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Block 4 - Peds > Clin Med - Developmental Peds > Flashcards

Clin Med - Developmental Peds Flashcards

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1
Q

For age 1wk to 1 month: amount/feeding & times/day

A
  • 2 to 4 oz
  • 7 to 8 (more for breastfed babies)
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2
Q

For age 1- 3 month: amount/feeding & times/day

A
  • 5 to 6 oz
  • 5 to 7 times/day
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3
Q

For age 3 - 6months: amount/feeding & times/day

A
  • 6 to 8 oz
  • 4 to 6 times/day
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4
Q

For age 6 - 12months: amount/feeding & times/day

A
  • 7 to 8 oz + incr amts of solid foods
  • 4 bottles/day & 2 to 3 meals of solid foods
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5
Q

Preventative Measure Taken @ birth

A
  • Erythromycin ointment
  • Vitamin K
  • Hep B Vax
  • newborn genetic screen
  • Congenital Heart Dz screen
  • Hearing screen
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6
Q

Contraindications to early newborn discharge (5)

A
  1. Jaundice </= 24hrs
  2. High risk for infx
  3. Known or suspected narcotic addiction or withdrawal
  4. Physical defects requiring eval
  5. Oral defects
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7
Q

Relative contraindications to early newborn discharge

A
  1. Premature or early term infant
  2. Birth weight <2700 g (6lb)
  3. Infant difficult to arouse for feeding; not demanding regularly in nursey
  4. Medical or neuro problems that interfere w/ feeding
  5. Twins or higher multiples
  6. ABO blood group incompatibility or severe jaundice in prev. kids
  7. Mother who prev. breast-fed infant w/ poor weight gain
  8. Mother w/ breast surg involving periareolar areas
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8
Q

What is considered hypoglycemia in newborns?

A
  • BG <50mg/dL @ birth - 4hrs
    OR
  • BG <45mg/dL 4-25hrs
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9
Q

RFs for hypoglycemia

A
  • LGA
  • SGA
  • IUGR
  • Preterm or post-term birth
  • Perinatal stress
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10
Q

Tx for hypoglycemia

A
  • start feedings w/n 1hr (at risk or sx neonates
  • start IV glucose (10% dextrose & H2O)
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11
Q

What are the 5 types of neonatal jaundice?

A
  • Physiologic
  • Pathologic
  • Bilirubin toxicity
  • Acute bilirubin encephalopathy
  • Chronic bilirubin encephalopathy
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12
Q

What are the main reasons for unconjugated hyperbilirubinemia? (3)

A
  • Incr bilirubin production
  • Decr rate of conjugation
  • Unknown/Multiple Factors
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13
Q

What are the 3 main causes of incr bilirubin production?

A
  • antibody mediated
  • non-antibody mediated
  • non-hemolytic
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14
Q

List the two antibody mediated causes of pathologic jaundice.

A
  • ABO incompatibility
  • RH isoimmunization
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15
Q

List the 2 non-antibody mediated causes of pathologic jaundice.

A
  • Hereditary Spherocytosis
  • G6PD deficiency
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16
Q

List the 2 causes for decr rate on conjugation.

A
  • Crigler Najjar Syndrome
  • Gilbert Syndrome
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17
Q

List the 3 reasons for unknown/multiple factors that cause pathologic jaundice.

A
  • race (east Asian)
  • prematurity
  • breast feeding
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18
Q

Causes of physiologic jaundice

A
  • 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
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19
Q

Diagnosis of physiologic jaundice is made if…

A
  • 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
20
Q

Describe ABO incompatibility.

A

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)

21
Q

Describe Rh incompatibility.

A

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

22
Q

Describe hereditary spherocytosis.

A

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

23
Q

Describe G6PD deficiency.

A

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

24
Q

How will a neonate present w/ G6PD deficiency?

A
  • poor feeding
  • fever
  • vomiting
25
Q

Diagnostics for G6PD deficiency.

A

-Heinz bodies & bite cells on PBS
- G6PD enzyme activity assay
- genetic testing

26
Q

Tx for G6PD deficiency

A
  • avoid oxidants
  • control triggers
  • monitor S/Sx (color of urine)
  • folic acid during hemolytic event
27
Q

When should you give a blood transfusion to someone w/ a hemolytic anemia?

A

<7g/dL

28
Q

Describe Non-hemolytic.

A

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.

29
Q

Describe Crigler-Najjar Syndrome.

A

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

30
Q

Tx for Crigler-Najjar Syndrome.

A

Liver transplant is curative

31
Q

Describe Gilbert Syndrome.

A

Pathologic–> Decr conjugation
- mild autosomal dominant d/o–> decr hepatic UDPGT activity
- higher risk of prolonged jaundice due to G6PD, breastfeeding

32
Q

Tx for Gilbert Syndrome

A

NO tx needed

33
Q

Early signs of Bilirubin toxicity

A
  • lethargy
  • poor feeding
  • high-pitched cry
  • hypotonia
34
Q

Late signs of bilirubin toxicity

A
  • Irritability
  • Fever
  • Opisthotonos
  • Oculogyric crisis
  • Seizures
  • Hypertonia
  • Apnea
35
Q

Chronic signs of bilirubin toxicity.

A
  • Dental dysplasia
  • High-freq hearing loss
  • Athetoid cerebral palsy
  • Mild mental retardation
  • Paralysis of upward gaze
36
Q

Describe findings of acute bilirubin encephalopathy

A
  • 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
37
Q

Describe findings of chronic bilirubin encephalopathy

A
  • Extrapyramidal movement
  • Gaze abnormality, especially limitation of upward gaze.
  • Dysplasia of the enamel of the deciduous teeth
  • Deafness
  • Kernicterus
38
Q

Tx for neonatal jaundice

A
  • 1st line: phototherapy–> incr H2O soluble
  • 2nd line: Exchange transfusion–>
    pt blood is removed &replaced by donated blood or blood components
39
Q

Causes of transplacental neonatal pneumonia.

A
  • Rubella
  • CMV
  • HSV
  • Adenovirus
  • Mumps virus
  • Toxoplasma gondii
  • Mycobacterium tuberculosis
  • treponema pallidum
  • Listeria monocytogenes
40
Q

Causes of at delivery neonatal pneumonia.

A
  • Group B strep
  • E. coli
  • S. aureus
  • Klebsiella sp.
  • Other strep
  • Haemophilus influenza
  • Candida sp
  • Chlamydia tachomatis
  • Ureaplasma urelyticum
41
Q

Causes of amniotic fluid neonatal pneumonia.

A
  • CMV
  • HSV
  • Enteroviruses
  • Genital mycoplasma
  • Listeria monocytogenes
  • Chlamydia tachomatis
  • Mycobacterium tuberculosis
  • Group B strep
  • E. coli
  • Haemophilus influenza
  • Ureaplasma urealyticum
42
Q

High Phenylalanine foods

A
  • Beans
  • Eggs
  • Dairy
  • Diet Soda
  • Fish
  • Meat
  • Nuts & Legumes
  • Wheat
43
Q

Causes of nosocomial neonatal pneumonia.

A
  • 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
44
Q

Low phenylalanine foods

A
  • Fruits
  • Low-PRO foods
  • Special breads, cookies, crackers
  • Sugars
  • Veggies
45
Q

Feeding Guidelines for All children

A
  • 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
46
Q

RFs for substance abuse

A
  • 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

Block 4 - Peds (10 decks)

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