CLIPP 1 Flashcards by Sanyu Janardan

3 leading causes of adolescent death in US

Accidents, homicide, suicide

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HEEADSSS

Home
Education/Employment
Eating disorders
Activity/Aspirations/Affiliations
Drugs
Sexuality
Suicide
Safety

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Alcohol–>
Marijuana–>
Cocaine–>
Tobacco–>

->FAS with distinct facies and neuro-behavioral-cognitive issues
-> no distinct effects elucidated
-> vasoconstriciton and low birth weight
->low birth weight

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Estimating gestational age

Measure fundal height, compare to established norms and compare to EGA based on LMP - if fundal height is consistent with 6 month gestation but LMP consistent with 8 month, may have IUGR

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IUGR vs SGA and types of IUGR

IURG - has not reached growth potential at given gestational age due to 1+ causative factors, noted in pregnancy
-Asymmetric IUGR aka head sparing - abdomen decreased relative to head, VS symmetric IUGR where both head and abdomen are decreased proportionately
SGA - definitions range from <10%ile for weight, dx at birth
Thus all IUGR are SGA but not all SGA are IUGR

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TORCH

Toxoplasmosis
Other - transplacental including HIV, HepB, parvovirus, syphilis) 
Rubella
CMV
HSV 2

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How does diabetes impact fetal growth?

—>macrosomia

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When to give intrapartum abx for GBS

active labor w/ ruptured membranes for >= 18h
GBS bacteria during any part of this pregnancy
Fever >38/100.4
Previous GBS+ infant
- intrapartum NAAT
38/100.4, + intrapartum NAAT, amniotic membrane rupture for >= 18 h

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breast feeding in AIDS

3 ARV drugs before delivery, during and while breastfeeding help reduce transmission while breastfeeding

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What drug and what delivery method reduces vertical AIDS transmission

Zidovudine - ideally before labor starts

-C section IF membranes have NOT already ruptured

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Immediate things to do to baby post-delivery

warm and dry
stimulate to cry
suction nose
respiratory support if needed (ranges from nothing to O2 to CPR and medication)

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APGAR meaning, what it doesn’t account for and scores

Appearance, Pulse/HR, Grimace, Activity, Respirations. Doesn’t account for maturity

score 0-2 in each
obtain scores at 1 and 5 minutes post delivery

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What is Ballard scoring?

Gestational age assessment tool that uses physical and NM maturity to estimate age

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“Term” infant

born after 37 weeks

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microcephalic

head circumference below 10th percentile for gestational age

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Problems in SGA infants

Hypothermia
Hypoglycemia
Hypergylcemia
Intrauteruine death
Asphyxia
Meconium aspiration
Persistent pulmonary hypertension
GI perforation
Polycythemia/hyperviscosity
ARF
Immunodeficiency

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Rooting
Sucking
Moro
Palmar/plantar
Asymmetric tonic neck
Stepping

Rooting: Turns head towards your finger if you touch cheek
Sucking: sucks finger if you touch roof of mouth
Moro: drop baby’s head a few cm–>he will flex his legs, fan and then clench fingers, throw arms out and then bring them together in an embrace
Palmar/plantar: will grasp your hand if you stroke palmar or plantar surface of hand/foot
Asymmetric tonic neck: turn baby’s head to one side which causes extension of arm in direction of gaze and flexion of other arm
Stepping: hold baby vertically and stroke dorusm of foot on table edge –>stepping

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3 causes of LOSS of red reflex (besides RB)

opacified cornea like in MPS, cataract, anterior chamber inflammation

Infant spleens

SPLEEN often palpable 1-2 cm below left costal margin

most likely dx in infant with HSM, purpuric rash and microcephaly

TORCH infection - especially consider if prenatal STI exposure/risk

Which hepatitis marker does not predict risk for vertical HepB transmission?

HepB CORE Ab

Testing for rubella in baby

IgM or IgG, but difficulty after 1 year of age

Testing for toxo in baby

IgM, IgG, or IgA positive assay in neonatal period, rising IgG in year 1 or persistently positive IgG after this

Testing for CMV in baby

Virus shed in urine and saliva - test this. PCR is not specifically advantageous here. Dx within first 3 weeks of life = congenital CMV

Normal BS in infant

>45mg/dL

meds routinely given to newborns

Vit K, hep B vaccine, tetracycline or erythromycin or silver nitrate eye drops to prevent gonoccal conjunctivitis (chlyamdial occurs 7-14 days after birth and can't be prophylaxed)

CMV symptoms

microcephaly, purpuric rash, HSM, calcifications in brain, smooth (too few gyri) in brain (lissencephaly or agyria/patchygyria), enlarged ventricles, jaundice, chorioretinitis, hearing loss (progressive), developmental delay -non neuro things resolve within weeks

tx CMV

parenteral ganciclovir or oral valganciclovir

breastfeeding indications and contraindications

``` indications = until 6 months, and then with addition of other things until 12 months. 8-12x/day contra= HIV, active untreated TB, galactosemic infants, active drug abuse by mom ```

NBS - all states and new rec

hypothyroidism, PKU | recommendation now to also screen for congenital heart defects

leading cause of congenital infection in the US

CMV

CMV follow up

ABR or otoacoustic emissions until 12 months of age (birth, 3, 6, 9, 12, 18, 24, 30, 36 months then annually until school) Test vision at birth, 12 months, 36 months, preschool

Hepatosplenomegaly in newborns

in metabolic diseases, storage diseases, HIV vertical transmission, intrinsic liver disease, and in congenital infections.

mother was on an anticonvulsant

anticonvulsants during pregnancy may lead to cardiac defects, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, IUGR, and microcephaly. Mental retardation may be seen. A rare neonatal side effect is methemoglobinuria.

Chorioretinitis due to

CMV or Toxo

Tremors in newborn due to

maternal substance abuse

CMV pathology

Enlarged cells with intranuclear inclusion bodies

Opiate use during pregnancy

CNS findings (irritability, hyperactivity, hypertonicity, incessant high-pitched cry, tremors, seizures), GI symptoms (vomiting, diarrhea, weight loss, poor feeding, incessant hunger, excessive salivation), and respiratory findings (including nasal stuffiness, sneezing, and yawning).

Congenital rubella presents with

sensorineural deafness, eye abnormalities (retinopathy, cataracts), and patent ductus arteriosus.

defect in cystathionine synthase

homocystinuria, a disorder of amino acid metabolism. Homocystinuria is inherited in an autosomal recessive pattern. Individuals display Marfanoid body habitus, a hypercoaguable state, and possible developmental delay. The condition can be diagnosed by testing for increased methionine in a patient’s urine or blood

A defect in sphingomyelinas

Niemann-Pick disease, a lysosomal storage disease. Children present by six months of age with hepatomegaly, ataxia, seizures, and progressive neurologic degeneration. Fundoscopic exam reveals a “cherry-red” macula

A defect in alpha-L-iduronidase

Hurler syndrome, a type of autosomal recessive lysosomal storage disease. Children typically do not display symptoms until one year of age. Symptoms include hepatosplenomegaly, coarse facial features, frontal bossing, corneal clouding, and developmental delay. Affected individuals typically do not live past fifteen years old.

A defect in glucose-6-phosphatase

Von Gierke’s disease, a glycogen storage disease. Von Gierke’s disease is inherited in an autosomal recessive pattern. Individuals present with hypoglycemia, hepatomegaly, and metabolic acidosis