Peds E1 -Neonatology

What is considered Early Term?

37 weeks to 38 + 6 days

What is considered Full Term?

39 weeks to 40 + 6 days

What is considered Late Term?

41 weeks to 41 + 6 days

What is a neonate?

infant aged 0-28

How is gestational age determined?

number of weeks from the first day of the last period

What is considered Pre-term?

born before 37 weeks.

What is considered Post-term?

born on or after the first day of week 42

What is a live birth?

expulsion w/ evidence of life

What is Fetal death (stillbirth)?

death prior to expulsion w/ no evidence of life

What is infant death?

death from birth to 1 yr

What range is considered Appropriate for Gestational Age (AGA)?

10th -90th percentile for a given GA

T/F: Birth weight is dependent on gestational age

False

What is considered a low birth weight?

</= 2500 gInfants weighing less than or equal to 2500 grams at birth.

What is considered a very low birth weight?

</= 1500 g

What is considered an extremely low birth weight?

</= 1000 g

What is considered advanced maternal age?

>/= 35 yo

What are the top 5 cause of infant mortality?

birth defects, preterm birth/low birth weight, maternal complications, SIDS, injuries

Which artery carries blood to the placenta?

Uterine arteries

Which has a higher affinity for O2?

Fetal

How does blood circulate in a fetus?

umbilical vein → ductus venosus → IVC → RA → foramen ovale → L side of heart→ aorta → umbilical arteries

Why is pulm HTN normal in a fetus?

Fetal Pulmonary Artery pressures are naturally high and does not drop until after birth

What allows the ductus arteriosus to close after birth?

pulm O2 sat inc → less circulating PGE2 allowing the hole to close

(prostaglandins keep the hole patent)

How do the ductus venous and umbilical vein close?

with the clamping of the umbilical cord

How does the foramen ovale close?

closes at birth as pressure in the LA exceeds the pressure in the right forcing the flap valve closed

What are the components of the umbilical cord?

2 arteries and 1 vein

If there is only one umbilical cord artery, what does this indicate?

congenital abnormalities (usually renal)

What is are the functions of the placenta?

exchange of gases, nutrients, electrolytes

hormone production

transmission of maternal antibodies

What do babies IgG level reach adult levels?

3 yo

What can cross the placenta barrier?

• maternal steroidal hormones

• synthetic progestins

• Thyroxine (slowly)

• Viruses

• Drugs (heroine, cocaine, DES, TDaP)

Which viruses can cross the placenta?

TORCH

• toxoplasmosis

• other: varicella, syphilis, parvovirus

• Rubella

• Cytomegalovirus

• Herpes Simplex

What is Abruption (abruptio placenta)?

placental lining separates from the uterus of the mother prior to delivery

What is the pathological cause of late pregnancy bleeding?

Abruption

What are common causes of Abruption?

HTN or cocaine abuse

What is Accreta?

all or part of the placenta attaches abnormally to the myometrium

What is Increta?

chorionic villi invade into the myometrium

What is Percreta?

choronic villi invade through the myometrium to uterine serosa or adjacent organs

What can cause minimally painful bleeding after 20wks gestation?

placenta previa

What is Placenta Previa?

placental implantation in the lower uterine segment covering the internal cervical os

Is placenta previa an emergency?

not always

What is necessary in a mother develops Placenta Previa?

will need C-section; CANNOT have vaginal delivery

What is Chorioamnionitis?

inflammation of fetal membranes (placenta & amniotic fluid)

What causes Chorioamnionitis?

ascending vaginal bacteria

When does Chorioamnionitis typically occur?

20-30 weeks

What are the risk factors for Chorioamnionitis?

Amniocentesis, + genital tract pathogens, premature rupture of the membranes

What is a Chorioangioma?

benign tumor of a blood vessel in the placenta

A Chorioangioma increases the risk for?

polyhydramnios, coagulopathies, premature delivery, toxemia, fetal heart failure, hyrops fetalis

Are the majority (90%) of twins monozygotic or dizygotic?

Dizygotic (fraternal)

Which type of twins is the result of simultaneous shedding of two oocytes and fertilization by different sperm?

Dizygotic

What is Erythrocyte Mosaicism?

placentas or chorionic sacs fuse → each twin possess 2 different types of RBCs

Which type of twins develops from a single fertilized ovum that splits?

Monozygotic

If identical twins share an amniotic sac they must’ve split after how many days?

8-12 days post-fertilizations (separate = 4th-8th day)

When can twin-to-twin transfusions happen?

when one placenta is shared between twins

What is the result of twin-to-twin transfusions?

unbalanced blood shared between placenta and fetuses → 1 gets too much blood & 1 too little blood

What can twin-to-twin transfusion cause?

CHF or fetal hydrops

What is the tx for twin-to-twin transfusions?

antenatal therapy

In order to be classified as hydrops fetalis, fluid must be accumulated in how many different organ space?

2

Which type of hydrops fetalis is most common?

non-immune hydrops

What causes immune hydrops (erythroblastosis fetalis)?

Rh incompatibility

What causes non-immune hydrops?

severe anemia, twin-twin transfusion syndrome, heart/lung defects, congenital infections

How do you prevent Hydrops fetalis?

RhoGAM for Rh incompatibility

If the Group B strep culture comes back + what do you need to do? (tested for at 35-37 wks)

tx prophylaxis w/ PCN

Why do we measure fundal height? (22-26 wks)

evaluate for intrauterine growth restriction

When do we start doing US?

16-20 wks gestation to assess anatomy

What are Non-Stress Tests (NST) looking for?

2 fetal heart rate accelerations w/in 20 minutes

*abn = non-reactive → poor fetal outcome

What does Contraction Stress Test look for?

change in FHR in response to uterine contractions (3 over 10 mins) → should see accelerations in FHR

What does a Fetal Biophysical Profile (BPP) check for?

movement, tone, breathing, amniotic fluid volume

What causes symmetric IUGR?

(symmetric = body proportionally small)

intrinsic causes: genetics, TORCH infxns

What causes asymmetric IUGR?

(asymmetric =normal head, small body)

extrinsic cause: chronic hypoxia, undernourishment, HTN

What is Preeclampsia?

multisystem progressive condition characterized by new onset HTN and proteinuria in the last half of pregnancy or postpartum

What is eclampsia?

maternal HTN, proteinuria, & seizures

What is the only curative tx for preeclampsia?

delivery of the baby

What may help preeclampsia in severe cases?

Mag sulfate

What is gestational diabetes?

diabetes that develops DURING pregnancy

What fetal complications can arise from diabetic mothers?

sudden fetal death, macrsomia, hypoglyemia (at birth), hypocalcemia/hypomagnesemia, polycythemia, respiratory distress, etc.

What is the concern w/ macrosomia?

traumatic or operative delivery

What happens if an infants BG drops below 40mg/dL?

lethargy, jitteriness, seizures

What is caudal regression syndrome?

Large top, small bottom

What inc pre-term infant mortality rate?

male, hypothermia, APGAR <4 @ 5min, persistent bradycardia @ 5min, hypothermia, IUGR, low birth weight

What is the APGAR score?

quick assessment of infant’s immediate adaptation to extrauterine life (obtained at 1 minute and 5 minutes after birth)

What are the components of APGAR?

Appearance, Pulse, Grimace, Activity, Respiration

What APGAR score indicates a smooth transition to extrauterine life?

5+ @ 1 minute; 8-10 @ 5 minutes

What APGAR indicates a severe depression and requires immediate resuscitation?

<4 @ 1 minute

What APGAR score indicates high risk for CNS dysfunction or cardiovascular abnormalities?

< 7 @ 5 minutes

When might an additional APGAR score be needed at 10 minutes?

cyanotic at 1 minute and not clear by 5 minutes

What features score a 2 (each) on APGAR?

pink, >100 bpm, cries and pulls away, active movement, strong cry

What features score a 1 (each) on APGAR?

blue extremities, < 100 bmp, grimaces or weak cry, arms/legs flexed, slow irregular respirations

What features score a 0 (each) on APGAR?

pale or blue, no pulse, no response to stimulation, no movement, no breathing

Which score is used to perform a gestational age assessment at birth?

New Ballard Score

What medication is given to Newborns to prevent hemorrhagic disease of the newborn?

Vitamin K 1mg IM

What vaccine is given after birth?

Hep B (#1); if mom + → Hep B Ig

What eye prophylaxis is given to Newborns?

silver nitrate solution & Erythromycin

What causes Amniotic bands seen on limbs/digits of some newborns?

tears in the amnion result in strictures that may encircle parts of the fetus

What causes Hyaline Membrane Disease (NRDS)?

surfactant deficiency

How does NRDS present?

w/in hours of delivery w/ tachypnea, grunting, inc work of breathing, cyanosis

What would a CXR of NRDS show?

air bronchograms, ground glass appearance

What is the tx for NRDS?

surfactant replacement w/in 30-60 min

What can prevent NRDS?

antenatal steroids used btwn 24-34 weeks gestational age

What is the MCC of respiratory distress in term infants?

Transient Tachypnea of the Newbron

What causes Transient Tachypnea of the Newborn?

fetal lung fluid is retained → persistent pulm edema

What would a CXR of Transient Tachypnea of the Newborn show?

no air bronchograms, no ground glass; streaky “sunburst” appearance