Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
336 Cards in this Set
- Front
- Back
|
1 in __ infants are born premature according to the march of dimes.
|
8
|
|
|
An infant that is considered very preterm is born < ___ weeks
|
32
|
|
|
An infant who is born < 25 weeks old is considered...
|
extremely preterm
|
|
|
What is the cut off to be considered low birth weight?
|
less than 2500grams
|
|
|
A child who is born weighing less than 1000 grams is said to have?
|
Extremely low birth weight
|
|
|
How much must an infant weigh at birth to be placed in the very low birth weight category?
|
less than 1500g but more than 1000
|
|
|
What is chronological age?
|
Time since birth
|
|
|
What is the definition of gestational age?
|
the time since conception
|
|
|
What is the corrected age?
|
age corrected for prematurity on the growth charts
|
|
|
What are the 4 U's of late preterm infants?
|
1. Unrecognized as premature
2. Underestimated for morbidity and mortality 3. Unpredictable timing for presentation 4. Understudied and under reserached |
|
|
Late preterm infants have rates that are __ times higher for morbidity and mortality compared to full term infants
|
3
|
|
|
List the contributing factors to prematurity.
|
-Advanced maternal age
-gestational hypertension -IUGR -chromosomal abnormalities -gestational disorders -chronic health disorders -use of assisted reproductive technologies -multiple births -cesarean section |
|
|
What are the key history findings that must be asked during pregnancy?
|
-Use of reproductive technology
-complications -overall health -screening tests -Amniocentesis -use of folic acid -Hx of GBS status -TB -Maternal health problems |
|
|
What are the maternal illnesses that must be known during pregnancy?
|
-Lupus
-Thyroid disease -Myasthenia -ABO setup |
|
|
What can maternal lupus cause in newborns?
|
heart block
|
|
|
What are the issue that can occur with the amniotic fluid in newborns?
|
-polyhydraminos
-oligohydraminos -meconium stained fluid |
|
|
What are the areas where transitional changes occur in the newborn period?
|
-respiration
-circulation -temperature control -glucose control -neurologic transition |
|
|
What factors are associated with the neurological transition in the newborn period?
|
-Irritability
-Jitteriness -Lethargy -Rooting -Sucking -Swallowing |
|
|
lIst the tests perfomed on the newborn in the newborn period?
|
-Blood type
-screening glucose (<40) -Total and direct bili -CBC -Coomb's test -RPR: syphilis |
|
|
What are the key factors of the first newborn visit?
|
-Adaptation to the home environment
-parental adjustment -establish relationship with parent -reassurance -get to know the infant well |
|
|
ToF: Depressed mothers are just as likely to have poor child developmental outcome for newborns as happy mothers?
|
FALSE: they are more likely to have poor outcome
|
|
|
What is the name of the screen for post partum depression?
|
Edinburgh Postpartum depression scale
|
|
|
What is the appropriate age of the infant to stop screening the mother for post partum depression, given the last screens were normal?
|
6 months
|
|
|
What is the rate of hospital readmissions for late preterm infants? compared to full term
|
LP: 25-58%
FT: 8-10% |
|
|
ToF: late preterm infants usually have readmissions only in the first year of life?
|
FALSE: they can continue into the second year
|
|
|
List the assessments of the throat that should be done on a late preterm infant and all newborns?
|
-evaluate suck-swallow
-tongue thrust -oral aversion -uvula movement -hyper/hypoactive gag reflex |
|
|
What is the HCP looking for when conducting the respiratory assessment in the newborn period?
|
-rate and retractions
-stridor -monitor closely for RSV-wheezing |
|
|
What are some physical assessment findings of the neck and shoulder that may be seen with late preterm infants?
|
-poor head control,
-tight scarf sign -difficulty bringing hands to midline |
|
|
List the issues of the trunk upon physical assessment of a late preterm infant.
|
-arching
-decreased ROM -hypotonia |
|
|
What should a late preterm be assessed for in terms of his or her extremities?
|
-hypo/hypertonia
-passive tone -hand to mouth coordination -hyperreflexia: how to test -clonus -testing for babinski to avoid plantar, gait -stress gait by putting penny on nose |
|
|
Describe the Landau reflex
|
Infant will lift head and extend the neck and trunk
present by 6 months |
|
|
When does the parachute reflex occur and what should be assessed for?
|
Present at 6-8 weeks and there should be symmetry
|
|
|
Describe the propping reflex.
|
Anterior propping when sitting up and lateral propping to maintain balance
|
|
|
ToF: the AAP recommend immunizations schedule to follow the chronological age with adjustments for prematurity
|
False: no adjustment for preterm
|
|
|
What is the requirement to receive the Hep B vaccine?
|
The child must weight at least 2.0 kilograms
|
|
|
What is synagis? When is it given?
|
Drug given to children with cyanotic heart disease phrophylatically for prevention of respiratory disease.
Given during october-april 15mg/kg monthly 100mg vials |
|
|
a newborn should grow __ to __ mg/ every day.
|
15-20
|
|
|
A late preterm infant should grow ___cm per week until __ then .75cm for __ months, down to __ cm from 3-__ months
|
1.1; term; 3; 6
|
|
|
How much should the head of a newborn grow in the first 3 months and 6 months?
|
.5cm/week for first 3 months
.25 cm/week from 3-6months |
|
|
What is the rate of head growth in the newborn period that would point to hydrocephalus?
|
1.25cm/week or more
|
|
|
How many calories per day does a premature newborn need for proper growth?
|
137-165 calories/kg/day
|
|
|
What is the appropriate daily multivitamin regimen for a premature infant?
|
0.5 to 1.0 ml until taking 25 ounces per day or until body weight is 3.5 to 4kg
|
|
|
How much vitamin D is given to premature newborns and when is it started?
|
400 IUs on the 2nd day of life
|
|
|
Which newborns get iron supplements and how much?
|
2-4mg/kg/day at 1-2 months of age in BREASTFED children
|
|
|
What is the caveat in nutrition for preterm infants?
|
Higher energy and nutrient requirements are needed due to IUGR, medical conditions, immaturity of the gut, and increased body surface area
|
|
|
How long does it usually take very low birth weight babies to catch up for weight? for head circumference?
|
24 months for weight
18 months for HC most catch up by 2-3 years |
|
|
When does a growth spurt occur for VLBW babies?
|
38-48 weeks and again at 6-9 months
|
|
|
What are the associated factors to feeding problems in preterm infants?
|
-Tonic bit reflex
-tongue thrust -hyperactive gag reflex -oral hypersensitivity (don't like things in their mouth) |
|
|
Who should preterm infants be referred to for feeding problems?
|
speech therapy with specialty in oral motor problems or PT with similar interest
|
|
|
What is the nature of the pulmonary vascular bed in utero? what does this cause?
|
In utero there is high resistance causing substantial bypass of blood away from the lungs through the PFO and the PDA
|
|
|
What occurs in the right ventricle for in utero?>
|
Provides systemic flow by shunting umbilical venous blood arriving through the lower right atrium across the ductus
|
|
|
Describe the placenta.
|
Supplied by the mom's left sided circulation is high flow but low resistance organ
|
|
|
When does the PDA often close?
|
by day 12 of life
|
|
|
What occurs in the cardiovascular system at birth?
|
-Pulmonary cap bed expands
-Right side heart pressure falls -Left side heart pressure rises -Increase left pressure closes the FO -Umbilical arteries, ductus venosus and arteriosus constrict due to increase O2 tension |
|
|
What must a newborn be given if arriving to the ER on the 10th-12th day of life with respiratory distress and no benefit from respiratory aids?
|
Prostaglandins to create a PDA in the event that they have an unknown heart defect: atresia
|
|
|
Newborns generate heat by ___ of __ __
|
lipolysis; brown fat
|
|
|
How do infants respond to hypothermia?
|
increasing cardiac output and insensible water loss
|
|
|
Term infants conserve heat by __ to ___ contact, light ___ and avoidance of environmental cold spot.
|
skin to skin; clothing
|
|
|
When should the umbilical chord fall of off the newborn?
|
By day 7
|
|
|
What is a possible diagnosis to a prolonged attachment of the umbilical chord remnants in newborn?
|
red flag for neutrophil defect.
|
|
|
ToF: Parents should be encourage to pat the babies back in order to burp the baby after feeding and prevent discomfort?
|
FALSE they should rub it, not pat
|
|
|
What is the proper protocol for circumcision care?
|
petroleum jelly after and gentle cleaning
|
|
|
ToF: spitting up is normal in the newborn
|
True: unless it is projectile at 6 weeks or later and this is a sign of pyloric stenosis
|
|
|
ToF: pyloric stenosis runs in families
|
True
|
|
|
What is the appropriate amount of diapers per day that should be reported for newborns?
|
8
|
|
|
Why are pacifiers recommended for newborns?
|
Have been found to help prevent SIDS
|
|
|
ToF: infants should be left to learn self soothing techniques?
|
True
|
|
|
How long should a newborn be placed in rear facing position in cars?
|
2 years old
|
|
|
What is an important education piece to tell parents in terms of the babies head position?
|
They need to turn the baby's head from side to side when sleeping
|
|
|
What are the postpartum adjustments that should be watched in the immediate newborn period with the caregivers?
|
-mother's mood swings
-edinburgh depression scal -father's reaction -siblings reaction |
|
|
What is the normal HR for the full term infant?
|
90-140 bpm
|
|
|
a newborn should be breathing __ to ___ breaths a minute
|
30 to 60
|
|
|
What is a reassuring temperature for a newborn?
|
97.8-98.6 degrees
|
|
|
What is a federal requirement of hospitals before discharging a newborn home?
|
hearing screen
|
|
|
How must the cord appear for discharge? Circumcision?
|
dry and clean.
Circumcision should be clear and not bleeding. |
|
|
What 2 drug prophylaxis should be given before discharge?
|
Eye and vitamin K
|
|
|
ToF: the follow-up appointment does not need to be made in the hospital to discharge the baby home?
|
FALSE: it must be arranged
|
|
|
Can the child have jaundice and be discharged home?
|
Yes, but not significant
|
|
|
Why is vitamin K given to newborns?
|
prevents hemorrhagic disease of the newborn
|
|
|
What should be a differential with a delay in meconium passing?
|
CF
|
|
|
Newborns must have coordination of __ and __ to be discharged home
|
suck and swallow
|
|
|
The gestational age of a newborn to go home is > __ weeks
|
35
|
|
|
ToF: a child who has significant vomiting in the nursery can be sent home, since vomiting in infants is normal./
|
FALSE: cannot be significant vomiting
|
|
|
How must the metabolic screening be done to go through?
|
The card must be saturated through and through to work.
|
|
|
Is there a prerequisite for the metabolic screening in the newborn period?
|
Yes, must happen at minimum 24 hours worth of feeding
|
|
|
What are the factors associated with the psychosocial attachment learned by the newborn?
|
-forming a secure and trusting relationship
- based on caregiver interaction -influences the development and growth later on |
|
|
What are the RED FLAGS of psychosocial development of the newborn?
|
-No comfort seeking from caregiver
-No checking back with caregiver when exploring new situations -no reaching out to caregiver after brief separation |
|
|
The HCP should promote __ __ __: fostering positive parent infant interaction.
|
goodness of fit
|
|
|
What should the HCP look for in terms of temperament and goodness of fit>?
|
-activity level
-regularity -adaptability -approach and withdrawal -quality of mood -distractibility -attention span and persistence -intensity of reaction |
|
|
What is the term to describe how the child behaves?
|
temperament
|
|
|
What are the 2 questions to answer when a child is suspected to have jaundice?
|
What color are the stools and was a direct bili done.
|
|
|
What are direct bilis and indication of?
|
liver problems
|
|
|
ToF: jaundice that develops in after the first 24 hours of life is a red flag?
|
FALSE: it is a red flag in the first 24 hours
|
|
|
What does jaundice in the first 24 hours often indicate?
|
sepsis or metabolic disease
|
|
|
Why is bilirubin production elevated often in the newborn period?
|
Increased breakdown of fetal erythrocytes, result of the shortened lifespan of fetal erythrocytes and the higher erythrocyte mass in newborns
|
|
|
The hepatic excretory capacity in infants is low because of low concentrations of the __ protein, __ in the hepatocytes
|
binding; ligandin
|
|
|
Why is bilirubin largely water soluble in the newborn period?
|
Low activity of glucuronyl transferase, the enzyme responsible for binding bilirubin to glucuronic acid
|
|
|
Babies have more (conjugated/unconjugated) bilirubin.
|
unconjugated
|
|
|
What does high levels of conjugated bilirubin often mean?
|
biliary atresia: total blockage of the bile duct and only seen with a direct bili screen. surgery needed
|
|
|
Once excreted into bile and transferred to the __, bilirubin is eventually reduced to colorless ___ by microbes in the ___
|
intestines; tetrapyrroles; colon
|
|
|
Some de-conjugation of bilirubin occurs in the proximal __ __ throug the action of beta-____ located in the __ __
|
small intestine; glucuronidases; brush border
|
|
|
ToF: conjugated bilirubin can be reabsorbed into circulation, increasing the total plasma bilirubin pool.
|
FALSE: UNCONJUGATED
|
|
|
What are the steps of the enterohepatic circulation?
|
Cycle of uptake, conjugation, excretion, deconjugation, and reabsorption
|
|
|
The process of enterohepatic circulation may be __ in the neonate because nutrient intake is __ and prolonging the __ transit time
|
extensive; limited; intestinal
|
|
|
List out the steps of the physiology of jaundice.
|
red cell hemolysis --> hemoglobin --> heme & globulin --> unconjugated bilirubin --> binds to albumin --> conjugated in the liver --> excreted through bile into the gut --> requires fat to exit the gut --> remaining gut bili becomes deconjugated and returns to liver
|
|
|
What are the 4 physiological factors of jaundice in well newborns?
|
1. Higher bili loads due to RBC life being shorter and Hct levels being higher than adults
2. liver conjugation enzymes much lower 3. empty gut contributes to increase enterhepatic circulation 4. low amount of breast milk contributes to increased in enterohepatic circulation |
|
|
WHat can occur in the newborn if the mother is O blood type and the newborn is AB?
|
hemolysis and jaundice due to increase in indirect bili
|
|
|
ToF: most cases of jaundice are pathologic?
|
FALSE: they are mild, idiopathic and benign
|
|
|
ToF: neonatal hyperbilirubinemia is extremely common?
|
true
|
|
|
ToF: almost every newborn develops an unconjugated serum bili level of more than 30mmol/L (1.8mg/dL) during the 1st week of life
|
TRUE
|
|
|
What is the most important factor in monitoring hyperbilirubinemia?
|
the rate of the rise
|
|
|
What is the lowest level of bili in children that can lead to neuro damage?
|
13 mg/dL
|
|
|
Where does jaundice often start in newborns?
|
in the head and then travels down the body as it gets more severe
|
|
|
WHich sex gets jaundice more often?
|
males
|
|
|
what are the hematologic risk factors of jaundice?
|
-ABO/Rh incompatibility
-G6PD deficiency |
|
|
Which races are more prone to jaundice?
|
East Asians and American indians. Lower in African americans
|
|
|
What are the geographic risk factors to jaundice in newborns?
|
-high altitude
-Greeks living in Greece -East asians |
|
|
What are the birth weight and age risk factors for jaundice?
|
higher incidence in premature and low birth weight
|
|
|
What disorder occurring during labor can lead to jaundice
|
cephalohematoma
|
|
|
ToF: neonatal jaundice runs in families?
|
true
|
|
|
ToF: there is a higher incidence of jaundice in infants who are breastfed or who not receive adequate nutrition,
|
true
|
|
|
formulas containing __ __ have been shown to promote bilirubin excretion.
|
protein hydrolysates
|
|
|
ToF: maternal diabetes can lead to infants with jaundice
|
true
|
|
|
Can smoking on part of the mother cause jaundice in the child?
|
YES
|
|
|
What is an example of a congenital infection that causes jaundice
|
sepsis!
|
|
|
What are the prenatal history findings that increase the risk of jaundice in the newborn?
|
-maternal illness
-maternal drug intake -delayed cord clamping -birth trauma with bruising -use of pitocin |
|
|
What are the postnatal history findings that are risk factors for jaundice.
|
-loss of stool color
-breastfeeding -greater than average weight loss -symptoms or signs of metabolic disease -exposure to total parenteral nutrition TPN -hypothyroidism |
|
|
physiologic jaundice occurs in the __ to __ day of life and sees rises in the bilirubin to __ levels
|
3rd-5th; 12mg/dL
|
|
|
What is the name of the syndrome that should be noted when working up a newborn for jaundice?
|
Gilbert syndrome
|
|
|
Pathologic jaundice occurs in the __ day of life
|
first: 24 hours
|
|
|
Describe biliary atresia.
|
-immune or non-immune hemolytic anemia
-polycythemia -presence of bruising or other exrtravasations of blood |
|
|
Where does bilirubin get trapped in hyperbilirubinemia?
|
in subcutaneous fat
|
|
|
What are the bili levels when jaundice can be seen?
|
usually 5mg but sometime 3mg
|
|
|
The progression of jaundice is deemed ___
|
cephalocaudal
|
|
|
__ % of all newborns have jaundice
|
20
|
|
|
Hyperbilirubinemia increases the risk of ___
|
kernicterus
|
|
|
Unconjugated bili is hazaradous to __ tissue
|
nervous
|
|
|
What must be known if jaundice continues in newborns after the first 1-2 weeks of life
|
results of the metabolic screen: galactosemia and congential hypothyroidism
|
|
|
what are the physical assessment findings of hemolytic anemia, sepsis and congenital infections?
|
-hepatosplenomegaly
-petechiae -microcephaly |
|
|
What is the name of the tool to use to treat jaundice?
|
bilitool.org
|
|
|
What are the differential diagnoses to jaundice?
|
-biliary atresia
-galactose 1 phosphate uridyltransferase deficiency -breast milk jaundice -hemolytic disease of the newborn -cholestasis -hep B -CMV -hypothyroidism -duodenal atresia -dubin-johnson syndrome |
|
|
Who created bilitool
|
american academy of pediatrics
|
|
|
ToF: it is normal for the bili levels to rise after the 3rd day of life as long as they stay within normal range.
|
false: they should not rise after day 3
|
|
|
What is the coomb's test?
|
Direct antiglobulin test
|
|
|
Why are serum albumin levels assessed in infants with jaundice?
|
useful adjunct in evaluating risk of toxicity levels b/c albumin bind bili in a ration of 1:1 at the primary high-affinity binding site
|
|
|
Should a retic count be done in a bili assessment?
|
yes
|
|
|
What are the two liver function tests done in a jaundice assessment
|
ASAT and ALAT to check for hepatocellular disease and cholestatic disease
|
|
|
Risk of bilirubin CNS tox is increased in acidosis, particularly __ acidosis
|
respiratory
|
|
|
What are the 2 diagnostic imaging test done for jaundice
|
-ulstrasound: cholestatic disease
-radionuclide scanning: indicated for extrahepatic biliary atresia is suspected. |
|
|
What is the treatment for jaundice
|
phototherapy, monitoring, exchange transfusion
|
|
|
What is the magic bili level indicating phototherapy for older infants
|
> 18 mg/dl
|
|
|
What does phototherapy do for jaundice?
|
increases bili excretion
|
|
|
When is an exchange transfusion indicated for jaundice?
|
Rh disease
|
|
|
What are the anticipatory guidance factors that are important in jaundce?
|
-know maternal blood type and baby's blood type
-0know mom's Rh status -identify the jaundice |
|
|
What is the generalized pealy/cracky skin problem that occurs in the first 24-48 hours of life, more commonly in post term infants and resolves within a week?
|
Desquamation
|
|
|
ToF: erythema toxicum neonatorum is a benign skin disorder in newborns.
|
True
|
|
|
What is the skin disorder that is characterized as small papules, vesicles or pustules surrounded by blotchy erythema and filled with eosinophils on smear?
|
Erythema toxicum neonatorum
|
|
|
What does erythema toxicum neonaturm often resemble?
|
herpes, but are not in groups
|
|
|
When does erythema toxicum neonatorum often occur and disappear?
|
Appears the fist week and disappears within 1-2 weeks
|
|
|
What is the cause of miliaria?
|
heat rash leading to occluded sweat glands
|
|
|
What is often the treatment for miliaria?
|
topical antibiotics but only if symptomatic
|
|
|
Describe sebaceous hyperplasia.
|
-small yellow white papules on the nose of newborns and resembles milia
|
|
|
Why does sebaceous hyperplasia occur?
|
hyperandrogen state of the newborn
|
|
|
Which race of newborns is most commonly affected by hemangiomas of infancy?
|
white NB 10%
|
|
|
What is the growth pattern of HOI?
|
hemangiomas grow rapidly in the first 2-5 months (vascular tumor)
-by age 5 50% involute -by age 9 95% involute |
|
|
ToF: once HOI involute, the skin is returned to normal
|
FALSE hemangiomas if not treated early, or if very severe do not allow skin to return to normal
|
|
|
What is the treatment for HOI?
|
hemangioma of infancy: beta blocker
|
|
|
What are the 4 types of congenital hemangiomas?
|
1. hemangioma of infancy
2. Rapidly Involuting Congenital Hemangioma (RICH) 3. Non-Involuting Congenital Hemangioma (NICH) 4. Venous Malformation (VM) |
|
|
Describe a venous malformation.
|
very slow progressing hemangioma that does not involute
|
|
|
What are the hemangiomas that require treatment?
|
-airway threatening (beard)
-eye/vision threatening: lid-slit closure: amblyopia -devastating facial/cosmetic features |
|
|
What is the workup for a midline lumbosacral hemangioma?
|
US in 1st 3 months
MRI: 3 months ruling out tethered cord, spinal dysraphism |
|
|
What is PHACES syndrome?
|
Large, segmental facial hemangioma that requires work up
|
|
|
What are the 2 medications used to treat hemangiomas?
|
oral prednisolone and oral propanolol
|
|
|
What are the dosing requirements for oral prednisolone in the treatment of hemangiomas?
|
3-5mg/kg/day
|
|
|
What are the adverse effects and length of treatment?
|
-mood changes and hypertension are common
-infectious "complication": urosepsis in female infant -3-9 months of treatment |
|
|
What is the proper dosing of propanolol in the treatment of hemangiomas? When should it start?
|
-2mg/kg/day in divided doses tid with meals
|
|
|
What is the medical term for blocked tear ducts?
|
dacryostenosis
|
|
|
What are the adverse effects and length of treatment?
|
-mood changes and hypertension are common
-infectious "complication": urosepsis in female infant -3-9 months of treatment |
|
|
What is the proper dosing of propanolol in the treatment of hemangiomas? When should it start?
|
-2mg/kg/day in divided doses tid with meals
|
|
|
What is the medical term for blocked tear ducts?
|
dacryostenosis
|
|
|
___% of all term infants get dacryostenosis. when is the onset
|
73!!
onset: first few days-weeks of life |
|
|
How does dacryostenosis appear upon physical exam?
|
firm blue gray swelling nasolacrimal area that can be unilateral or bilateral
|
|
|
What are the treatment options for dacryostenosis?
|
-moist warm soaks; massage
-90% resolve spontaneously by 1 year -treat if infection -unresolved: ophth referral by 12 months |
|
|
List the differentials to dacryostenosis.
|
-excessive tearing
-foreign body -corneal abrasion -glaucoma -rhinorrhea with tearing -chlamydia conjunctivitis |
|
|
Where do the white plaques of oral candidiasis occur?
|
-inflamed: buccal mucosa
-palate -tongue |
|
|
What is oral candidiasis often associated with?
|
Diaper rash
|
|
|
__ __ is a symptom of HIV disease or immune deficiency if recurrent and severe
|
oral candidiasis
|
|
|
What are the history findings of babies with thrush?
|
-fussy/asymptomatic
-maternal STD/HIV infection -recent antibiotic use |
|
|
What is the disorder that involves white, cud-like plaque; that when scraped off will bleed?
|
Thrush
|
|
|
A child with thrush must also have what area of the body assessed during the exam?
|
the diaper area
|
|
|
What are the treatment options for thrush?
|
-mycostatin (nystatin) susp 100,000u/ml
-Fluconazole: 10mg/ml or 40mg/ml (6mg/kg/day on day 1; 3mg/kg/day days 2-14 qd)PO |
|
|
What are the possible causes of noisy breathing?
|
-congenital stridor
-stuffed nose -URI |
|
|
If a child has late presentation of congenital stridor, what might be the cause?
|
Subglottic stenosis
|
|
|
WHat is the common cause of congenital stenosis?
|
laryngotracheomalacia
|
|
|
When does congenital stridor often occur?
|
common cause of noisy breathing in infancy to 1-3 years
|
|
|
What is the definition of high pitched upper airway crowing>
|
stridor
|
|
|
What are the risk factors for stridor?
|
-intubation
-birth trauma -cardio/neuro abnormalities -GERD |
|
|
What are the physical exam findings/pieces for congenital stridor?
|
-retractions, cyanosis
-apnea, poor feeding, FTT -identify site of lesion (aerodigestive tract) -laryngotracheomalacia |
|
|
what are the common symptoms associate with laryngotracheomalacia other than stridor?
|
-cough
-choking with feeds -cyanosis |
|
|
What are the Common Rx for stuffed nose and URI?
|
-Normal saline nose drops
-nasal bulb syringe |
|
|
List the red flags associated with more serious respiratory disorders in children.
|
-Tachypnea: >60 to 65pm
-Chest wall retractions -grunting -auscultation of adventitious sounds -cyanosis on room air |
|
|
List the congenital malformations leading to respiratory distress.
|
-Choanal atresia or stenosis: nos is blocked
-microganthia with or without cleft palate -congenital laryngeal or tracheal stenosis -Severe tracheomalacia -diaphragmatic hernia -pulmonary cystadenomatoid malformation -pulmonary hypoplasia |
|
|
What should be able to pass through the nasal canal to rule out choanal?
|
5 French catheter
|
|
|
Describe the pathophysiology of transient tachypnea of the newborn.
|
-rapid, non distress breathing caused by alveolar retention of amniotic fluid
-more common with material glucose intolerance or delivery C-section |
|
|
What are the clinical features of transient tachypnea of the newborn?
|
-need for O2 is minimal
-can be precipitated or aggravated by cold stress -Streaky chest radiography with clear parenchyma |
|
|
Transient __ of the newborn will have __ chest radiography with ___ parenchyma
|
tachypnea; streaky; clear
|
|
|
What are the 2 genera of chlamydiaceae?
|
-chlamydophilia
-chlamydia |
|
|
What is chlamydophilia? what can cause it?
|
pathogens causing pneumonia
-C. pneumonia, C.psittaci, and non human pathogens |
|
|
What are the pathogens causing chlamydia?
|
-C. trachomatis and non human pathogens
|
|
|
ToF: in order for chlamydia to replicate, a human cell is needed.
|
true
|
|
|
What is C. trachomatis?
|
obligate intracellular bacteria that has an infectious elementary body and a metabolically active reticulocyte form.
|
|
|
What are the adverse effects of chlamydia in the newborn?
|
-conjunctivitis
-trachoma -pneumonia -genital tract infections -lymphogranuloma venereum |
|
|
C. trach has more than ___ variants
|
18
|
|
|
____ is the most frequent cause of neonatal conjunctivitis, with a rate of __ to __ %
|
C. trachomatis; 25-50% infected
|
|
|
How does transmission of C. trach occur?
|
vervical maternal infection to infant during vaginal delivery 50% of the time
|
|
|
What is the most prevelant STD in the US?
|
C. trachomatis
|
|
|
How do they screen for C. trach?
|
urine test
|
|
|
What are the symptoms of Chlamydia conjunctivitis in the newborn?
|
-edema
-awful injection -watery to mucopurulent eye discharge -pseudomembrane with bloody discharge if prolonged |
|
|
When does chlamydia conjunctivitis tend to develop?
|
5-14 days after birth and lasts for longer than 2 weeks
|
|
|
What are the treatment options for chlamydia conjunct?
|
silver nitrate drops
|
|
|
what can erythromycin cause in the newborn?
|
pyloric stenosis
|
|
|
Which drugs are not very effective in treating chlamydia conjunct?
|
erythromycin and tetracycline
|
|
|
What is the dosing regimen for erythromycin in the treatment of chlamydia conjunctivitis?
|
50mg/kg, PO (4 divided doses) x 2 weeks
|
|
|
What are the preceding signs of chlamydia pneumonia?
|
rhinorrhea, congestion, conjunctivitis
|
|
|
What are the tell-tale signs of chlamydia pneumonia?
|
tachypnea with persistent "Staccato" cough with congestion
-rale and rarely wheezing |
|
|
ToF: preterm infants with chlamydia pneumonia can have apnea.
|
True
|
|
|
What is the gold standard for diagnosis of chlamydia pneumonia?
|
culture
|
|
|
When does chlamydia pneumonia often occur and what is the treatment?>
|
2-19 weeks of age
-erythromycin |
|
|
Chest radiograph of chlamydia pneumonia show ___ and infiltrates, but usually there is no __ ___ or pleural effusion.
|
hyperinflation; lobar consolidation
|
|
|
Newborns with chlamydia pneumonia will have elevated serum _____
|
immunoglobulins
|
|
|
The specimen for chlamydia pneumonia must contain ___ cells since chlamydia is intracellular
|
epithelial
|
|
|
What is the etiology of pneumothorax of the newborn?
|
-can be spontaenous or associated with meconium aspiration, bacterial pneumonia and sepsis, respiratory distress syndrome
|
|
|
What are the clinical features of pneumothorax of the newborn.
|
-Non distressed tachypnea is one end of the spectrum (decreased breath sounds with or without mediastinal shift. clear area with distinct margin and absent lung sounds)
-Dyspnea, retractions with decreased air exchange |
|
|
which type of pneumothorax may require a chest tube?
|
tension
|
|
|
What are the diagnostic evaluations to conduct with a child with respiratory distress?
|
-pass catheter into nose each side to rule out choanal atresia
-look at oropharynx -look at neck -chest: special attention to uneven breath sounds if posteriorly -Abdomen: scaphoid abdomen reflecting abdominal contents within the lung -Chest XRAY |
|
|
What are the 4 umbilical problems of the newborn?
|
-patent urachus
-granuloma -infection -umbilical hernia |
|
|
What is a patent urachus?
|
connection between the baldder and the umbilicus
|
|
|
How is a granuloma of the umbilicus treated?
|
Cauterized with silver nitrate
|
|
|
How would an infection of the umbilicus present?
|
-malodorus
-purulent -erythema |
|
|
When does an umbilical hernia often resolve?
|
By age 506 years old
|
|
|
What should be place around the skin of a granuloma?
|
vasoline
|
|
|
What is omphalitis?
|
infection of the umbilicus
|
|
|
What are the clinical manifestations of omphailitis?
|
-foul smelling discharge
-perimumbilical erythematous streaking, induration and tenderness to palpation -purulent and serosangueous discharge |
|
|
What is the incidence of omphalitis with hospital and home births
|
hospital: 2%
-home: 21% |
|
|
What are the predisposing factors to omphalitis
|
-prematurity
-complicated delivery -improper severing of the umbilical cord -poor hygienic practices during the neonatal period. |
|
|
What is the most common cause of omphalitis? what are the others?
|
staph aureus
strep pyogenes -gram negative: Ecoli |
|
|
What is the most recent stance of the AAP on circumcision?
|
Health benefits outweigh the risk, but the benefits are not great enough to recommend universal newborn circumcision
|
|
|
What % of 1, 3 and 6 year old males have retractable foreskin secondary to phimosis?
|
-50, 80, 90.
|
|
|
List the benefits of circumcision.
|
-prevents cancer of the penis
-decrease risk of UTI < 5 years old -prevents parahimosis -prevents recurrent balanitis -decrease risk of acquiring STDs including HIV -avoids later circumcision |
|
|
What are the post operative risks of circumcision?
|
-fibrous band
-meatal stenosis -adhesions, cysts |
|
|
How is pain controlled in a circumcision?
|
-Dorsal penile nerve block
-EMLA -oral sucrose or pacifier -acetaminophen |
|
|
When is circumcision contraindicated?
|
-hypospadious
-ambiguous genitalia -ill newborn -excessive oozing after heel stick -not in the first 24 hours of life |
|
|
DDH is actually a ___ of abnormalities from __ __ to discloation
|
spectrum; shallow hip
|
|
|
DDH may lead to clinical or subclinical ___
|
instability
|
|
|
What are the 4 risk factors to DDH?
|
-female
-first born -feet first -family history |
|
|
ToF: oligohydramnios has been associated with DDH?
|
True
|
|
|
What are the musculoskeletal abnormalities that are risk factors for DDH?
|
-Torticollis
-metatarsus adductus -CP/neuromuscular: up to 5 years old |
|
|
Which ethnic group has a high risk of DDH?
|
native american
|
|
|
Hip with DDH may become __, have residual instability, subluxate or ___
|
normal; dislocate
|
|
|
ToF: complete dislocation of the hip in DDH is very bad.
|
FALSE: it may not be as bad
|
|
|
What does the instability/subluxation of DDH lead to ?
|
abnormal wear
|
|
|
What is the estimated % of adult hip degenerative joint disease due to DDH in childhood?
|
25-50
|
|
|
DDH is a significant cause of early __
|
arthritis
|
|
|
How should an xray be done with DDH?
|
PA, lateral and frog leg
|
|
|
At what age can an US be done on a child with suspected DDH?
|
Not before 2 weeks of age
|
|
|
WHat are the diagnostic methods for DDH?
|
-primarily PE
-US -XRAY: after 4 months - MRI/CT (only pre or post op) and ordered by ortho |
|
|
What are the physical exam pieces in detecting DDH?
|
-Barlow
-Ortolani -Galeazzi -skin folds in groin or buttock -asymmetric abduction/motion of hip -remember, irreducible hip is barlow/ortolani negative |
|
|
The irreducible hip in DDH is Barlow/Ortolani ___
|
negative
|
|
|
Describe the factors of US use in DDH.
|
-Used for evaluation/treatment exam-positive hips
-may also be used for very high-risk patients -Not for general screening in US -DO after 2-3 weeks of age with a dynamic study |
|
|
What is the treatment for DDH?
|
Pavlik Harness
|
|
|
What are the complications with incorrect positioning of the pavlik harness?
|
-too much flexion: femoral nerve palsy
-too much abduction: possible AVN |
|
|
Describe the treatment options for DDH in Pediatrics 12/09.
|
-Some cases of mild dysplasia resolve
-may not be detriment in observing for 6 weeks -does not apply to unstable hips |
|
|
Describe the Children's Abduction Brace in DDH.
|
-Stiffer, more restrictive
- used for older children or as fallback to Pavlik |
|
|
What are the operative treatments to DDH?
|
-closed reduction
-open reduction -spica casting -pelvic osteotomy -femoral osteotomy |
|
|
What is the number 1 cause of sepsis in the first month of life? what are the other common causes?
|
-#1: GBS
-Ecoli -Listeria (after 1 month trep pneumonia) |
|
|
GBS is a gram __, beta ___ bacteria
|
positive; hemolytic
|
|
|
Where does GBS often colonize?
|
human GI and GU tracts
|
|
|
Other than sepsis, what does GBS often cause?
|
meningitis
|
|
|
List the clinical presentation of a child with early-onset GBS disease.
|
-Typically symptoms appear on day 0 or day 1 of life
-respiratory distress, apnea, signs of sepsis most common symptoms -bacteremia most common form of disease -pneumonia and meningitis are less common |
|
|
What is the fatality rate for GBS in the past? in recent years?
|
1970s: 50%
recent years: 4-6% |
|
|
ToF: babies with GBS can lose their limbs?
|
True: as a result of vasculitis
|
|
|
What % of women are colonized with GBS?
|
10-30%
|
|
|
HIgher portion of __ __ and nonsmoking women have GBS
|
african american
|
|
|
ToF: Women with GBS usually present with symptoms
|
FALSE
|
|
|
What is the colonization pattern of GBS in women?
|
It comes and goes over months
|
|
|
ToF: GBS is a sexually transmitted disease.
|
False
|
|
|
What is the biggest risk factor for the infant to have early onset disease GBS?
|
if the mother is colonized during labor and delivery
|
|
|
what are the obstetric risk factors for GBS in infants?
|
-preterm delivery
-prolonged rupture of membranes - infection of the placental tissues or amniotic fluid/fever during labor |
|
|
Does a mother who had a previous infant with GBS increase the risk of the next having it?
|
Yes
|
|
|
What are the demographic factors associated with increase risk of GBS in the infant?
|
-African American
-Young maternal age |
|
|
How is early onset GBS disease prevented?
|
-intrapartum antibiotic: highly effective at preventing early onset disease in women at risk of transmitting it to newborns
-efficacy is 100% in clinical trials -effectiveness in observational studies: 86-89% |
|
|
What is the key prevention strategy for GBS?
|
Universal screening of pregnant women for GBS at 35-37 weeks of gestation.
|
|
|
what is preferred drug for intrapartum antibiotics for GBS.
|
penicillin.
-ampicillin acceptable alternative -cefazolin preferred fot pen allergic |
|
|
What are the indications for intrapartum GBS prophylaxis?
|
-previous infant with invasive GBS disease
-GBS bacteriuria during current pregnancy -positive GBS screening test during current pregnancy -Unknown GBS status AND any of the following: --Delivery at <37 weeks gestation --Amniotic membrane rupture > 18 hours --intrapartum temp > 100.4 |
|
|
When is intrapartum GBS prophylaxis NOT indicated?
|
-colonization with GBS during a previous pregnancy
-GBS bacteriuria during a previous pregancy -Negative vaginal and rectal GBS screening test during the current prenancy -Cesarean delivery performed before labor onset on a woman with intact amniotic membranes |
|
|
what is the dosing for penicillin for IAP?
|
5 million IU IV then 2.5-3 million IU IV every 4 hours
-Revised dose (2.5-3 million IU) consistent with available pen formulations |
|
|
What is the diagnostic evaluation for GBS?
|
-Blood culture
-CBC count, including white blood cell differential and platelet counts -Chest radiograph (if respiratory abnormalities are present) -Lumbar puncture (if the patient is stable enough to tolerate procedure and sepsis is suspected). -C-reactive protein |
|
|
What is the number 1 viral infection leading to newborn sepsis?
|
CMV
|
|
|
Other than bacteria and viral infections, what other infections can lead to sepsis?
|
fungus
|
|
|
What is the transmission of early onset sepsis in newborns?
|
-vertical often acquired from mother's genital tract
|
|
|
What is the transmission process of late onset sepsis?
|
vertical or via postnatal environment
|
|
|
What is the single most important risk factor to neonatal sepsis bacterial infections?
|
prematurity
followed by low birth weight |
|
|
Which gender is at higher risk for sepsis?
|
males
|
|
|
What are the clinical manifestations of neonatal sepsis?
|
-resp distress
-fever > 100.4 -neurologic findings: seizures, full fontanelle even in absence of meningitis, lethargy, hypotonia -GI symptoms: hepatosplenomegaly, abdominal distention, vomiting, diarrhea, gastric aspirations, guaiac stools, jaundice -metabolic: prolonged jaundice, hypoglycemia |
|
|
What are the complications of neonatal sepsis?
|
DIC, CHF and shock
|
|
|
what are the worrisome lab values that often indicate sepsis in newborn?
|
-elevated I:T (immautre to total neutrophil ratios) > 0.2
-elevated band count > 2000 -neutropenia <1750 -total white count exceptionally high > 25000 or low < 5000 -platelets < 100,000 |
|
|
The use of the buffy coat test, immunoassays, ESR, procalcitonin and CXR are other diagnostic tests to find out the presence of ___
|
sepsis
|
|
|
ToF: ampicillin treatment is reliable for listeria, GBS and E. Coli infections?
|
FALSE: not E. coli
|
|
|
Which drug is given if meningitis is suspected for CNS procession of spesis?
|
cefotaxime
|
|
|
What are the too common bacteria involved in late onset sepsis, which drugs are used to treat it?
|
-staph pneumoniae and neisseria meningitidis
treat with ampicillin and cefotaxime |
|
|
Which drug works synergistically with amp against listeria and GBS for gram negatives
|
aminoglycosides
|
|
|
ToF: incidence of meningitis is higher in the first month of life than at any other age?
|
True
|
|
|
What are the organisms responsible for meningitis infections?>
|
same as sepsis
|
|
|
What are the 3 most common ways the meninges can become infected? which is the most common?
|
-Primary sepsis with hematogenous seeding ***
-focal infections outside the CNS with either secondary bacteremia and resulting hematogenous dissemination or direct extension -direct inoculation following head trauma or neurosurgery or from an open congenital defect such as myelomeningeocele or dermal sinus |
|
|
What are the pathologic sequelae of meningitis?
|
-hydrocephalus
-ventriculitis -brain abscesses usually due to citrobacter or enterobacter |
|
|
What are the signs and symps of meningitis?
|
-lethargy
-reluctance to feed -emesis -respiratory distress -irritability -temperature instability -seizures -bulging fontanelle |
|
|
What is the diagnostic criteria for meningitis?
|
-growth of micoorg from the CSF
-a presumptive diag can be made when the CSF indices are suggestive of bacterial process and a pathogen is isolated from a blood culture |
|
|
What should be included in the evaluation of the CSF for meningitis?
|
-culture
-gram stain -cell count with leukocyte diff -glucose -total protein |
|
|
What is the treatment for early onset meningitis?
|
-ampicillin, gentamicin, and Cefotaxzime
|
|
|
What is the drug for late onset meningitis?
|
vanco and aminoglycosides add ampicillin if GBS suspected
|
|
|
What is the mortality and morbidity of meningitis in newborns?
|
-10%
-30-50% |
|
|
What should the HCP think when they see a jittery baby?
|
low Mg and low Ca
|
|
|
ToF: herpes simplex is a viral infection that can kill infants?
|
TRUE!!
|
|
|
What is the most common congenital viral infection in the US?
|
CMV
|
|
|
What are the most common manifestations of CMV?
|
-petechiae
-blueberry muffin rash -SGA for weight -HSM -jaundice at birth |
|
|
What is the Dx test for CMV
|
isolation of CMV in urine in first 3 weeks of life
-IgM antibiodies to CMV |
|
|
What is the tramission of CMV?
|
-maternal fetal
-blood transfusion |
|
|
How often does encephalitis w/ or w/o CNS involvement occur with HSV?
|
30%
|
|
|
When does Herpes often occur in newborns?
|
day 10-11 of life
|
|
|
What is the drug of choice for HSV?
|
acyclovir
|
|
|
What is the dosing regimen for acyclovir with HSV?
|
60mg/kg/day
|
|
|
What is the preterm dosing interval based on for acyclovir treatment of HSV?
|
creatinine clearance
|
|
|
When does disseminated and CNS disease often occur with HSV?
|
21 days
|
|
|
When does Skin, eyes and mouth (SEM) sores occur with HSV?
|
14 days
|
|
|
All HSV patients with CNS diease should have a repeat __ at the end of therapy.
|
LP
|
|
|
In HSV patients, CSF with + ___ should continue treatment until ___ negative.
|
PCR; PCR
|
