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40 Cards in this Set

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How is appropriate size for gestational age determined?
By plotting age against an average growth chart.
How is gestational prematurity defined?
Delivery before 37 weeks
Why might a baby be "small for gestational age"?
"Small for Gestational Age" indicates some mechanism of growth retardation:
1) Insufficient delivery of nutrients
2) Defects in Fetal Circulation
3) Fetal defect in metabolism
What are the morphologic features of infantile respiratory distress syndrome?
1) Small terminal airways
2) Thick alveolar septae
3) Alveolae lack both Type 1 and 2 pneumocytes
What's missing IRDS lungs?
Surfactant and sufficient lung development to supply adequate tissue oxygenation.
What is the gestation age range at high risk for IRDS?
Less than 27-32 weeks gestational age.
Use of positive pressure ventilation in IRDS may lead to what complications?
* Pulmonary Hemorrhage
* Pulmonary Interstitial Emphysema
* Pneumothorax
* Bronchopulmonary dysplasia
What is bronchopulmonary dysplasia?
BPD results from extended periods of mechanical ventilation. BPD is characterized by patchy distribution of fibrotic pulmonary scarring.
What neonate cerebral structure is highly susceptible to ischemic injury?
The Periventricular Germinal Matrix
What cause is typically attributed to Cerebral Palsy?
Perinatal asphyxia
What are two complications of neonatal cerebral hypoxic injury?
1) Cerebral hemorrhage
2) Periventricular leukomalacia
What bowel pathology may affect premature newborns?
Necrotizing enterocolitis
Necrotizing enterocolitis has what major pathologic feature?
Pneumatic dissection of the bowel wall, with possible intravascular air emboli.
What is "nuchal thickening"?
Edema of the posterior neck, sign of mild fetal hydrops.
What are the three primary mechanisms of fetal hydrops?
1) Increased venous pressure (e.g. heart failure)
2) Defective Vascular/Lymphatic integrity (chromosomal)
3) Decreased Oncotic Pressure
What is the primary mechanism of Intrauterine Growth Retardation?
Placental Insufficiency (SLE, HTN)
Confined Placental Mosaicism
Inborn Errors of Metabolism
What is the major gestational effect of maternal diabetes? What's the proposed mechanism?
Fetal Macrosomia due to somatotrophic effects of high fetal insulin production (response to high maternal blood sugar)
Name a post-delivery complication of gestational diabetes.
Fetal rebound hypoglycemia due to high circulating insulin levels.
What is a "descending infection?"
Trans-placental infection of the fetus by a maternal blood-borne pathogen.
Name three common viral and bacterial ascending infections.
Viral: HSV, HBV, HIV, HPV
Bact: GBS, E coli, Listeria
Name three common descending viral, bacterial, and protozoan infections:
Virus: Rubella, CMV, HIV, Parvo, Varicella, HBV
Bact: Syphilis, Listeria
Proto: Toxoplasma
What are the two major reasons for macrosomia?
1) Maternal Diabetes
2) Edema/hydrops
Define "anascara"
Anasarca, also known as "extreme generalized edema" is a medical condition characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space.
What's the pathology?!?
Congenital Toxoplasmosis, developed heart failure and fetal hydrops.
Varicella
Route: Transplacental
Transmission: Rare
SXS: Chorioretinitis, Cataracts, Growth Retardation
Rubella
Route: Transplacental
Transmission: 1º Infection ONLY
SXS: Rubella Triad (cataract, deafness, heart disease), PDA
Outcome: spontaneous abortion, TORCH
CMV
Route: Transplacental
Transmission: mostly 1º infection
SXS: chorioretinitis, cerebral calcification
Outcome: Hearing loss, learning deficits
Toxoplasma gondii
Route: Transplacental
Transmission: 1º Infection Only
SXS: Chorioretinitis, hydrocephalus
Treponema palladium
Route: Transplacental
Transmission: universal with infected mother
SXS: TORCH
Outcome: Saddle nose, Hutchinson teeth
What is chorioretinitis?
Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is also known as choroid retinitis.
HIV
Route: Perinatal >> Transplacental/Lactational
Transmission: 10-40% w/1º Infection
SXS: Usually asymptomatic
Outcome: AIDS
Parvovirus B19
Route: Transplacental
Transmission: >50% with 1º
SXS: Severe anemia, CHF, Fetal Hydrops
Group B Strep
Route: Ascending
Transmission: 30-70%
SXS: Pneumonia, sepsis, meningitis, shock
Outcome: meningitis
TORCHES
* Toxoplasmosis
* Rubella
* CMV
* Herpes
* Parvo
* Syphilis
Liver Slide. What's the pathology?
Cytomegalovirus
What are the cytopathic changes associated with neonatal CMV infection?
* Intranuclear (Cowdry type A) and cytoplasmic (Cowdry type B) inclusions
* CNS calcifications
What are the cytopathic changes associated with neonatal HSV infection?
* Intranuclear inclusions (Cowdry type A)
* Multinucleate cells
* Tzanck smear
What are the cytopathic changes associated with neonatal Parvovirus B19 infection?
* Intranuclear inclusions in hematopoietic cells of the liver
* Cardiomyopathy
Listeria
Route: Transplacental > Ascending
Transmission: Frequent (both 1º and 2º)
SXS: fetal demise, sepsis, targatoid "puss lesions"
Outcome: 50% mortality
What are the features of congenital syphilitic lesions?
* Small vessel infiltrate, vessel wall thickening, and fibrosis
* Interstitial liver, pacreas and lung fibrosis
* Spirochetes