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Aquifer Pediatrics Exam Questions And Answers Verified
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Tobacco Effects in Pregnancy
Low birth weight
Fetal Alcohol Syndrome
Facial abnormalities, growth deficiency, CNS dysfunction, cognitive/behavioral issues
Heroine Effects in Pregnancy
Fetal growth restriction, fetal death, placental abruption, preterm labor, intrauterine
meconium
Cocaine/Stimulant Effects in Pregnancy
Uteroplacental insufficiency, low birth weight
SGA Infant
<10th percentile for weight or <3rd percentile
What maternal factors can lead to an infant that is SGA?
Age extremes, poor weight gain in 3rd trimester, nulliparity, substance abuse, lower
SES, AA race
What fetal factors can lead to an infant that is SGA?
Chromosomal abnormalities/syndromes, metabolic disorders, congenital infections
What medications can lead to an infant that is SGA?
Anti-metabolites, bromides, isotretinoin, steroids, propanolol, warfarin
What exposures can lead to an infant that is SGA?
Metals, PCBs, toluene, drugs
What uteroplacental issues can lead to an infant that is SGA?
Avascular villi, decidual a. arteritis, multiple gestation, partial molar pregnancy,
infarction, placenta previa/abruption, single umbilical a.
What are risk factors for early onset GBS infection?
Prolonged rupture of membranes, prematurity, intrapartum fever, mother with previous
delivery of infant with GBS
What factors determine management of newborn with GBS infection?
Clinical appearance, maternal chorioamnionitis, prophylactic antibiotics, membrane
rupture >18h, gestational age <37 weeks
What is the management of GBS infection if newborn is ill-appearing?
CBC, blood culture, CXR, lumbar puncture AND empiric IV antibiotics
What is the management of GBS infection if newborn does not appear ill?
CBC, blood culture AND/OR close observation for a few days
APGAR
Appearance (skin color)
Pulse (HR >100)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration (crying)
What APGAR 5-minute score indicates need for continued resuscitation efforts?
>7
What is the Ballard tool used for?
,Estimate gestational age when no early U/S is available or age is in question
What are components of the Ballard tool?
Neuromuscular maturity and physical maturity
What is examined for newborn neuromuscular maturity?
Posture, wrist position, arm recoil, popliteal angle, scarf sign, heel to ear position
What is examined for newborn physical maturity?
Appearance and/or presence of skin, lanugo, plantar crease, breasts, eyes, ears and
genitals
Symmetric Intrauterine Growth Restriction (IUGR)
Head circumference, length, weight proportionately small
What often causes symmetric IUGR?
Congenital infections
Asymmetric Intrauterine Growth Restriction (IUGR)
Decreased length and/or weight without a change in head circumference
What often causes asymmetric IUGR?
Maternal smoking
What are SGA newborns at risk of?
Hypoglycemia, hypothermia and polycythemia
What are symptoms of hypoglycemia and/or hypothermia in newborns?
Asymptomatic or poor feeding and listless
What are symptoms of polycythemia in newborns?
Ruddy complexion, respiratory distress, poor feeding and hypoglycemia
Newborn Resuscitation (in addition to ABCs)
Universal precautions, warm & dry infant, remove wet linens, stimulate infant to cry
(clear up lungs), suction nose & mouth, oxygen
How is oxygen delivered to newborns for resuscitation?
Blow-by, PPV with bag mask, chest compression, medications
Rooting Reflex
Stroke cheek
Startle/Moro Reflex
Quickly "drop" baby while held causing knee flexion, arms to be thrown outward then
inward (embracing) and fanning then clenching fingers
Asymmetric Tonic Neck Response
Turning head to side causes extension of arm toward infant's gaze with CL arm flexion
(fencer)
What vitamin must be administered to all newborns?
K (IV form)
What are the signs of early vitamin K deficiency in newborns?
Severe bleeding at <24 hours
What causes early vitamin K deficiency in newborns?
Medications that interfere with how the body uses it (anti-epileptics, isoniazid)
What are the signs of classical vitamin K deficiency in newborns?
1-7 days after birth with bleeding from umbilical cord
What are signs of late vitamin K deficiency in newborns?
2-12 weeks (up to 6 months) in previously healthy infants only breastfed, may bleed into
brain
, What is the management of newborns born to mothers positive for HBV?
Known (+) - vaccine + Ig within 12h of delivery, test for anti-HBs at 9-18 months of age
Unknown status - vaccine within 12h of delivery, or delay until results (effective up to 7
days)
What is the difference between gonococcal and chlamydial conjunctivitis?
1) Apparent soon after birth, can lead to blindness if not treated quickly
2) Presents 7-14 days after birth, no prophylaxis
What is the prophylaxis for gonococcal ophthalmoplegia?
Erythromycin
Prenatal Lab Screening
Type & screen, rubella IgG, HBsAg, HIV, RPR/VDRL, U/A, urine NAAT for G/C, GBS,
HCV antibody +/- TB skin or blood test
Why is it important for the fetus to control maternal DM?
Hyper-insulinemia as a result of hyperglycemia leads to increased size of insulin-
sensitive organs causing macrosomia & malformations
What maternal HbA1c level leads to 12 fold increase risk of major fetal
malformations?
> 12%
LGA Infant
>90th percentile for weight or >2 SD (~97th %)
What are complications for LGA infants?
C-section, instrumental delivery, birth injuries and hypoglycemia
Signs of Respiratory Distress in Newborn
Grunting, retractions, tachypnea
What is the management for feeding infants in respiratory distress?
PO < NG or IV if RR 60-80
NG < IV if RR >80
What must be done to increase chance of breastfeeding if an infant is in
respiratory distress?
Pump breastmilk until able to feed, get infant to mom ASAP after treatment, NG may
help
Why do NG feeding vs. bottle feeding improve breastfeeding rates?
Infant gets frustrated because milk is not expressed as quickly as it is from a bottle
What are late preterm infants at risk for?
Hypothermia, hypoglycemia, respiratory distress, apnea, hyperbilirubinemia, feeding
difficulties
What is the screening for hypoglycemia in newborns?
Target glucose >45 by glucometer test in ALL infants (hypoglycemia commonly causes
no sx)
What is the average blood glucose of an infant by 3-4 hours after birth?
65-71 mg/dL
What is the difference between whole blood glucose and plasma glucose levels?
10-15% lower
What is the management of newborn hypoglycemia?
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