A 38-year old obese woman brings her newborn son to your office for the establishment of care. She was diagnosed with diabetes mellitus when she was 22 years-old. She has been taking insulin and throughout her pregnancy she reports, ‘I tried to control my sugars as much as I can’. Her baby had to be delivered at 38 weeks via cesarean section a week ago because he weighed more than 11 lb (4900 g). Which of the following was a risk factor for macrosomia in this baby?
A 35-year-old pregnant woman at 32 weeks of gestation is referred for management of hepatitis B virus (HBV) infection. She is HBsAg and HBeAg positive, with an HBV DNA level of 350,000 IU/mL. She has no symptoms of liver disease, and her liver function tests are normal. The healthcare team discusses initiating antiviral therapy to reduce the risk of perinatal transmission. What is the recommended antiviral therapy for a pregnant woman with hepatitis B and a viral load >200,000 IU/mL to reduce perinatal transmission?
A 29-year-old pregnant woman at 34 weeks gestation is referred for management of chronic hepatitis B infection identified during prenatal screening. She is positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), with an HBV DNA level of 250,000 IU/mL. She has no symptoms of liver disease, and her ALT levels are mildly elevated. The healthcare team evaluates her risk for perinatal transmission to determine the appropriate interventions. Which maternal factor is the strongest predictor of perinatal transmission of hepatitis B?
A 32-year-old pregnant woman presents for her routine prenatal visit at 36 weeks of gestation. She was diagnosed with chronic hepatitis B earlier in the pregnancy, with positive HBsAg and HBeAg, and an HBV DNA level of 300,000 IU/mL. She has not started antiviral therapy. The obstetric team discusses strategies to minimize the risk of transmitting hepatitis B to her baby during and after delivery. Which of the following is the most effective way to prevent perinatal transmission of hepatitis B?
A 3-day-old neonate with abdominal distension, bilious vomiting, and failure to pass meconium is diagnosed with meconium ileus. Imaging shows a dilated bowel, and the obstruction is relieved by Gastrografin enema. Genetic testing confirms a mutation in the CFTR gene. Which of the following long-term complications is this neonate most at risk for?
A 1-day-old male neonate with a distended abdomen and failure to pass meconium undergoes an abdominal X-ray, which reveals dilated bowel loops. Contrast enema demonstrates a microcolon with inspissated meconium. The baby’s sweat chloride test is positive. Which of the following is the best initial treatment?
A 2-day-old term male neonate is brought to the hospital with abdominal distension and bilious vomiting. The baby has not passed meconium since birth. Physical examination reveals a distended abdomen without tenderness. Abdominal X-ray shows dilated loops of bowel with no air in the rectum. Contrast enema reveals a microcolon with inspissated material in the terminal ileum. What is the most likely underlying cause of this neonate’s condition?
A newborn male, born at 38 weeks gestation via spontaneous vaginal delivery, presents with persistent vomiting shortly after the first feed. The mother reports greenish-colored vomit and mild abdominal distension. The baby has not passed meconium since birth. There are no significant complications during pregnancy, but the mother mentions a prenatal ultrasound showing polyhydramnios. She has some relatives with genetic disorders. On physical examination, the baby appears slightly dehydrated but is otherwise alert and active. The abdomen is mildly distended, with no palpable masses or tenderness. Bowel sounds are present but reduced. A nasogastric tube is inserted, and bilious fluid is aspirated. X-rays reveal two distinct air-filled bubbles in the stomach and the proximal duodenum, separated by the atretic segment. Which of the following conditions is most commonly associated with this disorder?
A newborn male, born at 38 weeks gestation via spontaneous vaginal delivery, presents with persistent vomiting shortly after the first feed. The mother reports greenish-colored vomit and mild abdominal distension. The baby has not passed meconium since birth. There are no significant complications during pregnancy, but the mother mentions a prenatal ultrasound showing polyhydramnios. On physical examination, the baby appears slightly dehydrated but is otherwise alert and active. The abdomen is mildly distended, with no palpable masses or tenderness. Bowel sounds are present but reduced. A nasogastric tube is inserted, and bilious fluid is aspirated. You suspect duodenal atresia and decide to order some x-rays. What is the most characteristic radiological finding in duodenal atresia?
