Issues in a Newborn: First Half

37

Birth before __ weeks is considered premature

large, produce, apnea, hemorrhage, hypoglycemia, sepsis

Prematurity: Short Term Complications

-Hypothermia → ______ body surface area or an inability to _______ enough heat. This may be due in part to the hypothalamus needing to adjust to life outside of the uterus

-Respiratory abnormalities → RDS, _______, pulmonary hemorrhage

-Cardiovascular abnormalities → PDA, hypotension

-Neurologic abnormalities → intraventricular _____________

-Hypo/hyperglycemia → ____________ is more common due to metabolic immaturity

-GI abnormalities → necrotizing enterocolitis

-Infection → pneumonia, ______

-Retinopathy → neovascularization occurs

increased, cerebral palsy, growth, function

Prematurity: Long Term Complications

-__________ hospitalizations 

-Neurodevelopment disabilities → impaired cognitive skills, motor deficits, _______ _____, sensory impairment, behavior/psych problems

-Chronic health issues → CKD, _______ impairment, impaired lung __________

distress, hypertension, meconium, sepsis

Respiratory Disease of the Newborn

-Preterm infant 

• Respiratory _________ syndrome, erythroblastosis fetalis, nonimmune hydrops, pulmonary hemorrhage 

-Term infant

• Primary pulmonary ___________, ________ aspiration syndrome, polycythemia, and amniotic fluid aspiration 

-Preterm and term infants 

• Bacterial _______, transient tachypnea, spontaneous pneumothorax, congenital heart disease, pulmonary hypoplasia, viral infections, and inborn metabolic errors 

preterm, surfactant, decrease, atelectasis, collapse, 20, II, cortisol

RDS: Background

-Most common cause of respiratory distress in ________ infants

-Deficiency in _________, a _________ in quality and quantity

-Physiology

• Surfactant is a lipid/protein mixture

• Prevents ____________ by reducing alveolar surface tension, facilitating alveolar expansion, reduces alveolar _________

• Synthesis starts around __ weeks gestation by development of alveolar type __ cells

• Quantity and quality based on fetal ___________ levels, which begins production between 32-34 weeks

surfactant, tension, alveoli, inflammation, hypoxia, acidosis

RDS: Pathophysiology

-Inadequate ___________ → high alveolar surface ________ → low lung volume and decreased compliance → collapse of _______ (atelectasis) and lung ___________/injury → respiratory distress and _______ and hypercarbia → respiratory __________ and respiratory failure

-Can cause pulmonary edema and difficulty breathing

minutes, tachypnea, retractions, cyanosis, edema

RDS: Symptoms

-Presents within a few _________ to hours after birth 

-__________

-Nasal flaring

-Expiratory grunting 

-Intercostal/subcostal ____________

-________/hypoxemia or pallor

-Decreased breath sounds

-Diminished peripheral pulses 

-Possible peripheral ______

preterm, low, ground glass

RDS: Diagnosis

-________ infant with progressive respiratory distress/failure shortly after birth

-CXR shows ___ lung volume, diffuse ______ _______ appearance with air bronchograms. This is a result of alveolar atelectasis contrasting with aerated airways

corticosteroids, 23-34, nCPAP, ventilation, acidosis, apnea

RDS: Treatment

-Antenatal _______________ therapy

• Give to pregnant women at ___-___ weeks at risk of preterm delivery

• Try to prevent the development of RDS

-Positive end expiratory pressure (PEEP)

• Nasal continuous positive airway pressure (_____) preferred

• Helps keep alveoli from closing

• Preferred initial intervention after birth

-Exogenous surfactant

-Intubation and mechanical __________ with PEEP and indications of intubation

• Respiratory _________

• Hypoxemia despite supplemental oxygen or FiO2 > 0.40 on nCPAP

• Severe ______

clearance, fluid, full, short, c-section, retractions

Transient Tachypnea of the Newborn

-Delayed __________ or slow resorption of fetal lung _____

-Epidemiology → ____ or late term following a _____ labor or __________ without labor 

-Symptoms → tachypnea, mild ___________, hypoxia, and cyanosis 

perihilar streaking, fluid, self limited, oxygen

Transient Tachypnea of the Newborn: Diagnosis and Treatment

-CXR → central vascular markings (________ ___________) and ______ in lung fissures

-Treatment → _____ ________ (resolves within 12-48 hours), may need nCPAP and/or __________

meconium, amniotic, distress, pneumonia, term

Meconium Aspiration Syndrome: Background

-__________ stained _______ fluid

• Sign of fetal ________ like asphyxia, hypoxia, and acidosis

-High risk of developing ___________ and pneumothorax

-Epidemiology → ____ and post-term deliveries

aspirated, after, obstruction, leaks, pneumonitis, hypoxia

Meconium Aspiration Syndrome: Patho and Signs/Symptoms

-Patho → __________ in utero by distressed, gasping fetus or immediately _____ delivery

• Leads to small airway __________, air trapping, surfactant inactivation, alveolar air ______, atelectasis, or chemical ____________

-Signs/Symptoms → tachypnea, _________, hypercapnia, overdistention of the chest

infiltrates, flattening, supportive, nitric oxide 

Meconium Aspiration Syndrome: CXR and Treatment 

-CXR → patchy ________, overdistention (increased AP diameter), and ________ of the diaphragm

-Treatment → _________ care and assisted ventilation. In the case of persistent severe hypoxia, you could try surfactant therapy, inhaled ______ ______, or ECMO

asphyxia, meconium, hypoplasia, vasoconstriction, smooth muscle, increased

Persistent Pulmonary Hypertension of the Newborn: Background

-Epidemiology → post term, term, or near term infants

-Etiology → perinatal ________ (MC), _________ aspiration syndrome (MC), hyaline membrane disease, sepsis, and pulmonary __________

-Pathophysiology → _____________ due to perinatal hypoxia, prenatal increase in pulmonary vascular _______ ________ development, and decreased pulmonary vascular beds

-Overall result is __________ pulmonary vascular resistance instead of normal decrease after birth. Normally, there is a rapid fall in pulmonary vascular resistance and increase in systemic vascular resistance when the baby starts breathing outside the womb

hypoxia, oxygen, hypotension

PPHN: Symptoms

-Severe _________ → poor response to high concentrations of ___________

-Respiratory distress

-Systemic _____________

-Metabolic acidosis

normal, ECHO, elevated, oxygen, pressors, ECMO

PPHN: Diagnosis and Treatment

-CXR → usually ________, possible signs of pulmonary pathology 

-________ (confirms diagnosis) → __________ pulmonary artery pressures and sites of right to left shunting 

-Treatment → ___________, ventilation, fluids (first line) 

• Correct hypotension with fluids, _________ if needed

• Inhaled nitric oxide

• _____ if needed 

40-45, diabetic, hyperinsulinemia, reduced, feeding, seizure

Hypoglycemia: Background

-Risk Factors

• ________ mother → infant has abundant glucose stores, develops hypoglycemia due to ______________

• Intrauterine growth restriction → _________ glucose stores

• Preterm

-Symptoms

• Lethargy, poor ________, irritability, tremors, ________, and apnea

• Not specific to hypoglycemia

heelstick, blood draw, 45, dextrose

Hypoglycemia: Evaluation and Treatment

-Evaluation

• Screen infants with risk factors

• __________ and glucometer first

• Confirm low or borderline values by ______ ______

-Target glucose is > __ mg/dL before feeding

-Treatment

• __________ gel

• IV 10% dextrose in water (D10W)

decreased, LGA, delayed, plethora, emesis, hematocrit, 65, transfusion, removal, 50-55

Polycythemia

-Hyperviscosity with ___________ perfusion of capillary beds

-Epidemiology 

• Most prevalent in SGA and ___ populations 

• _________ cord clamping is the most common cause of benign polycythemia 

• Other causes → twin-twin transfusion, maternal-fetal transfusion, and chronic intrauterine hypoxia 

-Symptoms 

• ________, respiratory distress, hypoglycemia, poor feeding, _______, irritability, and lethargy 

-Diagnosis 

• Screen with capillary ___________ (heelstick) → if > 68% hct then do peripheral venous hct 

• If > __% hct = hyperviscosity 

-Treatment 

• Isovolemic partial exchange ___________ with normal saline 

• Blood ________ through umbilical venous line 

• Desired hct of ___-___% 

2-3, 1-2, increased, RBC, low

Anemia: Physiologic

-Normal

-Occurs at __-__ months of age in term infants and ___-___ months in preterm 

-Does not result in illness

-Related to _________ tissue oxygenation, shortened ___ life span, and ___ erythropoietin levels 

bone marrow, pallor, reticulocyte

Anemia: Decreased RBC Production

-_____ ________ failure syndromes, infection (like rubella), and congenital leukemia

-Sx include ______, low ____________ count, absence of erythroid precursors in the bone marrow

Rh, hydrops, hepatosplenomegaly, 24, ABO, mild

Anemia: Increased RBC Production

-Hemolysis in utero

• __ blood group incompatibility. Can lead to erythroblastosis fetalis → _____

• Asphyxia, _______________, pallor, jaundice within __ hours

-Hemolytic disease of the newborn

• ___ incompatibility

• Causes anemia and ____ hyperbilirubinemia/jaundice

rupture, previa, pulses, heart

Anemia: Blood Loss

-Acute → fetal-maternal hemorrhage, _______ of umbilical cord, placenta _____, internal hemorrhage 

• Pallor, diminished peripheral _______, shock 

-Chronic → chronic fetal-maternal hemorrhage, twin to twin transfusion

• Pallor, ______ failure, hepatosplenomegaly, hypochromic microcytic anemia