9 Flashcards
Infant Reginald birth weight by how old
Failure to thrive
How many feedings in newborn per day and the frequency
Voids and poops
An infant is expected to regain his birth weight by 2 weeks of age. An infant who has not regained birth weight by 2 weeks of age should generate concern and further evaluation.
Failure to regain birth weight by 3 weeks of age or continuous weight loss after 10 days of life has been defined as failure to thrive.
In general an infant is adequately nourished in the first few weeks of life if she or he receives at least six feedings per day. During the early weeks of breastfeeding, mothers should be encouraged to have 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger. feeding every 2–3 hours for 10–15 minutes per breast is about average; if there is more than 4 hours between feedings, or the infant is feeding for shorter durations, then intake is unlikely to be adequate.
There should be at least six wet diapers per day by 5-7 days before that the number matches their day of life
Lethargy definition
Lethargy has been defined as a level of consciousness characterized by poor or absent eye movements or as the failure of a child to recognize parents or to interact with persons or objects in the environment. The younger the child, the more difficult it is to assess lethargy. Also, in a brief encounter it may be difficult to judge lethargy.
Diff dx for neonate with poor feeding and decreased activity
11
Congenital hypothyroidism - iodine deficiency is most common cause in newborns
Common findings include:
Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia With time, if untreated, patients develop a large tongue, hoarse cry and puffy myxedematous facies.
Diagnosis and Treatment
Newborns with a low T4 and elevated TSH on the newborn screen are considered to have CH until proven otherwise.
Because early treatment is critical for normal development, serum for confirmatory measurements of T4 and TSH should be obtained, and the patient should be started on levothyroxine (L-thyroxine) pending confirmatory lab results.
Shaken baby syndrome
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 this diagnosis.
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, among others.
Congenital adrenal hyperplasia
Decreased feeding and activity are common in infants with CAH.
Salt-losing CAH presents with lethargy, vomiting, and dehydration that can progress to shock.
Inborn error of metabolism
Typically, newborns appear well for at least the first 1–2 days of life but then become symptomatic due to the protein load in breast milk or formula.
Initial signs include somnolence and poor feeding, usually followed by vomiting and lethargy.
Without treatment, patients develop a progressive encephalopathy.
Hypoglycemia
Clinical manifestations of hypoglycemia are variable, and infants frequently are asymptomatic.
Blood sugars are checked routinely with hospital deliveries, but may not 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!) and usually presents a little later (median onset 3-4 months of age).
Hypoxic-ischemic encephalopathy
Altered mental status can be seen with hypoxic-ischemic encephalopathy, 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 cardiac contractility, perfusion, renal insufficiency, seizures) early in the neonatal course.
Polycythemia
This occurs when the hematocrit is above the normal limit for gestational age (usually defined as > 65% in a term newborn).
Many infants are asymptomatic, and hematocrits are not routinely checked in newborns.
If infants do have symptoms, altered mental status and poor feeding may occur.
Other associated symptoms include plethora (an excess of blood in the circulatory system or in one organ or area), acrocyanosis, or hyperbilirubinemia.
Occurs in the first few hours to days of life.
Hyperbilirubinemia
An elevated bilirubin level usually does not cause symptoms by itself.
The symptoms would be related to the underlying cause of the jaundice.
Abnormalities in fontanels
4 different findings
Abnormalities in fontanels may be associated with a variety of conditions:
Abnormality Associated condition/disorder
Large
Skeletal disorders (e.g., rickets, osteogenesis imperfecta)
Chromosomal abnormalities (e.g., Down syndrome)
Hypothyroidism
Malnutrition
Increased intracranial pressure can also result in large fontanels and splitting of the sutures.
Small
Premature closure or a small fontanel for age may be a feature of:
Microcephaly Craniosynostosis Hyperthyroidism A normal variant Sunken* This is a sign of dehydration Bulging* A bulging fontanel is generally regarded as a sign of increased intracranial pressure, as may be seen in:
Meningitis
Hydrocephalus
Subdural hematoma
Lead poisoning
Umbilical hernia
Most common in - 2
Tx
Umbilical hernias are a common condition of newborns.
Umbilical hernias are more common in premature infants and in patients with congenital hypothyroidism.
Incarceration (in which the hernia is constricted) is a rare complication.
Treatment
Because the vast majority of umbilical hernias will close spontaneously, surgery is not generally required.
Lab work for infant with hypotonia
Serum sodium and serum potassium
A serum sodium and potassium are reasonable in order to evaluate for CAH, a potentially life-threatening disorder.
In a patient with CAH, a low sodium and high potassium would be expected.
If the electrolytes are suspicious for CAH, then further testing, such as 17-OH progesterone, should be obtained; this would be elevated in a patient with CAH.
Serum ammonia
Serum ammonia is elevated with many inborn errors of metabolism, particularly urea cycle disorders, organic acidemias, and fatty acid oxidation disorders.
Ornithine transcarbamylase deficiency (OTC), an X-linked condition, is the most common urea cycle disorder.
The sine qua non of an OTC deficiency diagnosis is hyperammonemia and elevated urine orotic acid.
(Ammonia would be expected to be normal with congenital hypothyroidism.)
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 TSH elevated.
