18- poor feeding Flashcards
organic causes of failure to thrive
Congenital heart defects Cystic fibrosis Gastroesophageal reflux Neurologic disorders Metabolic disease
definition of FTT
an infant is < 5th percentile for weight
an infant is < 5th percentile in weight for length, or
the rate of growth results in the infant crossing more than 2 major lines on the standard infant growth curve.
presentation of CHF in infant
dyspnea with feedings diaphoresis poor growth an active precordium hepatomegaly
regular newborn resp rate
40-60
are diastolic murmurs always pathologic?
yes
differential for hepatomegaly in infant
Congestive heart failure Congenital infections Inborn errors of metabolism Anemias, and (less commonly) Tumors.
most common murmur in child and in what ages
innocent murmur
3-7 yo
questions to ask to make sure the murmur is innocent
Is the child otherwise well?
Is the precordial activity normal?
Is the second heart sound normally split?
Is the murmur less than or equal to grade II/VI?
Is the oxygen saturation normal?
which murmurs are heard better as kids rather than infants?
ASD and bicuspid aortic valve
bicuspid aortic valve presentation
early systolic click made by the abnormal valve when it opens (occurring shortly after the first heart sound, signifying the end of isovolumic contraction when the aortic valve opens to allow left ventricular outflow)
heart defects that can cause CHF
VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus
what tests should you do to assess murmur in infant?
EKG
Echo
chest x ray
EKG findings in small, moderate, and large VSD
small- EKG normal
mod- LVH (LV overload)
large- RVH (RV overload- pulm HTN)
EKG in normal infant compared to normal adult
more right ventricular voltage, and have a more rightward axis
reason: lungs not contributing as much to ventilation –> PVR elevates–> RVH–> rightward axis
when do congenital heart disease infants need to be admitted?
sepsis
cyanosis
CHF
how does VSD cause CHF?
The infant with a VSD is supplying enough blood to the tissues to meet the body’s metabolic needs, but is doing so from an elevated filling pressure (due to the left ventricular volume overload). The adequate cardiac output is achieved by creating a high adrenergic state and by activating the renin-angiotensin system. Many of the symptoms of CHF in the infant are caused by these neurohormonal changes.
why isn’t VSD heard in the nursery?
elevated Pulm vascular resistance in newborn
drugs to treat CHF
furosemide- rid fluids
digoxin
enalapril- ACEI decrease SVR
what to do if VSD doesn’t decrease by 6 months?
camrdiopulm bypass surgery to avoid eisenmengers syndrome (late cyanosis from pulm HTN)- live until 20s
does ASD cause CHF?
no
Still’s murmur
most common innocent murmur
vibratory, musical, low pitched
heard at lower left sternal border
