Pediatrics: Block 1 Flashcards
What two phases is the prenatal period divided into?
What period overlaps the Prenatal and Postnatal periods?
Embryonic- first 8wks
Fetal- after 8wks of gestation
Perinatal- 20-28wks of gestation through 1-4 weeks after birth
Define Perinatal Mortality
What are the two most common causes of it?
Fetal death between 20wks EGA through 28 day pos-delivery
Congenital abnormalities
Prematurity <37wks
What is the range for normal respiration for newborns?
What is the range for normal heart rates? What ranges are indicative of necessary interventions needed?
30-60/min
120-160
>100: routine care
60-99: ventilation
<60: ventilation and chest compressions
What is the correlation between pediatric age, HR, BP and R?
How many chest compression and compression/breath ratio during NRP?
As they get older HR and RR decreases, BP increases. “Adult-like” around 12 y/o
120bpm
3 compression : 1 respiration w/ two thumbs method (preferred) or two finger method
When placed supine on tables, what breathing position do babies take?
When administering O2 to newborns by blow by, how much is used?
Sniffing position
Blow by= 10L/min @ < 1/2” from face
BVM= sniffing position @ 40-60/min
Intubated= done if no chest rise/fall w/ BVM and allows for med delivery and preferred for transport
What is done for neonatal HOTN?
What drugs are given for HR?
What drugs are given for opioid use/abuse?
10mL/kg NS or LR
Epi 0.1-0.3mL/kg or 1 : 10,000 for IV/ETT for Asystole/Brady and unresponsive to O2
Narcan- narcotic/opioid reversal 0.1mg/kg IV/IM/ET
DONT if mom is addict/methadone, leads to withdrawal seizures
USE if mom received opioids/short term use during delivery
What type of issues are seen in Hemorrhagic Disease of Newborns?
Generalized echymosis
GI bleeds
Umbilical stump bleeding
Circumcision bleeding
If baby is bottle fed, what does the formula need to contain when 4-6mon of age is reached?
Fe- deficiency risk starts at 4mon,
Starting @6mon: 1mg/kg/day, max 15mg
Vit D- 400 IU/day for first days of life; deficiency= rickets, most common in first 2yrs of life
What are the results of rickets in babies?
Craniotabes- thin skull, fells like ping pong ball
Thickened wrists/ankles
Rachitic Rosary- costochondral junction enlargement
Enlarged anterior fontanelle/delayed closure
Bow leg/knock knees
During a newborn exam, what does an enlarged anterior fontanelle greater than 5cm suggests ? issue
Define Craniosynostosis
Hypothyroidism
Closed fontanelles
Define Leukocoria
During newborn exams, how would congenital heart d/os present?
White reflex in the eye
Can be cataract, retinoblastoma, chorioretinits, hyperplastic primary vitreous, retinopathy of prematurity
Systemic Sxs, murmur may not be heard
What are the negative, false result and positive screenings for pulse oximetry for newborn screening and what are the next steps?
All 3 done at 24hrs of life or shortly before discharge
95% or more on R hand/foot w/ 3% difference= negative screening, plan for discharge
90-94% and 3% or less difference= repeat screening in 1hr. If repeat results are in low range, repeat again in 1hr. 3 readings in this range need echo
<90% in R hand or foot= positive screening result, Echo
What do each of the following findings during a newborn exam indicate? Weak pulse Bounding pulse Single second heart sound Continuous harsh holosystolic murmur Grade 3 or higher murmur Hepatomegaly
Poor CO- aortic stenosis High CO- PDA Cyanotic HDz- truncus arteriosus, hypoplastic left heart Pathologic Pathologic Pathologic L HF
Newborn exam should show a soft and round abdomen, what does a scaphoid shape mean?
Define Barlow and Ortolani maneuvers
Diaphragm hernia
Hip dysplasia indicator test
Ortalani- clunk of hip relocating anteriorly
What are the risk factors of congenital hip dysplasia
How is it evaluated?
Female, FamHx, Breech, First born, Oligohydramnios, Post natal swaddling
US suspicious findings or risk factors @ 4-6wks old
When are the following reflexes gone by Fencer/Asymmetric neck reflex Trunk Incurvature/Galant Placing Rooting- turns cheek to stimulus Moro Grasp Babinski
3mon 4mon 4-6mon 4-6mon 6mon 6mon 12-28mon
Define Caput Succedaneum
Define Cephalohematoma
Common boggy edematous swelling of scalp that crosses suture lines and resolved in 3 days
Less common swelling that doesn’t cross suture lines and resolves in wks/mon but can lead to jaundice
Define Subgaleal Hemorrhage
Rare subaponeurotic bleeding result of vacuum delivery that crosses suture lines and pushes ears anteriorly and increases risk of jandice; Tx by compression and resuscitation
Define Epstein Pearls
Define Vernix Caseosa
Keratin cysts, resolve in first weeks
Salivary tissue- Bohn nodules
Chalky white/gray mixture of epithelial cells, sebum, keratin and hair
Common in pre-terms
Thought to be protective/lubricant in womb
Define Milia
Define Milia Rubra
White smooth papules on face/scalp from epidermal occlusion of pores
Self limited and resolving
Overheated/febrile heat rash as erythematous papules
Tx by correcting over heating
Define Mongolian Spot
Define Cafe Au Lait Macules
Blue/black pigments on lower back/butt in AfAm/Asian/Indian infants that fades in life
Must be documented
Sharply defined oval macules/patches
6cm or larger Cafe or 5cm or larger diameter need further eval of neurofibromatosis, tuberous sclerosis, McCune-Albright Syndrome
Define Nevus Simplex
Define Nevus Flameus
AKA Salmon Patch
Stork bite- nape of neck
Angel kiss- forehead/eyelid
Transient and benign
Port wine stain from malformed capillary bed
Must consider Sturge-Weber Syndrome on face (trigeminal nerve distribution)
Define Erythema Toxicum Neonatorum
Define Neonatal Acne
Pustules w/ erythematous base appearing on back and trunk 24-48hrs after birth that lab results will show eosinophils and resolves in 2wks
Acne on cheeks/scalps in first few weeks of life from maternal estrogen
Define Cutis Marmorata
Define Cradle Cap
Mottling
Physiologic response to cold, resolves w/ warmth that decreases w/ age
If persistent: hypothyroid, vascular/congenital issue
Seborrheic Dermatitis
First sign of atopic dermatitis
Can treat resistant/persistant cases w/ mineral oil, white petrolatum emollient or medicated shampoo