Pediatrics Case 7: Tachypnea In Nb

Front 1

Potential Complications of LGA newborns?

Back 1

- Large infants often must be delivered by C-section, by forceps, or vacuum extraction (all of which have associated complications)
- Birth injuries are more common, such as fractured clavicle, brachial plexus injury, and facial nerve palsy
- Hypoglycemia is especially common in LGA infants born to diabetic mothers

Front 2

Potential complications for SGA newborns?

Back 2

- Temperature instability (hypothermia)
- Hypoglycemia because of inadequate glycogen stores
- Polycythemia and hyperviscosity

Front 3

At birth, successful transition to extrauterine life involves:

Back 3

Removal of the low-resistance placental circulation by cutting the umbilical cord.
- Initiation of air breathing by the newborn infant.
- Reduction of the pulmonary arterial resistance.
- Closure of the PFO and PDA.

Front 4

Persistent pulmonary hypertension of the newborn (PPHN)

Back 4

the result of elevated pulmonary vascular resistance to the point that venous blood is diverted to various degrees through fetal channels (the ductus arteriosus and foramen ovale) into the systemic circulation and bypasses the lungs, resulting in systemic arterial hypoxemia.

Front 5

PPHN causes:

Back 5

including meconium aspiration syndrome, diaphragmatic hernia, hypoplastic lungs, and in utero asphyxia.

Front 6

PPHN symptoms:

Back 6

- Tachypnea
- Tachycardia
- Respiratory distress, with findings such as expiratory grunting and nasal flaring
- Generalized cyanosis
- Low oxygen levels, even while receiving 100% oxygen

Front 7

Congenital diaphragmatic hernia

Back 7

congenital malformation resulting from a defect in the development of the diaphragm. The most common type is the Bochdelek hernia (a posterolateral hernia) that accounts for the majority (> 95%) of cases. This defect allows the passage of organs from the abdomen into the chest cavity and severely impairs lung development. Most defects occur on the left side. Absent breath sounds or presence of bowel sounds on one side of the chest are important diagnostic clues.

Front 8

Why are infants born to diabetic mothers LGA?

Back 8

High levels of maternal serum glucose during pregnancy result in hyperglycemia in the fetus. This stimulates the fetal pancreatic beta cells and the development of hyperinsulinemia. Maternal insulin does not cross the placenta.

Insulin is the primary anabolic hormone for fetal growth. High levels in the third trimester result in increased growth of the insulin-sensitive organ systems (heart, liver and muscle) and a general increase in fat synthesis and deposition. This combination of increased body fat, muscle mass, and organomegaly produces a macrosomic (LGA) infant. Insulin-insensitive organs, such as the brain and kidneys, are not affected by the elevated insulin levels, and have appropriate size for gestational age.

Front 9

Major malformations for infants of a diabetic mother are most likely caused by what?

Back 9

Control of diabetes during pregnancy is an important predictor of fetal outcome, especially with regard to the risk of birth defects. The incidence of major malformations is directly related to the First-Trimester HbA1C level: Infants born to women with HbA1C levels >12 have at least a 12-fold increase in major malformations.

Front 10

What are proper levels of glucose in a newborn?

Back 10

In utero, glucose crosses the placenta, maintaining the fetal blood glucose at approximately two-thirds of maternal levels. At birth, separation from the placenta results in a decline in the infant's glucose levels over the first 1-2 hours of life. Levels then increase and stabilize by 3-4 hours at mean levels of 65-71 mg/dL. - Asymptomatic infants and infants at risk for hypoglycemia: <35 mg/dL3
- Symptomatic infants: <45 mg/dL

Front 11

radiographic findings of an infant w/ TTN? RDS?

Back 11

- Significant perihilar streaking: interstitial fluid and engorged lymphatics. Coarse, fluffy densities that represent fluid-filled alveoli. Fluid in the pleural space and a small amount of fluid in the fissures on the lateral view. VS. (RDS) would have radiographic findings that typically include a diffuse reticulogranular appearance of the lung fields ("ground glass appearance") and air bronchograms

Front 12

Risk factors for DDH include:

Back 12

- Breech position: 30-50% of DDH cases occur in infants born in the breech position.
- Gender: 9:1 female predominance.
- Family history.