CPS 2019 Flashcards
The vertical rate of transmission of HIV in North America is now?
With no interventions perinatal HIV transmission rates can be as high as
well below 2%
25%
when does the majority of transmission of HIV occur?
Majority of transmission happens at the time of delivery, additional risk for infection if the newborn is breastfed
what are some risk factors for HIV
Late or no prenatal care
Injection drug use
Recent illness suggestive of HIV seroconversion
Regular unprotected sex with a partner known to be living with HIV (or risk of HIV infection)
Sexually transmitted infections during pregnancy
Emigration from an HIV-endemic area or recent incarceration
what is the standard for diagnosing HIV during pregnancy
The standard approach to diagnosing HIV infection during pregnancy is by multistep serology testing
1st step- screening for HIV antibodies using an enzyme immunoassay
If the enzyme immunoassay is reactive the sample is re-tested using a more specific confirmatory test for HIV antibodies (western blot)
If HIV test results are positive for mother or infant, infant antiretroviral prophylaxis should be initiated when?
If test results are positive for mother or infant, infant antiretroviral prophylaxis should be initiated immediately and no later than 72 hours post-delivery
Breastfeeding should be deferred until the confirmatory HIV antibody test result is available and proves negative
If a mother tests positive for HIV antibody what test should be done on the baby?
HIV (DNA or RNA) PCR within 48 hours of birth
if positive then prophylaxis should be stopped and antiretroviral treatment intitiated
* antibody test would only confirm the mother’s status
what has been identified as the single most important barrier to access of contraception?
Cost has been identified as the single most important barrier to access
what is the failure rate for IUD?IUSs? SARC?
IUDs: <1%
Short acting reversible contraception: 6-9%
OCP, patch, vaginal ring- 9% Depot- 6% IUS- 0.2% Copper IUD- 0.8% Condoms- 18-21%
what is first line for contraception
long acting reversible contraception
up to what age should have free contraception
All youth should have confidential access to contraception, at no cost, until the age of 25.
- has been shown to reduce the incidence of teen pregnancy
what are 2 antenatal strategies to reduce the incidence of acute brain injuries?
administering maternal corticosteroids
prompt antibiotic treatment for chorioamnionitis.
what infants are at higher risk for intracranial ischemic and hemorrhagic injuries? and when do they occur?
Infants born at ≤32+6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth.
The first 72 hours postbirth (‘the critical window’) is the highest risk period for acute preterm brain injury
what are some perinatal strategies to reduce the incidence of acute brain injuries? (3)
delivery within a tertiary centre
delayed cord clamping
preventing hypothermia
what are some postnatal strategies to reduce the incidence of acute brain injuries (4)
empiric treatment with antibiotics when chorioamnionitis is suspected
the cautious use of inotropes
the avoidance of blood PCO2 fluctuation (target PCO2 45-55, max 60)
neutral head positioning, HOB 30 degrees
In Canada, approximately ____% of preterm infants born at ≤32+6 weeks gestational age (GA) show an abnormal brain image (IVH or parenchymal lesions) on cranial ultrasound
21%
what age for antenatal steroids?
administering antenatal corticosteroids within 7 days to all mothers expected to deliver a premature infant ≤34+6 weeks GA is recommended, with the optimal interval being greater than 48 hours between the last dose administered and birth
what age for magnesium sulphate?
<34 weeks
what are some ways to prevent hypothermia in a preterm infant (7)
polyethylene wrapping or a bag
temperature in the delivery room at 25°C to 26°C
use a preheated servo-controlled radiant warmer with a temperature sensor
providing a thermal mattress
putting a hat on the infant
providing a preheated transport incubator
what type of ventilation should be used in preterm infants
Whenever possible, volume-targeted ventilation should be used in premature infants in the first 72 hours postdelivery
Mothers experiencing preterm premature rupture of membranes (PPROM) and expecting to deliver an infant ≤32+6 weeks gestational age (GA) should be treated with what antibiotics?
Mothers experiencing preterm premature rupture of membranes (PPROM) and expecting to deliver an infant ≤32+6 weeks gestational age (GA) should be treated with antibiotics: penicillin and a macrolide or a macrolide alone if she is allergic to penicillin
what is the best measure of stored iron
serum ferritin
what are the 3 progressive stages of iron deficiency
- depletion of iron stores
- depletion of iron transport
- iron deficiency anemia
what are risk factors for iron deficiency <2 years of age
- Male sex
- prematurity
- Low socioeconomic status
- exclusive breastfeeding >6 months
- prolonged bottle use
- lead exposure
- low dietary intake of iron-rich complementary foods
what is the recommended timing to start iron supplementation for low birth weight infants
The timing recommended for starting iron supplementation in LBW infants is at 2 to 3 weeks postnatal age
compared with 4 weeks postnatal age for infants in the normal range
For infants 7 to 12 months of age, what is the Recommended Dietary Allowance of iron
11 mg/day of elemental iron is the Recommended Dietary Allowance.
what are the iron recommendations for children 1-3 yo
4-8 years old?
iron recommendations decrease to 7 mg/day for children 1 to 3 years old
increase to 10 mg/day for children 4 to 8 years old
what are 4 ways to reduce iron deficiency in babies/infants
Delayed cord clamping
If formula feeding, providing iron-fortified formula
Feeding iron-rich complementary foods from age 6 months
Not using cow’s milk as the main milk source until infants are a year old, and limiting cow’s milk intake to 500 mL/day thereafter.
what is the treatment of iron deficiency anemia
2-6mg/kg/day divided TID
vitamin C helps with absorption
continue supplements for a minimum of 3 months
when should cows milk be introduced? how much?
delay cows milk until 9-12 months of age- 750mL
1-2 yo: 500mL
what are iron rich complimentary foods, when should they be introduced
meat
meat alternatives
iron rich cereals
introduce at 6 months
what bloodwork would you do to screen someone for iron deficiency
CBC
serum ferritin
For low birth weight infants (birth weight less than 2.5 kg) who are predominantly breastfed (i.e., greater than 50% of intake) is iron supplementation routinely recommended?
Yes!!
2.0- 2.5 kg: iron supplement of 1-2 mg/kg/day for the first 6 months of age
< 2.0 kg: 2-3 mg/kg/day for the first year of age
For low birth weight infants (birth weight less than 2.5 kg) who are predominantly formula-fed (i.e., greater than 50% of intake) is iron supplementation recommended?
Not required when the formula used is high in iron
what infants are at risk for hypoglycemia
- LGA (>90)
- SGA (<10)
- IUGR
- IDM
- Prematurity (<37 weeks)
- Maternal labetolol use
- Perinatal asphyxia
- Syndromes- such as BWS
What is the most common cause of hypoglycemia in infants?
Impairment of gluconeogenesis is the most common cause of hypoglycemia in infants
How long do you have to do glucose checks for IDM/LGA?
12 hours
How long do you have to do glucose checks for SGA?
24 hours
what is the therapeutic goal for glucose if a baby is >72 hours old
3.3
at what glucose level should you do a critical sample if a baby is >72 hours old
2.8
what are some physical strategies for managing pain/distress
sitting in caregiver's lap breastfeeding swaddling kangaroo care sucrose non nutritive sucking
what are some psychological strategies for managing pain/distress
preparation deep breathing distraction hypnosis music therapy
Influenza vaccination is particularly recommended for the following groups:
all children 6 months-59 months
all children >6 months with chronic medical conditions
indigenous
residents of chronic care facilitates
living in house with infant
living in house with someone immunocompromised
all adults >65 years of age
all pregnant people
health care providers
people who provide essential community services
what are 2 contraindications to the influenza vaccine
1) An anaphylactic reaction to a previous dose of influenza vaccine or to any of the components of the vaccine
2) onset of Guillain-Barré syndrome within 6 weeks of influenza vaccination
what are the contraindications to the LAIV influenza vaccine
- pregnancy
- immunocompromised
- medically treated wheeze in the last 7 days
- severe asthma (on high dose corticosteroids or oral steroids)
- ASA
what is the dose of influenza vaccine? who needs 2 doses?
The dose of IIV administered intramuscularly (IM) is 0.5 mL, regardless of age
children <9 need 2 doses the first year they receive the influenza vaccine
what are some climate related health risks
- heat and cold related morbidity and mortality
- air pollution
- water contamination
- natural hazards and extreme weather events
- ozone depletion- UV radiation exposure
- infections from insects/ticks/rodents
what is the largest global health threat of the 21st century
climate change
- driven mainly by pollution from fossil fuel emissions
who is considered high risk for food allergy
personal history of atopy or 1st degree relative with hx of atopy
what are some recommendations for introduction of foods for those at high risk for food allergy
- introduce foods at 6 months of age, not before 4 months
- allergenic foods should be introduced one at a time
- administer a few times per week to maintain tolerance
- breastfeeding should be promoted and protected up to 2 years and beyond
- The texture or size of any complementary food should be age-appropriate to prevent choking.
how do most people with polio present?
asymptomatic
1% present with paralysis- acute asymmetric flaccid paralysis
what is the workup for polio
stool culture
throat swab
How does a patient with measles present
cough coryza conjunctivitis koplik spots followed by DESCENDING maculopapular rash
what are some complications of measles (4)
- otitis media
- encephalitis
- pneumonia
- death
How do you test for measles
measles serology
NP swab
urine
How does a patient with diphtheria present
sore throat
fever
weakness
rapidly progressive swelling of neck “bull neck”
*clinical diagnosis
Does herd immunity protect against tetanus? how do they present
NO!!
muscle rigidity and spasms
*clinical diagnosis
exposure through a cut or puncture wound
what is the classic presentation of mumps
unilateral or bilateral parotitis
vaccine failure is common with mumps
what are some complications of mumps (6)
orchiditis mastitis oophoritis pancreatitis meningitis encephalitis
what is the workup for mumps
serology
NP swab
urine sample
what is the workup for rubella
serology
throat swab
NP swab
urine sample
What conditions are classified as severe invasive group A strep (5)
- toxic shock syndrome
- Necrotizing fasciitis
- Pneumonia
- Meningitis
- Bacteremia
what is toxic shock syndrome
hypotension plus 2 of
- renal impairment
- liver function abnormality
- coagulopathy
- Acute respiratory distress syndrome
- diffuse erythematous macular rash that may later desquamate
what is the treatment for toxic shock
cloxacillin + clindamycin
IVIG
what is the treatment for necrotizing fasciitis
pip/tazo+ clindamycin
what is chemoprophylaxis for IGAS
chemoprophylaxis if exposure to a known case of IGAS, 7 days prior to onset of symptoms and 24 hours after starting antimicrobials
cephalexin
alternatives: cefuroxime or cefixime
if allergy: macrolide (azithromycin, clarithromycin) or clindamycin
what investigations would you do for lead poisoning
- CBC
- Blood lead level (venous sample)
- Calcium
- Ferritin
- Protein
- Albumin
who should you investigate for lead poisoning
- Lived in a house <1960 in the last 6 months
- sibling, housemate or playmate with lead poisoning
- Pica, ate paint chips or tend to mouth painted surfaces
- Emigrated
- any of the above risk factors and neurodevelopment disorder
where is the body’s lead stored
bone
can be re-released into the bloodstream
what should you do if lead level is 5-14
- inform family
- repeat in 1-3 months
- obtain pediatric environment health history
- nutrition- calcium and iron
- neurodevelopmental follow-up
when should you repeat blood lead level is 15-44
repeat in 1-4 weeks
what should you do if lead level is >44
repeat venous lead level in 48 hours
consider hospitalization and/or chelation therapy in consultation with poison control centre
what are the 5 main categories for a pediatric environment health history
- home/school
- consumer products
- food
- occupation/hobbies
- family factors
what are the 3 most common potential sources of lead exposure in young children
food and water
household dust and soil
mouthing products that contain lead
what are the 3 main categories for risk factors for ASD
genetic/familial
prenatal
postnatal
what are some prenatal risk factors for ASD (5)
maternal age >35 maternal obesity, diabetes, hypertension exposure to valproate, air pollution, pesticide maternal infection close pregnancies (<12 months)
what are some postnatal risk factors for ASD (2)
low birth weight
extreme prematurity
what is the prevalence of ASD in Canada
1/66 Canadians
4x more common in males
what are early warning signs for autism 6-12 months
no smiling no eye contact no babbling or gestures limited reciprocal smiling, gestures, sounds limited response to name
what are early warning signs for autism 9-12 months
emerging repetitive behaviors
unusual play
what are early warning signs for autism 12-18 months
no single word
no gestures
no pretend play
limited joint attention
what are early warning signs for autism 15- 24 months
no spontaneous or meaningful two word phrases
what are concerning signs for autism at any age
parental concern
developmental regression
what are 3 key features of an ASD diagnostic assessment
- definitive diagnosis of autism
- look for co-morbidities
- determine level of adaptive function
what are the essential elements of an ASD diagnostic assessment
- Review records
- Interview parents
- Look for core features of autism
- Physical exam
- Look for co-morbidities
- Establish diagnosis of ASD
- Communicate findings of ASD diagnostic assessment
- Comprehensive assessment for intervention planning
What are common differential diagnosis and co-morbidities with ASD
neurodevelopment: ADHD Tourette's or tic disorder intellectual disability language disorder
Mental health: anxiety depression conduct disorder ODD social communication disorder reactive attachment disorder selective mutism
Genetic:
Fragile X
Rett
Neurologic: CP Epilepsy Landau- Kleffner syndrome Neonatal encephalopathy
what steps could you take if the diagnosis of ASD is unclear
Gathering additional information from other sources.
Observing the child in a different setting
Obtaining a second opinion from a specialized tertiary ASD team.
Conducting a repeat assessment to clarify potential diagnoses.
When children have developmental concerns that do not meet ASD criteria, they should be referred for further assessment and for services that address these concerns.
what is the main evidence based treatment for ASD
behavioural therapy
- should be initiated as early as possible
- based on the science of applied behavioural analysis
what 2 medications can be used for challenging behaviours in autism
risperidone
aripiprazole
what are 3 factors associated with positive outcomes in ASD?
early identification
timely access to behavioural interventions
higher cognitive abilities
what are some common medical problems for children with autism
sleep adhd GI conditions anxiety, depression nutrition
what are ACEs (4)
abuse
neglect
divorce
witnessing violence
what are 5 strategies to support relationships in families
ACBDE
A-ask questions
B- build on families relational strengths
C- counsel with family centred guidance
D- develop plan for changing behaviors related to sleep or discipline
E- Educate on positive parenting
what are the ABCs of positive parenting
A- Awareness around antecedents
B- Behaviors
C- consequences
REDIRECT acronym
Parenting strategies that ‘connect then redirect’ are at the heart of ‘time-in’. R- reduce words E- embrace emotions D- describe not lecture I- involve child in discipline R- reframe a no to yes E- emphasize the positive C- creatively approach discipline T- teach
Two principles of redirection are?
wait until parent and child are emotionally ready
consistent without being rigid
which medical conditions are considered significantly immunocompromised?
SCID asplenia aplastic anemia Malignancy HIV: CD4+ count <200mm3 age >5 or CD4+ count <15% age <5 solid organ transplant stem cell transplant (within 2 years of transplant or still taking immunosuppressive medication) high dose steroids >2 weeks biologics transplant related immunosuppressants azathioprine chemotherapeutic agents
