Pedi NEONATAL ILLNESS & INJURY Flashcards
What do we look for on head exam for a normal newborn?
Fontanelle, layers, abnormalities, overriding sutures, caput vs. cephalohematoma, subgaleal hemorrhage.
What is caput?
sits within the layer of the skin and is a bump on the back of the head, that can be red or purple
What is cephalhematoma?
Occurs under the periosteum and doesn’t cross the midline
When will a caput or cephalhematoma resolve?
Within the first 48 hours to a couple months of life
How would you know if an infant subgaleal hemorrhage?
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)
What do you look for on the face of a newborn?
Abnormal facies – such as a downs facie (wide spacing between the eyes, flattening of the nasal bridge) or fetal alcohol syndrome
What do you look for in the eyes of a newborn?
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)
What do we look for in the ears of a newborn?
ear pits (in front of the pinna) and skin tags
What do we look for in the mouth and neck of a newborn?
Palate, tongue tie, and natal teeth (most present between 6-12 months)
What do we look for in the chest, lungs, and heat of a newborn?
shape of chest is even, good air exchange with clear lung sounds, and murmurs
When should a murmur be evaluated?
If it persists longer than 24 hours especially if it is lower in the ventricle and a louder sound
What should we look for on abdominal and genital area on a newborn?
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!
What is Hirschsprung disease?
A genetic motility disorder – congenital megacolon
What must you always look for in the extremities of a newborn?
Otolani & Barlow tests – for hip dysplasia
Check for number of digits!
What do we look for on neuro exam in a newborn?
Morrow (symmetry of arms out and coming back in), suck, and grasp reflex
What do we look for in the skin of a newborn?
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)
Why do you always need to document a Mongolian spot on a child?
Because it looks like a bruise, and later people can think child abuse
Are children born with moles?
No, and if they do it’s probably best to have them evaluated by a dermatologist
How do we categorize a neonate?
SGA (small for gestational age), AGA (appropriate for gestational age), or Large for gestational age)
If a mother smoked throughout the entire pregnancy what would the size of the baby be?
SGA symmetric (not asymmetric)
What are the major maternal risk factors?
Gestational diabetes, hypertension, chronic medical issues (thyroid, DM, or mental health issues), and genetic risks (sickle cell)
What are some of toxins a neonate can be exposed to?
Maternal medications, smoking, and drugs
What are some medications that can transfer to the baby?
SSRIs (patient can have a small withdrawal), lithium, and ACE
If a neonate was exposed to smoking or cocaine in the womb, what is the child at increased risk for?
SGA & SIDS and vascular infarcts
If a mother is a regular pot smoker, should they breast feed?
NO!!
What is neonatal abstinence syndrome?
Opiate products during pregnancy (narcotic pain medication & heroin)
What do you do after the baby is born with neonatal abstinence syndrome?
Take a meconium & urine collection to see when (within a few months) a mother was using an opioid
When would a baby show sxs of withdrawal from NAS?
5-7 days (Finnegan scores; higher than 8 is bad)
What are some examples of non-accidental trauma?
Shaken baby, SIDS, and domestic violence
Period of purple crying (occurring during 2-3 months) – it’s okay to put them down
What 3 things do we look for with prenatal imaging?
Congenital defects, hydronephrosis, and heart defects
What is a full term baby?
37-42 weeks
What is a late pre-term baby?
34-36/37 (they can have the same risks as preterm, don’t just think they seem like a term baby)
What is a pre-term baby?
less than 37 weeks
What’s the biggest concern with a pre-term baby?
Not enough surfactant – therefore respiratory issues
Also feeding issues
What is a low birth weight? What’s a very low birth weight?
low birth weight is less than 2500g
very low is less than 1500g
What is chorioamnionitis?
An infection in womb; or maternal fever
What should we always monitor in the baby during labor?
Decelerations in the heart rate or breathing
What concerns do you have during the actual birthing process?
Shoulder dystocia (fx clavicle or Erb’s palsy) & breech position (hip dysplasia)
What scoring system do we use the moment a baby is born, over the next 10 minutes?
Apgar scoring system
What can meconium cause during birth?
It can be swallowed and cause a pneumonitis
What infections do we look for in a neonate?
ToRCH = Toxoplasmosis, Treponema, rubella, CMV, and herpes, Hep B&C, and HIV
What if a baby presents with jaundice, hepatosplenomegaly, and a fever, what diagnosis?
Toxoplasmosis
How does a mother get Toxoplasmosis & how do you treat it?
From cat litter and raw meat
Tx with Pyrimethamine + sulfadiazine
If a neonate has anemia, periventricular calcifications, deafness, and a blueberry muffin rash, what did they contract in utero?
CMV
How do you treat CMV?
There’s no treatment, just prevent the STI in the mother
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?
Skin lesions!
How would the neonate present if the Herpes infection was passed on?
Encephalitis & skin lesions
What other maternal STD infections do we always want to test for?
Gonorrhea, syphilis, and chlamydia
If a child has a rash, thrombocytopenia, and later in life develops Hutchinson teeth, what are you concerned they acquired in utero?
Syphilis
How do you treat syphilis?
PCN
What STD infection passes on to children and affects the eyes?
Chlamydia
If a neonate has microcephaly, eye issues, deafness, and a blueberry muffin rash, what did they contract in utero?
Rubella from their unvaccinated mother
What do all pregnant women have to be tested for at 36 weeks?
Group B strep! Remember some women deliver before 36 weeks
What do you do if a mom does have group B strep?
They will be treated with Abx during labor and for 48 hours after birth
What does Group B strep cause in a neonate?
SEPSIS!!
In the first days of life if a neonate has a fever, poor feeding, and respiratory difficulty what diagnosis do you think of?
Sepsis!
When is sepsis typically seen in neonates?
Birth – 7 days
Late onset is 7-28 days
If a child has sepsis in the first 7-28 days of life, what might they have?
Flu, pneumonia, meningitis
If a neonate has a fever and is less than 2 months, what do you do?
INVESTIGATE!
What if an infant over two-three months has a fever and they are very uncomfortable?
Give them medication
What is the number that you would want tell a mother with a child to be concerned?
104
What if a child has a fever and is mildly uncomfortable but able to do their regular activities?
They don’t need medication
What labs do you do for sepsis in a neonate?
CBC, CRP, lytes, Bcx, UA, LP
What treatment do you give for sepsis?
Ampicilin & Gentamicin – be aware of hearing problems
What medication is best to give a child with a fever? And at what age?
Ibuprofen! MUST BE OVER 6 MONTHS
What would a parent give for fever if less than 6 months?
Tylenol
If a baby has elevated direct bilirubin, what does that indicate?
Hyperbilirubinemia due to pathologic cause
What are some of the pathologic causes of hyperbilirubinemia?
Extrahepatic obstruction; cholestasis; and genetic/metabolic disorders
What is a neonate has elevated indirect bilirubin, what does that mean?
Hyperbilirubinemia due to physiologic cause
What are some of the physiologic causes of hyperbilirubinemia?
Hemolytic process – polycythemia, swallowed maternal blood, intestinal obstruction, and breast milk jaundice
How do you treat hyperbilirubinemia?
Treat the cause, phototherapy, and transfusion
