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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
Q

What is a “Low birth weight”

A

Any baby below 2500 grams

VERY LOW- 1500 grams

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26
Q

What are NML fontanels in a newborn

A

Should be open and flat

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27
Q

An enlarged anterior or posterior Fontanels is a sign of…

A

Greater than 5 cm anterior or 1 posterior

Hypothyroidism

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28
Q

Define Caput succedaneum

A

Common/ Normal fontanels shape in a newborn

Resolves in days

Crosses suture lines

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29
Q

Define Cephalohematoma

A

Less common fontanels/ headchape in newborns

Often from vacuum or forceps use

Can lead to jaundice

DOES NOT CROSS SUTURE LIINES

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30
Q

What is the tx for subgaleal hemorrhage in a newborn

A

S/s ears pushed anteriorly

Tx: compression bandage and resus as needed

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31
Q

What is the main concern of microcephaly

A

Hydrocephalus or a mass

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32
Q

A pt presents with a bulging fontanel, irritability, vomiting, anorexia, papilledmea, or setting sun gaze

Tx?

A

Microcephaly

Under 6 months? US the skull

Over: Head CT w/o con

Abnml VP shunt (Neuro referral)

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33
Q

What is leukocria

A

White reflex in the eye of a neonate

Ocular TUMOR!!!!!

Or cataract

If premature can be retinopathy

34
Q

Does retinopathy of the eye happen to full term babies

A

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
Q

Is disconjugate gaze normal in newborns

A

Normal until 4 months of age

Eye alignment typically achieved by then

36
Q

If a baby is born with teeth

What should you do

A

Refer to dental for removal (chocking hazard)

37
Q

A bulge on a newborns neck that is posterior to the SCM

Think

A

Cystic hygroma

38
Q

A cyst on the neck of a newborn that is anterior to the SCM

Think

A

Branchial cleft cyst

39
Q

In a newborn if the LE pulses are less than the UE pulses

Think

A

Coart of Art

40
Q

What are the normal number of vessels in the umbilicus

A

3 vessels

2 arteries and 1 vein

O2 carrying is reversed in fetal circulation

41
Q

When should the umbilical chord “fall off”

A

Typically falls off within 2-4 weeks of birth

Persistence of cord beyond 4 weeks requires further investigation

42
Q

What is an umbilical granuloma

A

Friable, red papule

Common after stump falls off within 1-3 weeks

Tx: Cauterize w/ Silver Nitrate

43
Q

Which is more likely to Dislocate in a new Nate

L or R?

A

L also more common in female pts

44
Q

Swaddling with the hips adducted and extended can lead to what problem in newborns

A

Hip dislocation/ Dysplasia

45
Q

What is the proper responce for appreciating a “clunk” on Bartlow maneuver

A

US the Hips!

Obtain after 4-6 weeks of age to avoid confusion of the normal physiologic laxity at birth

46
Q

What is Pavllik harness used for

A

Congenital hip Hysplasia

47
Q

In supernumerary fingers and toes

What is important to tell ortho

A

is there bone involved

48
Q

When should metatarus adducts resolve in a newborn

A

Within 2 years

49
Q

What is the tx approach to Clubfoot ( Taliopes Equinovarus)

A

Ortho referral at birth

50
Q

What is the treatment approach for Sonia bifida

A

Neuro Referal

Prevention with folate vit.

51
Q

What is c5/c6 palsy in newborns

A

Erb-duchennes palsy

-grasp present and -bicep reflex absent

(Waiters tip deformity)

52
Q

What is a c8/T1 lesion in a newborn

A

Klumpke’s palsy (<1%)
C8-T1 lesion

Grasp reflex absent

Biceps reflex present

“Claw” hand

53
Q

What is the vernix caseosa

A

Chalky-white to gray mixture of shed epithelial cells, sebum, keratin and sometimes hair

Common in pre-term infants

54
Q

What is milia

A

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
Q

What is a babies common physiological response to cold

A

Cutis Marmorata (mottling)

56
Q

If you find cafe au lait macules

What is the workup

A

≥ 6 Café-au-lait macules
≥ 0.5 cm in diameter

Evaluation for genetic disorders: neurofibromatosis, tuberous sclerosis, McCune-Albright syndrome

57
Q

When do Nevis simplex
(Stork bite/ Angel Kiss)
Go away

A

Transient and benign—typically fades by 4-6 years of age

58
Q

What is a Nevis flameus

A

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
Q

Describe Erythema Toxicum Neonatorum

A

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
Q

What are the most common early onset neonatal sepsis causes

A

GBS (#1)

```
E. Coli
Klebsiella
Listeria monocytogenes
Salmonella
Developing countries
Mycoplasma
~~~

61
Q

What are the common agents of late onset neonatal sepsis causes

A 
H. influenzae
Staphylococcus
HSV 
CMV
Enterovirus
S. pneumoniae
Neisseria meningitidis
62
Q

What is the w/u for a Neonatal Sepsis eval

A

CBC, Blood Cultures x2,
UA with urine Culture & blood glucose
!!!!LUMBAR PUNCTURE!!!

Cerebrospinal Fluid (CSF) culture, cell count, gram stain, protein & glucose levels

63
Q

What are the ABX approach to Neonatal sepsis tx

A

IV Ampicillin & Gentamicin if <3 weeks of age

IV Ampicillin & Cefotaxime if >3 weeks of age

64
Q

What ABX should be added to the Tx approach if we are suspecting a late onset of neonatal sepsis

A

Consider adding Vancomycin if late onset and/or meningitis present

MRSA coverage

65
Q

What ABX should you add to neonatal sepsis tx if you are concerned for HSV infection

A

Add acyclovir

66
Q

What are the 3 steps to a GBS pos mom (newborn protocol)

A

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
Q

What is the deficiency in RDS in neonates

A

Insufficient surfactant production by type II pneumatocytes

68
Q

What is the tx for RDS in neonates

A

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
Q

What is the tx for apnea of prematurity

A

Oxygen
Stimulants
(caffeine or theophylline)

Anemia correction
(i.e., transfusions)

Usually corrects by 36-40 weeks postconceptual age

70
Q

What is the most common congenital tracheal abnormality

A

Tracheomalacia

71
Q

A baby presents with high pitches harsh wheezing that is worse during expiration

Think

A

Tracheomalcia

Tx wtih ENT referral

72
Q

What would you see on CXR if you suspect a mecanismos aspiration

A

coarse, irregular infiltrates

73
Q

What is kernicterus

A

Bilirubin encephalopathy

indirect bilirubin is toxic to developing CNS

74
Q

What are the early S/s of Kernicterus

A

Lethargy, hypotonia, irritability, poor Moro response, poor feeding, high-pitched cry, & emesis

Typically noted after day 4 of life

75
Q

What are the late s/s of kernicterus

A

Bulging fontanelle, opisthotonic posturing, pulmonary hemorrhage, fever, hypertonicity, paralysis of upward gaze, & seizures

76
Q

What is breast feeding jaundice

A

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
Q

What is breast milk jaundice

A

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
Q

Should babies have jaundice on day 1

A

NO!

79
Q

Where is the 1st place that jaundice shows in a newborn

A

1st is under the tongue

Most apparent is in the sclera

80
Q

What is the progression of Jaundice in a neonate

A

Progresses from head toward the toes

81
Q

What is the first line lab for jaundice in a neonate

A

Transcutaneous

If elevated get serum

82
Q

At what value of jaundice should an exchange transfusion be given to a neonate

A

Greater than 20

Senoir 21-2 (77 decks)

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