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83 Cards in this Set

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What age range does neonatology cover?
0-28 days
Most neonatologists deal with what pts?
premature neonates
What are some maternal conditions that can increase the risk to the new born?
-antiphospholipid syndrome
-hyperthyroidism
-DM
-cyonotic heart disease
-SLE
-HTN
-CKD
-hemoglobinopathies
What are some pregnancy associated conditions that put the newborn at risk?
-PIH
-decreased fetal movements
-oligohydramnios
-IUGR
-polyhydromnios
-multiple gestations
-previous demise
-premature rupture of membranes
-unexplained third trimester bleeding
What does a CST test?
it evaluates fetal HR in response to maternal stimuli
What is included in a biophysical profile?
-reactive NST (non-stress test)
-fetal breathing
-movement
-tone
-amniotic fluid volume
What are some non reassuring fetal heart patterns?
-persistent late decelerations or severe variable decelerations associated with the absence of variability are always non reassuring and require prompt intervention
If persistent late decelerations or severe variable decelerations associated with the absence of variability persist, what must be done?
-induction of labor or C-section would be the tx of choice to prevent asphyxia with subsequent brain injury
What are some things in a neonate that require resuscitation at birth?
-respiratory distress
-hypotension
-PDA
-hypothermia
Give me some examplse of respiratory distress
-RDS
-pneumothorax
-apnea and bradycardia
Name some metabolic problems that can be seen in the neonate
-hypoglycemia
-hypocalcemia
-lyte imbalance
-osteopenia pf prematurity
What is asphyxia?
-acute deprivation of oxygen accompanied by reduced oxygen delivery to the tissues
What is done to test asphyxia at birth? (well score it that is)
Apgar Score
What do you do if the Apgar is less than 5?
-obtain a re test q 5 minutes until 2 scores above 7
Apgar is poor at predicting outcome, but does reflect what?
delayed onset of respiration failure and circulatory failure
If Apgar score remains low after 15-20 minutes, what does this mean?
there is a markedly increased risk for long term disability or mortality
Acidosis is cord blood below what?
pH of 7
What are some component of skilled resuscitation?
-respiratory support
-tx of seizures with anticonvulsants
-prevention of cerebral edema
-tx of hypotension
-renal support with dopamine
-tx hypoglycemia and hyponatremia
Correlation between CP and birth asphyxia is what?
a mispreception
Less than a fourth of infants with neonatal encophalopathy have what at birth?
evidence of hypoxia at birth
Only ________ hypoxia has been associated with subsequent neurological dysfunction.
severe
What is the Dx/Dx for respiratory distress?
-RDS
-pneumothorax
-anatomic condistions
-muconium aspiration
-infections
What is a common cause of respiratory distress in term infants?
-transietn tachyponoea of the newborn
In respiratory distress, there is increased pressure in the lungs due to what?
collapsed alveoli
In respiratory distress, less blood goes where?
to the lungs
PDA is maintained by what?
low oxygen and high acidosis
In muconium aspiration syndrome, there is partial airway obstruction, and the ball valve effects of this leads to what?
air leaking
A collapsed lung leads to what?
increased pulmonary pressure
What is a deficiency of surfactant known as?
respiratory distress syndrome
RDS leads to what?
alveolar collapse and poor gas exchange
What are some causes of RDS?
-prematurity
-maternal diabetes inhibits secretion of surfactant to newborn
-acidosis
-infections
-hypoxia
-hypothermia
What are some S/S of RDS?
-tachypnea
-retractions
-grunting
-cyanosis
-CXR shows ground glass apprearance
What is the tx for RDS?
-intubation and mechanical ventilation
-surfactant therapy
What are some causes of Jaundice in the newborn?
-rapid fall of HGB after birth from hemolysis
-decreased life span of the red cells in newborns
-hepatic insufficiency
Jaundice may be a sign of another disorder like what?
sepsis
Deposition of unconjugated bilirubin in the basal ganglia causes what?
kernicterus
What is kernicterus?
neurotoxicity that ranges from transient disturbance to death
Management of jaundice varies based on what things?
-age of onset
-bili level
-rate of increase
-infant gestational age
-clinical condition
What are some causes of hemolytic disorders?
-RH incompatibility
-ABO incompatibility
RH incompatiblity :
-age?
-how fast is the rise?
-worst case scenario?
-<24 hrs
-rise is rapid
-at worse pt develops hydrops
Jaundice for ABO incompatiblity is usually less or more severe than RH incompatiblity?
less severe
What are some other hemolytic disorders that deal with unconjugate hyperbilirubin at less than 24 hrs of age?
-G6PD def
-spherocytosis
-congenital infections
What are some causes of unconjugated hyperbilirubinemia at 2 days to 2 weeks of age? (main causes)
-physiologic
-infection
-other
What are some causes of unconjugated hyperbili that is at >2 weeks of age?
-phsiologic or breast milk
-infection (UTI)
-hypothyroidism
-high gastrointestinal obstruction
-hemolytic disorders
What are some causes of conjugated hyperbili that is at > 2 weeks of age?
-liver problem until proven other wise

-neonatal hepatitis
-biliary tress obstruction
What are some management options for jaundice?
-correct poor fluid intake and feeding
-phototherapy
-exchange transfusion
-phenobarbital treatment
Don't give a baby fluids with out what in it?
dextrose in it
What is the inital fluid given to a neonate?
D10W
What is the rate of infusion for a neonate?
80cc/kg/24 hrs
If a bolus fluid is required for a neonate, what do you give?
D5NS at 10cc/kg pushed
In fluid replacement of a newborn, diuresis usually begins after the 3rd day, and at that point what do you switch that fluid to?
D5 1/2NS with 10meq kcl?l

-100cc/kg/24 will be used at this point
What is apnea?
cessation of breathing for over 10 seconds
What are some causes of apnea?
-central mediated by the premature brain
-obstructive mediated by anatomy
-periodic breathing is normal
What is the tx for apnea?
-obstruction-remove obstruction
-central-caffeine is DOC
Toxoplasmosis is associated with what mainly?
cats
What does toxoplasmosis cause?
-IUGR
-brain calcification
What is the tx for toxoplasmosis?
-maternal-Spiramycin to prevent transmission

-fetal-Azithromiacin or Clarithromycin
Can Syphilis cross that placenta?
yes, at will
What are some early complications of congenital syphilis?
-IUGR
-brain involvement
-hemolytic anemia
-bone and eye problems
What is the tx for Syphilis?
PCN
Listeriosis can cause what?
-sepsis
-premature birth
-fetal loss
-hepatosplenomegaly
-neurologic sequele
What is the tx for Listeriosis?
Amp and Gent
Congenital Chlamydia can cause what?
-conjuctivis
-pneumonia
What is the tx for congenital chlamydia?
sliver nitrate in eyes of all babies, and Zithromax
Congenital N....clap causes what in the neonate?
-neonatal sepsis
-PROM
-prematurity
-IUGR
What is the tx for congenital N....clap?
silver nitrate and Ceftriaxone
Congenital herpes can cause what?
herpetic lesions or disseminated disease with encephalitis
What is the tx for congenital HSV?
-c-section
-acyclovir prophylaxis in newborns
What is the presentation of neonatal seizures?
-tonic, clonic, cycling of the limbs, or Apnea and bradycardia
What are some causes of neonatal seizures/
-hypoglycemia (suspect this first)
-calcium and Na abnormalities
-trauma
-sepsis
What is the tx to neonatal seizures?
-anticonvulsants
Cocaine in a neonate can cause what?
vasoconstriction and neurotoxicity
What are some associated findings of cocaine in a neonate?
-microcephaly
-vascular accidents
-abruptions
-PROM
-w/drawal symptoms
What are some characteristic traits that are found in FAS?
-saddle shaped nose
-maxillary hypoplasia
-absent philtrum btw the nose and upper lip
-short, thin upper lip
-strawberry naevus
How many types of Esophageal Astresia are there?
3 and H is least common
What is the presentation for esophageal astresia?
-drooling
-salivation
-choking
-vomiting with feeding
-RDS
How do you dx esophageal atresia?
scope for H type (passed tube will not reach stomach with others)
How does a small bowel obstruction present present?
-persistent vomiting mostly bile stained unless obstruction above the ampula of Vater
What are some causes of small bowel obstruction?
-duodenal atresia
-malrotation with vulvulus
-jejunum or ileum atresia
What are some causes of large bowel disorders?
-Hirschsprung
-Rectal Atresia
What is the tx for Hirschsprung or a Rectal Atresia?
surgical
Follow up from NICU is usually done when?
by 6-9 months of age
Follow up from NICU assesses what things?
-nurtition
-catch up growth
-neurological deficits
-vision problems
-preparation for school
-psychological stressors