Flashcards in neonatology Deck (146)
What are the 5 basic causes of apnea?
Metabolic, infectious, neurological, cardiac and Gi
What is primary vs secondary apnea?
Primary is reversed with tactile stimulation but secondary requires positive pressure ventilation
What is the diagnosis in a healthy newborn with respirations>60, retractions and grunting but normal CXR?
Transient tachypnea of the newborn
Newborn had increased anion gap metabolic acidosis, thrombocytopenia, high serum ammonia and elevated urine ketones, what is the likely diagnosis?
Newborn with high ammonia, high PT/PTT and serum glutamic oxaloacetic transaminase who presents with respiratory alkalosis?
What could be the cause of elevated AFP?
RAIN= renal disease, abdominal wall defects, incorrect dates /multiple pregnancy and neuro defects (anencephaly or spina bifida)
Low AFP is associated with what?
Trisomy 21 and 18
What is a measure of fetal autonomic nervous system integrity?
Non stress test
What measures uteroplacental insufficiency and tolerance of labor?
What is included in the biophysical profile?
Non stress test + ultrasound for fetal movement, HR, breathing, tone and amniotic fluid
What is the result of deficient surfactant in alveolar lining?
What is the diagnosis and what should you do of the fetus has HR>240?
Svt- Give anti arrhythmic to mother to avoid congestive Heart failure and hydrops
What condition causes X-ray findings of granular lung opacification and air bronchograms? What is the classic description on chest xray
Rds - ground glass appearance
What are symptoms or rds?
Respiratory distress in the newborn. Cyanosis is possible
How can you distinguish RDS from pneumonia in a newborn ?
Calculate ratio of bands to neutrophils. If >0.2, think sepsis !
What 6 coexisting conditions can worsen RDS?
What can occur in a patient with RDS and hyperbilirubinemia?
Threshold for kernicterus is lower
What 3 factors increase the risk for RDS?
Diabetes, c sections, birth asphyxia
What 2 factors decrease the risk for RDS?
Prolonged rupture of membranes, prenatal steroids
What test can predict the risk of RDS?
L:S ratio > 2 suggests a low risk for RDS
When is mechanical ventilation indicated in a patient with RDS?
Ph <7.2 and pCo2 > 60
What 3 things does administration of surfactant cause in the lungs?
Decreased oxygen requirements, reduces inspiratory pressure and improved lung compliance
What is pulmonary interstitial emphysema ?
Air leak into the interstitium due to mechanical ventilation -- leads to PTX
What is the goal po2 in an infant with RDS?
Patients on prolonged ventilator support are at risk for what and why?
Bronchopulmonary dysplasia due to prolonged oxygen exposure and barotrauma
What are the indications for ECMO?
Infant with reversible lung disease for less than 14 days and failure of other methods. Pt can not have intracranial bleed or congenital heart disease
What is the treatment of BPD and what is a side effect of this treatment?
Diuretics - can increase risk of hypocalcemia
What is found on X-ray in a newborn with BPD?
Diffuse opacities, cystic areas with streaky infiltrates and ground glass appearance
What is the name of a chronic lung disease of the newborn that is not associated with prolonged ventilator use?
Wilson Mikity syndrome