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Senoir 21-2 > New Born To Adolexsecnt Development > Flashcards

New Born To Adolexsecnt Development Flashcards

1
Q

Define neonate

A

0-28 days old

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2
Q

Define infant

A

29 days to 1 year

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3
Q

Define toddler

A

1-3 year old

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4
Q

Define preschooler

A

3-6 yr.old

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5
Q

Define school aged child

A

6-12 years/old

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6
Q

When does adolescence start

A

Age 12

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7
Q

What is the STORCH infections

A

Syphilis, Toxoplasmosis, Other, Rubella, CMV, HSV

Other: HIV, Hepatitis B/C, varicella, parvovirus B19, Gonorrhea, Chlamydia, Tuberculosis

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8
Q

When is preterm deliveries..

A

37 weeks or before

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9
Q

What is the range for perinatal mortality

A

20 weeks gestation to 28 days post delivery

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10
Q

Define APGAR score

A

Appearance, Pulse, Grimace, Activity, Respiration

Scale 0-10

Perform at 1 and 5 minutes
Continue q 5 min if score is less than 8

Goal score greater than 8

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11
Q

If a neonate has a heart rate below 60

Start…

A

Ventilation and CPR

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12
Q

How do neonates respond to hypoxia

A

Neonates

(esp premature neonates) respond to hypoxia with apnea rather than tachypnea

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13
Q

What is the IV fluid bolus rate for Neonates

A

10 ml/kg

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14
Q

What is the role or erythromycin ointment in the eyes of after birth care

A

Prevent gonococcal conjunctivitis (blindness risk)

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15
Q

What is the Vit K after care for neonates

A

Prevents Vitamin K Deficient Bleeding

(aka Hemorrhagic Disease of the Newborn)

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16
Q

What is the only vaccine given at birth

A

Hep B Vaccine

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17
Q

What is the state mandated 24 hour routine care

A

The newborn screen

Genetic/metabolic screening

Minimum PKU, TSH, Cystic Fibrosis, CAH, Sickle Cell Anemia

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18
Q

When should newborns be screened for hearing loss?

A

No later than 1 month

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19
Q

Babies who do not pass hearing screening at 1 month get what F/u

A

See a specialist nlt 3 months

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20
Q

When do we do Gongenital heart screening on newborns

A

After 24 hours of life

≥ 95% in right hand or foot, with 3% or less absolute difference in O2 sat between the right hand and foot= plan for D/C

If: 90% to 94% in right hand or foot, or 3% or more absolute difference in O2 sat between the right hand and foot= repeat screening

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21
Q

What is a positive congenital heart screening

A

< 90% in right hand or foot

GET AN ECHO!

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22
Q

What is the Ballard Scale

A

A way to determine the gestational age of a newborn

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23
Q

What are the 5 S of calming maneuvers

A

Swaddling, sid-lying, swaying, shushing, suck

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24
Q

How do you measure a baby

A

In centimeters

Plotted on a curve for GA

Done laying down until 2 years of age

Often inaccurate within first week of life due to positioning

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25
What is a “Low birth weight”
Any baby below 2500 grams VERY LOW- 1500 grams
26
What are NML fontanels in a newborn
Should be open and flat
27
An enlarged anterior or posterior Fontanels is a sign of…
Greater than 5 cm anterior or 1 posterior Hypothyroidism
28
Define Caput succedaneum
Common/ Normal fontanels shape in a newborn Resolves in days Crosses suture lines
29
Define Cephalohematoma
Less common fontanels/ headchape in newborns Often from vacuum or forceps use Can lead to jaundice DOES NOT CROSS SUTURE LIINES
30
What is the tx for subgaleal hemorrhage in a newborn
S/s ears pushed anteriorly Tx: compression bandage and resus as needed
31
What is the main concern of microcephaly
Hydrocephalus or a mass
32
A pt presents with a bulging fontanel, irritability, vomiting, anorexia, papilledmea, or setting sun gaze Tx?
Microcephaly Under 6 months? US the skull Over: Head CT w/o con Abnml VP shunt (Neuro referral)
33
What is leukocria
White reflex in the eye of a neonate Ocular TUMOR!!!!! Or cataract If premature can be retinopathy
34
Does retinopathy of the eye happen to full term babies
NO! Term infant eye is fully vascularized so not susceptible to this Excessive O2 causes vasoconstriction of retinal vasculature which leads to vaso-obliteration and blindness
35
Is disconjugate gaze normal in newborns
Normal until 4 months of age | Eye alignment typically achieved by then
36
If a baby is born with teeth What should you do
Refer to dental for removal (chocking hazard)
37
A bulge on a newborns neck that is posterior to the SCM Think
Cystic hygroma
38
A cyst on the neck of a newborn that is anterior to the SCM Think
Branchial cleft cyst
39
In a newborn if the LE pulses are less than the UE pulses Think
Coart of Art
40
What are the normal number of vessels in the umbilicus
3 vessels 2 arteries and 1 vein O2 carrying is reversed in fetal circulation
41
When should the umbilical chord “fall off”
Typically falls off within 2-4 weeks of birth Persistence of cord beyond 4 weeks requires further investigation
42
What is an umbilical granuloma
Friable, red papule Common after stump falls off within 1-3 weeks Tx: Cauterize w/ Silver Nitrate
43
Which is more likely to Dislocate in a new Nate L or R?
L also more common in female pts
44
Swaddling with the hips adducted and extended can lead to what problem in newborns
Hip dislocation/ Dysplasia
45
What is the proper responce for appreciating a “clunk” on Bartlow maneuver
US the Hips! Obtain after 4-6 weeks of age to avoid confusion of the normal physiologic laxity at birth
46
What is Pavllik harness used for
Congenital hip Hysplasia
47
In supernumerary fingers and toes What is important to tell ortho
is there bone involved
48
When should metatarus adducts resolve in a newborn
Within 2 years
49
What is the tx approach to Clubfoot ( Taliopes Equinovarus)
Ortho referral at birth
50
What is the treatment approach for Sonia bifida
Neuro Referal Prevention with folate vit.
51
What is c5/c6 palsy in newborns
Erb-duchennes palsy -grasp present and -bicep reflex absent (Waiters tip deformity)
52
What is a c8/T1 lesion in a newborn
Klumpke’s palsy (<1%) C8-T1 lesion Grasp reflex absent Biceps reflex present “Claw” hand
53
What is the vernix caseosa
Chalky-white to gray mixture of shed epithelial cells, sebum, keratin and sometimes hair Common in pre-term infants
54
What is milia
White, smooth papules (up to 2mm) primarily on face and scalp ``` Very common (50%) in newborns can appear later in infancy/childhood ``` Caused by epidermal occlusion of pores (trapped keratin)
55
What is a babies common physiological response to cold
Cutis Marmorata (mottling)
56
If you find cafe au lait macules What is the workup
≥ 6 Café-au-lait macules ≥ 0.5 cm in diameter Evaluation for genetic disorders: neurofibromatosis, tuberous sclerosis, McCune-Albright syndrome
57
When do Nevis simplex (Stork bite/ Angel Kiss) Go away
Transient and benign—typically fades by 4-6 years of age
58
What is a Nevis flameus
AKA “Port Wine Stain” Caused by deeper malformation of capillary bed Persist throughout the patient’s life Dermatology eval for pulsed dye laser tx when older —Must consider Sturge-Weber Syndrome if on the face (trigeminal nerve distribution)
59
Describe Erythema Toxicum Neonatorum
Pustules with erythematous base Appear 24-48 hrs post-birth Transitory throughout the day Resolves in ~14 days Located on the back and trunk —Microscopic evaluation reveals eosinophils
60
What are the most common early onset neonatal sepsis causes
GBS (#1) | ``` E. Coli Klebsiella Listeria monocytogenes Salmonella Developing countries Mycoplasma ```
61
What are the common agents of late onset neonatal sepsis causes
``` H. influenzae Staphylococcus HSV CMV Enterovirus S. pneumoniae Neisseria meningitidis ```
62
What is the w/u for a Neonatal Sepsis eval
CBC, Blood Cultures x2, UA with urine Culture & blood glucose !!!!LUMBAR PUNCTURE!!! Cerebrospinal Fluid (CSF) culture, cell count, gram stain, protein & glucose levels
63
What are the ABX approach to Neonatal sepsis tx
IV Ampicillin & Gentamicin if <3 weeks of age IV Ampicillin & Cefotaxime if >3 weeks of age
64
What ABX should be added to the Tx approach if we are suspecting a late onset of neonatal sepsis
Consider adding Vancomycin if late onset and/or meningitis present MRSA coverage
65
What ABX should you add to neonatal sepsis tx if you are concerned for HSV infection
Add acyclovir
66
What are the 3 steps to a GBS pos mom (newborn protocol)
Step 1- Are the S/s of infection ? Yes= Full emperic Tx Step 2 - Is child preterm Yes? = 48 hour observation Step 3- Was the mother treated with 2+ doses of ABX prior to delivery Yes? No worries No? 48 hour observation
67
What is the deficiency in RDS in neonates
Insufficient surfactant production by type II pneumatocytes
68
What is the tx for RDS in neonates
Preventive Treatment prior to birth -Maternal steroids prior to delivery (32-34 wks) to mature infant lungs Treatment after birth - Intubation & respiratory support - Artificial surfactant via ET tube
69
What is the tx for apnea of prematurity
Oxygen Stimulants (caffeine or theophylline) Anemia correction (i.e., transfusions) Usually corrects by 36-40 weeks postconceptual age
70
What is the most common congenital tracheal abnormality
Tracheomalacia
71
A baby presents with high pitches harsh wheezing that is worse during expiration Think
Tracheomalcia Tx wtih ENT referral
72
What would you see on CXR if you suspect a mecanismos aspiration
coarse, irregular infiltrates
73
What is kernicterus
Bilirubin encephalopathy indirect bilirubin is toxic to developing CNS
74
What are the early S/s of Kernicterus
Lethargy, hypotonia, irritability, poor Moro response, poor feeding, high-pitched cry, & emesis Typically noted after day 4 of life
75
What are the late s/s of kernicterus
Bulging fontanelle, opisthotonic posturing, pulmonary hemorrhage, fever, hypertonicity, paralysis of upward gaze, & seizures
76
What is breast feeding jaundice
Lack of adequate feeds = ↓ gut motility Common in first time moms Insufficient production of milk Insufficient intake by infant Usually seen within 2-3 days after birth
77
What is breast milk jaundice
Adequate intake—problem is in milk itself May contain inhibitor of bilirubin conjugation May increase enterohepatic recirculation of bilirubin due to glucuronidase in milk Usually first seen 7-10 days after birth
78
Should babies have jaundice on day 1
NO!
79
Where is the 1st place that jaundice shows in a newborn
1st is under the tongue Most apparent is in the sclera
80
What is the progression of Jaundice in a neonate
Progresses from head toward the toes
81
What is the first line lab for jaundice in a neonate
Transcutaneous If elevated get serum
82
At what value of jaundice should an exchange transfusion be given to a neonate
Greater than 20

Senoir 21-2 (77 decks)

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