Pedi NEONATAL ILLNESS & INJURY

Question 1

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

Answer 1

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

Question 2

What is caput?

Answer 2

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

Question 3

What is cephalhematoma?

Answer 3

Occurs under the periosteum and doesn’t cross the midline

Question 4

When will a caput or cephalhematoma resolve?

Answer 4

Within the first 48 hours to a couple months of life

Question 5

How would you know if an infant subgaleal hemorrhage?

Answer 5

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)

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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)

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

When should a murmur be evaluated?

Answer 11

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

Question 12

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

Answer 12

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!

Question 13

What is Hirschsprung disease?

Answer 13

A genetic motility disorder – congenital megacolon

Question 14

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

Answer 14

Otolani & Barlow tests – for hip dysplasia

Check for number of digits!

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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)

Question 17

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

Answer 17

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

Question 18

Are children born with moles?

Answer 18

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

Question 19

How do we categorize a neonate?

Answer 19

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

Question 20

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

Answer 20

SGA symmetric (not asymmetric)

Question 21

What are the major maternal risk factors?

Answer 21

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

Question 22

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

Answer 22

Maternal medications, smoking, and drugs

Question 23

What are some medications that can transfer to the baby?

Answer 23

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

Question 24

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

Answer 24

SGA & SIDS and vascular infarcts

Question 25

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

Answer 25

NO!!

Question 26

What is neonatal abstinence syndrome?

Answer 26

Opiate products during pregnancy (narcotic pain medication & heroin)

Question 27

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

Answer 27

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

Question 28

When would a baby show sxs of withdrawal from NAS?

Answer 28

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

Question 29

What are some examples of non-accidental trauma?

Answer 29

Shaken baby, SIDS, and domestic violence Period of purple crying (occurring during 2-3 months) – it’s okay to put them down

Question 30

What 3 things do we look for with prenatal imaging?

Answer 30

Congenital defects, hydronephrosis, and heart defects

Question 31

What is a full term baby?

Answer 31

37-42 weeks

Question 32

What is a late pre-term baby?

Answer 32

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

Question 33

What is a pre-term baby?

Answer 33

less than 37 weeks

Question 34

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

Answer 34

Not enough surfactant – therefore respiratory issues Also feeding issues

Question 35

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

Answer 35

low birth weight is less than 2500g | very low is less than 1500g

Question 36

What is chorioamnionitis?

Answer 36

An infection in womb; or maternal fever

Question 37

What should we always monitor in the baby during labor?

Answer 37

Decelerations in the heart rate or breathing

Question 38

What concerns do you have during the actual birthing process?

Answer 38

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

Question 39

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

Answer 39

Apgar scoring system

Question 40

What can meconium cause during birth?

Answer 40

It can be swallowed and cause a pneumonitis

Question 41

What infections do we look for in a neonate?

Answer 41

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

Question 42

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

Answer 42

Toxoplasmosis

Question 43

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

Answer 43

From cat litter and raw meat Tx with Pyrimethamine + sulfadiazine

Question 44

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

Answer 44

CMV

Question 45

How do you treat CMV?

Answer 45

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

Question 46

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?

Answer 46

Skin lesions!

Question 47

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

Answer 47

Encephalitis & skin lesions

Question 48

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

Answer 48

Gonorrhea, syphilis, and chlamydia

Question 49

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

Answer 49

Syphilis

Question 50

How do you treat syphilis?

Answer 50

PCN

Question 51

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

Answer 51

Chlamydia

Question 52

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

Answer 52

Rubella from their unvaccinated mother

Question 53

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

Answer 53

Group B strep! Remember some women deliver before 36 weeks

Question 54

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

Answer 54

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

Question 55

What does Group B strep cause in a neonate?

Answer 55

SEPSIS!!

Question 56

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

Answer 56

Sepsis!

Question 57

When is sepsis typically seen in neonates?

Answer 57

Birth – 7 days | Late onset is 7-28 days

Question 58

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

Answer 58

Flu, pneumonia, meningitis

Question 59

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

Answer 59

INVESTIGATE!

Question 60

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

Answer 60

Give them medication

Question 61

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

Answer 61

104

Question 62

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

Answer 62

They don’t need medication

Question 63

What labs do you do for sepsis in a neonate?

Answer 63

CBC, CRP, lytes, Bcx, UA, LP

Question 64

What treatment do you give for sepsis?

Answer 64

Ampicilin & Gentamicin – be aware of hearing problems

Question 65

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

Answer 65

Ibuprofen! MUST BE OVER 6 MONTHS

Question 66

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

Answer 66

Tylenol

Question 67

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

Answer 67

Hyperbilirubinemia due to pathologic cause

Question 68

What are some of the pathologic causes of hyperbilirubinemia?

Answer 68

Extrahepatic obstruction; cholestasis; and genetic/metabolic disorders

Question 69

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

Answer 69

Hyperbilirubinemia due to physiologic cause

Question 70

What are some of the physiologic causes of hyperbilirubinemia?

Answer 70

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

Question 71

How do you treat hyperbilirubinemia?

Answer 71

Treat the cause, phototherapy, and transfusion