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28 Cards in this Set
- Front
- Back
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Which is the least important?
Length Weight HC |
Length. Not accurate.
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At what point on the growth curve should you reevaluate / get a 2nd opinion?
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<5th
OR > 95th |
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Weight Over Time
- Describe weight pattern in first six weeks |
Lose 10% of BW in first week
Gain 20 - 30 grams / day Should gain 700 - 1000g by 6 weeks. |
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HC
- What is small? - Growth in first six weeks? |
- < 32 cm = concerning
- 0.5cm / week |
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Neonatal Sepsis: Presentation
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- nonspecific
- rare -25% mortality |
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Neonatal Sepsis: Risk Factors
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PROM
Chorioamnionitis GBS test +ve mum Male (6-7 x) prematurity perinatal asphyxia bad smelling fluid or baby maternal UTI in labour |
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Neonatal Sepsis: Signs and Symptoms
(several) |
1. Poor feeding
2. vomiting 3. lethargy 4. Resp distress 5. low tone 6. fever > 37.8 or persistent hypothermia 7. petechiae / cyanosis 8. seizures |
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When to Investigate?
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ASAP
Delay in Dx = bad outcome |
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Central Cyanosis:
How to Recognize? How to distinguish from acrocyanosis? When is it normal? |
Blue coloured membraned, nail beds, skin
DeOxy Hb at 50g / litre Acrocyanosis = extremities only Central Cyanosis: Never Normal |
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Central Cyanosis: Causes (5)
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1. Airway Obstruction
2. Chest compression of lungs 3. Lung disease 4. Cardiac 5. CNS: hypoventilation |
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Respiratory Distress: Signs and Symptoms
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RR > 60 breaths / min
substernal / intercostal retractions feeding difficulty grunt, stridor, wheezing, crackles nasal flaring HR > 160 cyanosis |
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Respiratory Distress: Causes
- immediate period - later - after first few days |
Immediate: TTN, RDS, Pneumonia, Meconium aspiration, congenital
Later: infection / sepsis, metabolic, cardiac, cranial bleed After first few days: Infection and Cardiac |
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Upper Airway Obstruction: Causes
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1. Choanal atresia / stenosis
2. Micrognathia 3. Trachea: tracheomalacia, clefts, webs, goiter 4. Nasal stuffiness 5. Cleft palata 6. Masses: tongues, tumors, encephalocele |
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RDS
- Cause and Tx |
- Decreased surfactant
(prematurity, gest diabetes and sepsis increase risk) - Give surfactant |
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Respiratory Distress: Cardiac causes
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1. CHD (cyanotic or acyanotic)
2. arrythmia 3. Inc IV volume 4. High output vailure: AVM, hyperthyroidism 5. Cardiomyopathy 6. Pneumopericardium |
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GI Issues: Urgent Signs
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Tense Distension
Bile stained vomit Blood per rectum Absent bowel sounds Vomiting (persistent) , poor weight gain and dehydration |
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GERD
How common? What is it? |
90% of newborns
Non-forceful reflux of food due to week cardiac sphincter |
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Persistent Vomiting: Causes
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Congenital: malrotation, volvulus, strictures
Pyloric stenosis Necrotizing enterocolitis Less common: infection, allergy |
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Pyloric Stenosis
-what? - when? - consequences? |
Common cause of persistent non-bilious vomiting.
Often begins 2-3 weeks of age. Baby can show poor weight gain and dehydration. |
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Jaundice: Causes
Unconjugated |
Hemolysis due to ABO incompatibility, Rh disease
Sepsis |
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Pathologic Jaundice: Causes
Conjugated |
Sepsis, hepatitis
Anatomic: biliary atresia, choledochal cyst |
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What is kernicterus?
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CNS damage due to elevated BR.
Affects BG and can cause CP |
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Tx for HyperBRemia
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Phototherapy. Tx depends on age, size, cause of jaundice, and risk factors.
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Jaundice Post Week 1
Investigations? |
If recurrent, may be physiological and may need no Tx
If onset post one week, must r/o pathologic jaundice |
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Jaundice Beyond First Week
Causes - Unconjugated |
Breast milk jaundice
Hypothyroidism Sepsis Hemolysis due to Hbopathy, RBC defect Metabolic (Gilberts, Craigler- Najir) Drugs |
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Jaundice Beyond First Week
Causes - Conjugated |
Viral hepatitis
Sepsis Anatomic Metabolic: CF, galactosemia, tyrosemia, a1antitrypsin def |
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What is Breast Milk Jaundice?
What is the mechanism? |
Significant unconjugated hyperBRemai in breast fed baby 7 days age or older; NO other etiology
Mechanism: ??? Breast milk inhibits glucoronyl transferase which is needed to conjugate BR |
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Dx?
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If not sure, stop breast feeding for 48 hrs.
Rarely causes kernicterus. |
