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83 Cards in this Set
- Front
- Back
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What age range does neonatology cover?
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0-28 days
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Most neonatologists deal with what pts?
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premature neonates
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What are some maternal conditions that can increase the risk to the new born?
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-antiphospholipid syndrome
-hyperthyroidism -DM -cyonotic heart disease -SLE -HTN -CKD -hemoglobinopathies |
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What are some pregnancy associated conditions that put the newborn at risk?
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-PIH
-decreased fetal movements -oligohydramnios -IUGR -polyhydromnios -multiple gestations -previous demise -premature rupture of membranes -unexplained third trimester bleeding |
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What does a CST test?
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it evaluates fetal HR in response to maternal stimuli
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What is included in a biophysical profile?
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-reactive NST (non-stress test)
-fetal breathing -movement -tone -amniotic fluid volume |
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What are some non reassuring fetal heart patterns?
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-persistent late decelerations or severe variable decelerations associated with the absence of variability are always non reassuring and require prompt intervention
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If persistent late decelerations or severe variable decelerations associated with the absence of variability persist, what must be done?
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-induction of labor or C-section would be the tx of choice to prevent asphyxia with subsequent brain injury
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What are some things in a neonate that require resuscitation at birth?
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-respiratory distress
-hypotension -PDA -hypothermia |
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Give me some examplse of respiratory distress
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-RDS
-pneumothorax -apnea and bradycardia |
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Name some metabolic problems that can be seen in the neonate
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-hypoglycemia
-hypocalcemia -lyte imbalance -osteopenia pf prematurity |
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What is asphyxia?
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-acute deprivation of oxygen accompanied by reduced oxygen delivery to the tissues
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What is done to test asphyxia at birth? (well score it that is)
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Apgar Score
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What do you do if the Apgar is less than 5?
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-obtain a re test q 5 minutes until 2 scores above 7
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Apgar is poor at predicting outcome, but does reflect what?
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delayed onset of respiration failure and circulatory failure
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If Apgar score remains low after 15-20 minutes, what does this mean?
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there is a markedly increased risk for long term disability or mortality
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Acidosis is cord blood below what?
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pH of 7
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What are some component of skilled resuscitation?
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-respiratory support
-tx of seizures with anticonvulsants -prevention of cerebral edema -tx of hypotension -renal support with dopamine -tx hypoglycemia and hyponatremia |
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Correlation between CP and birth asphyxia is what?
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a mispreception
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Less than a fourth of infants with neonatal encophalopathy have what at birth?
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evidence of hypoxia at birth
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Only ________ hypoxia has been associated with subsequent neurological dysfunction.
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severe
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What is the Dx/Dx for respiratory distress?
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-RDS
-pneumothorax -anatomic condistions -muconium aspiration -infections |
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What is a common cause of respiratory distress in term infants?
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-transietn tachyponoea of the newborn
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In respiratory distress, there is increased pressure in the lungs due to what?
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collapsed alveoli
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In respiratory distress, less blood goes where?
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to the lungs
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PDA is maintained by what?
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low oxygen and high acidosis
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In muconium aspiration syndrome, there is partial airway obstruction, and the ball valve effects of this leads to what?
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air leaking
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A collapsed lung leads to what?
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increased pulmonary pressure
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What is a deficiency of surfactant known as?
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respiratory distress syndrome
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RDS leads to what?
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alveolar collapse and poor gas exchange
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What are some causes of RDS?
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-prematurity
-maternal diabetes inhibits secretion of surfactant to newborn -acidosis -infections -hypoxia -hypothermia |
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What are some S/S of RDS?
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-tachypnea
-retractions -grunting -cyanosis -CXR shows ground glass apprearance |
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What is the tx for RDS?
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-intubation and mechanical ventilation
-surfactant therapy |
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What are some causes of Jaundice in the newborn?
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-rapid fall of HGB after birth from hemolysis
-decreased life span of the red cells in newborns -hepatic insufficiency |
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Jaundice may be a sign of another disorder like what?
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sepsis
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Deposition of unconjugated bilirubin in the basal ganglia causes what?
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kernicterus
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What is kernicterus?
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neurotoxicity that ranges from transient disturbance to death
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Management of jaundice varies based on what things?
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-age of onset
-bili level -rate of increase -infant gestational age -clinical condition |
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What are some causes of hemolytic disorders?
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-RH incompatibility
-ABO incompatibility |
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RH incompatiblity :
-age? -how fast is the rise? -worst case scenario? |
-<24 hrs
-rise is rapid -at worse pt develops hydrops |
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Jaundice for ABO incompatiblity is usually less or more severe than RH incompatiblity?
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less severe
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What are some other hemolytic disorders that deal with unconjugate hyperbilirubin at less than 24 hrs of age?
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-G6PD def
-spherocytosis -congenital infections |
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What are some causes of unconjugated hyperbilirubinemia at 2 days to 2 weeks of age? (main causes)
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-physiologic
-infection -other |
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What are some causes of unconjugated hyperbili that is at >2 weeks of age?
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-phsiologic or breast milk
-infection (UTI) -hypothyroidism -high gastrointestinal obstruction -hemolytic disorders |
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What are some causes of conjugated hyperbili that is at > 2 weeks of age?
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-liver problem until proven other wise
-neonatal hepatitis -biliary tress obstruction |
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What are some management options for jaundice?
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-correct poor fluid intake and feeding
-phototherapy -exchange transfusion -phenobarbital treatment |
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Don't give a baby fluids with out what in it?
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dextrose in it
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What is the inital fluid given to a neonate?
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D10W
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What is the rate of infusion for a neonate?
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80cc/kg/24 hrs
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If a bolus fluid is required for a neonate, what do you give?
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D5NS at 10cc/kg pushed
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In fluid replacement of a newborn, diuresis usually begins after the 3rd day, and at that point what do you switch that fluid to?
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D5 1/2NS with 10meq kcl?l
-100cc/kg/24 will be used at this point |
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What is apnea?
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cessation of breathing for over 10 seconds
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What are some causes of apnea?
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-central mediated by the premature brain
-obstructive mediated by anatomy -periodic breathing is normal |
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What is the tx for apnea?
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-obstruction-remove obstruction
-central-caffeine is DOC |
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Toxoplasmosis is associated with what mainly?
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cats
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What does toxoplasmosis cause?
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-IUGR
-brain calcification |
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What is the tx for toxoplasmosis?
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-maternal-Spiramycin to prevent transmission
-fetal-Azithromiacin or Clarithromycin |
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Can Syphilis cross that placenta?
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yes, at will
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What are some early complications of congenital syphilis?
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-IUGR
-brain involvement -hemolytic anemia -bone and eye problems |
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What is the tx for Syphilis?
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PCN
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Listeriosis can cause what?
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-sepsis
-premature birth -fetal loss -hepatosplenomegaly -neurologic sequele |
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What is the tx for Listeriosis?
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Amp and Gent
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Congenital Chlamydia can cause what?
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-conjuctivis
-pneumonia |
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What is the tx for congenital chlamydia?
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sliver nitrate in eyes of all babies, and Zithromax
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Congenital N....clap causes what in the neonate?
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-neonatal sepsis
-PROM -prematurity -IUGR |
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What is the tx for congenital N....clap?
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silver nitrate and Ceftriaxone
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Congenital herpes can cause what?
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herpetic lesions or disseminated disease with encephalitis
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What is the tx for congenital HSV?
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-c-section
-acyclovir prophylaxis in newborns |
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What is the presentation of neonatal seizures?
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-tonic, clonic, cycling of the limbs, or Apnea and bradycardia
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What are some causes of neonatal seizures/
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-hypoglycemia (suspect this first)
-calcium and Na abnormalities -trauma -sepsis |
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What is the tx to neonatal seizures?
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-anticonvulsants
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Cocaine in a neonate can cause what?
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vasoconstriction and neurotoxicity
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What are some associated findings of cocaine in a neonate?
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-microcephaly
-vascular accidents -abruptions -PROM -w/drawal symptoms |
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What are some characteristic traits that are found in FAS?
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-saddle shaped nose
-maxillary hypoplasia -absent philtrum btw the nose and upper lip -short, thin upper lip -strawberry naevus |
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How many types of Esophageal Astresia are there?
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3 and H is least common
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What is the presentation for esophageal astresia?
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-drooling
-salivation -choking -vomiting with feeding -RDS |
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How do you dx esophageal atresia?
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scope for H type (passed tube will not reach stomach with others)
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How does a small bowel obstruction present present?
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-persistent vomiting mostly bile stained unless obstruction above the ampula of Vater
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What are some causes of small bowel obstruction?
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-duodenal atresia
-malrotation with vulvulus -jejunum or ileum atresia |
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What are some causes of large bowel disorders?
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-Hirschsprung
-Rectal Atresia |
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What is the tx for Hirschsprung or a Rectal Atresia?
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surgical
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Follow up from NICU is usually done when?
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by 6-9 months of age
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Follow up from NICU assesses what things?
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-nurtition
-catch up growth -neurological deficits -vision problems -preparation for school -psychological stressors |
