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41 Cards in this Set
- Front
- Back
FTT in an infant? |
Failure to regain birth weight by 3 weeks of age or continuous weight loss after 10 days of life hasbeen defined as failure to thrive.
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In an infant adequately nourished: number of feeds number of wet diapers |
6 feeds per day six wet diapers per day (at least) |
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Why breastfeed in one sentence? |
Human milk is the preferred feeding for all infants, including premature and sick newborns, withrare exceptions (e.g., an HIV-infected mother).
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During early weeks of breastfeeding, mothers should be encouraged to have how many feeds per day? |
8 to 12 every 24 hours |
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Signs of hunger in an infant? |
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How to assess how much milk a breastfed infant is getting? |
adequate if:
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Vit D supplementation for babies? |
All breastfed infants, regardless of whether he or she is being supplemented with formula,should receive 400 IU of supplemental oral vitamin D beginning within the first few days oflife
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Definition of lethargy? |
level of consciousness characterized by poor or absent eyemovements or as the failure of a child to recognize parents or to interact with persons or objects inthe environment.
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T/F: infants are much more prone to dehydration than larger children and adults |
True: and an infant with vomiting and/or diarrhea can become easily dehydrated |
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Significance of large fontanel? |
increased ICP can also result in large fontanels and splitting of the sutures |
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Significance of small fontanel? |
Premature closure or a small fontanel for age may be a feature of:
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Significance of sunken fontanel? |
dehydration |
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Significance of bulging fontanel? |
increased ICP
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Most common cause of congenital hypothyroidism? |
some form of thyroid dysgenesis
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Primary vs secondary hypothyroidism |
primary is the major cause |
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presentation of infants with congenital hypothyroidism? |
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Diagnosis and treatment of CH? |
Newborns with a low T4 and elevated TSH on the newborn screen are considered to haveCH until proven otherwise.
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Why is newborn screening done? |
The ideal targets for newborn screening are serious diseases for which:
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The newborn screening system consists of 5 parts: |
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The benefits of newborn screening may include the following
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Risks of newborn screening may include
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what to inquire about regarding first outpatient visit for newborn visit? |
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*Differential Diagnosis for a Neonate with Poor Feeding and DecreasedActivity |
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Congenitalhypothyroidism
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Shaken babysyndrome |
Risk factors for shaken baby syndrome include: Young/single parents Significant stressors at home (finances, living situation, etc.) Lower education level A history of seizures or irritability would increase the suspicion for thisdiagnosis. |
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Down syndrome |
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Sepsis |
Signs of sepsis include poor feeding and decreased activity, amongothers. |
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Signs of sepsis include poor feeding and decreased activity, amongothers. |
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Inborn error ofmetabolism
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Hypoglycemia
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Botulism
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Hypoxic-ischemicencephalopathy
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Altered mental status can be seen with hypoxic-ischemicencephalopathy, but would typically appear shortly after birth.Infants with this disorder often have low APGAR scores.Often there is evidence of multi-system dysfunction (poor cardiaccontractility, perfusion, renal insufficiency, seizures) early in theneonatal course.
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Polycythemia
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This occurs when the hematocrit is above the normal limit for gestational age(usually defined as > 65% in a term newborn).
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Hyperbilirubinemia
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An elevated bilirubin level usually does not cause symptoms by itself.The symptoms would be related to the underlying cause of thejaundice
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Diagnostic Labwork for an Infant with Hypotonia
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serum sodium and potassium serum ammonia glucose T4, TSH |
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Serum sodiumand serumpotassium
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In a patient with CAH, a low sodium and high potassium would beexpected.If the electrolytes are suspicious for CAH, then further testing, such as17-OH progesterone, should be obtained; this would be elevated in apatient with CAH.
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Serum ammonia
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Ornithine transcarbamylase deficiency (OTC), an X-linked condition, isthe most common urea cycle disorder.The sine qua non of an OTC deficiency diagnosis is hyperammonemiaand elevated urine orotic acid.
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Glucose
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Critical to check in any infant with hypotonia.
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T4, TSH
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These are essential to obtain in the evaluation for thyroid disorder.In congenital hypothyroidism, the T4 is predicted to be low and the TSHelevated.
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Treatment of Hypothyroidism
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The goal of treatment with levothyroxine is to maintain the TSH at approximately 1 μIU/mL(1mIU/L) and the T4 in the upper half of the normal range for age.
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Follow-up of Hypothyroidism
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It has been recommended that TSH and free T4 should be measured at two and four weeks afterinitiating therapy, then:every one to two months until 1 year of age,every two to three months until 3 years of age, andevery three to twelve months until growth is completed.
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