Peds Recall: Newborns

Front 1

What are five things looked for on apgar?

Back 1

Appearance
Pulse (above 100)
Grimace
Activity
Respiration

Front 2

When do you do additional apgar assessment?

Back 2

If less than 7 at five minutes, check again each five minutes.

Front 3

Where is the larynx in the neonate?

Back 3

More caudad, more anterior than in adult.

Front 4

Name three indications for umbilical vein catheter.

Back 4

1. Resuscitation
2. IV fluids, alimentation, meds
3. Exchange transfusion

Same for arterial catheter + ABGs

Front 5

Name three causes of symmetric growth retardation.

Back 5

1. Infection
2. Teratogens early on
3. Chromosomal problems or malformations
(4. small parents )

Recall that symmetric are generally earlier and worse than asymmetric (htn, placental insuff)

Front 6

Name three causes of large for gestational age.

Back 6

1. maternal diabetes (gestational)
2. twin-twin transfusion
3. Beckwith Wiedeman syndrome

Front 7

What is Beckwith Wiedeman syndrome?

Back 7

An overgrowth disorder at birth due to imprinted genes on chromosome 11. Has increased risk of childhood cancer and some of these features:
1. macroglossia
2. macrosomia
3. midline abdominal wall defects
4. ear creases or ear pits
5. hypoglycemia

Mostly have normal cognitive development and normal intelligence.

Front 8

Four things to worry about in infant of diabetic mom.

Back 8

1. hypoglycemia
2. hypocalcemia
3. polycythemia
4. hyperbilirubinemia

Front 9

What is normal RR for newborn?

Back 9

40-60 breaths/minute

Front 10

What is vernix caseosa?

Back 10

White greasy coating composed of sebum and exfoliated skin cells that covers newborn; perhaps protects fetus from wrinkling in amniotic fluid. Seen after birth.

Front 11

What are milia?

Back 11

Tiny white papules that form over sebaceous glands in newborns. Mostly on nose. Benign.

Front 12

What is differential diagnosis for erythema toxicum?

Back 12

1. Herpes
2. Staph aureas rash

Front 13

What are "blueberry muffin" rashes?

Back 13

Macular raised purple lesion indicating congential rubella or CMV.

Front 14

What three conditions are associated with decrease femoral pulses?

Back 14

1. interrupted aortic arch
2. coarctation
3. hypoplastic left heart

Front 15

What are four disorders associated with enlarged fontanel (anterior)?

Back 15

1. hydrocephalus
2. hypothyroid
3. hypophosphatasia
4. osteogenesis imperfecta

Front 16

How can you distinguish between cephalohematoma and caput?

Back 16

Caput crosses suture lines; because cephalohematoma is subperiostial (diff from subgaleal bleed), it cannot cross suture lines.

Front 17

What are Epstein's pearls?

Back 17

Small with epithelial inclusion cysts in midline of roof of mouth. Go away spontaneously.

Front 18

When does umbilical cord fall off?

Back 18

10 days to 4 weeks

Front 19

When are dimples worrisome?

Back 19

When above the natal cleft, worry about spina bifida.

Front 20

What drops are put in baby's eyes and why?

Back 20

0.5% erythromicin OR
1.0% tetracycline OR
1.0% silver nitrate

Front 21

What percentage of males are circumcised?

Back 21

60-70%

Front 22

At what level of bilirubin is jaundice evident?

Back 22

5.0mg/dL or more in serum

Front 23

What causes kernicterus and what are long term consequences?

Back 23

Caused by excess unbound bilirubin (not bound to albumin). Long term: deafness, CP, death, other brain damage.

Front 24

What is ddx for jaundice?

Back 24

1. Physiologic (immature enzymes in liver)
2. Breast feeding
3. Hemolytic dz (ABO or Rh)
4. RBC membrane defects
5. RBC biochemical defects (G6PD)
6. Hypothyroid
7. Bruising/Cephalohematoma
8. Sepsis
9. Deficiency in glucuronyl transfersase (crigler najjar)
10. Also causes of conjugated hyperbili, like Rotors/Dubin, cholestasis, hepatitis, biliary atresia

Front 25

What is the most common cause of seizures in newborn? Other causes?

Back 25

Hypoxic-ischemic encephalopathy, which is caused by intrauterine or birth related insult.

Others: infxn, lyte problem, ICH, CNS malformation, drug withdrawal, metab defects, benign familial neonatal seizures

Front 26

What things should be asked of mom if neonate has seizures?

Back 26

1. FH of neonatal seizures
2. Drug use
3. Complications during pregnancy/delivery
4. Risk factors for sepsis

Front 27

What studies do you do for seizures?

Back 27

1. Chem 10 (Chem 7 + ca, p, mg)
2. Blood culture and LP (for sepsis)
3. CT/MRI for hemorrhage
4. EEG

Front 28

What is normal UOP for infant?

Back 28

2mL/kg/hour

Front 29

What is the most common renal malformation?

Back 29

Horseshoe kidney

Front 30

What should you be thinking about with reduced urine output?

Back 30

1. prerenal until proved otherwise
2. obstruction
3. congenital kidney disease
4. ischemic event during pregnancy
5. drug exposure

Front 31

What is ddx for failure to pass meconium?

Back 31

1. Preterm (don't pass for 3 days)
2. Anatomic (Hirschsprung, atresia)
3. Meconium ileus (CF), Meconium plug
4. Drugs: Mg Sulfate during pregnancy
5. Bowel (malrotation, small left colon syndrome)

Front 32

What is treatment for failure to pass meconium?

Back 32

1. contrast enema
2. surgical exploration

Front 33

At what %O2 does neonate show cyanosis?

Back 33

88% (less if anemic)

Front 34

What are the three main causes of cyanosis (categories)?

Back 34

1. Heart (congenital disease, poor output, pulm hypertension)
2. Lung (primary lung dissease)
3. Other (methomoglobinemia)

Front 35

How can you exclude cyanotic heart disease is ddx for cyanosis of newborn?

Back 35

If PaO2 is greater than 60mmHg when giving 100% FiO2, excludes cyanotic heart disease (think of correcting shunt, which heart disease is, with oxygen -- can't be done)

Front 36

When will you see 10% diff in 02 sat between right and left arms?

Back 36

When have pulm htn that forces blood through PDA. Right arm is preductal, left arm is postductal.

Front 37

What causes hypotonia without weakness? With weakness?

Back 37

Without:CNS injury, resp dz, maternal meds, sepsis
With: CNS injury, myasthenia, myotonic dystrophy, myopathy, metabolic disorders

Front 38

What is normal EKG finding in neonate?

Back 38

Right axis deviation (+60 to +160)

Front 39

Where do intraventricular hemorrhages usually come from?

Back 39

Capillary network of subependymal germinal matrix layer

Front 40

What predisposes to IVH?

Back 40

1. Prematurity
2. Acute Resp Failure

Front 41

What is treatment for IVH?

Back 41

Supportive care. Treat associated seizures or posthemorrhagic hydrocephalus.

Front 42

What is transient tachypnea of the newborn?

Back 42

Early onset of mild resp distress (tachypnea, cyanosis) caused by reduced clearance of lung fluid. Can be caused by cesarian section, late clamping of cord. Tx with supportive care and oxygen b/c it goes away in 72 hours.

Front 43

What is persistent pulmonary htn of newborn?

Back 43

Aka persistent fetal circulation. Open PDA and PFO, sometimes depressed heart function. SEVERE HYPOXEMIA.

Front 44

What is the most common cause of neonatal pneumonia immediately after birth? Weeks after birth?

Back 44

GBS. Can also be E coli, listeria, pneumococcus.

Staph and pseudomonas take a little bit longer.

Chlamydia takes 3-4 weeks.

Front 45

What is normal WBC count for infant?

Back 45

8K-20K

Front 46

What is workup for infant less the three months old with subtle signs of sepsis OR fever?

Back 46

1. CBC and blood culture
2. UA and urine culture
3. LP with gram stain, cell count, culture, protein/glucose

Front 47

What is tx for meningitis in newborn?

Back 47

Broad spectrum antibiotics (amp + aminoglycoside)

Front 48

What are the major acyanotic heart lesions in newborns?

Back 48

Three letters each:
1. PDA
2. VSD
3. ASD
4. AVSD (atrioventricular septal defect, aka AV canal, aka endocardial cushion defect; an ASD + VSD + AV valve defect; seen in Downs; have diastolic and systolic)

Front 49

How does PDA present?

What should you look for on CXR?

Back 49

1. Continuous machinery murmur over LSB
2. Increasing O2 need b/c (a) backup in the lungs can cause edema and (b) systemic hypoperfusion (c) heart gets overloaded and can fail

On CXR: pulm congestion, cardiomegaly

Front 50

How does PPHN present?

Back 50

1. Cyanosis
2. Tachypnea

Front 51

What causes a widened pulse pressure?

Back 51

Pulse pressure is the difference between the systolic and diastolic pressures. Generally correlates with stroke volume. Thus anything that raises the stroke volume will widen the pulse pressure.
1. Fever
2. Hyperthyroid
3. Anemia
4. AV fistulae
5. PDA

Front 52

When does a PDA close?

Back 52

10-15 hours after birth, usually.

Almost always by 48 hours.

Front 53

How does VSD present?

Back 53

Dyspnea, feeding difficulty, growth failure. Dusky during feeding or crying, but not cyanotic.

Often don't become visible until after 5 days of life, as right sided forces are strong in first few days so pressures do not favor L to R shunt.

Front 54

What is the treatment for VSD?

Back 54

1. Small -- 50% close spontaneously, so only monitoring.
2. Others -- close by 1 year of life by surgery.

Front 55

How does ASD present?

Back 55

Asx, growth failure, exercise intolerance, "fixed splitting" heart sound (not from ASD itself but from increased RV -> PA flow).

Often tolerated in kids, present in adults.

Front 56

What is a voiding cystourethrogram?

Back 56

Technique for watching for vesicouretal reflex. Inject die in, watch for dye going into urethras during micturition under fluoroscopy.

Front 57

What is the primary complication of surgery for cyanotic heart lesions?

Back 57

Stenosis of surgical anastamosis sites.

Front 58

When is apnea in infants concerning?`

Back 58

20+ seconds, or see symptoms like cyanosis. When reach this point, called "ALTEs" or "near sids events".

Front 59

What is the most common cause of neonatal diarrhea after 4 months? Before 2 months?

Back 59

4+: rotavirus
2-: E coli (also salmonella, campy)

Also think of bowel defects, hormone problems, allergies.

Front 60

Patient is born with micropenis, hypotonia, and unilateral cryptorchidism. What is likely diagnosis?

Back 60

Praeder Willi Syndrome

Front 61

What is deficient in Gaucher's disease?

Back 61

Beta glucocerebrosidase (chromosome 1), leading to accumulation of glucocerebroside in the reticuloendothelial system of the liver and spleen (organomegaly)

Present with HSM, bone issues [osteoporosis] and heme issues

Front 62

What are the types of Gaucher's?

Back 62

Type 1- non neuropathic (most common, present childhood/adolescence/adult), Jews
Type 2- acute neuropathic (death in 2 yrs)
Type 3- chronic neuropathy (death in 15 years), Swedes

Front 63

Tx for Gaucher's?

Back 63

1. Enzyme replacement
2. BMT

Front 64

Which lysosomal storage disorders are X linked?

Back 64

1. Fabry's
2. Hunter's

Front 65

What is dacrosynostosis?

Back 65

-Common neonatal condition caused by unilateral or bilateral blockage of nasolacrimal ducts.
-Caused by failure of canalization.
-Most resolve on own by 1 year, but can do surgery.
-Wash and express with warm water; if mucopurulent give abx.


DDx conjunctivitis (but not inflamed conjunctiva).

Front 66

What are signs of glaucoma?

Back 66

1. tearing
2. blepharospasm
3. photophobia

Front 67

When does gonorrhea conjunctivitis start? Chlamydia?

Back 67

GC - 2-5days
chlamydia - 5-14days

Front 68

Why are premies hypoglycemic?

Back 68

B/c they dont have glycogen or fat stores. Could also be insulin excess.

Front 69

What puts you at risk for neuro damage due to bilirubin in early life?

Back 69

1. met acidosis
2. TMPSMX
3. hypoalbuminema
4. sepsis (disturbs BBB, letting in unconj bili)

recall that phenobarb can help treat if lights dont work b/c it revs CYP system

Front 70

When do you give VZIG and acyclovir for varicella in newborn?

Back 70

When mom had chicken pox within five days before birth or within two days after. Otherwise, baby has no worse a course than any other kid.

Front 71

What drugs are contraindicated for nursing moms?

Back 71

Lithium, antineoplastics, cyclosporine, illicit drugs.

Front 72

Does mom's breast milk have enough calcium for baby?

Back 72

Yes, unless trying to catch up in terms of growth (premies).

Front 73

What are small for dates babies at risk for?

Back 73

1. congenital malformations
2. growth retardation
3. mec or other asphyxiation

Front 74

How are clavicle fractures noticed?

Back 74

Immediately: crepitus, stepoff
1 week later: callus formation

Front 75

When do bleeds happen in babies not given vit K shot?

Back 75

2-7 days, when 2,7,9,10 run out.

Front 76

When is cleft lip repaired? Palate?

What is % who get cleft palate?

Back 76

2-3 months.

6 months.

0.1%, or 4% if sibling had it.

Front 77

What is long term sequelae of cleft lip/palate?

Back 77

Speech difficulties, recurrent otitis media, hearing loss are all common