increased insensible water loss
Loose stools
Skin rash
Bronze baby syndrome
Hyperthermia
Upsets maternal baby interaction
May result in hypocalcemia

Front 36

What are the causes of prolonged indirect jaundice?

Back 36

Crigler Najjar syndrome
Breast milk jaundice
Hypothyroidism
Pyloric stenosis
Ongoing hemolysis, malaria

Front 37

What are two things that would make you suspect conjugated hyperbilirubinemia?

Back 37

High colored urine
White or clay colored stool

Always refer to hospital for investigations so that biliary atresia or metabolic disorders can be diagnosed and managed early

Front 38

What are the causes of conjugated hyperbilirubinemia?

Back 38

Idiopathic neonatal hepatitis
Infections -Hepatitis B, TORCH, sepsis
Biliary atresia, choledochal cyst
Metabolic -Galactosemia, tyrosinemia, hypothyroidism
Total parenteral nutrition

Front 39

What is the differential diagnosis of respiratory distress syndrome?

Back 39

1- Transient tachypnea of newborn
2- Congenital heart disease
3- Hyaline membrane disease
4- Neonatal sepsis
5- Hyperviscosity syndrome

Front 40

Most common cause of respiratory distress.
40% cases.
Residual fluid in fetal lung tissues.
Risk factors- maternal asthma, c- section, male sex, macrosomia, maternal diabetes

Back 40

Transient tachypnea of newborn

Front 41

Tachypnea immediately after birth or within two hours, with other predictable signs of respiratory distress.
Symptoms can last few hours to two days.
Chest radiography shows diffuse parenchymal infiltrates, a “ wet silhouette” around heart, or intralobar fluid accumulation

Back 41

Transient Tachypnea of Newborn

Front 42

What will an X-Ray show with transient tachypnea of newborn?

Back 42

Fluid in the fissure

Front 43

Also called as hyaline membrane disease
Most common cause of respiratory distress in premature infants, correlating with structural & functional lung immaturity.
1/3 infants born between 28 to 34 weeks, but less than 5% of those born after 34 weeks.
Pathophysiology- surfactant deficiency- increase in alveolar surface tension- decrease in compliance.

Back 43

Respiratory distress syndrome

Front 44

Hyaline membrane- combination of sloughed epithelium, protein & edema.
Diagnosis of respiratory distress should be suspected when grunting, retraction or other typical distress symtoms occur in premature infant.
CXR- homogenous opaque infiltrates & air bronchograms.

Back 44

Respiratory distress syndrome

Front 45

Incidence- 1.5- 2 % in term or post term infants.
Meconium is locally irritative, obstructive & medium for for bacterial culture
Meconium aspiration causes significant respiratory distress. Hypoxia occurs because aspiration occurs in utero.
CXR- Patchy atelectasis or consolidation.

Back 45

Meconium aspiration syndrome

Front 46

Risk factors- prolonged rupture of membranes, prematurity,& maternal fever.

Back 46

risk factors for infection

Front 47

What will you see on CXR with an infection?

Back 47

CXR- bilateral infiltrates suggesting in utero infection.

Front 48

The following are caused by what?

Pulmonary hypoplasia, congenital emphysema, esophageal atresia & diaphragmatic hernia.

Back 48

Congenital Malformations

Front 49

What is a cause for the following?
hydrocephalus & intracranial hemorrhage.

Back 49

Neurological causes

Front 50

What can cause hypoglycemia, hypocalcemia, polycythemia?

Back 50

Metabolic Derangements