Peds EOR Exam

cardiac defects (VSD, transposition) and neural tube defects

-polyhydramnios

congenital anomalies related to maternal diabetes

-fetal growth restriction

-pre-term birth

-placental abruption

-still birth (due to chronic hypoxia or placental compromise)

effects of maternal hypertension (chronic or gestational)

Microcephaly, smooth philtrum, thin upper lip, ADHD-like behavior. Most common cause of mental retardation.

signs of fetal alcohol spectrum disorder

IUGR and placental abruption

-nicotine causes vasoconstrictionn of uteroplacental vesssels

complications of smoking in pregnancy

Vasoconstriction → placental abruption, IUGR, stroke

complications of cocaine use in pregnancy

Fetal hydantoin syndrome

-IUGR, cleft lip/palate, hypoplastic nails, developmental delay

complications of phenytoin use in pregnancy

Neural tube defects (e.g., spina bifida), cognitive impairment, facial dysmorphisms

complications of valproate use in pregnancy

Necrotizing enterocolitis

mostly preterm infants from underdeveloped intetestine/gut immunity so bacteria is introduced into bowel and get worse fast bc compromised immunity

inflammation and ischemic necrosis of the intetsine

pogression causes bowel congestion and gangrenous with gas forming inside bowel wall

patent ductus arteriosus----> poor systemic perfusion

most common CV risk associated with prematurity

patent ductus arteriosus

passageway between the aorta and the pulmonary artery remains open after birth

Intraventricular hemorrhage, apnea of prematurity

-caused by the fragility of blood vessels in the brain, which are not yet fully developed in premature babies

neurologic complications associated with prematurity

they have decreased brown fat and increased surface area

why are premature babies at a higher risk of hypothermia?

-meconium aspiration syndrome

-oligohydramninos

-uteroplacental insufficieny

postmaturity babies (>42 wks gestation) are at a greater risk of

symmetric IUGR

growth restriction in which the weight, length, and head circumference are all affected

-EARLIER insult (infection, genetic)

asymmetric IUGR

growth restriction in which the head circumference remains within normal parameters while the birth weight falls below the 10th percentile

-LATER insult (e.g. placental insuffficiency)

prematurity

most common complication of multiple gestations (twins, triplets)

Twin-to-Twin Transfusion Syndrome (TTTS)

a rare pregnancy condition affecting identical twins or other multiple births; occurs in pregnancies where twins share one placenta (afterbirth) and a network of blood vessels that supply oxygen and nutrients essential for development in the womb

-Unequal blood flow → anemia in donor, polycythemia in recipient

placenta previa

placenta implants over or near the cervical os

-Preterm birth (due to maternal bleeding and need for early delivery)

-Low birth weight

-Fetal anemia (from antepartum hemorrhage)

-Malpresentation (breech or transverse)

-Abnormal placental attachment syndromes (e.g., placenta accreta) may result in uteroplacental insufficiency

neonatal risks associated with placenta previa

-Perinatal hypoxia/asphyxia → can lead to hypoxic-ischemic encephalopathy (HIE)

-Stillbirth

-Preterm delivery

-Fetal growth restriction (from chronic placental insufficiency)

-Fetal anemia or shock if hemorrhage is severe

neonatal risks associated with placental abbruption

-Uteroplacental insufficiency (e.g., HTN, IUGR)

-Premature rupture of membranes (PROM)

-Fetal renal anomalies (e.g., renal agenesis, obstructive uropathy)

most common causes of oligohydramnios

Pulmonary hypoplasia (especially if early and severe)

Cord compression → variable decelerations, non-reassuring fetal heart rate

Orthopedic anomalies (e.g., clubfoot) from fetal constraint

Growth restriction

neonatal risks associated with oligohydramnios

Fetal inability to swallow (e.g., esophageal or duodenal atresia, anencephaly)

Maternal diabetes (increased fetal urination)

Multiple gestation or idiopathic

common causes of polyhydramnios

Preterm labor

Cord prolapse

Malpresentation

Neonatal respiratory distress

GI anomalies (e.g., TEF, intestinal atresias)

risks associated with polyhydramnios

-birth trauma: increased risk of head entrapment, brachial plexus injury, or clavicle fracture

-asphyxia

-increased risk of intraventricular hemorrhage, hip dysplasia

risks associated with transverse lie or breech presentation in delivery

-neonatal sepsis

-pneumonia (from aspiration off infected fluid)

-meningitis, encephalopathy

complications associated with chorioamnioniitis

meconium aspiration syndrome

Meconium inhaled into lungs causes inflammation, surfactant dysfunction, and airway obstruction

persistent pulmonary hypertension of the newborn

This disorder is a complication that can result from meconium aspiration; Ductus arteriosus & foramen ovale remain open

Hypoxic Ischemic Encephalopathy

Global brain injury from oxygen deprivation (esp. if prolonged bradycardia or late decelerations)

moderate to severe hypoxic ischemic encephaopathy within 6 hours of birth

indication for therapeutic hypothermia of a newborn

morphine, fentanyl

which narcotics cross the placenta and suppress CNS/respiratory drive wen adminisstered <4hours before birth?

Cephalohematoma

Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.

-complication of vacuum delivery

Subgaleal hemorrhage

Bleeding between the periosteum of the skull and the galea aponeurosis.

-crosses suture lines

-complication of vacuum delivery

transient tachypnea of the newborn

Condition of rapid respirations caused by inadequate absorption of fetal lung fluid.

-Due to delayed clearance of lung fluid in C-section infants without labor

Relies on non-shivering thermogenesis using brown adipose tissue (BAT), which produces heat via mitochondrial uncoupling

neonatal response to the cold, cold world

ductus venosus

connects the umbilical vein to the inferior vena cava, bypassing the liver

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

↓ Venous return from placenta

↑ Systemic vascular resistance (SVR)

how does umbilical cord clamping efffect newborn blood flow

infant breathing ->

increase oxygenated blood in aorta ->

decrease prostaglandins ->

closure of ductus arteriosus

what causes the ductus arteriosuus to close?

Jitteriness

Poor feeding

Lethargy

Seizures

signs off hypoglycemia in the newborn

ideally in the first hour of life

when should the first feed of a newborn be?

IgA

what Ig is colostrum rich in?

Appearance: 0 for blue all over, 1 for pink body and blue extremities, 2 for completely pink

Pulse: 1 pt for below 100 bpm, 2 pt for at or above 100 bpm

Grimace: 0 pt for no response to stimulation, 1 pt for weak cry, 2 pts for cry

Activity: 0 pts for limp, 1 pt for some flexion, 2 pts for active motion

Respiration: 1 pt for slow or irregular breathing, 2 pts for good, strong cry

list the components and scoring of APGAR

1 minute: Indicates how well the baby tolerated the birth process

5 minutes: Reflects the baby’s adaptation to the environment

the APGAR scoring at 1 and 5 min represents

If score at 5 minutes is <7, assess again every 5 minutes up to 20 minutes

indication for APAR scoring at 10 min

0-3

APGAR scores indicating need for immediate full resuscitaiton: positive pressure ventilation (PPV), chest compressions, possibly intubation and medications

heartrate

______ is the most critical sin of neonatal resuscitation

ballard score

clinical tool used to estimate a newborn’s gestational age based on neuromuscular and physical maturity. It is especially helpful when the date of the last menstrual period (LMP) is unknown or uncertain.

-helps assess growth appropriateness when compared to weight

1. posture

2. square window (wrist flexibility)

3. arm recoil

4. popliteal angle

5. scarf sign (how far elbow crosses the ches)

6. heel to ear

neuromuscular maturity criteria in ballardd scorin

lanugo

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

Total Score | Gestational Age (approx)

5–10 26–28 weeks (very preterm)

15–20 30–32 weeks

25–30 34–36 weeks

35–40 38–40 weeks (term)

45–50 42+ weeks (post-term)

interpreting ballard scores

Should be performed within 12–24 hours of birth, especially in preterm or ill infants.

when should ballard scoring be performed?

<28 weeks gestational age

this gestational age is associated with very high risk of respiratory distress syndrome due to insufficient surfactant production; most require intubation

Transient Tachypnea of the Newborn (TTN)

born 34-27 weeks gestation age significantly increases risk o f

birth weight below 10th percentile

Define small for gestational age (SGA)

97.7 to 99.5 degrees Fahrenheit

normal newborn temperature

30-60 respiratory

normal newborn respsiratory rate

coarctation of the aorta

weak femoral pulses in newborn is concerning for

Barlow maneuver

newborn hip evaluation - adduction of hip - evaluates for congenital dislocation

Ortolani maneuver

check hips for congenital dislocation, done until 1 yr old, should be smooth with no sounds

, abnormal= feels like a clunk as head of femur pops back into place- positive ortolani sign

Moro reflex

Reflex in which a newborn strectches out the arms and legs and cries in response to a loud noise or an abrupt change in the environment

erythema toxicum

pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.

-normal!

mongolian spots

areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched

Congenital cataracts

Retinoblastoma

Retinal detachment

Persistent hyperplastic primary vitreous

Severe refractive error

absence of the red reflex in newborn period may indicate

pre-auricular pits/tags

remnants of the first and second branchial arches

Renal anomalies (ear and kidney develop simultaneously)

Syndromes (e.g., branchio-oto-renal syndrome)

though usually benign, ear pit and or tags in newborn may be associated with

epstein pearl

The small white papule seen in the midline of the palate of this infant is an _____.

It represents epithelial tissue that becomes trapped during the palatal fusion

-benign, no treatment needed and will resolve spontaneously

Indomethacin or ibuprofen (prostaglandin inhibitors)

Surgical ligation if refractory or contraindications

treatment of symptomatic or persistent PDA:

beta blockers

treatment of complicated or high risks hemangiomas in neonates

caput succedaneum

Edema of the scalp crosses suture lines

Resolves in days

Cephalohematoma

Subperiosteal hemorrhage, does not cross suture lines

Can cause hyperbilirubinemia

Subgaleal hemorrhage

Bleeding under the scalp aponeurosis; crosses suture lines, can expand

Emergency → can lead to shock or anemia

erythema toxicum neonatorum

Most common rash (blotchy red macules with central pustules)

Benign, appears in first 2-3 days, resolves in a week

milia

Benign, keratin-filled cysts that can appear just under the epidermis and have no visible opening.

Barlow: attempts to dislocate a dislocatable hip

Ortolani: attempts to reduce a dislocated hip

what is the difference between barlow an ortoloni maeuvvers

Pavlik Harness

used for hip dysplasia in infants

Remove only to take baths

simple dimple: <5 mm diameter

<2.5 cm from anus

No other anomalies → no imaging

atypical ddimple: (deep, wide, >2.5 cm, tuft of hair, skin tag, etc.) → spinal ultrasound or MRI

how to determine workup of a sacral dimple

slate grey patch (formerly mongolian spot)

Congenital dermal melanocytosis

Most common in infants of African, Asian, or Hispanic descent

Bluish-gray patch over sacrum or buttocks

-benign, no treatment

Placental insufficiency, maternal illness (HTN, smoking), TORCH infections

IUGR → poor nutrient/oxygen delivery

pathohphysiology of SGA

Beckwith-Wiedemann, familial trait, maternal diabetes

DDx for a newborn who is largge ffor estational age

Beckwith-Wiedemann syndrome

a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver

Sepsis, hypoglycemia, NAS, CHD, craniofacial anomaly, HIE

DDx for a poor feedingn neonante

Hyperinsulinism (IDM)

Sepsis, adrenal or metabolic disorders

DDx of hypoglycemia in neonate

Physiologic jaundice (common)

Pathologic: ABO/Rh incompatibility, G6PD deficiency, sepsis

DDx for hyperbilirubinemia in neonate

ampicillin + gentamicin

empiric abx used in septic neonates

Hydrocephalus, chorioretinitis, intracranial calcifications

classsic findings of toxoplasmosis

Snuffles, rash on palms/soles, hepatomegaly

classic findings of congenital syphilis

Cataracts, PDA, blueberry muffin rash

classic finidinigs of congenital rubella

Periventricular calcifications, sensorineural hearing loss

classic findings of congenital CMV

Vesicular rash, encephalitis, sepsis-like

classic findings of congenital HSV

neonatal abstinence syndrome

drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy

Supportive: swaddling, low stimulation, frequent feeds

Medications (if severe): morphine or methadone taper

Social work and CPS involvement as needed

management of neonatal abstinence syndrome

-Prevents Vitamin K Deficiency Bleeding (VKDB), also known as hemorrhagic disease of the newborn

-Newborns have low hepatic stores of vitamin K and sterile intestines (no gut flora to synthesize vitamin K)

-Vitamin K is essential for activation of clotting factors II, VII, IX, X

rationale for IM injection of vit K at birth

Prevents ophthalmia neonatorum (neonatal conjunctivitis), most commonly from:

Neisseria gonorrhoeae (can cause corneal ulceration, blindness)

Chlamydia trachomatis (later onset conjunctivitis)

rationale for the 0.5% erythromycin ophthalmic ointments appliied shortly after birth

ophthalmia neonatorum

A purulent (contains pus) inflammation of the conjunctiva and/or cornea in the newborn.

-most commonly caused by gonorrhea and chlamydia

-CAN cause vision loss! necessitatess erythromycin ointment at birth

1st dose: at birth

2nd dose: 1–2 months

3rd dose: 6–18 months

vaccine schedule for hepatitis B

-PKU, MSU

-congenital hhypothyroidism

-sickle cell

-cystic fibrosis

-deficiencies

give some examples of conditions screened in the newborn heel prick

Otoacoustic emissions (OAE) – measures cochlear function

Auditory brainstem response (ABR) – evaluates auditory nerve pathway

methods of hearing screening in the newborn

Measures pre- and post-ductal oxygen saturation (right hand and foot) at 24–48 hours

Normal: ≥95% in both, and ≤3% difference

describe pulse oximetry screening in the newborn