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Pediatrics > Pedi NEONATAL ILLNESS & INJURY > Flashcards

Pedi NEONATAL ILLNESS & INJURY Flashcards

1
Q

What do we look for on head exam for a normal newborn?

A

Fontanelle, layers, abnormalities, overriding sutures, caput vs. cephalohematoma, subgaleal hemorrhage.

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2
Q

What is caput?

A

sits within the layer of the skin and is a bump on the back of the head, that can be red or purple

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3
Q

What is cephalhematoma?

A

Occurs under the periosteum and doesn’t cross the midline

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4
Q

When will a caput or cephalhematoma resolve?

A

Within the first 48 hours to a couple months of life

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5
Q

How would you know if an infant subgaleal hemorrhage?

A

They are very limp, their suck is off, they are not waking to eat – can progress quickly (think about bleeding disorders or continuous bleed that needs to be stopped)

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6
Q

What do you look for on the face of a newborn?

A

Abnormal facies – such as a downs facie (wide spacing between the eyes, flattening of the nasal bridge) or fetal alcohol syndrome

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7
Q

What do you look for in the eyes of a newborn?

A

Conjunctival hemorrhage (doesn’t affect vision), red reflex (concern if asymmetry), blocked tear ducts (conjunctiva is white and clear, if a problem for longer than a year then refer)

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8
Q

What do we look for in the ears of a newborn?

A

ear pits (in front of the pinna) and skin tags

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9
Q

What do we look for in the mouth and neck of a newborn?

A

Palate, tongue tie, and natal teeth (most present between 6-12 months)

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10
Q

What do we look for in the chest, lungs, and heat of a newborn?

A

shape of chest is even, good air exchange with clear lung sounds, and murmurs

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11
Q

When should a murmur be evaluated?

A

If it persists longer than 24 hours especially if it is lower in the ventricle and a louder sound

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12
Q

What should we look for on abdominal and genital area on a newborn?

A

look for any abnormalities (weakest point is in the center line), stool in the first 24 hours, urethra opening at the tip of penis (don’t miss because he can’t have a circumcision), and check for the two testicles!

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13
Q

What is Hirschsprung disease?

A

A genetic motility disorder – congenital megacolon

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14
Q

What must you always look for in the extremities of a newborn?

A

Otolani & Barlow tests – for hip dysplasia

Check for number of digits!

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15
Q

What do we look for on neuro exam in a newborn?

A

Morrow (symmetry of arms out and coming back in), suck, and grasp reflex

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16
Q

What do we look for in the skin of a newborn?

A

Nevus flammeus (stork bite), erythema toxicum (comes and goes not a problem), dry skin (no need for moisturizer unless they crack and bleed), Mongolian spot (non-caucasian infant look like a bruise always document), pustular melanosis, and milia (white spots on the nose)

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17
Q

Why do you always need to document a Mongolian spot on a child?

A

Because it looks like a bruise, and later people can think child abuse

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18
Q

Are children born with moles?

A

No, and if they do it’s probably best to have them evaluated by a dermatologist

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19
Q

How do we categorize a neonate?

A

SGA (small for gestational age), AGA (appropriate for gestational age), or Large for gestational age)

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20
Q

If a mother smoked throughout the entire pregnancy what would the size of the baby be?

A

SGA symmetric (not asymmetric)

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21
Q

What are the major maternal risk factors?

A

Gestational diabetes, hypertension, chronic medical issues (thyroid, DM, or mental health issues), and genetic risks (sickle cell)

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22
Q

What are some of toxins a neonate can be exposed to?

A

Maternal medications, smoking, and drugs

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23
Q

What are some medications that can transfer to the baby?

A

SSRIs (patient can have a small withdrawal), lithium, and ACE

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24
Q

If a neonate was exposed to smoking or cocaine in the womb, what is the child at increased risk for?

A

SGA & SIDS and vascular infarcts

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25
Q

If a mother is a regular pot smoker, should they breast feed?

A

NO!!

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26
Q

What is neonatal abstinence syndrome?

A

Opiate products during pregnancy (narcotic pain medication & heroin)

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27
Q

What do you do after the baby is born with neonatal abstinence syndrome?

A

Take a meconium & urine collection to see when (within a few months) a mother was using an opioid

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28
Q

When would a baby show sxs of withdrawal from NAS?

A

5-7 days (Finnegan scores; higher than 8 is bad)

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29
Q

What are some examples of non-accidental trauma?

A

Shaken baby, SIDS, and domestic violence

Period of purple crying (occurring during 2-3 months) – it’s okay to put them down

30
Q

What 3 things do we look for with prenatal imaging?

A

Congenital defects, hydronephrosis, and heart defects

31
Q

What is a full term baby?

A

37-42 weeks

32
Q

What is a late pre-term baby?

A

34-36/37 (they can have the same risks as preterm, don’t just think they seem like a term baby)

33
Q

What is a pre-term baby?

A

less than 37 weeks

34
Q

What’s the biggest concern with a pre-term baby?

A

Not enough surfactant – therefore respiratory issues

Also feeding issues

35
Q

What is a low birth weight? What’s a very low birth weight?

A

low birth weight is less than 2500g

very low is less than 1500g

36
Q

What is chorioamnionitis?

A

An infection in womb; or maternal fever

37
Q

What should we always monitor in the baby during labor?

A

Decelerations in the heart rate or breathing

38
Q

What concerns do you have during the actual birthing process?

A

Shoulder dystocia (fx clavicle or Erb’s palsy) & breech position (hip dysplasia)

39
Q

What scoring system do we use the moment a baby is born, over the next 10 minutes?

A

Apgar scoring system

40
Q

What can meconium cause during birth?

A

It can be swallowed and cause a pneumonitis

41
Q

What infections do we look for in a neonate?

A

ToRCH = Toxoplasmosis, Treponema, rubella, CMV, and herpes, Hep B&C, and HIV

42
Q

What if a baby presents with jaundice, hepatosplenomegaly, and a fever, what diagnosis?

A

Toxoplasmosis

43
Q

How does a mother get Toxoplasmosis & how do you treat it?

A

From cat litter and raw meat

Tx with Pyrimethamine + sulfadiazine

44
Q

If a neonate has anemia, periventricular calcifications, deafness, and a blueberry muffin rash, what did they contract in utero?

A

CMV

45
Q

How do you treat CMV?

A

There’s no treatment, just prevent the STI in the mother

46
Q

What do you look for in the mother before the baby is born to see if she’s going to pass on her Herpes infection?

A

Skin lesions!

47
Q

How would the neonate present if the Herpes infection was passed on?

A

Encephalitis & skin lesions

48
Q

What other maternal STD infections do we always want to test for?

A

Gonorrhea, syphilis, and chlamydia

49
Q

If a child has a rash, thrombocytopenia, and later in life develops Hutchinson teeth, what are you concerned they acquired in utero?

A

Syphilis

50
Q

How do you treat syphilis?

A

PCN

51
Q

What STD infection passes on to children and affects the eyes?

A

Chlamydia

52
Q

If a neonate has microcephaly, eye issues, deafness, and a blueberry muffin rash, what did they contract in utero?

A

Rubella from their unvaccinated mother

53
Q

What do all pregnant women have to be tested for at 36 weeks?

A

Group B strep! Remember some women deliver before 36 weeks

54
Q

What do you do if a mom does have group B strep?

A

They will be treated with Abx during labor and for 48 hours after birth

55
Q

What does Group B strep cause in a neonate?

A

SEPSIS!!

56
Q

In the first days of life if a neonate has a fever, poor feeding, and respiratory difficulty what diagnosis do you think of?

A

Sepsis!

57
Q

When is sepsis typically seen in neonates?

A

Birth – 7 days

Late onset is 7-28 days

58
Q

If a child has sepsis in the first 7-28 days of life, what might they have?

A

Flu, pneumonia, meningitis

59
Q

If a neonate has a fever and is less than 2 months, what do you do?

A

INVESTIGATE!

60
Q

What if an infant over two-three months has a fever and they are very uncomfortable?

A

Give them medication

61
Q

What is the number that you would want tell a mother with a child to be concerned?

A

104

62
Q

What if a child has a fever and is mildly uncomfortable but able to do their regular activities?

A

They don’t need medication

63
Q

What labs do you do for sepsis in a neonate?

A

CBC, CRP, lytes, Bcx, UA, LP

64
Q

What treatment do you give for sepsis?

A

Ampicilin & Gentamicin – be aware of hearing problems

65
Q

What medication is best to give a child with a fever? And at what age?

A

Ibuprofen! MUST BE OVER 6 MONTHS

66
Q

What would a parent give for fever if less than 6 months?

A

Tylenol

67
Q

If a baby has elevated direct bilirubin, what does that indicate?

A

Hyperbilirubinemia due to pathologic cause

68
Q

What are some of the pathologic causes of hyperbilirubinemia?

A

Extrahepatic obstruction; cholestasis; and genetic/metabolic disorders

69
Q

What is a neonate has elevated indirect bilirubin, what does that mean?

A

Hyperbilirubinemia due to physiologic cause

70
Q

What are some of the physiologic causes of hyperbilirubinemia?

A

Hemolytic process – polycythemia, swallowed maternal blood, intestinal obstruction, and breast milk jaundice

71
Q

How do you treat hyperbilirubinemia?

A

Treat the cause, phototherapy, and transfusion

Pediatrics (12 decks)

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