newborn Flashcards
down’s syndrome
s/s and parent education
palpebral fissures ( upward slant eyes), macroglossia ( enlarged tongue, chronic open mouth), simian crease (transverse palmar cease), 50% change heart defects, early alzheimers, visual problems, low set ears
education:AVOID trampoline (esp
fetal alcohol syndrome s/s
microcephaly, shortened palpebral fissures (narrow eyes), flat nasal bridge, underdeveloped ears, smooth philtrum.
cryptochidism (undescended testes)
how to assess
empty scrotal sac.
infant sitting, warm to relax muscle, massage inguinal canal. Or exam after warm bath
increase risk of TESTICULAR CANCER if testes are not removed from the abdomen.
if does not descend after 1 year, surgical orchiopexy.
gonococcal ophthalmia neonatorum
s/s
tests
tx
2-4 days post birth
can cause blindness!- DON”T DELAY TX
s/s: red conjuntiva, discharge
tests: gonococcal Thayer Martin, herpes simplex culture, chlamydial PCR, gram stain of eye exudate.
hospital and tx with IV or IM ceftriaxone.
prophalaxis topical .5% erythromycin ointment ( 1cm rib be per eye)
chlamydial opthalmia neonatorum (Trachoma)
s/s
tests
tx
4-10 days after birth.
s/s: edematous eyelids, watery/purulant eyes
tests: sample of exudate and conjuntival cells
tx: systemic antibiotics, macrobid IM, tx only 80% effective and may need 2nd course. (i.e. azithromycin, erythromycin).
REPORTABLE DISEASE.
treat mom and sexual partner
** rule out chlamydial pneumonia with nasopharyngeal culture
chlamydial pneumonia
test with nasopharyngeal culture.
cough, rales, tachypnea, hyperinflation, diffused infiltrates on xray.
tx: erythromycin, DAILY follow up.
REPORTABLE DISEASE
SIDS
risk with premature/low birth weight, maternal smoking/drugs, poverty
cause unknown
only back sleeping and avoid “overheating” baby
weight loss >7%
weight loss should be regained 10-14 days. loss >7% abnormal assess for dehydration/lactation
when does mongolian spot fade
2-3 yrs
most common pigmented spots on babies
erythema toxicum
whitish/yellow pustules
erupts during the 2nd/3rd day.
resolves spontaniously 1-2 wks
faun tail nevus
hair at lumbosacral area, ultrasound of the lesion to r/o spin bifida
cafe au lait spots, when to rule out?
if >6 spots >5mm (.5cm), rule out neurofibromatosis or von recklinghausen’s disease (neuro disorder marked by sz, learning disorder).
refer to neurologist!
port wine stain (nevus flammeus) when to r/o?
on the v1 and v2 branch of trigemenal nerve
refer ophthalmologist to r/o glaucoma.
blanches to pressure, irregular size
if half of face may be sign of trigemenal nerve involvement and STURGE-WEBER syndrome (neuro disorder). tx with pulse dye laser
if port wine stain more than half of the face, what is the sign of
trigemimenal nerve/sturge weber
newborn vision
newborns are nearsighted (myopia)
normal: 30/400
amblyopia
lazy eye, correct early
esotropia
misalignment of eyes (“cross eyed”)
when to refer (eyes)
abnormal red reflex ( r/o retinoblastoma, cataract, glaucoma)
white reflex (r/o retinoblastoma)
strabismus ( r/o CN 3, 4, 6 abnormalities)
**vision 20/30 or worse in child >6yo
** > to line difference between each eye
new onset of strabismus
red reflex
to test for cataracts and retinoblastoma
red reflex showing a white colored pupil- congenital cataract
retinoblastoma
An eye cancer that begins in the back of the eye (retina), most commonly in children.
auditory test newborn
test for CN 8 (acoustic) by use of “click” stimuli
risk for hearing loss
“HEARS”
hyperbilirubinemia, ear infection, apgar score low, rubella, cmv, toxoplasmosis, seizures
PKU
phenylketonuria.
mental retardation if not treated early
inability to metabolize phenylalanine to tyrosine because of the defect if phenylalaline hydrosylase.
Test ONLY after 48 hours, treated by following PKU free diet.
laboratory tests
PKU, TSH, sickle cell, h/h, lead
