New Born To Adolexsecnt Development Flashcards
Define neonate
0-28 days old
Define infant
29 days to 1 year
Define toddler
1-3 year old
Define preschooler
3-6 yr.old
Define school aged child
6-12 years/old
When does adolescence start
Age 12
What is the STORCH infections
Syphilis, Toxoplasmosis, Other, Rubella, CMV, HSV
Other: HIV, Hepatitis B/C, varicella, parvovirus B19, Gonorrhea, Chlamydia, Tuberculosis
When is preterm deliveries..
37 weeks or before
What is the range for perinatal mortality
20 weeks gestation to 28 days post delivery
Define APGAR score
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
If a neonate has a heart rate below 60
Start…
Ventilation and CPR
How do neonates respond to hypoxia
Neonates
(esp premature neonates) respond to hypoxia with apnea rather than tachypnea
What is the IV fluid bolus rate for Neonates
10 ml/kg
What is the role or erythromycin ointment in the eyes of after birth care
Prevent gonococcal conjunctivitis (blindness risk)
What is the Vit K after care for neonates
Prevents Vitamin K Deficient Bleeding
(aka Hemorrhagic Disease of the Newborn)
What is the only vaccine given at birth
Hep B Vaccine
What is the state mandated 24 hour routine care
The newborn screen
Genetic/metabolic screening
Minimum PKU, TSH, Cystic Fibrosis, CAH, Sickle Cell Anemia
When should newborns be screened for hearing loss?
No later than 1 month
Babies who do not pass hearing screening at 1 month get what F/u
See a specialist nlt 3 months
When do we do Gongenital heart screening on newborns
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
What is a positive congenital heart screening
< 90% in right hand or foot
GET AN ECHO!
What is the Ballard Scale
A way to determine the gestational age of a newborn
What are the 5 S of calming maneuvers
Swaddling, sid-lying, swaying, shushing, suck
How do you measure a baby
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
What is a “Low birth weight”
Any baby below 2500 grams
VERY LOW- 1500 grams
What are NML fontanels in a newborn
Should be open and flat
An enlarged anterior or posterior Fontanels is a sign of…
Greater than 5 cm anterior or 1 posterior
Hypothyroidism
Define Caput succedaneum
Common/ Normal fontanels shape in a newborn
Resolves in days
Crosses suture lines
Define Cephalohematoma
Less common fontanels/ headchape in newborns
Often from vacuum or forceps use
Can lead to jaundice
DOES NOT CROSS SUTURE LIINES
What is the tx for subgaleal hemorrhage in a newborn
S/s ears pushed anteriorly
Tx: compression bandage and resus as needed
What is the main concern of microcephaly
Hydrocephalus or a mass
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)
What is leukocria
White reflex in the eye of a neonate
Ocular TUMOR!!!!!
Or cataract
If premature can be retinopathy
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
Is disconjugate gaze normal in newborns
Normal until 4 months of age
Eye alignment typically achieved by then
If a baby is born with teeth
What should you do
Refer to dental for removal (chocking hazard)
A bulge on a newborns neck that is posterior to the SCM
Think
Cystic hygroma
A cyst on the neck of a newborn that is anterior to the SCM
Think
Branchial cleft cyst
In a newborn if the LE pulses are less than the UE pulses
Think
Coart of Art
What are the normal number of vessels in the umbilicus
3 vessels
2 arteries and 1 vein
O2 carrying is reversed in fetal circulation
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
What is an umbilical granuloma
Friable, red papule
Common after stump falls off within 1-3 weeks
Tx: Cauterize w/ Silver Nitrate
Which is more likely to Dislocate in a new Nate
L or R?
L also more common in female pts
Swaddling with the hips adducted and extended can lead to what problem in newborns
Hip dislocation/ Dysplasia
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
What is Pavllik harness used for
Congenital hip Hysplasia
In supernumerary fingers and toes
What is important to tell ortho
is there bone involved
When should metatarus adducts resolve in a newborn
Within 2 years
What is the tx approach to Clubfoot ( Taliopes Equinovarus)
Ortho referral at birth
What is the treatment approach for Sonia bifida
Neuro Referal
Prevention with folate vit.
What is c5/c6 palsy in newborns
Erb-duchennes palsy
-grasp present and -bicep reflex absent
(Waiters tip deformity)
What is a c8/T1 lesion in a newborn
Klumpke’s palsy (<1%)
C8-T1 lesion
Grasp reflex absent
Biceps reflex present
“Claw” hand
What is the vernix caseosa
Chalky-white to gray mixture of shed epithelial cells, sebum, keratin and sometimes hair
Common in pre-term infants
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)
What is a babies common physiological response to cold
Cutis Marmorata (mottling)
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
When do Nevis simplex
(Stork bite/ Angel Kiss)
Go away
Transient and benign—typically fades by 4-6 years of age
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)
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
What are the most common early onset neonatal sepsis causes
GBS (#1)
```
E. Coli
Klebsiella
Listeria monocytogenes
Salmonella
Developing countries
Mycoplasma
~~~
What are the common agents of late onset neonatal sepsis causes
H. influenzae Staphylococcus HSV CMV Enterovirus S. pneumoniae Neisseria meningitidis
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
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
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
What ABX should you add to neonatal sepsis tx if you are concerned for HSV infection
Add acyclovir
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
What is the deficiency in RDS in neonates
Insufficient surfactant production by type II pneumatocytes
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
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
What is the most common congenital tracheal abnormality
Tracheomalacia
A baby presents with high pitches harsh wheezing that is worse during expiration
Think
Tracheomalcia
Tx wtih ENT referral
What would you see on CXR if you suspect a mecanismos aspiration
coarse, irregular infiltrates
What is kernicterus
Bilirubin encephalopathy
indirect bilirubin is toxic to developing CNS
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
What are the late s/s of kernicterus
Bulging fontanelle, opisthotonic posturing, pulmonary hemorrhage, fever, hypertonicity, paralysis of upward gaze, & seizures
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
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
Should babies have jaundice on day 1
NO!
Where is the 1st place that jaundice shows in a newborn
1st is under the tongue
Most apparent is in the sclera
What is the progression of Jaundice in a neonate
Progresses from head toward the toes
What is the first line lab for jaundice in a neonate
Transcutaneous
If elevated get serum
At what value of jaundice should an exchange transfusion be given to a neonate
Greater than 20
