High-risk Infant Flashcards by Rian L.

a birth defect where ther is incomplete closing of backbone and membranes around the spinal cord.

spina bifida

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the most common location of spina bifida is _, but in rare cases it may be the _ or _.

the most common location of spina bifida is lower back, but in rare cases it may be the middle back or neck.

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two main types of spina bifida

spina bifida occulta
spina bifida cystica

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type of spina bifida that has no or only mild sign, and may include hairy patch, dimple, dark spot, or swelling on back at the site of the gap in the spine.

spina bifida occulta

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signs of spina bifida occulta (4)

hairy patch
dimple
dark spot
swelling on back at the site of the gap in the spine

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two types of spina bifida cystica

meningocele
myelomeningocele

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type of spina bifida cystica that typically causes mild problems with a sac of fluid present at the gap in the spine.

meningocele

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type of spina bifida cystica that is also known as open spina bifida, is the most severe form. learning problems are relatively uncommon.

myelomeningocele

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spina bifida is believed to be caused by _.

a combination of genetic and environmental factors

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_ deficiency during pregnancy plays a role in spina bifida.

folic acid deficiency

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6 risk factors for spina bifida

anti-seizure medications
obesity
poorly managed diabetes
drinking alcohol
white or hispani
newborn girls

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drinking alcohol often triggers _, which discards folate – and may lead to folic acid deficiency, leading to spina bifida.

drinking alcohol often triggers macrocytosis which discards folate – and may lead to folic acid deficiency, leading to spina bifida.

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drinking alcohol often triggers macrocytosis which discards folate that may lead to spina bifida. after stopping drinking alcohol, a time period of months is needed to rejuvenate _ and recover from the macrocytosis.

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a condition where red blood cells are larger than normal.

macrocytosis

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open spina bifida can usually be detected during pregnancy by _.

open spina bifida can usually be detected during pregnancy by fetal UTZ.

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one helpful way to reduce the incidence of spina bifida and give 5 examples.

dietary supplementation with folic acid
- whole grains
- fortified breakfast cereals
- dried beans
- leafy vegetables
- fruits

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7 signs and symptoms of spina bifida

physical signs
leg weakness and paralysis
orthopedic abnormalities (club foot, hip dislocation, scoliosis)
bladder and bowel control problems, including incontinence, UTI, and poor kidney function
pressure sore and skin irritations
abnormal eye movement
68% of children with spina bifida have an allergy to latex, ranging mild to life-threatening

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3 orthopedic abnormalities in children with spina bifida

club foot
hip dislocation
scoliosis

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3 bladder and bowel control problems for children with spina bifida

incontinence
UTI
poor kidney function

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68% of children with spina bifida have an allergy to _.

latex

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t/f: there is a known cure for nerve damage caused by spina bifida.

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standard treatment for spina bifida

surgery by a pediatric neurosurgeon to close the opening on th back after delivery

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surgery for _ is done to prevent further damage of the nervous tissue and to prevent infection.

spina bifida

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in the surgery done for spina bifida, after a pediatric neurosurgeon closes the opening on the back after delivery,the spinal cord and its nerve roots ar put back inside the spine and covered with _.

in the surgery done for spina bifida, after a pediatric neurosurgeon closes the opening on the back after delivery,the spinal cord and its nerve roots ar put back inside the spine and covered with meninges.

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in addition to surgery for spina bifida, a _ may be surgically installed to provide continuous drain for the excess CSF produced in the brain, into the abdomen, or chest wall, as happens with hydrocephalus.

in addition to surgery for spina bifida, a **shunt** may be surgically installed to provide continuous drain for the excess CSF produced in the brain, into the abdomen, or chest wall, as happens with hydrocephalus.

two forms of prenatal treatment for spinal bifida

open fetal surgery fetoscopy

if open fetal surgery is done as prenatal treatment for a bab with spina bifida, what is the risk for the bother and baby?

mother - scarring of the fetus fetus - risk of preterm birth

medical specialist that coordinates the rehabilitation efforts of differenttherapists, and prescribes specific therapies, adaptive equipment, or medications to encourage as high of a functional performance within the community as possible.

psychiatrist

medical specialist that monitors growth and development of bones, muscles, and joints.

orthopedist

medical specialist that performs surgeries at birth and manage complications associated with tethered cord and hydrocephalus.

neurosurgeon

medical specialist that treats and evaluates nervous system issues, such as seizue disorders.

neurologist

medical specialist that addresses kidney, bladder, and bowel dysfunctions.

urologist

medical specialist that evaluates and treats complications of the eyes.

ophthalmologist

medical specialist that designs and customizes various types of assistive technology, including braces, crutches, walkers, and wheelchairs to aid in mobility.

orthoptist

(4) medical specialists that aids in rehabilitative therapies and increase independent living skills.

PT OT psychologist speech/language pathologist

a condition in which accumulation of cerebrospinal fluid occurs within the brain.

hydrocephalus

hydrocephalus is _, it is present in th infant prior to birth, meaning the fetus developed it in _ during fetal development.

hydrocephalus is **congenital**, it is present in th infant prior to birth, meaning the fetus developed it in **utero** during fetal development.

hydrocephalus may also be acquired as a consequence of (5)

CNS infections meningitis brain tumors head trauma intracranial hemorrhage

two types of causes of hydrocephalus

congenital acquired

two classifications of hydrocephalus

communicating non-communicating

_, also known as _, is hydrocephalus caused by impaired CSF reabsorption in the absence of any CSF flow obstruction between the ventricles and subarachnoid space.

**communicating**, also known as **non-obstructive hydrocephalus**, is hydrocephalus caused by impaired CSF reabsorption in the absence of any CSF flow obstruction between the ventricles and subarachnoid space.

_, also known as _, is caused by a CSF flow obstruction. both forms can be either congenital or acquired.

**non-communicating**, also known as **obstructive hydrocephalus**, is caused by a CSF flow obstruction. both forms can be either congenital or acquired.

early symptoms of hydrocephalus (6)

irritability sleepiness eyes that appear to gaze downward (sunset eyes) seizures vomiting separated sutures

the symptoms of hydrocephalus depends on (3)

the cause of the blockage age how much brain tissue has been damaged by the swelling

in infants with hydrocephalus, CSF build up in the CNS causing the _ to bulge and the head to be larger than expected.

in infants with hydrocephalus, CSF build up in the CNS causing the **fontanelle** to bulge and the head to be larger than expected.

hydrocephalus is successfully treated by placing a _ between the brain ventricles and abdominal cavity.

drainage tube (shunt)

risk of placing a drainage tube (shunt) in a child with hydrocephalus

infection may be introduced into the brain

considerations for drainage tube (shunts) used for treating hydrocephalus

the shunts must be replaced as the person grows

type of drain that provides relief in children with hydrocephalus

external ventricular drain, also known as extra-ventricular drain or ventriculostomy

a relief for hydrocephalus, it involves the placement of a ventricular catheter into the cerebral ventricles to bypass the flow obstruction and drain the excess fluid into other body cavities, from wher it can be resorbed.

external ventricular drain also known as extra-ventricular drain or ventriculostomy

ventriculostomy provides relief for hydrocephalus, it involves the placement of a _ into the _ to bypass the flow obstruction and drain the excess fluid into other body cavities, from where it can be resorbed.

ventriculostomy provides relief for hydrocephalus, it involves the placement of a **ventricular catheter** into the **cerebral ventricles** to bypass the flow obstruction and drain the excess fluid into other body cavities, from where it can be resorbed.

five different sites for treatment of hydrocephalus

ventriculoperitoneal shunt ventriculoatrial shunt ventriculopleural shunt lumbar-peritoneal shunt endoscopic third ventriculostomy

type of shunt site for treatment of hydrocephalus that drain fluid into the peritoneal cavity (most).

ventriculoperitoneal shunt

type of shunt site for treatment of hydrocephalus that drain fluid into the right atrium.

ventriculoatrial shunt

type of shunt site for treatment of hydrocephalus that drain fluid into the pleural cavity and gallbladder.

ventriculopleural shunt

type of shunt site for treatment of hydrocephalus that is placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity.

lumbar-peritoneal shunt

an alternative treatment for obstructive hydrocephalus in selected people, a surgical opening in the floor of the third ventricle allows the CSF to flow directly to the basal boilers, thereby shortcutting any obstruction.

endoscopic third ventriculostomy (ETV)

a group of inflammatory diseases of the middle ear.

otitis media

the most common cause of all forms of otitis media.

eustachian tube dysfunction

eustachian tube dysfunction is usually due to inflammation of the mucous membranes in the _, which can be caused by a viral URTI, step throat, or possibly by allergies.

eustachian tube dysfunction is usually due to inflammation of the mucous membranes in the **nasopharynx**, which can be caused by a viral URTI, step throat, or possibly by allergies.

eustachian tube dysfunction is usually due to inflammation of the mucous membranes in the nasopharynx, which can be caused by a (3)

viral URTI step throat allergies

because of the eustachian tube dysfunction, the gas volume in the middle ear is trapped and parts of it are slowly absorbed by the surrounding tissues, leading to _ in the middle ear.

because of the eustachian tube dysfunction, the gas volume in the middle ear is trapped and parts of it are slowly absorbed by the surrounding tissues, leading to **negative pressure** in the middle ear.

eventually, during a eustachian tube dysfunction, the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked into the middle ear's cavity (_), causing a _.

eventually, during a eustachian tube dysfunction, the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked into the middle ear's cavity (**tympanic cavity**), causing a **middle-ear effusion**.

during eustachian tube dysfunction, by _ or _ of unwanted secretions from the nasopharynx into the normally sterile middle ear space, the fluid may then become infected - usually with bacteria.

during eustachian tube dysfunction, by **reflux** or **aspiration** of unwanted secretions from the nasopharynx into the normally sterile middle ear space, the fluid may then become infected - usually with bacteria.

t/f: in eustachian tube dysfunction, the virus that caused the initial URTI can itself be identified as pathogen causing the infection.

4 types of otitis media

acute otitis media (AOM) otitis media with effusion (OME) chronic suppurative otitis media (CSOM) adhesive otitis media

type of otitis media that is an infection of rapid onset that usually presents with ear pain.

acute otitis media (AOM)

acute otitis media may cause (5) in children

pulling at the ear increased crying poor sleep decreased eating fever

otitis media with effusion is also known as

serous otitis media (SOM) or secretory otitis media (SOM)

otitis media with effusion is colloquially known as

glue ear

type of otitis media with fluid accumulation that can occur in the middle ear and mastoid air cells due to negative pressure produced by dysfunction of the eustachian tube.

otitis media with effusion (OME)

children with otitis media with effusion typically does not feel symptoms, but it has occasional _.

feeling of fullness

type of otitis media with presence of non-infectious fluid in the middle ear for more than three months.

otitis media with effusion (OME)

otitis media with effusion is presence of non-infectious fluid in the middle ear for more than _.

three months

type of otitis media which is middle ear inflammation of greater than 2 weeks that results in episodes of ear discharge for at least 6 weeks.

chronic suppurative otitis media (CSOM)

chronic suppurative otitis media is a type of otitis media which is middle ear inflammation of greater than _ that results in episodes of ear discharge for at least _.

chronic suppurative otitis media is a type of otitis media which is middle ear inflammation of greater than **2 weeks** that results in episodes of ear discharge for at least **6 weeks**.

type of otitis media that may be a complication of acute otitis media.

chronic suppurative otitis media (CSOM)

t/f: pain is always present in csom.

t/f: all three types of otitis media may be associated with hearing loss.

the hearing loss in otitis media with effusion, due to its _, may affect a child's ability to learn.

the hearing loss in otitis media with effusion, due to its **chronic nature**, may affect a child's ability to learn.

type of otitis media that occurs when a thin retracted ear drum becomes sucked into the middle-ear space and stuck to the ossicles and other bones of the middle ear.

adhesive otitis media

adhesive otitis media is a type of otitis media that occurs when a thin retracted _ becomes sucked into the middle-ear space and stuck to the _ and other bones of the middle ear.

adhesive otitis media is a type of otitis media that occurs when a thin retracted **ear drum** becomes sucked into the middle-ear space and stuck to the **ossicles** and other bones of the middle ear.

acute otitis media is far less common in _ infants.

acute otitis media is far less common in **breastfed** infants.

2 ways to prevent otitis media

breastfeeding pneumococcal conjugate vaccines

for infants with otitis media, greatest protection is associated with exclusive breastfeeding for the first _.

6 months of life

t/f: longer duration of breastfeeding is correlated with longer protective effect for infants that are prone to otitis media.

what vaccine is given to infants to prevent otitis media?

pneumococcal conjugate vaccines

t/f: pneumococcal conjucate vaccines does not decrease the risk of otitis media when given to high-risk infants or older children who have previously experienced otitis media.

what are used to treat pain caused by otitis media?

oral and topical painkillers

a treatment option for chronic suppurative otitis media with discharge is _.

topical antibiotics

to treat AOM, what is given?

tympanostomy tube "grommets"

grommets for AOM recommended with _ episodes in _, or _ in a _, with at least _ attacks in the preceeding _.

grommets for AOM recommended with **3 or more** episodes in **6 months**, or **4 or more** in a **year**, with at least **1 episode or more** attacks in the preceeding **6 months**.

otitis media with effusion's decision to treat is usually made after a combination of physical exam and laboratory diagnosis like (4).

audiometry tympanogram temporal bone CT scan MRI

in less severe cases or those without significant hearing impairement, otitis media with effusion can resolve spontaneously with or more conservative measures such as _.

auto-inflation

in more severe cases of otitis media with effusion, _ can be inserted.

tympanostomy tubes

complications that otitis media may cause (7)

ear drum perforation mastoid space infection behind the ear mastoiditis rarely, intracranial complications like bacterial meningitis, brain abscess, dural sinus thrombosis membrane rupture tympanocentesis hearing loss

a complication of otitis media where in severe or untreated cases, tympanic membrane can perforate, allowing pus in the middle-ear space to drain into the ear.

membrane rupture

a treatment for otitis media where needle aspiration through tympanic membrane to relieve ear pain and to identify causative organisms. an option for severe AOM in which analgesics are not controlling ear pain.

tympanocentesis

a complication of otitis media where children with recurrent episodes of AOM and those with OME or CSOM have higher risks of developing _.

conductive and sensorineural hearing loss