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
H/H
tests at 9-12 months.
newborns have Hemoglobin F/A. The have iron stores to last 6 months due to maternal RBC
lead screening
1-2 years for high risk children
how much Vit D supplement
minimum of 200IU if not more
how much calories in Breast milk or formula
20kcal/oz
cow’s milk
avoid 1st yer
common cause of iron def anemia in babies
when is meconium passed
1st 24 hours after birth
caput succedaneum
diffused edema crosses midline, normal dt labor and resolved spontaniously
cephalohematoma
does NOT cross midline or suture lines, r/o skull fracture
birth weight
loses 7%, regains in 1-2 wks. double weight by 6 months triple by 1 year.
when to measure head circumference
at each wellness visit until 3 years old
chest is 1-2cm less than head circumference
when does baby have ALL their teeth
2.5 years old
first permanent teeth
6 years old
hypospadias
A condition in which the opening of the penis is on the underside rather than the tip.
refer
anal wink
look for contraction of perianal muscle. If not present, risk of spina bifida
when does morro reflex disappear
3-4 months
if NOT present, rule out spinal cord/brain lesion
if one side, r/o shoulder dystocia/fracture
when does stepping reflex disappear
6 wks
tonic neck reflex
(fencing reflex) neck turned on one side will cause limbs on same side to extend,opposite flex
if moro reflex strong on infant OLDER than 6 months..
indicative of brain damage
MMR
2 doses
given AFTER 12 months, then 4-6 years
live attenuated virus vaccine
avoid aspirin to children less than 1 year old
avoid salicylates 6 wks ( reyes syndrome), no aspirin products (pep to, alka seltzer, kaopectate)
influenza
do NOT give before 6 months
flu mist: age 2-49 yo healthy and non pregnant
DTAP
use for 7 years or younger ( if older use, TDAP)
age 12-15 months, which vaccines are completed
hep B hib (hemophilus type b pcv rv dtap mmr varicella ipv (inactived polio)
ONLy vaccine at birth
hepatitis B
which vaccines NOT to give before 12 months
varicella, MMR ( live vaccine)
if hbsaG positive mother, what to give neonate
give hbig and hep b
when to give tdap booster
11-12 yo. if older than 12 replace one dose of TD with trap ( once in a lifetime)
fine motor, can feed self with spoon, drink from a cup
knows 4-6 words
15 months
can walk up steps, turns pages of book, point to 4 body parts, knows 10-20 words
18 months
rear facing
birth -2 yo
when to put child in back seat
until 13 yo
school age seat
booster seats, until child reaches 4 feet, 9 inches or is 8-12 yo.
physiologic jaundice
5mg/dl or higher
elevation of bilirubin due to increased breakdown of fetal RBC.
kernicterus
neuro disorder caused by high levels of bilirubin in infant
associated with mental retardation
physiologic anemia of infancy
hemoglobin drops at losel level at 2 months
temporary decrease in erythropoietin production by kidneys, which prompts gown marrow to product more.
infant colic rule of 3
last 3 hours or more during the day
under 3 months
occurs more than 3 days/week
coarctation of the aorta
congenital narrowing of portion of the heart. compare radial and femoral pulses simultaneously (bp @ arms vs legs).
if abnormal order keg, echo, chest x ray
neonates screening pulse
compare femoral and brachial pulse (wrist)
normal findings in older infant: systolic BP higher in legs than arms
barlow versus ortolani
barlow- push both knees together at midline downwards
ortalani- abduct/adduct frog leg position
