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Pediatric Primary Care Exam 1 > Newborn Care II > Flashcards

Newborn Care II Flashcards

1
Q

Patent Urachus

A

Umbilical problem; connection between bladder an the umbilicus remains open

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2
Q

Granuloma of Umbilicus (4)

A
  1. Small, firm nodule – red/pink in color that stays after the umbilicus falls off
  2. Ooze and irritate
  3. Cauterize with silver nitrate
  4. Don’t touch it to healthy skin or it will burn
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3
Q

Omphalitis (3)

A
  1. Infection of umbilical cord; malodorous, purulent, and erythema present
  2. May be from staph aureus or gram negative bacteria (E. coli, Klebsiella)
  3. More common in home deliveries
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4
Q

Umbilical Hernia Resolution (2)

A
  1. Self resolving by 3 years

2. If persists beyond 4 years - surgical repair

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5
Q

Clinical Manifestaitons of Omphalitis (3)

A
  1. Foul smelling discharge
  2. Periumbilical erythematous streaking, induration and tenderness to palpation
  3. Purulent or serosanguineous discharge
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6
Q

Predisposing Factors to Omphalitis (4)

A
  1. Prematurity
  2. Complicated delivery
  3. Improper severing of the umbilical cord
  4. Poor hygienic practices during neonatal period
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7
Q

Umbilical Hernia (5)

A
  1. Occurs when part of the intestine protrudes
    through the umbilical opening in the abdominal muscles
  2. Common in infancy; more common in African American infants
  3. Evident with crying, straining or coughing
  4. Disappear when resting on back; Classic sign ( in and out )
  5. Cultural treatments: Tape, penny, quarter, binders are not helpful may increase strangulation risk
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8
Q

Benefits of Circumcision (6)

A
  1. Prevents cancer of the penis (rare)
  2. Decreased risk of UTI less than 5 years old
  3. Avoids later circumcision
  4. Prevents paraphimosis; Emergency, risk of necrosis
  5. Prevents recurrent balanitis
  6. Decrease risk of acquiring STDs
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9
Q

Risks of Circumcision (3)

A
  1. Operative risks: Bleeding, infection, poor results
  2. Complications of anesthesia
  3. Post operative risks
    - Fibrous bands
    - Meatal stenosis
    - Adhesions
    - Cysts
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10
Q

Pain control and circumcision (5)

A
  1. Dorsal penile nerve block
  2. EMLA
  3. Oral sucrose
  4. Pacifier
  5. Acetaminophen
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11
Q

Phimosis

A

A condition in which tight foreskin can’t be pulled back over the head of the penis.
*Physiological until 6 years old

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12
Q

Contraindications to Circmucision (4)

A
  1. Hypospadias (may need tissue for later repair)
  2. Ambiguous genitalia
  3. Sick newborn
  4. Excessive oozing after heel stick; needs further evaluation
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13
Q

Developmental Dysplasia of the Hip (5)

A
  1. Poor formation of hip joint; may lead to clinical or subclinical instability
  2. More common in females, oligohydramniois, and breech position
  3. Musculoskeletal risk factors include torticollis, metatarsus adductus, CP/neuromuscular
  4. HIGH RISK PATIENTS ARE FEMALE INFANTS IN BREECH POSITION W/ STRONG FAMILY HISTORY
  5. Some cases of mild dysplasia resolve on their own; may be no detriment in observing for 6 weeks
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14
Q

Effects of DDH (4)

A
  1. Hip with DDH may become normal, have residual instability, subluxate or dislocate
  2. Instability / subluxation leads to abnormal wear
  3. Estimated to account for 25-50% of adult hip
    degenerative joint disease
  4. Significant cause of early arthritis
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15
Q

Barlow Manuever (5)

A
  1. Do Barlow before Ortolani; passively dislocate
  2. “Click of exit”; determines dislocatable hip
  3. Femur gently ADDUCTED and FLEXED; thumb pushes laterally on the upper inner thigh
    * Adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly.
  4. Clunk indicates femoral head has slipped over the lateral edge of the acetabulum- demonstrates an unstable hip joint that is dislocatable
  5. Feel for palpable give or click
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16
Q

Ortolani Maneuver (6)

A
  1. Confirms Barlow; femoral head is reduced back
  2. “click of entry”
  3. Test of hip reduction- of the dislocated femoral
    head into the acetabulum
  4. Maneuver used to place the hip back into a normal
    position
  5. Femur gently abducted, trochanter elevated
  6. Feel for palpable “clunk” as head falls into the
    acetabulum
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17
Q

Diagnosis of DDH (4)

A
  1. Primarily physical exam; exam performed after birth and all follow up visits up to 12 months
  2. Ultrasound
  3. X-Ray after 4 months
  4. MRI/CT; only pre or post op and ordered by ortho
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18
Q

Other signs of DDH (4)

A
  1. Galeazzi sign: Femur appears short with hip flexed
  2. Skin folds in groin or buttock
  3. Asymmetric abduction/motion of hip
  4. Remember- irreducible hip is Barlow/Ortalani negative
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19
Q

DDH Referral (3)

A
  1. Refer to ortho if positive exam findings
  2. Repeat exam at 2-4 day visit if questionable exam – follow up positive refer to ortho
  3. If exam equivical – refer to ortho and followup
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20
Q

DDH Ultrasound (5)

A
  1. Used for evaluation/treatment for exam positive hips
  2. May also be used for very high-risk patients (breech, family history)
  3. Not for general screening
  4. Do after 3-4 weeks of age
  5. If family history or risk factors (female/breech) use at 6 weeks
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21
Q

Pavlik Harness

A

Treatment of DDH

  1. Complications with incorrect positioning
  2. Too much flexion can lead to femoral nerve palsy
  3. Too much abduction can lead to possible avascular necrosis
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22
Q

Operative Treatments of DDH (5)

A
  1. Closed reduction
  2. Open reduction
  3. Spica casting
  4. Pelvic Osteotomy
  5. Femoral Osteotomy

**Diagnosis and appropriate treatment can
minimize operative treatments*

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23
Q

Newborn Period: Infection Checks (6)

A
  1. Fever is an emergency! Esp 100.4 and above in first 30 days of life (rectal temp.)
    * Must receive full sepsis work up if 0-30 days old
  2. Chest X-Ray w/ symptoms of respiratory distress
  3. Blood culture and CBC with differential
  4. CRP responds to inflammation; collect 2 samples 24 hours apart; can give you an idea of bacterial vs viral
  5. Urine culture/urinalysis if still sick after 72 hours
  6. Lumbar puncture/spinal tap to check for meningitis
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24
Q

Group B Streptococcal Disease (3)

A
  1. Gram positive beta hemolytic bacteria; causes serious disease in young infants, pregnant women, and older adults
  2. Most common cause of sepsis and meningitis in infants less than 3 months old
  3. Primary risk factor is maternal colonization
25
Q

GBS Early vs Late

A

Early onset: 0-7 days (first week); usually presents within first 24 hours

Late onset: after first week of life

26
Q

GBS Clinical Presentations (3)

A

Typically symptoms appear w/i first 24 hours

  1. Respiratory distress
  2. Apnea
  3. Temperature Instability
27
Q

GBS Carriers: Maternal Colonization (5)

A
  1. Higher proportion in African American
  2. GBS usually live in GI tract but can spread to GU
  3. No symptoms or signs on examination
  4. Not a sexually transmitted infection
  5. Risk factor for early-onset disease: GBS colonization during labor and delivery; Prenatal cultures late in pregnancy can predict delivery status
28
Q

Risk Factors of GBS (8)

A
  1. Prolonged rupture of membranes
  2. Preterm delivery
  3. Infection of the placenta tissues or amniotic fluid (ex: chorio)
  4. Fever during labor
  5. GBS in the mother’s urine during pregnancy is a marker for heavy colonization
  6. Previous infant with GBS disease
  7. Low maternal levels of anti-GBS antibodies
  8. Demographic risk factors: African American, Young maternal age
29
Q

Prevention of GBS in Newborn (2)

A
  1. Intrapartum Antibiotics (IAP); highly effective at preventing GBS in women at risk for transmitting it to their newborn
    * The challenge is how to identify the women who should receive it
    * PCN is preferred (ampicillin acceptable); Cefazolin (non-anaphylactic allergy) or Clindamycin (anaphylactic allergy) if PCN allergy
  2. Universal screening of pregnant women for GBS at 35-37 weeks gestational age
30
Q

When to give GBS Antibiotic Prophylaxis (1 and 2E)

A
  1. GBS positive screening test
2. GBS colonization status unknown with:
A. Delivery <37 weeks
B. Temp during labor over 100.4 
C. Rupture of membranes over 18 hours
D. Previous infant with GBS
E. GBS in the mother's urine during current pregnancy
31
Q

GBS Prophylaxis Not Indicated If.. (4)

A
  1. Colonization with GBS during previous pregnancy –
    unless another indication during current pregnancy
  2. GBS bacteriuria during a previous pregnancy unless
    another indication during current
  3. Negative vaginal and rectal GBS screening test
    during current pregnancy
  4. C-Section delivery performed before labor onset on
    a women with intact amniotic membranes
    -Regardless of maternal GBS status
    -Regardless of gestational age
32
Q

Bacteriuria (3)

A
  1. GBS in urine during pregnancy; marker of heavy vagina-rectal colonization
    * Risk factor for GBS in newborn
  2. Antibiotic tx of GBS bacteriuria during pregnancy does not eliminate GBS from GI and GU tracts - recolonization after tx is typical
  3. Women with GBS isolated from the urine at any time during current pregnancy should receive IAP
33
Q

When should antibiotic prophylaxis for GBS be given?

A

IV every 4 hours at least 4 hours before delivery

34
Q

When is 48 hours or more of monitoring for the newborn required?

A
  1. If the mother was required to received IV prophylaxis for over 4 hours prior to delivery (may be due to signs of infection or chorio, etc)
  2. If the mother is greater than or equal to 37 weeks and duration of membrane rupture is less than 18 hours
  3. If the mother is less than 37 weeks or the rupture of membranes has been over 18 hours
35
Q

Causes of Newborn Sepsis (3)

A
  1. Bacteria: GBS, E.Coli or Listeria
  2. Viral
  3. Fungal
36
Q

Characteristics of Neonatal Sepsis: Early onset Less than 7 days (4)

A
  1. Intrapartum Complications: often present
  2. Transmission: vertical often acquired from mothers genital tract
  3. Clinical Manifestations: Fulminent (sudden) course, multisystem involvement, PNEUMONIA common
  4. Mortality rate: 5-20%
37
Q

Characteristics of Neonatal Sepsis: Late onset of 7-90 days (4)

A
  1. Intrapartum Complications: Usually absent
  2. Transmission: Vertical or via postnatal environment
  3. Clinical Manifestations: insidious (gradual), focal infection, MENINGITIS common
  4. Mortality rate: 5%
38
Q

Characteristics of Neonatal Sepsis: Late onset over 90 days (4)

A
  1. Intrapartum Complications: Varies
  2. Transmission: Usually postnatal environment
  3. Clinical Manifestations: Insidious (gradual)
  4. Mortality rate: Low
39
Q

Maternal Risk Factors for Neonatal Sepsis

A
  1. AA
  2. Malnutrition
  3. Recently acquired STDs
  4. Lower socioeconomic status
40
Q

Peripartum Risk Factors for Neonatal Sepsis (4)

A
  1. Untreated or incomplete treatment for infections
  2. Maternal fever over or equal to 100.4
  3. UTI, vaginal, cervical, systemic infections without identified foci
  4. Rupture of membranes over 12-18 hours, chorioamnionitis and ROM over 24 hours increases the risk of neonatal infection 4 fold
  5. Prematurity
41
Q

Neonatal Risk Factors of Neonatal Sepsis (3)

A
  1. Males > females
  2. Immaturity of immune system of the newborn host
  3. Late onset infection in VLBQ infants related to intubation and prolonged ventilation
42
Q

Clinical Manifestations of Neonatal Sepsis (7)

A
  1. Respiratory distress
  2. Fever over 100.4
  3. Neurologic findings: seizures, full fontanelle, lethargy, hypotonia
  4. GI symptoms: HSM, abdominal distention, vomiting, gastric aspirates, bloody stools, jaundice
  5. Metabolic: Prolonged jaundice, hypoglycemia
  6. BABY IS JUST NOT LOOKING WELL!!
  7. Complications (of neonatal sepsis): DIC, Shock
43
Q

CBC in Diagnosing Sepsis in the Newborn (5)

A
  1. WBC count: elevated immature to total neutrophil ratio is over 0:2
  2. Elevated band count over 2,000
  3. Neutropenia of <1750
  4. Total white count is exceptionally high of 25,000 or more or below 5,000
  5. Platelets less than 100,000
44
Q

Diagnostic Tests for Sepsis in newborn (5)

A
  1. CBC
  2. Acute Phase Reactants (CRP)
  3. ESR
  4. CXR
  5. Lumbar puncture
45
Q

Treatment of Early Onset Newborn Sepsis (3)

A

Antimicrobial Therapy: usually PCN/Ampicillin and Gentamycin (PCN and Aminoglycoside)

  1. Ampicillin for Listeria and GBS (less reliable for E.Coli)
  2. Aminoglycosides for gram negatives work synergistically with Ampicillin against GBS and Listeria
  3. Cefotaxime for meningitis or suspicion of meningitis
46
Q

Treatment of Late Onset Sepsis

A

Staph pneumoniae, Neisseria meningitis –– Ampicillin and Cefotaxime because meningitis is frequently a component of late onset sepsis

47
Q

Pathogenesis of Meningitis (3)

A
  1. Primary sepsis - most common
  2. Focal infections outside the CNS (ex: infected sinus)
  3. Direct inoculation following head trauma or neurosurgery or an open congenital defect (myelomeningocele)
48
Q

Sequelae of Meningitis (4)

A

1st: Hydrocephalus
2nd: Ventriculitis - can result in thrombosis or cerebral infarcts
3rd: Brain abscesses
4th: Hearing loss

49
Q

Clinical Manifestations of Meningitis (8)

A
  1. Lethargy
  2. Poor feeding
  3. Emesis
  4. Respiratory distress
  5. Irritability
  6. Temperature instability
  7. Seizures
  8. Bulging fontanelle
50
Q

Diagnosis of Meningitis (2)

A
  1. Requires growth of the microorganism from the CSF
  2. Evaluation of CSF should include culture and gram stain, cell count, glucose, total protein
    * Gram stain is most useful after culture will identify offending bacteria is present
51
Q

Treatment of Meningitis (2)

A
  1. Early onset meningitis: Ampicillin (meningitic dose), gentamicin and cefotaxime pending final culture
  2. Late onset meningitis: Vancomycin, aminoglycoside + Ampicilin if GBS suspected
52
Q

Duration of Meningitis Therapy (3)

A
  1. 14 days for Listeria or GBS
  2. 3 weeks for gram negative bacilli- more difficult to
    eradicate from CSF
  3. Some treat for 2 weeks from negative CSF
53
Q

Newborn Viral Infections (7)

A
  1. CMV
  2. Herpes Simplex
  3. Varicella
  4. Enterovirus
  5. Rotavirus
  6. Parvovirus
  7. RSV
54
Q

Cytomegalovirus Manifestations

A

CMV is the Most common congenital viral infection in the U.S.

  1. Petechiae
  2. Blueberry muffin rash (indicates rubella)
  3. SGA for weight
  4. HSM
  5. Jaundice at birth
55
Q

CMV Diagnosis (2) and Transmission

A

Dx:

  1. Isolation of CMV from urine in 1st 3 weeks of life is most reliable
  2. IgM antibodies to CMV
  3. Transmission: Maternal – fetal transmission
56
Q

Herpes Simplex Virus (3)

A
  1. Disease localized to the skin, eye and mouth (45%)
  2. Encephalitis with or without CNS involvement (30%)
  3. Disseminated Infection including CNS and lungs (25%)
57
Q

Times of HSV Transmission (3)

A

HSV of the newborn is acquired during one of the
3 distinct time intervals

  1. Intrauterine (in utero 5%)
  2. Peripartum (perinatal 85%)
  3. Postpartum (postnatal 10%)
58
Q

HSV Treatment (3)

A
  1. Acyclovir 60mg/kg/day improves measules and mumps
    * Disseminated and CNS disease 21 days
    * SEM 14 days
  2. All patients must have a repeat lumbar puncture at end of therapy if CNS disease
  3. CSF with PCR standard
    * Positive CSF PCR- continue treatment until PCR negative
59
Q

Summary of Newborn Visits (4)

A
  1. Within 24 hours after birth (in patient)
  2. 48-72 hours after discharge (3-5 days)
  3. At 1,2,4,6,9,12,15,18 and 24 months
  4. If discharged before 48 hours of delivery must be
    examined within 48 hours of discharge

Pediatric Primary Care Exam 1 (7 decks)

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