2nd through Flashcards
Warning to f/u café-au-lait macule criteria?
> = 6
5mm
Not confined to single segment/region
Pre-term infant defined?
Low vs Very low birth weight defined?
<38wk ga
LBW - <2500g
VLBW - <1500g
APGAR stands for?
Appearance/Pulse/Grimace/Activity/Resp H - HR R - RR M - Musc R - Reflex C - Color
Care for newborn based upon Heart rate?
HR
>100 - Routine care
60-99 - Ventilation
<60 - Ventilation + Chest compressions
What is normal response of neonate to hypoxia?
Tachypnea
Nursery care vitamins supplementation?
And breast vs formula?
Vit D - 400/d for Breast fed infants
Iron - Breast fed - Begin at 4mo and Formula fed - none
Neck cysts/bulges?
Anterior midline = thyroid
Anterior to SCM = brachial cleft cyst
Posterior to SCM = cystic hygroma
Weak pulses may indicate what cardiac finding?
Aortic stenosis - low CO
Bounding pulses may indicate what cardiac finding?
PDA - high CO
Pathologic murmurs?
Holosystolic - continuous - harsh murmur
Grade 3 or higher murmur
Diastolic murmur
Congenital hip dysplasia screening?
U/S of hips after 6wk
- Girls w/ positive family Hx
- Breech presentation
Elevated pulse pressure >40mmHg of newborn
OR
Decreased pulse pressure indicates?
PDA - Elevated
COA - Decreased
Reflexes gone by?
Fencer - 3mo Galant - 4mo Rooting/placing - 4-6mo Moro/Grasp - 6mo Babinski - 12-18mo
Jaundice during 1st 24hr of life is normal? Y/N
NO!
GBS positive mother - discharge protocol?
- Infant have S/S of sepsis/infx? NO otherwise TXT
- <35wks EGA? Yes = Eval+48d hold
- Mom Abx 2 doses? Yes - no eval/48h - eval/48h
TXT of Neonatal sepsis? Rx/duration?
(IV) Ampicillin+Gentamicin or Cefotaxime
+ Vancomycin - If late onset sepsis and/or meningitis
+ Acyclovir - If HSV
TXT until
1. Cx = 2. Sepsis - 14d 3. Meningitis - 21d
Attributes/Pathophys of Respiratory distress syndrome
AKA - Hyaline membrane disease Insufficient surfactant by T-II pneumatocytes > End-expiration atelectasis MC - <34wk premmie CXR - Bilateral ground glass
PVT before birth AND TXT after birth for RDS?
Maternal CCS 32-34wks
Intubate AND artificial surfactant
Complications of RDS?
PDA - PG - Indomethacin/IBPRF to close
PTX - chest tube
Bronchopulm dysplasia- Vent-O2 toxicity/barotrauma
Retinopathy of prematurity - O2 toxicity on eyes
Apnea of maturity causes?
Central - Medulla/Pons don’t stimulate phrenic nerve
Periph - AW obstruction - malformation or positioning
TXT of Apnea of maturity ?
O2
Stimulants - caffeine OR theophylline
Trxf - if anemic
Breath sound of Tracheomalacia?
High pitch or Rattling/noisy breath sounds
Meconium present during delivery indicates?
Stressed baby - (+- suction/intubation or PPV w/ PPV)
CXR of Meconium aspiration syndrome?
Coarse irregular infiltrates
CXR of Transient tachypnea of newborn?
Fluid in fissures
MC population to see Transient tachypnea of newborn?
C-section or LGA
Causes of respiratory distress in newborn?
Sepsis/Pneumonia
MAS > PTX
Transient tachypnea
CHD - (PDA)
Pulm HTN classifications/causes?
Primary - Hypoxia w/ ABNL heart/lungs
Non-primary - L>R shunt (PFO/PDA)
Inherited, autoimmune, Rx
Hyperbilirubinemia is defined as?
> 5mg/dL
Kernicturus Bilirubin levels?
Nl Term infant >20-25
Premmie or Stessed term infant (sepsis etc. +- <20
ABNL levels of Bilirubin during 1st days of life?
> 13mg/dL 1st day of life in term infants
Rate rise >0.5/h –OR– >5mg/dL/d
Onset of jaundice during 1st/24h of life
NL bilirubin levels during 1st days of life?
TERM - <12 on day 3 –OR– up to 17 if breast fed
PRE-T - <15 on day 5
When does jaundice become evident per bilirubin levels?
5-6mg/dL
1st areas jaundice begins?
1st - Under tongue > Sclera
F/U timing per discharge of jaundice infant?
Discharged - F/U
<24h - 72h
24-48h - 96h
48-72h - 120h
Difference between -
B. feed Jaundice
vs
B. milk Jaundice
B. feed Jaundice
- supply issue (synth/intake) 1st wk but also decreases gut motility - MC in 1st time mom
B. milk Jaundice
- Fatty acid unconjugates bili from albumin +- increases intestinal bili reabsorption occurring after 1st week lasting 1-2w
- labs - increased unconj bili <20 - W/OUT hemolysis
Gross motor - red flags of development?
Hypertonia = Rolling prior to 3mo
Hypotonia = Poor head control at 5mo / cant sit 7mo
Neuro d/o contralateral side = Hand dominance <18mo
Language - red flags of development?
Cant vary voice @ 4mo Cant babble/localize sound @ 6mo No true words/gestures by 15mo No pointing by 18mo <50% intelligible speech by 2yr
Anemia screening is at what age?
4mo - high risk
12mo
Lead screening is at what age?
12 and 24mo
When is immunizations post-poned in premature infants?
Hep B - <2000g and mom is HBsAg NEG > Give Hep B at 1mo
Counterindications of Immunizations?
Hx of anaphylaxis
No live vaccines: x-imm states or pregnancy
Mod to Severe illness (Not related to previous imms)
Egg Allergy (flu or yellow fever)
Car safety age?
2yr > front facing > booster seat at 4ft 9in and 8-12yo
<13yo = in backseat
When to refer child for plagiocephaly?
No improvement by 4-6mo
Nutrition in infants? stool habits.
Breast milk - only source until 6mo - 8-12 feeds/d
6-8 wet diapers, >=4 loose stools/day
Aboslute CI to breastfeeding
Lithium, radioactive compounds,
Anti-cancer/immune/thyroid
ETOH/Drugs
Infections - HIV, Active TV, varicella, H1N1, HSV of tit
When should a child be a diet for obesity?
> 3yo
Teeth grow in what order?
Low, up, lateral incisors
Max amount of cow milks/day?
24oz/d
