CLIPP 1 Flashcards
3 leading causes of adolescent death in US
Accidents, homicide, suicide
HEEADSSS
Home Education/Employment Eating disorders Activity/Aspirations/Affiliations Drugs Sexuality Suicide Safety
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
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
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
TORCH
Toxoplasmosis Other - transplacental including HIV, HepB, parvovirus, syphilis) Rubella CMV HSV 2
How does diabetes impact fetal growth?
—>macrosomia
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
breast feeding in AIDS
3 ARV drugs before delivery, during and while breastfeeding help reduce transmission while breastfeeding
What drug and what delivery method reduces vertical AIDS transmission
Zidovudine - ideally before labor starts
-C section IF membranes have NOT already ruptured
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)
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
What is Ballard scoring?
Gestational age assessment tool that uses physical and NM maturity to estimate age
“Term” infant
born after 37 weeks
microcephalic
head circumference below 10th percentile for gestational age
Problems in SGA infants
Hypothermia Hypoglycemia Hypergylcemia Intrauteruine death Asphyxia Meconium aspiration Persistent pulmonary hypertension GI perforation Polycythemia/hyperviscosity ARF Immunodeficiency
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
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
