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91 Cards in this Set

  • Front
  • Back
apgar score
heart rate
respiration
color
tone
reflex irritability
routine newborn care
cleanse and rinse
bacterocidal agent to cord
1% silver nitrate or 0.5% erythromycin for eyes
1mg vitamin K IM
birth injuries
subconjunctival hemorrhage
skull fracture
brachial palsy
clavicular fracture
facial nerve palsy
caput succedaneum
cephalohematoma
subcutaneous fat necrosis
subconjunctival hemorrhage
from sudden increase in intrathoracic pressure passing through canal; resolves spontaneously
skull fractures of newborn
linear --> most common; no symptoms nor treatment needed
depressed --> elevate to prevent cortical injuries
basilar --> fatal
brachial palsy
Erb-Duchene --> C5-C6; no sholder abduction, external rotation or supination of arm
Klumpke --> C7/C8 +- T1; paralyzed hand +- Horner syndrome
most will recover
clavicular fracture
from shoulder dystocia in vertex position and arm in extension in breech; palpable callus within a week; immobilization
facial nerve palsy
from forceps or pressure during delivery; improves over week or neuroplasty
caput succedaneum
diffuse edematous swelling of scalp which crosses suture lines; spontaneously dissapears
cephalohematoma
diffuse edematous swelling of scalp which does not cross suture lines; spontaneously dissapears
subcutaneous fat necrosis
difficult labor/delivery, perinatal asphixia, prolonged hypothermia; hypocalcemia
cutis marmorata
lacy, reticulated vascular pattern over skin on most of the body; improves but may be associated with syndromes
milia
firm white papules, inclusion cyst and Epstein pearls on palate midlines; resolves
salmon patch
nevus simplex; pale pink vascular macules usually symmetric; facial ones dissapear
mongolian spots
blue to slate-gray macules on presacral, back or posterior thighs; improves; differentiate from child abuse
erythema toxicum
firm yellow-white papules/pustules with erythematous base; self-limited; differentiate from SSSS
port-wine stain
vascular malformation, permanent, unilateral; rule out Sturge-Weber; laser treatment
hemangioma
superficial --> bright red protuberant sharply demarcated; involutes in years
deep --> bluish hue firm cystic; may persist; check internal organs; laser therapy
neonatal acne
erythematous papules on face from high maternal androgens; no treatment
preauricular tags/pits
may indicate hearing loss and GU anomalies
nevus sebaceous
area of alopecia with nodular orange skin; possible malignancy; remove before adolescence
coloboma of iris
cleft at six-o-clock position; most have other eye anomalies; CHARGE association
aniridia
hypoplasia of iris; associated with Wilms tumor
brachial cleft cyst
mass on lateral neck; infections are common; surgical removal
thyroglosal duct cyst
mass on neck midline; moves with swallowing
congenital torticollis
knotted-up sternocleidomastoid; treat with passive ROM exercises
breast hypertrophy
common; should be symmetric; otherwise may be absecess or mastitis
suppernumerary nipples
usually along mammary gland; associated with renal and cardiovascular anomalies
Poland syndrome
amastia, pectoralis muscle aplasia, rib deformities, webbed fingers, radial nerve aplasia
pectus excavatum/carinatum
usually benign; correction for cosmetic reasons
diaphramagmatic hernia
scaphoid abdomen and bowel sounds in chest
omphalocele
sac covered protrusion through umbilicus; associated with malformations and chromosome disorders
umbilical hernia
most close spontaneously; consider congenital hypothyroidism
gastroschisis
uncovered protrusion lateral to abdominal midline; may have intestinal atresia
abdominal masses in newborn
polycystic kidney disease, hydronephrosis, enlarged bladder
hydrocele
transitory; palpation and illumination of testes diffrentiated from inguinal hernia
hypospadia
urethral opening on ventral surface of penis
epispadia
urethral opening on dorsal surface
undescended testes
usually in inguinal canal; differentiate from retractile testes; if not descended by one year then surgical removal to avoid sterility and malignancy
hernias in newborn
usually inguinal and indirect; surgical treatment
syndactyly
fusion of fingers or toes; get x-ray first for surgical planning
polydactyly
> 5 fingers; no treatment needed if good blood supply
newborn screening
do before discharge or fourth day
more realiable after 48 hours
examples: phenylketonuria, galactosemia, hypothyroidism
phenylketonuria
phenylalanine hydroxylase deficiency with excess phe; mental retardation, vomiting, abnormal movements, fair hari skin blue eyes, normal at birth; treatment is phenylalanine restriction for life
galactosemia
G-1-P uridyltransferase deficiency; jaundice, hypoglycemia, catarracts, mental retardation, e. coli sepsis; restric lactose
intrauterine growth restriction
symmetric --> genetic syndromes, chromosomal abnormalities, congenital infections, teratogens
assymetric --> uteroplacental insufficiency due to maternal diseases; placental dysfunction
infants of diabetic mothers
fetal hyperinsulinemia --> hypoglycemia
large for gestational age and plethoric
hyperbilirubinemia
tachypnea
cardiomegaly - assymetric septal hypertrophy
birth trauma - macrosomia
polycythemia
renal vein thrombosis
causes of respiratory distress in newborn
respiratory distress syndrome
transient tachypnea of the newborn
meconium aspiration
diaphragmatic hernia
respiratory distress syndrome of newborn presentation
due to surfactant deficiency in premature
tachypnea, nasal flaring, grunting
hypoxemia, hypercabia and respiratory acidosis
respiratory distress syndrome of newborn diagnosis
initial diagnostic test --> chest x-ray (ground glass appearance, atelectasis, air bronchograms)
most accurate test --> L/S ratio (done on amniotic fluid prior to birth)
respiratory distress syndrome of newborn treatment
best initial treatment --> oxygen + nasal continuous positive airway pressure
most effective treatment --> exogenous surfactant administration

prevention --> avoid prematurity with tocolysis
antenatal betamethasone
transient tachypnea of newborn
due to slow absorption of lung fluid with increased dead space
presents with tachypnea after birth
do chest x-ray (air trapping, fluid in fissures, perihilar streaking
improves within hours to days
meconium aspiration presentation
meconium passes as result of fetal hypoxia and distress
severe respiratory distress
hypoxemia
barrel chest
meconium aspiration diagnosis
chest x-ray --> patchy infiltrates, increased AP diameter, flattening of diaphragm
meconium aspiration complications
pneumothorax
aspiration pneumonitis
pulmonary artery hypertension
meconium aspiration treatment and prevention
treatment --> positive pressure ventilation, high frequency ventilation, nitric oxide, extracorporeal membrane oxygenation
prevention --> endotracheal intubation and airway suction of depressed infants with thick meconium
diaphragmatic hernia
abdominal content into thorax causes pulmonary hypoplasia
respiratory distress
scaphoid abdomen
bowel sounds in chest
bowel in chest seen in x-ray
diagnosis --> prenatal ultrasound
treatment --> immediate intubation and surgical correction
meconium plugs
seen in IODM, Hirchsprung, cystic fibrosis, maternal drug abuse
meconium ileus
mostly in cystic fibrosis
abdominal distention, vomitting, perforation, no passage of meconium within 24-48 hours
first test --> abdominal x-ray shows distention of bowel loops
treatment --> high gastrografin enemas
tracheoesophageal fistula
coughing choking or gagging with first feeding
respiratory distress
aspiration pneumonia
mostly proximal esophageal atresia and distal fistula with air in stomach
necrotizing enterocolitis
transmural intestinal necrosis associated with prematurity
bloody stools, apnea, lethargy, abdominal distention
pneumatosis intestinalis on abdominal x-ray is pathognomonic
Hirchsprung disease
initial test --> barium enema shws megaacolon proximal to aganglionic segment
best test --> rectal biopsy shows absent ganglionic cells
duodenal atresia
bilious vomiting from first feeding
abdominal x-ray shows double bubble sign
surgical correction
kernicterus
unconjugated bilirubin in basal ganglia and brain stem nuclei
hypotonia
seizures
opisthotonos
delayed motor skills
choreoathetosis
sensorineural hearing loss
physiologic Vs. pathologic jaundice
physiologic --> 2-3 day of life, dissapears by 5th, peak bilirubin 10-12mg/dL, rate of rise <5mg/dL/day
pathologic --> appears in 1st 24 hours, variable dissapearance, unlimited bilirubin, rate of rise > 5mg/dL/day
jaundice work-up in newborn
1) determine if it's physiologic or pathologic
2) determine if it's direct or indirect
3) if indirect --> Coombs test; if negative -->
4) determine hemoglobin levels
indirect hyperbilirubinemia, Coombs test +
Rh/ABO incompatibility
thalassemia minor
indirect hyperbilirubinemia, Coombs test -, high hb
polycythemia
twin-twin transfusion
maternal-fetal transfusion
delayed cord
IUGR
infant of diabetic mother
indirect hyperbilirubinemia, Coombs test -, low hb
spherocytosis
eliptocytosis
G6PD deficiency
pyruvate kinase
direct hyperbilirubinemia causes
sepsis
TORCH
total parenteral nutrition
hypothyroidism
galactosemia
tyrosinemia
cystic fibrosis
choledochal cyst
treatment of hyperbilirubinemia
phototherapy (complications are loose stools, rash, overheating, dehydration, bronze baby)
if phototherapy is not enough --> double volume exchange transfusion
Crigler-Najjar type I
glucoronyl transferase deficiency leads to unconjugated hyperbilirubinemia
rapid rise in indirect bilirubin >20mg/dL, no hemolysis, kernicterus
Dx --> closed liver bipsy to measure glucoronyl transferase
Tx --> intensive phototherapy and exchange transfusions
Crigler-Najjar type II
partial glucoronyl transferase deficiency leads to unconjugated hyperbilirubinemia
milder than type I with no kernicterus
Tx --> phenobarbital
Gilbert syndrome
unconjugated hyperbilirubinemia
low glucoronyl transferase levels
benign, no treatment necessary
Dubin-Johnson
conjugated bilirubin cant get out of liver
mild disease detected in adolescence
Rotor syndrome
conjugated bilirubin can't get out of liver
mild disease detected in adolescence
neonatal sepsis presentation
irritability
poor feeding
fever
grunting
bulging fontanel
delayed capillary filling
neonatal sepsis risk factors
prematurity
chorioamnionitis
intrapartum fever
maternal leukocytosis
prolonged rupture of membranes
neonatal sepsis bugs
group B strep
E. coli
listeria
neonatal sepsis work-up and diagnosis
CBC
blood culture
urinalysis
urine culture
chest x-ray
if meningitis is suspected --> lumbar puncture
neonatal sepsis treatment
if no meningitis --> ampicillin + aminoglycoside
if meningitis --> ampicillin + 3rd gen ceph (except ceftriaxone)
TORCH
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
toxoplasmosis congenital infection
usually in cat feces or undercooked raw meat
chorioretinitis
hydrocephalus
generalized intracranial calcifications
seizures
visual impairments

treat mother with spiramycin
treat baby with sulfonamide for 6 months
congenital rubella
blueberry muffin spots
PDA
pulmonary artery stenosis
cataracts
congenital hearing loss
cytomegalovirus neonatal infection
periventricular calcifications
microcephaly
chorioretinitis
sensorineural hearing loss
neonatal herpes
disseminated --> pneumonia, shock, hepatitis
skin, eyes, mouth --> keratoconjunctivits
CNS --> meningitis, lethargy, seizures
outcomes --> deafness, blindness, microcephaly, seizures

diagnosis --> PCR + Tzanck smear culture
treatment acyclovir
congenital syphilis
before 2 --> fever, anemia, rash, jaundice, anemia
after 2 --> Hutchinson teeth, Clutton joints, saber shins, saddle nose, osteochondritis, rhagades
diagnosis --> radiographic bone changes, treponema in scrapings from lesions; most specific --> FTA-ABS
treatment --> penicillin
TORCH work-up if suspected
total cord IgM
urine CMV culture --> if negative, excludes CMV
IgM --> toxoplasmosis, rubella
maternal rubella status --> if positive, excludes it
PCR --> for herpes
neonatal seizures causes
hypoxic ischemic encephalopathy --> cerebral palsy
intraventricular hemorrhage --> preterm
metabolic --> IODM, inborn errors of metabolism, DiGeorge
infection --> TORCH, maternal fever, sepsis/meningitis
neonatal seizures work-up
EEG --> may be normal
CBC, electrolytes, glucose
if meningitis --> lumbar puncture
if infection --> blood and urine cultures
if preterm --> ultrasound of the head for intraventricular hemorrhage
neonatal seizures presentation
chewing, tongue thrusting, apnea, staring, blinking, color changes, desaturation