Clin Med - Developmental Peds Flashcards
For age 1wk to 1 month: amount/feeding & times/day
- 2 to 4 oz
- 7 to 8 (more for breastfed babies)
For age 1- 3 month: amount/feeding & times/day
- 5 to 6 oz
- 5 to 7 times/day
For age 3 - 6months: amount/feeding & times/day
- 6 to 8 oz
- 4 to 6 times/day
For age 6 - 12months: amount/feeding & times/day
- 7 to 8 oz + incr amts of solid foods
- 4 bottles/day & 2 to 3 meals of solid foods
Preventative Measure Taken @ birth
- Erythromycin ointment
- Vitamin K
- Hep B Vax
- newborn genetic screen
- Congenital Heart Dz screen
- Hearing screen
Contraindications to early newborn discharge (5)
- Jaundice </= 24hrs
- High risk for infx
- Known or suspected narcotic addiction or withdrawal
- Physical defects requiring eval
- Oral defects
Relative contraindications to early newborn discharge
- Premature or early term infant
- Birth weight <2700 g (6lb)
- Infant difficult to arouse for feeding; not demanding regularly in nursey
- Medical or neuro problems that interfere w/ feeding
- Twins or higher multiples
- ABO blood group incompatibility or severe jaundice in prev. kids
- Mother who prev. breast-fed infant w/ poor weight gain
- Mother w/ breast surg involving periareolar areas
What is considered hypoglycemia in newborns?
- BG <50mg/dL @ birth - 4hrs
OR - BG <45mg/dL 4-25hrs
RFs for hypoglycemia
- LGA
- SGA
- IUGR
- Preterm or post-term birth
- Perinatal stress
Tx for hypoglycemia
- start feedings w/n 1hr (at risk or sx neonates
- start IV glucose (10% dextrose & H2O)
What are the 5 types of neonatal jaundice?
- Physiologic
- Pathologic
- Bilirubin toxicity
- Acute bilirubin encephalopathy
- Chronic bilirubin encephalopathy
What are the main reasons for unconjugated hyperbilirubinemia? (3)
- Incr bilirubin production
- Decr rate of conjugation
- Unknown/Multiple Factors
What are the 3 main causes of incr bilirubin production?
- antibody mediated
- non-antibody mediated
- non-hemolytic
List the two antibody mediated causes of pathologic jaundice.
- ABO incompatibility
- RH isoimmunization
List the 2 non-antibody mediated causes of pathologic jaundice.
- Hereditary Spherocytosis
- G6PD deficiency
List the 2 causes for decr rate on conjugation.
- Crigler Najjar Syndrome
- Gilbert Syndrome
List the 3 reasons for unknown/multiple factors that cause pathologic jaundice.
- race (east Asian)
- prematurity
- breast feeding
Causes of physiologic jaundice
- low UDPGT activity
- relatively high red cell mass
- absence of intestinal flora
- slow intestinal motility
- incr enterohepatic circulation of bilirubin in the 1st days of life
Diagnosis of physiologic jaundice is made if…
- Visible jaundice appearing after 24hrs of age.
- Total bilirubin rises by < 5 mg/dL (86 mmol/L) per day.
- Peak bilirubin occurs at 3–5 days of age, w/ a total bilirubin of </= 15 mg/dL
- Visible jaundice resolves by 1 week in the full-term infant & by 2wks in preterm infant
Describe ABO incompatibility.
Pathologic–> Incr Production–> Ab Mediated
- Mom type O, neonate w/ A or B
- Can be mild to severe, subsequent pregnancies more severe
- Can progress over the several months (mom’s Abs present)
Describe Rh incompatibility.
Pathologic–> Incr Production–> Ab Mediated
- Less common, but more serious than ABO
- Erythroblastosis fetalis is most severe form
–>life-threatening anemia
–> generalized edema
–> fetal or neonatal HF
–> can result in death if not treated
- Can req transfusions, Ig tx, phototherapy
- Tx may needed for months
Describe hereditary spherocytosis.
Pathologic–> Incr Production–> Non Immune
- d/o of the RBC membrane, leading to chronic hemolytic anemia, autosomal dominant
- RBCs aren’t able to deform & get stuck/clump together, causing hemolysis
- Splenomegaly present
- Dx by FHx & blood smear
- May req exchange transfusion
Describe G6PD deficiency.
Pathologic–> Incr Production–> Non Immune
- x-linked genetic defect–> decr activity of G6PD enzyme
- enzyme protects RBCs from oxidative injury
Jaundice appears around one week of age
How will a neonate present w/ G6PD deficiency?
- poor feeding
- fever
- vomiting
Diagnostics for G6PD deficiency.
-Heinz bodies & bite cells on PBS
- G6PD enzyme activity assay
- genetic testing
Tx for G6PD deficiency
- avoid oxidants
- control triggers
- monitor S/Sx (color of urine)
- folic acid during hemolytic event
When should you give a blood transfusion to someone w/ a hemolytic anemia?
<7g/dL
Describe Non-hemolytic.
Pathologic–> Incr Production–> Non Immune
- Enclosed hemorrhage (cephalohematoma or intracranial hemorrhage) or extensive bruising in the skin
- Polycythemia leads to jaundice by incr red cell mass,
- Bowel obstruction, functional or mechanical, leads to an incr enterohepatic circulation of bilirubin.
Describe Crigler-Najjar Syndrome.
Pathologic–> decr conjugated
- gene mutation that codes for UDPGT
(none of the enzyme or a def.)
(Bilirubin not conjugated therefore can’t be excreted, so unconjugated bilirubin builds up in the blood)
- 2 types: autosomal dominant, autosomal recessive
- Rare
- Can cause severe bilirubin encephalopathy
Tx for Crigler-Najjar Syndrome.
Liver transplant is curative
Describe Gilbert Syndrome.
Pathologic–> Decr conjugation
- mild autosomal dominant d/o–> decr hepatic UDPGT activity
- higher risk of prolonged jaundice due to G6PD, breastfeeding
Tx for Gilbert Syndrome
NO tx needed
Early signs of Bilirubin toxicity
- lethargy
- poor feeding
- high-pitched cry
- hypotonia
Late signs of bilirubin toxicity
- Irritability
- Fever
- Opisthotonos
- Oculogyric crisis
- Seizures
- Hypertonia
- Apnea
Chronic signs of bilirubin toxicity.
- Dental dysplasia
- High-freq hearing loss
- Athetoid cerebral palsy
- Mild mental retardation
- Paralysis of upward gaze
Describe findings of acute bilirubin encephalopathy
- Lethargy, poor feeding (may present as “sleepy”)
- Irritability, high-pitched cry
- Arching of the neck (retrocollis) & trunk (opisthotonos)
- Apnea, seizures, coma (late)
- Correlation b/t TSB level & neurotoxicity is poor
Describe findings of chronic bilirubin encephalopathy
- Extrapyramidal movement
- Gaze abnormality, especially limitation of upward gaze.
- Dysplasia of the enamel of the deciduous teeth
- Deafness
- Kernicterus
Tx for neonatal jaundice
- 1st line: phototherapy–> incr H2O soluble
- 2nd line: Exchange transfusion–>
pt blood is removed &replaced by donated blood or blood components
Causes of transplacental neonatal pneumonia.
- Rubella
- CMV
- HSV
- Adenovirus
- Mumps virus
- Toxoplasma gondii
- Mycobacterium tuberculosis
- treponema pallidum
- Listeria monocytogenes
Causes of at delivery neonatal pneumonia.
- Group B strep
- E. coli
- S. aureus
- Klebsiella sp.
- Other strep
- Haemophilus influenza
- Candida sp
- Chlamydia tachomatis
- Ureaplasma urelyticum
Causes of amniotic fluid neonatal pneumonia.
- CMV
- HSV
- Enteroviruses
- Genital mycoplasma
- Listeria monocytogenes
- Chlamydia tachomatis
- Mycobacterium tuberculosis
- Group B strep
- E. coli
- Haemophilus influenza
- Ureaplasma urealyticum
High Phenylalanine foods
- Beans
- Eggs
- Dairy
- Diet Soda
- Fish
- Meat
- Nuts & Legumes
- Wheat
Causes of nosocomial neonatal pneumonia.
- S. aureus
- S. epidermidis
- Group B strep
- Klebsiella sp.
- Enterobacter
- Pseudomonas
- Bacillus cereus
- Citrobacter diversus
- Influenza virus
- Resp syncytial virus
- Enteroviruses
- herpes virus
- candida sp
- Aspergillus sp
Low phenylalanine foods
- Fruits
- Low-PRO foods
- Special breads, cookies, crackers
- Sugars
- Veggies
Feeding Guidelines for All children
- avoid distractions during mealtimes
- Maintain pleasant neutral attitude through meal
- feed to encourage appetite
- serve age-appropriate foods
- Systematically introduce new foods (8-15 times)
- Encourage self-feeding
- Tolerate age appropriate mess
RFs for substance abuse
- FHx of substance use
- Favorable parental attitudes towards the behavior
- Poor parental monitoring
- Parental substance use
- Family rejection of sexual orientation or gender identity
- Assoc. w/ delinquent or substance using peers
- Lack of school connectedness
- Low academic achievement
- Childhood sexual abuse
- Mental health issues
