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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.

In an infant adequately nourished:


number of feeds


number of wet diapers

6 feeds per day


six wet diapers per day




(at least)

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).

During early weeks of breastfeeding, mothers should be encouraged to have how many feeds per day?

8 to 12 every 24 hours

Signs of hunger in an infant?

  • Increased alertness
  • Increased physical activity
  • Mouthing
  • Rooting

How to assess how much milk a breastfed infant is getting?

adequate if:



  • infant gaining weight well
  • 3-5 voids and 3-4 stools per day by 3-5 days of age; 4-6 voids and 3-6 stools by 5-7 days of age
  • feeding every 2-3 hours for 10-15 min per breast is about average

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

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.

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

Significance of large fontanel?


  • Associated condition:
  • skeletal disorders
  • chromosomal abnormalities
  • hypothyroidism
  • malnutrition



increased ICP can also result in large fontanels and splitting of the sutures

Significance of small fontanel?

Premature closure or a small fontanel for age may be a feature of:



  • microcephaly
  • craniocsynostosis
  • hyperthyroidism
  • normal variant

Significance of sunken fontanel?

dehydration

Significance of bulging fontanel?

increased ICP



  • meningitis
  • hydrocephalus
  • subdural hematoma
  • lead poisoning

Most common cause of congenital hypothyroidism?

some form of thyroid dysgenesis



  • aplasia
  • hypoplasia
  • ectopic gland

Primary vs secondary hypothyroidism

primary is the major cause

presentation of infants with congenital hypothyroidism?

  • Feeding problems
  • Decreased activity
  • Constipation
  • Prolonged jaundice4/12
  • Skin mottling
  • Umbilical hernia

Diagnosis and treatment of CH?

Newborns with a low T4 and elevated TSH on the newborn screen are considered to haveCH until proven otherwise.

Why is newborn screening done?

The ideal targets for newborn screening are serious diseases for which:


  • effective treatment is available and
  • early diagnosis and treatment can prevent morbidity and mortality

The newborn screening system consists of 5 parts:

  • Newborn testing
  • Follow-up of abnormal screening results to facilitate timely diagnostic testing andmanagement
  • Diagnostic testing
  • Disease management, which requires coordination with the medical home and geneticcounseling
  • Continuous evaluation and improvement of the newborn screening system.
The benefits of newborn screening may include the following
  • Detection of a serious, treatable disorder before symptoms are present.
  • Institution of treatment that can prevent serious problems.
  • Detection of carriers of certain genetic disorders.
Risks of newborn screening may include
  • Failure to identify some children who actually have the condition (false negative result).
  • Parental anxiety after false-positive results.
  • Genetic tests' revelation of misattributed paternity.
  • Detection of disorders for which treatment is not effective.

what to inquire about regarding first outpatient visit for newborn visit?

  • Pregnancy and birth history
  • Status of Hepatitis B vaccine administration and hearing screening
  • Feeding history (breast or formula, how much, how often)
  • Developmental milestones

*Differential Diagnosis for a Neonate with Poor Feeding and DecreasedActivity


  • congenital hypothyroidism
  • shaken baby syndrome
  • down syndrome
  • sepsis
  • cah
  • inborn error of metabolism
  • hypoglycemia,botulism
  • hyperbili


Congenitalhypothyroidism
  • Feeding problems
  • Decreased activity
  • Constipation
  • Prolonged jaundice
  • Skin mottling
  • Umbilical hernia

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.

Down syndrome


  • Down syndrome patients may feed poorly because of hypotonia.
  • Typically the ROS would be otherwise normal.

Sepsis

Signs of sepsis include poor feeding and decreased activity, amongothers.

Signs of sepsis include poor feeding and decreased activity, amongothers.


  • Decreased feeding and activity are common in infants with CAH.
  • Salt-losing CAH presents with lethargy, vomiting, and dehydration thatcan progress to shock.
Inborn error ofmetabolism
  • Typically, newborns appear well for at least the first 1-2 days of life butthen become symptomatic due to the protein load in breast milk orformula.
  • Initial signs include somnolence and poor feeding, usually followed byvomiting and lethargy.
  • Without treatment, patients develop a progressive encephalopathy.
Hypoglycemia
  • Clinical manifestations of hypoglycemia are variable, and infantsfrequently are asymptomatic.
  • Blood sugars are checked routinely with hospital deliveries, but maynot be done in babies born at home.
Botulism
  • Infants with botulism present with a poor suck and weak cry.
  • This is a rare diagnosis (about 900 cases reported worldwide!) andusually presents a little later (median onset 3-4 months of age).
Hypoxic-ischemicencephalopathy
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.
Polycythemia
This occurs when the hematocrit is above the normal limit for gestational age(usually defined as > 65% in a term newborn).
Hyperbilirubinemia
An elevated bilirubin level usually does not cause symptoms by itself.The symptoms would be related to the underlying cause of thejaundice
Diagnostic Labwork for an Infant with Hypotonia

serum sodium and potassium


serum ammonia


glucose


T4, TSH

Serum sodiumand serumpotassium
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.
Serum ammonia
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.
Glucose
Critical to check in any infant with hypotonia.
T4, TSH
These are essential to obtain in the evaluation for thyroid disorder.In congenital hypothyroidism, the T4 is predicted to be low and the TSHelevated.
Treatment of Hypothyroidism
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.
Follow-up of Hypothyroidism
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.