Pediatic Review: Newborns

Question 1

What are the definitions of failure to thrive (FTT)?

Answer 1

1. Weight for age that falls below third to fifth percentile for gestation-corrected age and gender when plotted on an appropriate growth chart (on more than one occasion). 2. Infant who’s rate of weight change decreases over two or more major percentile lines (90th, 75th, 50th, 25th, and 5th) exhibit FTT (50th to 5th over several months).

Question 2

What are the major causes of FTT?

Answer 2

Inadequate dietary intake, diarrhea, malabsorption (celiac disease, cystic fibrosis, food allergy), poor maternal bonding, frequent infections, and others.

Question 3

What causes Down Syndrome?

Answer 3

A genetic defect caused by trisomy 21 (three copies instead of two).

Question 4

What is the most common chromosomal disorder?

Answer 4

Down Syndrome

Question 5

What is the average life span for a person with Down Syndrome in the U.S.?

Answer 5

60 years old

Question 6

What are the physical attributes of down syndrome?

Answer 6

1. A round face that appears “flat” (decreased anterior-posterior diameter), accompanied by upward-slanting eyes (palpebral fissures) and low-set ears. 2. Chronic open mouth caused by enlarged tongue (macroglossia). 3. Shorter neck with short broad hands with transverse palmar crease (simian crease). Newborns have hypotonia and poor Moro reflex. 4. Higher risk of congenital heart defects (50%), congenital hearing loss, visual problems, cataracts, sleep apnea, and early onset of Alzheimer’s disease (average age 54 years).

Question 7

Parental education should include what information?

Answer 7

High-risk sports (risk of spinal cord injury): contact sports (football, soccer), trampoline, or gymnastics. Avoid trampoline use, especially before age 6 years.

Question 8

What is the classic appearance (facies) of a newborn with fetal alcohol syndrome (FAS)?

Answer 8

A small head (microcephaly) with shortened palpebral fissures (narrow eyes) with epicanthal folds and a flat nasal bridge. There is a thin upper lip with no vertical groove above the upper lip (smooth philtrum). Ears are underdeveloped.

Question 9

What is another term for FAS?

Answer 9

Fetal Alcohol Spectrum Disorder (FASD)

Question 10

The effects of FASD can range from:

Answer 10

Severe disease with mental retardation to mild developmental defects that may not be obvious until adolescence (i.e., attention deficit disorder [ADD]).

Question 11

When is it safe for an expecting mother to drink alcohol?

Answer 11

There is no safe dose or time for alcohol during pregnancy. Alcohol adversely affects the CNS, somatic growth, and facial structure development.

Question 12

Cryptorchidism is a term which describes what condition?

Answer 12

Undescended testes (one or both); empty scrotal sac. Testis does not descend with massage of the inguinal area.

Question 13

The majority of cases (90%) of cryptorchidism are associated with what?

Answer 13

Patent processus vaginalis.

Question 14

Which techniques should be utilized when assessing for cryptorchidism?

Answer 14

Infant should be sitting and the exam room should be warm to relax muscles when massaging the inguinal canal. Another option is to examine child after a warm bath.

Question 15

What are the associated risks of cryptorchidism?

Answer 15

There is Increased risk of testicular cancer if testicles are not removed from the abdomen.

Question 16

How is cryptorchidism corrected?

Answer 16

Surgical correction necessary within the first year of life if testicles does not spontaneously descend (orchiopexy).

Question 17

What is the time of onset for Gonococcal Ophthalmia Neonatorum?

Answer 17

2-5 days after birth and is rapidly spread.

Question 18

Whar is a major adverse effect of Gonococcal Ophthalmia Neonatorum?

Answer 18

Blindness.

Question 19

Treatment for Gonococcal Ophthalmia Neonatorum should be delayed until culure results are available? True of False?

Answer 19

False.

Question 20

What are the symptoms of GON?

Answer 20

Symptoms include injected (red) conjunctiva with profuse purulent discharge and swollen eyelids.

Question 21

How is GON acquired?

Answer 21

Majority of cases of congenital gonorrhea infection are acquired during delivery (intrapartum).

Question 22

Is there any possibily that GON may have a coinfection?

Answer 22

Yes. Coinfection with chlamydia is common with gonococcal infection.

Question 23

Neonates < 30 days old should be tested for which conditions?

Answer 23

Chlamydia, gonorrhea, herpes simplex, and bacterial infection.

Question 24

Which tests (GON) should be ordered?

Answer 24

Gonococcal culture (Thayer-Martin), herpes simplex culture, and chlamydial polymerase chain reaction (PCR) with Gram stain of eye exudate.

Question 25

What is the approriate treatment/management plan for GON?

Answer 25

1. Hospitalize and treat with high-dose intravenous or intramuscular ceftriaxone.
2. Preferred prophylaxis is with topical 0.5% erythromycin ointment (1-cm ribbon per eye) immediately after birth.
3. Test (and treat) mother and sexual partner for sexually transmitted diseases (STDs).

Question 26

What is the time of onset for Chlamydial Ophthalmia Neonatorum (Trachoma)?

Answer 26

4-10 days after birth.

Question 27

What are the symptoms of Chlamydial Ophthalmia Neonatorum (Trachoma)?

Answer 27

Eyelids become edematous and red with profuse watery discharge initially that later becomes purulent.

Question 28

How should testing for Trachoma occur?

Answer 28

1. When obtaining a sample, collect not only the exudate, but also conjunctival cells as well.
2. Rule out concomitant chlamydial pneumonia.

Question 29

What is the appropriate treatment/management plan for Trachoma?

Answer 29

1. Treated with systemic antibiotics such as azithromycin IM or oral erythromycin base or erythromycin ethylsuccinate syrup QID x 14 days.
2. Treatment only 80% effective. May need second course.
3. Use only systemic antibiotics.
4. rophylaxis is with topical 0.5% erythromycin or tetracycline ointment (1-cm ribbon per eye).
5. Reportable disease.
6. Test (and treat) mother and sexual partner for STDs.