Neuroblastoma Flashcards
Well child visits
Any illness/problems since last visit? Birth history? Developmental screening tests (PEDS) Growth chart Diet History Social History PE Anticipatory Guidelines Immunizations
Nutrition guidance
breast milk preferred for infants
milk or soy based formula (2 scoops for 4 ounces)
- transition to milk at 12 months
Caloric requirements of 1-2 month olds
100-120 cal/kg/day
- preterm and low birth weight require more calories
Early growth
babies can lose 10% of birth weight but should regain that by 2 weeks
Developmental Screening
Gross motor
Fine motor
Communication/Social
Cognitive/Adaptive
Anticipatory guidelines at 2 months
rice cereal by 4 months may be appropriate
Vit D = 400 units/day
Child care
Sleep - sleeping through night by 6 months, place on back
Safety - house, family members
Car seat safety
Under age 12 not in front seat
Under age 2 - rear facing seat
Back is safest
Immunizations in childhood
DTap - 5 IPV - 4 Hib - 3-4 PCV - 4 MMR - 2 Varicella - 2 RotaV - 2 Hep A - 2 Hep B - 3 Seasonal influenza - yearly after 6 months
Typical growth patterns
should double weight by 4-5 months, triple weight by 1 year, double length by 4 years
Red Reflex
Red or orange color reflected from fundus through pupil;
- absence? ==> refer to opthomologist
6 month milestones
Gross motor - rolls over, sit up
Fine motor - reach for objects, looks for dropped items
Language - turns to voice, babbles
Social - feeds self, stranger recognition
Toddler proofing home
install outlet covers, cabinet locks, stair barriers, cleaning supplies safe
Anticipatory guidlines at 6 months
car seat
walkers - NO
diet - new foods every 5 days
Tylenol and vaccines
don’t use tylenol unless necessary –> lower immune response
12 month milestones
Gross motor - stand alone, may not walk
Fine motor - well developed pincer grasp
Language - mama, dada
Social - hand parent book and imitates play
Neuroblastoma stage 4S prognosis
infants tumors may spontaneously regress (unique nature from embryonal cell lines)
Genetics of Neuroblastoma
many chromosomal and molecular abnormalities have been found
- REALLY IMPORTANT ONE - MYCN gene (oncogene)
Staging Neuroblastoma
1 - localized area
2 - extends beyond local area but doesn’t cross midline
3 - crosses midline and lymph nodes involved
4 - disseminated
4S - localized primary tumor with disseminated
Rectal Exam in Infant
not routine part of exam but should be done with abdominal mass felt
- infant supine, hold extremities, lubricate finger
DDx for RUQ mass and pallor in 9-month old
Hepatic neoplasm Hydronephrosis Neuroblastoma Teratoma Wilms' Tumor
Hepatic neoplasm
rare in kids, can be asymptomatic
jaundice would be a common feature
Hydronephrosis
obstruction of uretero-pelvic junction –> palpable kidney
- mutlicystic kidney disease can cause obstruction
Neuroblastoma
most frequently diagnosed neoplasm in infants
Painless mass in neck, chest or abdomen
- fever, pallor, weight loss
Teratoma
rare malignant tumor
painless abdominal mass without other symptoms
Wilms’ Tumor
likely diagnosis in kid with asymptomatic RUQ mass with no lymphadenopathy or jaundice
- discovered by parents or by routine exam
- smooth mass rarely crossing midline
Initial testing for RUQ mass
CBC with differential - anemia
Catecholamine VMA/HVA - elevated in neuroblastoma (90-95% sensitive in detection)
CXR - can identify metastasis
Ab US - ID mass on organ, best choice for 1st imaging
Ab Xray - can detect mass or calcification
Presentation of neuroblastoma
Can be VARIABLE
Asymptomatic —-> ab pain, emesis, weight loss, anorexia, fatigue, bone pain
