Pediatric Diseases - Block 4 Flashcards
Describe the categories of pre-term neonates?
Late: 34-37 W
Moderate: 32-34 W
Very: 28-32 W
Extremely: less than 28 W
What is gestational age?
Time between last mentrual period and day of birth
What is postnatal age?
Time sinse birth
What is postmenstrual age?
GA plus chronological age
What is very low BW? extremely?
1500 g
1000 g
Examples of preterm complications?
- Respiratory distress
- Congenital heart defects
- Intraventricular hemorrhage
- SZ
- Necrotizing entercolitis
- Hypoglycemia
- Jaundice
- Sepsis
How do assess neonatal cardiopulmonary resuscitation?
Tone, RR, cry, HR
Target lungs not heart
How do you treat Neonatal cardiopulmonary Resuscitation?
- Initiation of positive pressure ventilation, positioning airway, clearing secretions, intubation
- Chest compression if HR <60
- Epinephrine <60 for 30 seconds
Routes of epinephrine use?
IV (umbilical)
IO/endotracheal (longer onset)
What is the difference between EOS and LOS?
EOS: withing 3 days of birth and risk factors originate from mother
LOS: after 3 days of life and risk factors from hospitalization, NEC
What are the sites of infection?
- Pneumonia
- UTI/pyelonephritis
- Menangitis
- Bacteriemia
What are the clincal prensentations of spesis in neonates?
Temp instability, feeding intolerance, lethargy, grunting, flaring, retractions, apnea
Meningitis -> bulging fontanelle and sz
What are the clincal prensentations of spesis in children?
Fever, loos of appetite, emesis, myalgia
Meningitis -> Nuchal, back pain, Kernig, Bruzinski, HA, photophobia, sz, altered mental status
Recommend temperature route for <4YO?
Rectall
Low grade fever?
100-102
High fever?
104
Normal body temp?
98.6
Temperature that qualifies for antipyretics?
101
What is the diagnosis for infection?
In serum:
↓ WBC
↓ ANC
↑ I:T
↑ CRP
Diagnosis for meningitis?
In CSF:
↑ WBC
↑ Protein
↓ Glucose
What is the tx for sepsis?
Abx based on culture
What are the types of congenital heart defects?
Acyanotic: artial and ventricular septum defects, patent ductus arteriosus
Cyanotic: tetralogy of fallots, hypoplastic left heart syndrome, transposition of the great arteries
What is paten ductus arteriosus?
High prostaglandin -> failure of ductus closure -> right to left shunt
Tx for patent ductus arteriosus
Prophylaxisis (24H of birth)
Eary sx (1-3 days)
Late sx (7-10 days) - surgery
Indomethacin
Ibuprofen
APAP
Monitoring for Indomethacin and IBU?
UO
Monitoring for APAP?
LFTs
WHo are more prone to patency?
Preterm infants who have:
1. Incomplete metabolism of PG
2. Increased sensitivity of PG
3. Increased ductus tone
4. Decreased muscle fibers of the ductus
What are the alterations of tetralogy of fallots?
- Override of aorta
- Hypertrophy of right ventricle
- Pulmonary stenosis
- Intraventricular septal defect (right to left shunt)
What are the alteration of hypoplastic left heart syndrome?
- Hypoplastic left ventricle
- Hypoplastic ascending aorta
- ASD
What are the alterations of transposisition of great arteries
Pulmonary arteries and aorta are switched
What is the tx for cyanotic heart defects?
PG E1 (aprostadil) IV infusion 0.05-0.1 mcg/kg/min
What is the definition of neonatal hypotention?
- Below 5th-10th percentile
- Loss of autoregulation of organ blood flow
- MAP below GA of the infant
What are the labs associated with neonatal hypotention?
- Capillary refill times >3 secs
- HR >160 bpm
- Weak pulse
- Mottled skin
- Lethargy
- Metabolic acidosis
- Decreased UO
What is the tx for neonatal hypotention?
- Fluid bolus 10-20 mL/kg IV
- Dopamine
- Epinephrine
- DObutamine
Medications for adult hypotention and refractory neonates?
- NE
- Vasopression
Uses of hydrocortisone in hypotension?
Not recommneded for routine uses
What is the difference between under and oversedation?
Under: accidental displacement of tube and catheter
* Ax and stress
Over: Increased hospital cost
* Longer hospitalization
* Prolonged need of mechanical ventilation
Tx for pain and sedation?
- Sucrose
- APAP
- Morphine
- Fentanyl
- Midazolam
- Dexmedatomidine
What are the non pharm for pain?
- Swaddling
- Pacifier
- Skin to skin
- Massage
- Feeding
- Reduce pain interventions
- Bundled bed care
What are you upper respiratory infection?
- Otis media
- Acute bacterial rhinosinusitis
- Acute pharyngitis
What is AOM?
Middle ear effusion: bulging tympanic membrane and fluid
Middle ear inflammation: erythema, otalgia
What is OME?
Fluid in middle ear with no infection
What is recurrent AOM?
3+ episodes of acute otis within 6 months or 4+/yr
What is the most common RF of AOM?
Day care attendance
Common pathogens that cause AOM?
- Viral
- S pneumonia
- H influenzae
- Moraxella catarrhalis
Describe the tx for AOM?
When should OME get Abx?
Bilateral effusions for 3 months
What is given during delayed abx prescribing?
APAP 10-15 mg/kg Q4-6H
IBU 5-10 mg/kg Q6-8
For infants ≥ 6 months
What are the types of lower respiratory tract infections?
- Bronchiolitis
- Pertussis
- Acute bronchitis
- Influenza
- Community acquired pneumonia
What is pertussis?
Whooping cough:
Contagious 102 weeks or 2 weeks of onset of cough
What are the phases of pertusis?
Catarrhal: 1-2 wk of cold sx
Paroxymal: 1-6 wk pf cough and whoop
Convalescent: weeks to months of slow resolution
What is the tx for pertusis?
Macrolides:
1. Azithromycin PO QD for 5 days
2. Erythromycin
3. Clarithromycin
Alt is allergic to macrolides: Bactrim x 14 days
* Not for <2 months due to ↑ bilirubin and kernicterus
What are the presentation of RSV?
Neonates: lower respiratory sx, wheezing, lethargy, fever
Children: upper respiratory tract sx
What products are used for RSV prophylaxis?
Non pharm: Avoid crowds during season, handwashing
Pharm: Palivizumab 15 mg/kg durign season
*Beyfortus IM
How is Beyfortus dosed?
<5kg -> 50 mg
>5kg -> 100 mg
2nd season and severe risk -> 200 mg
What is the tx for active RSV?
Supportive care: O2 supplementation, mechanical ventilation, hydration
Ribavirin: acitve RSV for high risk patients
- Inhaled beta2 agonist
- CS
- Antibiotics (only for concurrent bacterial infection)
What are acute viral gastroenteritis?
- Rotavirus
- Enteric adenovirus
- Norovirus
What are the sx of rotavirus?
Intubation: 1-3 day (vomiting, low grade fever, water diarrhea)
Diarrhea lasts 4-8 days
How do you prevetn Rotavirus?
- Good hygiene
- Prevention of fecal-oral contamination
- Vaccination
What is the tx for rotavirus?
- Supportive to prevent dehydration and malnutrition
*DO NOT USE ANTIDIARRHEAL
What is ProQuad?
MMR and varicella -> ↑ febrile sz
Interchangability of DTap?
Must use same the brand for first 3 doses of 5
Interchangeability if Tdap?
Boostrix or Adacel may be used for booster dose
Interchangeability of HepB?
Engerix-B and Recombivax HB is Interchangeable
Interchangeability of Polio
Not recommended
Interchangeability of Hib?
Yes
Interchangeability of HPV?
Gardasil products against 4 types (6, 11, 16, 18) and Cervarix 2 types (16 & 18)
CI for immunization?
- Anaphylaxis
- Febrile illness
- Immunodef and pregnancy
- Intussusception (rotavirus)
- Admin of immune globulin (MMR, Varicella)
Preterm infants vaccinations?
- Immunize according to chronologic age
- Do not lower vaccine doses
- If birth weight < 2 kg, delay HepB until neonate is 30 days old or at hospital discharge
Immunocoprimised immunization?
- No live vaccines
- Household contacts should not receive oral polio vaccine
Corticosteroid patients immunization?
Live vaccines for topicals, maintenance, low-mode but not high doses
HIV immunizations?
Live vaccines are not recommneded due to immunocompromised
What are the culture-proven sepsis ranges? For meningitis?
10-14 days
Meningitis: 14 days from G+, 21 days for G-
How do you do with negative cultures?
Abx should be discontinued by 36-48 hr or as soon as clinicla imporvement is seen
What are factors to consider for Abx selection?
- EOS vs LOS
- Empiric vs known bug
- Location of infection
What is the tx for empiric Abx for EOS?
Ampicillin + AMG (or cefotaxime)
What is the tx for empiric abx for LOS?
Vancomycin + gentamycin (or amikacin)
