Aquifer - Newborn and Well-Child Visits Flashcards
1
Q
What is fetal alcohol syndrome?
A
A distinct pattern of facial abnormalities, growth deficiency, and evidence of CNS dysfunction; victims may exhibit cognitive disability and learning problems, as well as neurobehavioral deficits such as poor motor skills and impaired hand-eye coordiation
2
Q
Effect of maternal tobacco use on the baby?
A
Increased risk of low birth weight
NO characteristic facial abnormalities
3
Q
Effect of maternal alcohol use on the baby?
A
Facial abnormalities
Growth deficiency
CNS dysfunction
4
Q
Effect of maternal marijuana use on the baby?
A
Currently unknown
5
Q
Effect of maternal heroin/opioid use on the baby?
A
Fetal growth restriction Placental abruption Fetal death Preterm labor Intrauterine passage of meconium Neonatal absence syndrome
6
Q
Effect of maternal cocaine/stimulant use on the baby?
A
Vasoconstriction
Placental insufficiency
Low birth weight
Possible cognitive deficits later in life
7
Q
Maternal use of what substances can cause low birth weight?
A
Tobacco
Cocaine/stimulants
8
Q
Symptoms of neonatal abstinence syndrome?
A
Uncoordinated sucking reflexes leading to poor feeding, irritability, high-pitched cry
9
Q
When is SGA/LGA diagnosed?
A
At birth
10
Q
When is IUGR diagnosed?
A
During pregnancy
11
Q
Define IUGR
A
Fetus that has not reached its growth potential at a given gestational age due to 1+ causative factors
12
Q
What is symmetric IUGR and what can cause it?
A
Head, length, and weight are decreased proportionately
Congenital infections may adversely affect brain growth and often result in symmetric IUGR
13
Q
What is asymmetric IUGR and what can cause it?
A
Greater decrease in the size of the length and/or weight without affecting head circumference
Poor delivery of nutrition to the fetus
14
Q
Maternal factors that can lead to SGA?
A
Young and advanced age Prepregnancy short stature/thinness Poor weight gain in 3T Nulliparity Abnormal prenatal care Lower SES African-American Polyhydramnios Substance use
15
Q
Fetal factors that can lead to SGA?
A
Chromosomal abnormalities and syndromes
Metabolic disorders
Congenital infections
Structural abnormalities
16
Q
Medications and other exposures that can lead to SGA?
A
Antimetabolites Bromides Hydantoin Isotretinoin Metal (mercury, lead) PCBs Propranolol Steroids Toluene Trimethadione Warfarin Substance use: amphetamines, cigarette smoking, cocaine, ethanol, heroin/narcotics, PCP
17
Q
Uterine and placental abnormalities that can lead to SGA?
A
Avascular villi Decidual or spiral artery arteritis Infectious villitis Multiple gestation (limited surface area, vascular anastamoses) Multiple infarctions Partial molar pregnancy Placenta previa/abruption Single umbilical artery Umbilical thrombosis Abnormal umbilical vascular insertions Syncytial knots Tumors including chorioangiom and hemangioma
18
Q
3 major risks for SGA newborns?
A
- Hypoglycemia
- Hypothermia
- Polycythemia
19
Q
Causes of hypoglycemia in SGA newborns?
A
Decreased glycogen stores, heat loss, possible hypoxia, decreased gluconeogenesis
20
Q
Presentation of hypoglycemia and hypothermia in SGA newborns?
A
Commonly asymptomatic, though may exhibit poor feeding/listlessness
21
Q
Causes of hypothermia in SGA newborns?
A
Cold stress, hypoxia, hypoglycemia, increased surface area, decreased subcutaneous insulation
22
Q
Causes of polycythemia in SGA newborns?
A
Chronic hypoxia, maternal-fetal transfusion
23
Q
Presentation of polycythemia in SGA newborns?
A
Ruddy or red color to skin, respiratory distress (hyperviscosity syndrome -> inadequate oxygenation), poor feeding, hypoglycemia
24
Q
Define LGA and SGA.
A
LGA: newborns with birth weight >90th percentile
SGA: newborn with birth weight <10th percentile (varying)
25
Etiologies of LGA?
Many are constitutionally large
| Most important pathologic etiology - maternal DM (hypoglycemia is common)
26
List the prenatal lab screening tests.
1. Maternal blood type, Rh and Ab screen
2. Rubella IgG
3. HBSAg
4. HIV antibody
5. RPR or VDRL
6. UA
7. Urine NAAT for chlamydia and gonorrhea
8. Urine or vaginal culture for GBS
9. Hepatitis C antibody (in women with a history of IV drug use)
10. TB skin or blood test (in women with HIV or who live in a household with someone with active TB)
27
Special precautions in newborn resuscitation?
Universal precautions
Warm/dry the infant, remove any wet linens (large surface area relative to body weight, can experience significant hypothermia from evaporation)
Stimulate the infant to elicit a vigorous cry
Suction amniotic fluid from nose and mouth
Initiate further resuscitation if required (blow-by oxygen, PPV with oxygen, chest compression, medications)
28
APGAR components?
```
Appearance (skin color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
```
29
What APGAR score should prompt continued resuscitation?
<7 at 5 minutes
30
What can the Apgar score do and not do?
Assess the condition of the newborn immediately after birth
Does not identify birth asphyxia
Does not predict individual neurologic outcome or mortality
31
What is the Ballard Gestational Age Assessment Tool used for?
Uses signs of physical and neuromuscular maturity to estimate gestational age; helpful if there is no early prenatal U/S to confirm dates or i the age is in question because of uncertain maternal dates
32
Purpose of demonstration of primitive reflexes?
Evaluate integrity of CNS, detect developmental delay, and assess normal development (abnormalities include asymmetry, absence of appearance, delayed disappearance)
33
Primitive reflexes present at birth?
Moro, palmar, plantar grasps
Asymmetric tonic neck reflex
Babinski resopnse
34
Babinski response is normal until what age?
2 years
35
Normal Moro reflex?
Symmetric abduction and extension of the arms followed by adduction of the arms
36
When does the Moro reflex disappear?
By 4 months
37
When does the palmar and plantar grasp reflex disappear? It must disappear before the infant can do what?
2-3 months; grasp objects voluntarily, begin taking steps
38
Normal asymmetrical tonic neck reflex?
Turning the newborn's head to one side causes gradual extension of the arm toward the direction of the infant's gaze with contralateral arm flexion
39
The asymmetrical tonic neck reflex must disappear before what?
The infant can reach for objects in or across the midline
40
Routine care of the newborn in the hospital + timing?
1. Vitamin K IM injection (immediately)
2. Hepatitis B vaccine (first 12 hours)
3. Erythromycin eye ointment (immediately)
4. CCHD screen
5. Hearing screen
6. Newborn metabolic screen
41
Define early, classical, and late VKDB + presentation.
Early: 0-24 hours after birth (severe, primarily seen in infants whose mothers use medications that interfere with how the body uses vitamin K (antiepileptics or isoniazid))
Classical: 1-7 days after birth (bruising, bleeding from umbilical cord)
Late: 2-12 weeks after birth, but up to 6 months in previously healthy infants (rarer, typically no warning bleeds, only in breastfed babies who don't get the shot)
42
Rx infants >2000 g + Mom positive for HBsAg?
Vaccine + HBIG within 12 hours of delivery + routine series beginning at 1 month + test for anti-HBs and HBsAg at 9-18 months + reimmunize if inadequate protection
43
Rx infants >2000 g + Mom's HBsAg unknown
Vaccine within 12 hours + delay HBIG until maternal HBsAg is known up to 7 days
44
If the newborn hearing screen is failed, what should be done next?
Full hearing test by 3 months of age
45
Presentation of PKU?
Normal at birth, fail to attain early milestones, develop microcephaly and progressive cognitive impairment including seizures
Albinism and a musty odor of sweat and urine due to phenylacetate
46
Those who are exclusively or partially breastfed should receive ___ daily beginning soon after birth. Why?
400 IU supplemental vitamin D; to avoid the development of rickets
(Also for infants who are breastfed with formula supplementation + those who do not ingest at least 1 L of vitamin D-fortified formula daily)
47
Prepare powder vs. formula concentrate?
Powder: 2 scoops powder + 4 oz water
Formula concentrate: 1 part concentrate + 1 one part water
48
Infants should take breast milk or formula until ___ months of age.
12
49
Discuss reasons young infants should not take cow's milk prior to 12 months of age.
Cannot digest cow's milk as completely or easily
Contains high concentrations of proteins/minerals which can stress a newborn's immature kidneys
Lacks iron, vitamin C, and other nutrients
Can irritate the lining of the stomach/intestine, leading to blood loss in the stool
Does not contain the optimal types of fat for growing infants
50
Discuss normal weight loss and gain in babies.
1. Most babies lose up to 10% of their birth weight after birth
2. Expected to regain birth weight as early as 1 week, but by 2 weeks.
51
Average daily weight gain for term infants in the first 4 months of life?
20-30 g
52
Weight doubles by ___ for the average infant, although some reach this weight by ___. Weight triples by what age? Length doubles by what age?
4-5 months; 3 months
1 year of age
4 years of age
53
___-fed infants tend to gain weight faster than do ___-fed infants because they ingest more calories.
Formula; breastfed
54
Caloric requirements of 1- to 2-month olds (term, preterm, very preterm)
Term: 100-120 kcal/kg/day
Preterm: 115-130 kcal/kg/day
Very preterm: up to 150 kcal/kg/day
55
How to measure the head circumference?
Measure the widest portion of the head, from the broadest part of the forehead to the occipital prominence at the back of the head
56
What is weight and height age?
Age at which the patient's weight/height would plot at the 50th percentile
57
When can solid foods be introduced?
4-6 months
58
Recommended allowance of Vitamin D for children up to 12 months?
400 IU/day (~32 oz of formula or milk/day)
59
Most babies sleep through the night by what age?
4-6 months
60
Anticipatory guidance for the 2-month visit?
1. Solid foods can be introduced at 4-6 months
2. 400 IU vitamin D/day
3. Most babies sleep through the night by 4-6 months
4. Child care decisions
5. Safety: no smoking around children, keep small objects/plastic bags away from the baby, do not drink hot liquids while holding baby, do not leave baby alone on high places
61
Anticipatory guidance for the 6-month visit?
1. Toddler proof the home before crawling/walking begins
2. Car seat in the back, rear-facing
3. No walkers (dangerous, do not teach children to walk earlier)
4. Dietary changes: introduce foods one at a time, no juice needed, solid foods should be soft and easy to swallow
5. Stranger anxiety at this time is normal. Start reading books
6. 2 naps/day and sleeping through the night
62
9-month-old infant calorie requirements?
100 kcal/kg/day
63
Anticipatory guidance for the 9-month visit?
1. ~24 oz milk/formula/day to hit 100 kcal/kg/day goal
2. No foods requiring chewing
3. Can feed themselves with finger foods
4. Meats can be started at this age
5. Foods one at a time to identify allergies
6. No choking hazards - popcorn, grapes, ahrd candies, hot dogs
64
Most effective car seat restraint?
5-point harness
65
Recommendations for car seats by age?
<2 years + not over manufacturer's weight/height requirement: rear-facing car safety seat, restrained in the rear seat
2-4 years: forward facing care safety seat in the rear
4-8 years: belt-positioning booster seat restrained in the rear
>8 years: lap-and-shoulder seat belts who have outgrown booster seat restrained in the rear
13+ years: lap and shoulder seat belt in the rear or front
66
When is hearing screened in children?
1. Initially in the newborn period (universal)
2. Between birth and age 3 (subjective screening via history)
3. Audiometry at age 4
67
When is vision screened in children?
1. Between birth and age 3 (subjective screening via history)
2. Screening using a chart at age 3
68
When should children be seen by a dentist?
Within 6 months of the first tooth eruption or by 1 year of age (screen by 6 months if at higher risk for caries)
69
List the vaccines + # of doses through 6 years of age.
1. DTaP: 5
2. IPV: 4
3. Hib: 3 or 4 (manufacturer)
4. PCV13: 4
5. MMR: 2
6. Varicella: 2
7. RotaV: 2 or 3 (manufacturer)
8. HepA: 2
9. HepB: 3
70
Recommendations for influenza vaccine for pediatric patients?
Annual
Recommended for all persons 6+ months who do not have contraindications
First year of immunization, children less than 9 years need 2 doses 1 month apart
71
Possible adverse effects of vaccinations?
Redness or selling at the injection site, fussiness, low-grade fever
72
Why does the use of antipyretics for the prevention of fevers associated with vaccine administration merit careful consideration?
Prophylactic administration of acetaminophen has been associated with decreased antibody concentrations for some vaccine antigens, although all concentrations remain in the protective range.
73
Why is iron of crucial importance to normal development in early childhood?
Due to its role as a CNS co-catalyst
74
Discuss presentation of early childhood caries.
Lag time before visible delay (1-3 years old -> presents when the child is 3-5 years)
75
By what age should parents discontinue bottle use?
12-15 months
76
What is used to prevent dental caries?
Fluoride (promotes remineralization of calcium into the enamel)
77
Children living in lead-contaminated environments are at greatest risk for having elevated blood lead levels between ___ months. Why?
6-36; normal mouthing behavioral and increasing mobility at this stage + lead absorption is higher in younger children + iron deficiency (common in toddlers) increases lead absorption
78
Common sources of lead exposure?
House paint used before 1978 and especially before 1960
Soil, plumbing, pipes, hobbies, occupational exposures, imported toys/ceramics/candy, cosmetics, folk remedies
79
Current policy recommends blood testing for lead for whom?
All children 12-24 months of age in areas where >25% of housing was built before 1960 or where the prevalence of blood lead levels >5 mcg/dL in children is 5% or greater
Individual children who live in or regularly visit homes/facilities built before 1960 that are in poor repair or have been renovated within the past 6 months
80
When should anemia screening be done in children?
At 12 months and again at preschool or kindergarten entry
81
Who should be screened for TB?
Any individual with any of the following risk factors:
1. Spending time with an individual known or suspected to have TB
2. Being infected with HIV or another condition that weakens the immune system
3. Having symptoms of TB
4. Living in or coming from a country where TB is common
5. Living somewhere in the US where TB is more common (homeless shelter, migrant farm camp, prison, some nursing homes)
6. Use of injected illegal drugs
82
What immunizations are given in adolescence?
1. Tdap - first dose at 11-12
2. MCV4 - 2 (at 11/12 and at 16)
3. MenB - 2 (at 16 and 6 months later)
4. HPV - 3 (as early as 9, routinely given at 11, series occurs over 6 months)
83
Difference between DTaP and Tdap?
Amount of diphtheria toxoid contained in each dose (3-5x more in DTaP)
84
Names of MCV4 vaccine and serotypes included?
Menactra and Menveo
A, C, W, Y (quadrivalent)
85
MCV4 vaccine is indicated as early as 2 months for what high risk populations?
1. Complement component deficiency
2. Functional/anatomic asplenia
3. Individuals who are part of a community outbreak
4. Those traveling internationally or to a region with endemic meningococcal disease
86
Name of MenB vaccine and serotypes included?
Trumenba and Bexsero
Includes B
87
When does vitamin D deficiency rickets appear in infants?
Between 6-24 months
88
Discuss recommendations regarding iron supplementation in infants.
Although a 2010 clinical report recommended iron supplementation for all exclusively breastfed infants beginning at 4 months of age, this recommendation has been debated. Most pediatricians do recommend the addition of iron-containing foods to the infant's diet starting at 6 months. Most standard formulas are iron-fortified.
89
Who should receive fluoride supplementation?
Breast- and bottle-fed infants after age 6 months IF the water supply lacks fluoride.
90
Discuss the timing of potential fever after vaccine administration based on the type of vaccine and mechanism of inducing immunity.
Inactivated subunit or toxoid vaccines: inert vaccine components induce an immune response with potential fever within a few days of immunization
Live attenuated vaccines: immune response with potential fever 6-14 days after immunization
91
Fetal effects of maternal hyperglycemia?
Results in hypoglycemia in the fetus -> stimulates fetal pancreatic beta cells -> hyperinsulinemia (maternal insulin does not cross the placenta) -> risk for significant hypoglycemia after birth
Insulin is the primary anabolic hormone for fetal growth -> high levels in T3 result in increased growth of the insulin-sensitive organs (heart, liver, muscle) and a general increase in fat synthesis and deposition
Ultimately leads to increased body fat, muscle mass, and organomegaly -> macrosomia
92
The incidence of major fetal malformations is directly related to the first-trimester ___ level.
HbA1c
93
Why is hypoglycemia in neonates dangerous?
Glucose is the primary substrate for brain metabolism and even asymptomatic hypoglycemia may have negative consequences for long-term neurodevelopment
94
Target glucose value in neonates?
>45 mg/dL prior to routine feeds
95
Who should be screen for glucose instability?
All newborns at risk, including term infants who are SGA or LGA, late preterm, and infants of diabetic mothers because they can be asymptomatic
96
What should happen with any glucometer reading of <40 mg/dL in a newborn?
Confirm by lab analysis of serum or plasma glucose, but start treatment immediately (IV dextrose if symptomatic, feeding if asymptomatic)
97
Risk factors for DDH?
Breech
F>M
Family Hx
98
AAP Recommendations for DDH screening?
AAP - serial exams until 12 mo + hip imaging for F infants born in breech position + optional imaging for boys born in breech and girls with a positive family hx
