3 Flashcards
XR of a newborn with increased respiratory effort shows “wet” looking lungs, no consolidation, and no air bronchograms.. What is the cause?
TTN
I say “ground glass” CXR, you say….
RDS
Which side do diaphragmatic hernias typically occur?
L - causes hear to be pushed to R and constricts lungs
What needs to be ruled out before preterm babies can go home?
Hypothermia Hypoglycemia Respiratory distress Apnea Hyperbilirubinemia Feeding difficulty
What is cut off for hypoglycemia?
45
When do blood sugars typically fall and rise in neonatal period?
Fall first 1-2 hrs neonatal after placenta separates, then reaches stable point at 3-4 hrs (65-71)
What are risk factors for developmental dysplasia of the hips?
Breech position (30-50% of DDH cases occur in infants born in the breech position) Gender (9:1 female predominance) Family history
What supplement should exclusively breast fed babies get?
400 U Vitamin D
What’s on your differential for a baby with low temp?
sepsis, disorders of metabolic function, and abnormal brain thermoregulation.
What is about average for breast feeding of neonate?
every 2-3 hours for 10-15 minutes per breast
How many wet diapers per day indicates adequate breast feeding?
> 6 per day
How do seizures manifest in young infants?
often subtle and may manifest as jerking or horizontal deviation of the eyes; blinking or fluttering of the eyelids; drooling, sucking, or lip smacking; tonic posturing of a limb; or apnea.
How do we screen for “critical congenital heart diseases” following birth?
pulse oximetry to screen for “critical” cardiac defects, i.e. those that typically require surgery or cardiac catheterization in the first year of life.
A baby girl failed hearing exam at the hopsital. when to repeat?
At 3 mo
How would a baby with congenital adrenal hyperplasia present?
decreased activity, virilized genitalia in female baby, poor weight gain; newborn screen measure 17-OH-Progesterone
When does polycythemia of newborn typically occur?
In first few hours of life
When would you see following constellation of sx?
Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia
Congenital hypothyroidism
If a newborn has an inborn error of metabolism, what is the eventual risk?
progressive encephalopathy
When may you see large fontanelles?
Skeletal disorders (e.g., rickets, osteogenesis imperfecta)
Chromosomal abnormalities (e.g., Down syndrome)
Hypothyroidism
Malnutrition
Increased intracranial pressure
When may you see small fontanelles?
Microcephaly
Craniosynostosis
Hyperthyroidism
A normal variant
Meningitis, hydrocephalus, subdural hematoma, and lead poisoning may all lead to increased intracranial pressure and _______ fontanelles
BULGING = meningitis, hydro, subdural hematoma, lead poisoning
In which patients are umbilical hernias more common?
premature infants and congenital hypothyroidism
Newborn has Hypotonia, large fontanelles, an umbilical hernia, and jaundice - what is likely diagnosis?
Congenital hypothyroidism
What electrolytes to look to in evaluated CAH?
Potassium (high), sodium (low) –> follow up with 17 OH Progesterone
If you suspect a child has an inborn error of metabolism, what lab should you look at?
Ammonia
What level of bili poses risk of bilirubin-induced neurologic dysfunction?
TsB > 25
If a newborn has delay in diagnosis of congenital hypothyroidism, what signs may it develop?
large tongue, hoarse cry and puffy myxedematous facies
I say albinism, musty order, failure to meet milestones, seizures – you say…
PKU
What is fever without a source?
when a complete history has been obtained and a detailed physical examination performed, and there is no identified source of the child’s fever.
Fever in newborn. What is on your ddx?
viral syndrome Urinary tract infection (UTI) - most common Meningitis Sepsis/Bacteremia Pneumonia Bacterial gastroenteritis Osteomyelitis Septic arthritis
What sx indicate meningitis as cause of infant fever?
Fever Hypothermia Bulging fontanelles Lethargy Irritability Restlessness Paroxysmal crying (crying when picked up) Poor feeding Vomiting and/or Diarrhea
What is kernigs sign?
For meningitis - Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
What is brudzinski sign?
For meningitis - severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
What labs is CSF sent for in LP evaluation of fever in infant?
gram stain, cell counts, chemistries, and culture
What do you expect the glucose and protein to be in CSF of bacterial meningitis?
Bacterial meningitis =
Glucose LOW
Protein HIGH
(both would be normal in viral meningitis)
Why do we look for nitrites as sign of infection in urine?
Gram negative bacteria which normally cause UTIs have capacity to convert nitrates to nitrites
How is leukocyte esterase helpful in dip for UTI?
byproduct of leukocyte breakdown, thus indicates presence of leukocytes and infection
List 4 oral abx appropriate in UTI tx
Cephalexin/Keflex
Trimethoprim/Sulfamethoxazole
Nitrofurantoin
Amoxicillin/Clavulonate (augmentin)
What is the use of a voiding cystourethrogram?
Demonstrates presence of vesicoureteral reflux, an important risk factor for recurrences of urinary tract infections
After infant has febrile UTI, what should be examined?
US of bladder and kidneys to screen for abnormalities
