MedU Clipp Cases 1 and 2 Flashcards
Infants born to adolescent mothers are at greater risk for?
- Lower birth weight
- Vertically acquired STIs (high inidence rate)
- Poorer developmental outcomes
- Increased risk of Fetal death
- Additionally, pregnant teenager has an increased risk of premature death compared to her non-pregnant peers
HEEADSSS Questions?
- Home
- Education / Employment
- Eating disorder screening
- Activities / Affiliations / Aspirations
- Drugs (EtOH, Tobacco, Steroids)
- Sexuality (abuse, fights, weapons, seatbelts)
- Suicide (depression, mental health)
Prenatal Effects of Tobacco?
- Low birth weight in the Fetus
- Characteristic facies
Prenatal Effects of Alcohol?
- No “Safe” amount of alcolhol during pregnancy
- FAS is a distinct pattern of facial abnormalitis, growth defeciencies, CNS dysfunction
- Poor Motor skills
- Poor Eye Hand Coordination
- Learning Problems
- Difficulties w/ Memory
- Attention
- Judgment
Prenatal Effects of Marijuana?
- Distinctive effects of Marijuana have not been identified
Prenatal Effects of Cocaine?
- Vasoconstriction
- -> Placental insufficiency
- -> Low Birth Weight
- Deficits:
- Cognitive performance
- Information-processing
- Attention to tasks
Maternal Factors Limiting Fetal Growth in Utero?
- Poor weight gain in the 3rd Trimester
- Preeclampsia
- Maternal Prescription
- Illicit Drug use
- Maternal Infections
- Uterine Abnormalities
Placental Factors Limiting Fetal Growth in Utero?
- Placenta Previa
- Placental abruptions
- Abnormal Umbilical Vessel Insertions
Fetal Abnormalities Limiting Fetal Growth in Utero?
- Fetal Malformations
- Metaboic Disease
- Chromosomal Abnormalities
- Congenital Infections
Prenatal Lab Screening?
- Serelogical screening for Infections
- HIV
- Rubella
- Hepatitis B
- Blood Type and Rh
- Urine Drug screen
Factors that Increase Risk of HIV Transmission
from Mother to Infant?
- Frequent, unprotected sex during pregnancy
- Advanced maternal HIV disease (High Viral Load)
- Membrane rupture > 4 hours prior to delivery if mother is not on anti-retroviral therapy
- Vaginal Delivery
- Breastfeeding
- Premature delivery ( < 37 weeks)
GBS intrapartum antimicrobial prophylaxis?
- < 37 weeks
- Ruptured > 18 hours
- Temp > 100.4 F (38 C)
- Positive for GBS
- Previous infant w/ GBS
- GBS bacturia during any trimester
- Positive GBS vaginal-rectal screening in late gestation
- Unknown GBS status w/ onset of Labor
Steps used to decrease risk of HIV Transmission?
- Treatment of anti-retroviral therapy if viral load > 1000 copies/mL
- Cessarian delivery preferred
- Formula feed infants (NO Breastfeeding)
Methods to Stabilize a Infant’s Tempature?
- Skin-to-Skin contact
- Radiant warmer
- Incubator
Elements of APGAR score?
- Apprearance (skin color)
- Pulse (heart rate)
- Grimace (reflex irritability)
- Activity (muscle tone)
- Respirations
What percentalie is Small for Gestational Age (SGA)?
- Weight < 10th Percentile for Gestational Age
What Percentage is Microcephalic?
- Head circumference < 10th Percentile for Gestational Age
Hypoglycemia in Newborns?
- Decreased Glycogen storage
- Heat Loss
- Hypoxia
- Decreased Gluconeogenesis
Hypothermia in Newborns?
- Cold stress
- Hypoxia
- Hypoglycemia
- Increased Surface Area
- Decreased Subcutaneous Insulation
Polycythemia in Newborns?
- Chronic Hypoxia
- Maternal-fetal Transfusion
DDx of Microcephaly and Purpuric Rash?
- TORCH infection
- Fetal Alcohol Syndrome
- Chromosomal Abnormality
- Prenatal Tobacco Exposure
- HIV Infection
What does the O in TORCH stand for?
- Other Transplacental Infections
- HIV
- Hepatitis B
- Human Parvovirus
- Syphilis
What Labs do you order for TORCH testing?
- Toxoplasma - Infant Toxoplasma Titer
- Other
- Rubella - Maternal and Infant Rubella Titer
- CMV - Infant Urine Culture
- Hepatitis B - Maternal Hepatitis B Surface Antigen (HBsAg)
What are the Routine Newborn Medications?
- Vitamin K
- prevent Hemorrhagic disease (Vit. K def.)
- Hepatitis B vaccine
- > 2000 grams
- HBIG - vertical transmission of Hep. B
- Erythromycin (also Tetracycline or Silver Nitrate)
- Gonococcal conjunctivitis
- Chlamydia trachomatis conjunctivitis presents with a stachato cough 7 - 14 days later and neonatal prophylaxis does little to prevent Chlamydia conjunctivitis
Neurological CMV findings?
- Intracranial calcifications
- Diminished number of Gyri
- Abnormally thick Cortex (Lissencephaly or Agyria-pachygyria)
- Enlarged Ventricles
Sequelae of Congenital CMV?
- Hearing Loss (progressive)
- Microcephaly
- Intracranial Calcifications
- Hepatosplenomegally
- Rash
What is the Treatment for Congenital CMV?
- 6 months Therapy:
- Ganciclovir or Oral Valganciclovir
Absolute Contraindictations for Breastfeeding?
- Maternal HIV
- Active Herpes Simplex lesions on the Breats
- Active TB
- Drug use and abuse
- Infants w/ Galactosemia
Signs and Symptoms of Metabolic Disorders?
- Anorexia
- Lethargy
- Vomiting
- Seizures
- Metabolic Acidosis
- Unusual Odors
Anticonvulsants during pregnancy?
- Leads to Cardiac Defects
- Dysmorphic Craniofacial features
- Hypoplastic nails
- Distal phalanges
- IUGR
- Microcephaly
- Mental Retardation
Opiate use during pregancy appears as?
- CNS Findings
- Irritability
- Hyperactivity
- Hypertonicity
- High-pitched Cry
- Tremors
- Seizures
- GI (vomiting, diarrhea, weight loss, hunger, salvation)
- Respiratory (nasal stiffness, sneezing, yawning)
Fetal Alcohol Syndrom Facial Features?
- Smooth Philtrum
- Thinning of the Upper lip
- Small Palpebral fissures
Clinical features of PKU?
(Phenylketonuria)
- Vomitting
- Hypotonia
- Musty Odor
- Developmental delay
- Decreased Pigmentation of the Hair and Eyes
- Phenylalanine-restricted diet is necessary
Caloric requirement of Term Infant?
100 - 120 cal/kg/day
Caloric requirement for Preterm Infant?
115 - 130 cal/kg/day
Caloric requiremtn for VLBW infants?
(Very Low Birth Weight)
up to 150 cal/kg/day
Car Safety Guidelines for Kids?
- Children < 13 y.o. should not sit in Front Seat
- Until 2 y.o. –> Face rearward
- Middle of Backseat is most protected position
- Most effective seat is a 5-point harness
2 month immunizations?
- DTaP
- Hib
- IPV
- PCV13
- RotaV
- HepB - 2nd dose
What age should an infant double and tripple
their birth weight?
- Double - 5 months
- Triple - 12 months
What age will children double their birth length?
4 years
Absence of Red Reflex in infants suggests?
- Cataracts
- Glaucoma
- Retinoblastoma
- Chorioretinitis
6 month milestones?
- Gross Motor
- Rolls over, Sits unsupported, No Head lag pull to sit
- Fine Motor
- Reaches for objects, Looks at dropped items
- Language
- Turns toward voice, Babbles
- Social / Adaptive
- Feeds self, Stranger recognition
12 Month Milestones?
- Gross Motor
- Stands alone (many can walk well)
- Fine Motor
- Pincer Grasp
- Language
- Mama, Dada, and 1 or 2 other words
- Social / Adaptive
- Hands parents book wants to read
- Points when wants something
- Plays ball with examiner
18 months old milestones?
- Walk Backward
- Run
- Scribble
- 2 Block Tower
- 3 - 6 words
- Can help remove Garments
Wilm’s Tumor?
- A/w Beckwith-Wiedemann Syndrome
- Genetic overgrowth syndrome
- Omphalocele
- Hemihypertrophy
- Hypoglycemia
- Large for Gestational Age
- Dysmorphic Features
What is a favorable characterristic for Neuroblastoma?
Non-ampliffication of the N-myc gene
