CLIPP 09: 2-week old female with lethargy

Question 1

List a few conditions that can lead to hypothermia

Answer 1

sepsis, disorders of metabolic function, and abnormal brain thermoregulation

Question 2

What is the recommendation for Vit D supplementation for breastfed infants?

Answer 2

All breastfed infants, regardless of whether he or she is being supplemented with formula, should receive 400 IU of supplemental oral vitamin D beginning within the first few days of life

Question 3

How to define lethargy?

Answer 3

Lethargy may be thought of as a level of consciousness characterized by the failure of a child to recognize parents or to interact with persons or objects in the environment.

Question 4

How do define listlessness in a young child?

Answer 4

A listless child shows no interest in what is happening around herself.

Question 5

When is the hep B vaccine generally administered?

Answer 5

Within the first 12 hours of life

Question 6

Why is Vit K administered right after birth?

Answer 6

To help with coagulation

- Prevents life threatening GI or CNS bleeding

Question 7

Why is erythromycin administered immediately after birth?

Answer 7

prevents Ophthalmia Neonatorum caused by Neisseria gonorrhea.

Question 8

What is a critical congenital heart disease screen?

Answer 8

pulse ox used to screen for “critical” cardiac defects that requires surgery or cardiac cath within the first year of life

Question 9

Why do patients with down syndrome present with poor feeding/

Answer 9

Hypotonia

Question 10

When do inborn errors of metabolism generally present?

Answer 10

After 1-2 days of life

Question 11

What electrolytes to test if you are concerned about congenital adrenal hyperplasia?

Answer 11

Serum sodium
Serum potassium

Sodium will be low, potassium high

Question 12

At what levels of bilirubin does neurologic damage occur?

Answer 12

> 25 mg/dL

Question 13

What serum level should you test if you are concerned about an inborn error of metabolism?

Answer 13

ammonia

Question 14

What is the most common form of CAH?

Answer 14

21-OH deficiency, causes decreased production of cortisol and aldosterone

Question 15

What are the most common causes of congenital hypothyroidism in the US?

Answer 15

Aplasia
Hypoplasia, or
An ectopic gland (accounts for two thirds of thyroid dysgenesis

worldwide is iodine deficiency

Question 16

Feeding problems
Decreased activity
Constipation
Prolonged jaundice
Skin mottling
Umbilical hernia

All early features of which disease process?

Answer 16

Congenital hypothyroidism

Develops a little later as the infant is initially protected by mom’s thyroid hormone

Question 17

Later signs of congenital hypothyroidism?

Answer 17

large tongue, hoarse cry and puffy myxedematous facies

Question 18

When should a specimen be collected for a newborn screen?

Answer 18

It is recommended that the initial screening specimen be collected as close as possible to the time of discharge and in no case later than seven days of age.
If the initial specimen is collected before 24 hours of age, a second specimen should be collected before two weeks of age

Question 19

List clinical signs of congenital hypothyroidism

Answer 19

Congenital hypothyroidism may not be clinically evident until 6 weeks of age due to circulating maternal thyroid hormone transmitted from the placenta. Signs and symptoms of congenital hypothyroidism include feeding problems, large fontanels, hypotonia, large tongue, coarse cry, and frequently an umbilical hernia. Congenital hypothyroidism should be picked up on routine neonatal screening