Infancy & Early Childhood - Test 2 Flashcards
What is the APGAR score?
Appearance (skin color)
Pulse
Grimace (response to catheter in nostril)
Activity
Respiratory
When is the APGAR score measured (When in the baby’s life)? What is a normal APGAR score?
first minute of life and 5th minute of life
less than 7 is abnormal
What are normal newborn vitals (respirations, HR, temp, blood pressure)?
Respirations: 30-60 breaths per minute
Heart Rate: 100-160 bpm
Temperature: 96-99.5 F
Blood pressure: 60-80/40-50 mmHg
When a baby is born, we give it three post-parturition medications. What are they?
erythromycin eye ointment
Intramuscular vitamin K
Hepatitis B immunization
Is it good for the mother and baby to initiate skin-to-skin after birth?
yes
How do you assess intake in a breastfeeding infant? (8 points)
Frequency of latch (normal every 1-3 hours)
Duration of latch (10-30 minutes)
Infant feeding cues (rooting [moving head], wake up, chews on hands)
Behavior at breast (stays latched, active/audible swallowing)
Quality of latch (opens mouth wide to latch)
Feeling of breast milk emptying
Observe mother breast feed
Daily weights, urine, and stool output
Is weight loss normal after birth? Why?
yes
babies lose water weight
How much weight can newborns lose? When do they start to regain their weight?
newborns can lose up to 10% of their weight
babies begin to regain weight in 3 days and should regain their birth weight around 2 weeks
What is the expected urine output for the 5 days of life?
1 = 1 diaper
2 = 2 diapers
3 = 3 diapers
4 = 4 diapers
5+ = 5+ diapers
Is it normal for a baby to not produce any urine during the first day of life?
NO!!!!
Name the type of stool
black and tarry. Passes in first 3 days of life
meconium
Name the type of stool
Dark green and sticky. Begins at day 4
transitional stool
Name the type of stool
green-yellow-brownish. Liquid but not watery
normal infant stool
is it normal for a baby to not pass stool within the 1st 24 hours of life?
NO!!!
If a baby doesn’t pass stool within the first hour, what are some of the possible causes?
no butthole (imperforate anus)
hirschprung’s, meconium plug, meconium ileus, neurointestinal disorders
If a baby has pale stools, what could be a cause?
no bile –> biliary obstruction or atresia
If a baby has blood in stool, what could be a cause?
anal fissure, swallowed maternal blood, milk protein intolerance
should babies sleep in a flat crib, on their own, and on their back?
yeah
What are some signs of respiratory distress?
cyanosis
tachypnea
nasal flaring
grunting
subcostal retractions
What is the differential for a cyanotic baby?
depends on whether the baby is presenting with respiratory distress!!!
A pre-maturely born (cannicular stage; 16-25 weeks) baby becomes cyanotic. You observe nasal flaring, subcostal retractions, grunting, and tachypnea. Because you want the baby to become exposed to radiation, you order a CXR to diagnose this baby. What does this baby have and explain the pathophysiology?
This baby has NRDS
premature babies lack sufficient surfactant, which is produced by type II pneumocytes. Surfactant deficiency causing decreased lung compliance and atelectasis. Blood being shunted through areas of atelectasis leads to hypoxia
How do you treat a pre-mature baby with NRDS? What would you do if a baby might be born pre-maturely?
exogenous surfactant
steroids to increase surfactant production before birth
A term baby is born today. After delivery, you notice this baby is becoming cyanotic. The baby is showing signs of respiratory distress. You run some tests and realize that the baby has increased pulmonary vascular resistance. You decide to order a CXR. What’s going on with this baby? Explain the pathophysiology
Meconium aspration syndrome
The baby aspirated meconium (shit). Aspirated meconium causes obstruction and inflammation of the lung. The inflammation causes increased pulmonary vascular resistance
A baby is cyanotic. This little shit was born at term, and doesn’t have poop around his mouth. You decide to do a pulse ox on his right and left hands. His right hand has a higher O2 saturation compared to his left. What does this baby have? how do you treat this guy?
Persistent Pulmonary Hypertension (PPHN)
Failure of pulmonary vascular resistance to decrease due to maladaptation after birth or maldevelopment of system
respiratory support
A baby was born to a mother who did not recieve prenatal care. The mother tested positive for GBS. The baby is now cyanotic and is showing signs of repsiratory distress. CXR shows this. What does this baby have?
pneumonia
A baby is cyanotic and is showing signs of respiratory distress. You exhausted your differentials. You take an CXR and you see this. What does the baby have?
Transient tachypnea of the newborn (TTN)
diagnosis of exclusion
usually resolves within 24-72 hours
NOTICE THE FISSURE IN THE RIGHT LOBE
A baby is diagnosed with a respiratory illness. According to this CXR, what does the baby have?
pneumothorax
A baby is jaundiced. What are some potential causes?
Hemolytic disease (ABO and Rh), fetal delivery trauma, and increased interohepatic circulation (slow bowel reabsorbs the junk) are pretty high on the DDx
When evaluating jaundice, what labs are helpful?
total serum bilirubin
ABO or Rh disease (coombs test)
Do all babies need phototherapy for jaundice? How do you know?
no. It depends on the nomogram
What does human breast milk contain?
protein
fats (medium-chain and long-chain polyunsaturated fatty acids; LCPUFA have docosahexaenoic acid (DHA) which is important for brain and eye development)
biological components (antibodies, etc)
What are the height equations for a male and female?
male = [father height + (mother height + 4)]/2
female = [(father height - 4) + mother height]/2
What is the differential for failure to thrive?
Are adverse childhood experiences associated with a higher risk of disease and early morality?
yes
If you are born prematurely, are you at higher risk for disease?
yeah
When is autism screened?
around 2 years old
What can a 6 month do in terms of developmental milestones?
palmer reflex disappears
can sit up
can roll over
can transfer objects between hands
can rake grasp
can babble
can respond to name
stranger anxety
What can a 1 year old do in terms of developmental milestones?
can stand
starts walking
point
throw ball
babinski reflexes disappear
two-pincher grasp
perform simple commands
can say mama and dada
What is the screening tool for ASD?
CHAT
