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Pediatrics > Congential CMV > Flashcards

Congential CMV Flashcards

1
Q

Risks for infants of adolescent mothers

A

Lower birth weight
Vertically acquired STI
Poorer developmental outcomes
Increased risk of fetal death

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2
Q

Tobacco effects

A

maternal use increases risk of low birth weight

- no charateristic facies

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3
Q

Alcohol affects

A

there is no “safe” amount

  • distinct pattern of facial abnormalities, growth deficiency, and CNS dysfunction
  • neurobehavioral deficits and learning problems
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4
Q

Marijuana effects

A

no distinctive effects have been identified

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5
Q

Cocaine effects

A

cause vasoconstriction leading to placental insufficiency and low birth weight

  • can cause some cognitive deficits later in life as well
  • possible withdrawal symptoms
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6
Q

Maternal factors limiting growth of fetus

A
  • poor weight gain in 3rd trimester
  • preeclampsia
  • drug use
  • infections
  • uterine abnormalities
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7
Q

Placental factors limiting growth of fetus

A

Placenta previa
Placental abruption
Abnormal vessel insertions

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8
Q

Fetal factors limiting growth of fetus

A

Malformations
Metabolic disease
Chromosomal abnormalities
Congenital infections

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9
Q

Small for Gestational Age

A

newborns who are smaller than expected

- not same as IUGR

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10
Q

Risks of vertical transmission of HIV

A
  • frequent, unprotected sex during pregnancy
  • advanced maternal HIV
  • membrane rupture > 4 hrs and mom not on anti-retroviral therapy
  • vaginal delivery
  • breastfeeding
  • premature delivery
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11
Q

APGAR scores

A 
Appearance (color)
Pulse (HR)
Grimace (irritability)
Activity (tone)
Respirations
At 1 and 5 minutes, max of 10
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12
Q

Growth terms reviewed

A

SGA - weight below 10th percentile for age
Microcephalic - head circumference below 10th percentile
Term - born at > 37 weeks gestation

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13
Q

Ballard gestational age

A

uses signs of physical and neuromuscular maturity to estimate gestational age
- helpful if no early US to gage

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14
Q

Risks for SGA in newborns

A
  1. Hypoglycemia - decreased glycogen stores, heat loss, hypoxia
  2. Hypothermia - cold stress, hypoxia, hypoglycemia, decreased insulation
  3. Polycythemia - chronic hypoxia, maternal-fetal transfusion
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15
Q

TORCH infections

A 
T - toxoplasmosis
O - HIV, Hep B, parvovirus, syphilis
R - rubella
C - CMV
H - herpes simplex 2
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16
Q

Sequelae Congenital CMV

A

hearing loss –> often progressive (bilateral)
Microcephaly and Intracranial calcifications
- developmental delay, retardation, cerebral palsy
Hepatosplenomegaly and Rash
- self resolve

17
Q

Brain imaging in CMV

A

intracranial calcifications
diminished brain gyri and thick cortex
enlarged ventricles

18
Q

Breastfeeding

A

preferred method of nutrition for infants
Contraindications
- HIV, herpes lesions on breast, TB, drug use

19
Q

Benefits of breastfeeding

A
  • GI growth and maturity
  • decreases acute illnesses
  • reduction in obesity and other problems
20
Q

Newborn Screening

A

Metabolic disorders - PKU, hypothyroidism, MSUD, G6PD deficiency, CF
Congenital deafness - hearing test before leaving hospital

21
Q

Signs and symptoms of inborn errors in metabolism

A 
present 24-72 hours after birth
anorexia
lethargy
vomiting
seizures
22
Q

Clinical findings of newborns with CMV

A

leading congenital infection in US - 90% of kids asymptomatic

  • Skin: petechiae, jaundice, purpura
  • Liver: high bilirubin, elevated ALT, heptaomegaly
  • Hematopoietic: anemia, thrombocytopenia
  • CNS: microcephaly, seizures, calcifications
  • Auditory: sensorineural hearing loss
  • Visual: chorioretinitis
23
Q

Adolescent Interview

A 
H - home
E - eating disorders
E - employment/education
A - activity
D - drugs
S - safety
S - sexuality
S - suicide
24
Q

Newborn Resuscitation

A

warm and dry the infant
stimulate infant to cry
suction amniotic fluid from nose and mouth
initiate further resuscitation if needed

25
Q

Primitive Reflexes

A 
Rooting - turn cheek when touched
Sucking - sucks finger appropriately
Moro (startle) 
Palmar/plantar grasp - grasps finger when stroked
Neck Response 
Babinski
26
Q

DDx for SGA, microcephaly, and rash

A 
TORCH infection
FAS
Chromosomal abnormality
Tobacco exposure
HIV infection
27
Q

Prenatal lab screening

A

serological screening for HIV, rubella, Hep B
Blood type and Rh
Urine drug screen

28
Q

Testing for TORCH infections

A

Maternal HBsAg
Maternal and infant rubella titer
Infant toxoplasma titer
Infant urine culture (CMV)

29
Q

Decreasing risk of vertical HIV transmission

A

treat mother with anti-retrovirals
C-section delivery
No breastfeeding

30
Q

Routine Newborn Medications

A

Vitamin K - hemorrhagic disease of newborn
Hep B vaccine
Erythromycin - gonococcal conjuctivitis

31
Q

Antiviral treatment of congenital CMV

A

gangciclovir IV for 6 months to prevent progression of hearing loss and CNS sequelae

32
Q

CMV follow-up

A

Audiometry - at all first year check-ups
Vision - 12 months and 3 years
Neuro - at all checkups

Pediatrics (36 decks)

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