Pediatrics: Newborns and Infants Flashcards

Question

Hypertropia

Answer 1

one one higher than the other

Answer 2

one eye lower than the other

Answer 3

double vision

Answer 4

"Lazy eye" - If corrected early, affected eye can have normal vision

Answer 5

- misalignment of one or both eyes ("crossed-eye") - Infants (<20 weeks) may have intermittent esotropia, which usually resolves spontaneously - some infants with obvious epicanthal folds appear "cross-eyed" (pseudostrabismus), but corneal light reflex will be normal → Refer to pediatric ophthalmologist if in doubt

Answer 6

- Abnormal red reflex (R/O retinoblastoma, cataract, glaucoma) - Presence of white reflex (R/O retinoblastoma) - Strabismus (R/O CN III, IV, and VI abnormalities, retinoblastoma) - >2-line difference b/w each eye - Esodeviation presents after 3-4 months of age - Corneal light reflex test w/ abnormal results - Shape/appearance of pupils not equal - New onset of strabismus (e.g., retinoblastoma, brain mass, bleeding, lead poisoning)

Answer 7

- Screening test for cataracts and retinoblastoma - abnormal if there are white-colored opacities (cataracts) or white spots (leukocoria) - determine presence of white reflex → R/O retinoblastoma → Refer to infant/pediatric ophthalmologist ASAP - Even if test is normal during visit, but parent reports that one eye appears white on a digital photograph → Refer - If absence or ↓ intensity of red reflex, R/O cataract and refer to pediatric ophthalmologist Procedure: - Perform test in a darkened room - use a direct ophthalmoscope and shine light about 12-18 inches away from the infant - Normal finding is symmetrical and round orange-red glow from each eye

Answer 8

- Red reflex exam on neonate shows a round, white-colored pupil

Answer 9

Light Reflex Test or Corneal Light Reflex - Screening test for strabismus - abnormal if corneal light reflex is not clear or if it's "off-center" Procedure: - Shine light directly in eyes (24 inches away) using a fixation target - Infant or child must look directly forward w/ both eyes aligned - Observe for the symmetry and brightness of light reflecting from both eyes

Answer 10

Universal screening for hearing loss is done while in nursery before discharge

Answer 11

- Each state has its own rules about neonatal hearing exams

Answer 12

- ;Measures CN VIII by use of "click" stimuli

Answer 13

1. as a response to loud noise, look for startles response (neonates), blinking, turning toward sound - measures the middle ear mobility only - less sensitive than auditory brainstem response (ABR)

Answer 14

H - Hyperbilirubinemia E - Ear infections (frequent) A - Apgar scores low at birth R - Rubella, cytomegalovirus (CMV), toxoplasmosis infections S - Seizures Premature infant sand infants admitted to NICUs have a higher incidence of hearing loss compared w/ full-term infants

Answer 15

- testing varies from state to state - blood is obtained by heel stick or from cord blood - a spot of blood is blotted into filter paper for stable transport

Answer 16

- federally mandated - Lack of thyroid hormone results in mental and somatic growth retardation - treated by thyroid hormone supplmentation

Answer 17

- PKU testing is federally mandated - severe intellectual disability results if not treated early * inability to metabolize phenylalanine to tyrosine d/t defect in production of enzyme phenylalanine hydroxylaze - Perform test only after infant has protein feeding (breast milk or formula) for at least 48 hours - higher risk of false negatives if done too early (<48 hours) Tx: - following special diet (phenylalanine-free diet)

Answer 18

- Required test can detect 4 types of hemoglobin: F, S, A, and C

Answer 19

- normal NB have Hgb F (fetal hemoglobin) and Hgb A - healthy term infants have enough iron stores to last up to 6 months - screening for anemia is done in late infancy (9-12 months) for healthy full-term infants - Not screened at birth because hemoglobin is ↑ from maternal RBCs mixed in fetal RBCs

Answer 20

- high-risk children (e.g., children living below poverty level or living in homes built prior to 1978) should be screened at 1-2 years (12 and 24 months)

Answer 21

Breastfeeding is preferred over formula - If formula chosen, start w/ one fortified w/ iron

Answer 22

1. Give Vit D drops (400 IU of vit D) starting in first few days of life if breastfeeding because breast milk alone does not provide adequate levels of vit D - Infant formula is supplemented w/ Vit D, iron, other vitamins, and essential fatty acids 2. Breast milk or formula contains 20 calories/ounce 3. ↓ risk of infections (e.g., otitis media) during the first few weeks of life

Answer 23

- Sticky and thick - yellowish fluid that comes before breast milk - Secreted first few days after birth - contains large amounts of maternal antibodies and nutrients (IgG antibodies)

Answer 24

- Avoid cow's milk the first year of life (causes GI bleeding) - Common cause of iron-deficiency anemia in babies and young children

Answer 25

- Recommended to wait until 4-6 months for complementary foods - start w/ a single-grain, iron-fortified baby cereal, mix w/ 4 tablespoons of breast milk/formula - serve 1-2 a day after bottle or breastfeeding - avoid feeding only rice cereal d/t possible exposure to arsenic - Introduce one food at a time for 405 days (if allergic, easier to identify offending foods)

Answer 26

- thick dark-green to black-colored stool, odorless - most full-term neonates pass meconium stool within a few hours of birth - Failure to pass meconium within 24 hours of birth is worrisome - may be a sign of intestinal obstruction, Hirschsprung's disease, or cystic fibrosis

Answer 27

- Caput succedaneum is diffused edema of scalp that crosses the midline - Caused by intrauterine and vaginal pressure from prolonged or difficult vaginal labor - scalp becomes molded and "cone-shaped" - self-limited and resolves spontaneously ** Caput succedaneum crosses midline and cephalohematoma does not (blood blocked byu scalp sutures)

Answer 28

AKA occipitofrontal circumference (OFC) - use paper tape (cloth tape stretches) and place above the ear - Avg head circumference at birth is 13.7 inches (35 cm) - Head circumference is measured at each wellness visit until 36 months (3 years) - In NB, chest is about 1-2 cm smaller in size than head circumference - head circumference will ↑ by 12 cm during first 12 months - fastest rate of head growth is during first 3 months os life (2 cm/month)

Answer 29

- Traumatic subperiosteal hemorrhage - R/O skull fracture → Order radiographs of skull - swelling does NOT cross the midline or suture lines

Answer 30

- Neonates lose up to 10% of body weight but should regain it by 2 weeks of age - double their birth weight by 6 months - triple their birth weight by 12 months

Answer 31

1. 6-8 ounces/week and 1 inch per month 2. 3-4 ounces/week and 1/2 inch per month If child's weight and/or length decelerates across ≥2 major percentiles, R/O FTT - any child who is at 3rd-5th percentile is considered to have FTT - Of many causes of FTT, the most common in primary care are undernutrition and malnutrition - Evaluate child, but do not forget to assess maternal bonding and depression

Answer 32

Length (linear growth) of infants is measured from birth to ~24 months - starting at 2 years, measure height (child is standing up) - calculate BMI - plot measurements on infants/child's percentile growth chart

Answer 33

Primary teeth Both left and right teeth erupt bilaterally at the same time (symmetrical) 1. symptoms are drooling, chewing on objects, irritability, crying, and low-grade fever 2. lower central incisors (lower front teeth) 3. Has complete set of primary teeth (20 teeth) - Will typically lose teeth in same order that they erupt

Answer 34

Deciduous Teeth @ 6 years of age - shed central incisors - first permanent teeth to erupt are upper and lower first molars

Answer 35

Urethral meatus located on ventral aspect of penis - location may be at the glans or shaft - some have 2 urethral openings → one opening is normal and other is lower on the glans/shaft → Refer to pediatric urologist * Urethral opening under glans/shaft

Answer 36

Urethral meatus is located on dorsal aspect (upper side) of penis * Urethral opening on top of glans/shaft → Refer to pediatric urologist

Answer 37

Presence of fluid inside scrotum (tunica vaginalis/processus vaginalis) resulting in swelling of affected scrotum - skin is normal color and temp - fairly common in NB males - Incidence is 10-20 causes/1,000 live births Transillumination - affected testicle(s) will show ↑ size in the "glow" of light compared w/ normal scrotum - darken room and place light source on scrotal skin - compared each scrotum * Used to asses for hydrocele, empty scrotal sac, and scrotal masses - Infant w/ hydrocele and transillumination → Scrotal sac w/ hydrocele will appear "brighter" or will have more light glow compared w/ scrotum w/ a testicle (solid objects block light, so less glow of light)

Answer 38

Caused by withdrawal of maternal hormones - disappears within a few days

Answer 39

- Retention of 1-2 testicles in abdominal cavity or inguinal canal - markedly ↑ risk of testicular CA and infertility - Order inguinal and abdominal US - corrected surgically before 12 months of age → Refer to pediatric urologist for eval b/w 6-12 months of age

Answer 40

White papules found on gum line resembling an erupting tooth

Answer 41

Gently stroke anal region - Look for contraction of perianal muscle * Absence is abnormal → suggestive of lesion on spinal cord (e.g., spina bifida)

Answer 42

Babinski Reflex - Upward extension of big toe w/ fanning of the other toes - Starting on heel, stroke firmly the outside of the sole toward front of foot

Answer 43

Grasp Reflex - Place finger on infant's open palm - infant closes its hand around finger - Pulling away the examiner's finger causes infant's grip to tighten

Answer 44

Startle Reflex - Sudden loud noise will cause symmetric abduction and extension of arms followed by adduction and flexion of arms over body - disappears by 3-4 months Absence on one side → R/O brachial plexus injury, fracture, or shoulder dystocia Absence on both sides → R/O spinal cord or brain lesion Older infant: Persistence of Moro reflex is abnormal → R/O brain pathology * A strong Moro reflex in an older infant (≥6 months) is abnormal and indicative of brain damage

Answer 45

- Hold baby upright and allow dorsal surface of one foot to touch the edge of a table - Baby will flex the hip and knee - place stimulated foot on tabletop (stepping motion) Absent w/ paresis and breech births - Disappears by 6 weeks

Answer 46

- Eyelids will close in response to bright light or touch

Answer 47

Fencing Reflex - Turning head to one side w/ jaw over shoulder causes arm and leg on same side to extend - arm and leg on the opposite side will flex

Answer 48

Stroke corner of mouth causes baby to turn toward stimulus and suck - disappears by 3-4 months

Answer 49

- Live attenuated virus - NOT recommended before 12 months (no effective d/t immature immune system) - If dose given before 12 months, must be repeated! - Avoid salicylates for 6 weeks (theoretical risk of Reye's syndrome) - Children age birth-12 years should NOT be given any aspirin or aspirin products (e.g., Pepto-Bismol, Paprin, Alka Seltzer, Kaopectate) 1st dose: 12 months 2nd dose: 4-6 years (preschool age) Prof of varicella: chickenpox hx or herpes zoster on chart y healthcare provider - record of 2 doses - or positive varicella titer

Answer 50

- Since 2016-17, CDC recommends injectable flu vaccines; nasal spray form is not to be used (live attenuated influenza vaccine) - Do not give influenza vaccines before 6 months; not effective d/t immature immune system - takes 2 weeks to produce antibodies after vaccination - Recommended for anyone ≥6 months (with rare exceptions) Esp for people w/: - children 6 months-4 years - congenital heart disease - asthma - cystic fibrosis - sickle cell anemia - heart disease - COPD - pregnant women during flu season - Native Americans/Alaskan natives - healthcare personnel - elderly - Trivalent inactivated influenza vaccines (protect against 3 types of influenza viruses) - Minimum age: 6 months → give fall to winter as injection - Quadrivalent influenza vaccines (protects against 4 types of influenza viruses)

Answer 51

- Age <6 months - Severe egg allergy → If hives only, can receive flu vaccine → but IF severe reaction to eggs (hypotension, wheezing, N/V) requiring med tx or epinephrine, pt can only receive flu vaccinee in Output or Inpt clinic that has provider who can tx anaphylaxis (e.g., epinephrine, intubation, O2) - Mod-severe illness w/ fever (wait until pt is better) - Hx of Guillain-Barre syndrome (GBS)

Answer 52

- Use of live influenza nasal spray (FluMist); recommendations change annually Avoid in: - Children < 2 years - Children 2-4 ys w/ wheezing within past 12 months - Child w/ other underlying conditions predisposing them to influenza complications → use inactivated form of flu vaccine (injection form) * Use inactivated injection form of flu vaccine

Answer 53

- has fewer side effects than older DTP form - Diphtheria-tetanus (DT) → used for infants and children < 7 years unable to tolerate pertussis component -Tdap: For ≥7 years - at 11-12 → give Tdap - Or if due for tetanus booster, give Tdap once in a lifeetime - Then Td (tetanus diphtheria) Q10 years for lifetime - If incomplete TDaP series and children ≥ 7 years, give Tdap instead - can be given to pregnant and breastfeeding mothers - Tdap given to children <7 years is NOT valid (use DTaP)

Answer 54

- fever (100.4ºF), up to 50% of pts - Swelling, pain, and/or redness at injection site, up to 50% of pts - Irritability in up to 50% of pts - Acute encephalopathy (1/110,000) Contraindications: - Severe allergic reactions - Encephalopathy (e.g., prolonged seizures, changes in LOC not attributed to another cause within 7 days of vaccine administration) Precautions: - Fever ≥105.0 º F w/in 48 hrs of dose - Seizures w/in <3 days of last dose - Collapse or shock-like state w/in 48 hrs of last dose Not considered contraindications: - Fam hx of seizures - Fam hx of SIDS - Fever <105ºF from prior DTaP vaccine

Answer 55

- national postmarking vaccine safety surveillance program in US managed by both CDC and FDA - report vaccine adverse events

Answer 56

By 15-18 months, the following vaccines are usually completed for most infants: - Hep B vaccine (3 doses) - Haemophilus influenzae type b (Hib) vaccine (several types of Hib vaccines; may required 2, 3, or 4 doses) - Pneumococcal vaccine (PCV 13, 4 doses) - Rotavirus vaccine (2-3 doses) - Hep A (HepA; 2 doses)

Answer 57

Hepatitis B - If Hep B surface antigen (HBsAg)-positive mother, give neonate hepatitis B immunoglobulin (HBIG) and Hep B vaccine

Answer 58

Do NOT use DTaP if ≥ 7 years; use Td or Tdap. Give Tdap vaccine at 11-12 as booster. If older, then replaced 1 dos of Td w/ Tdap (once in a lifetime)

Answer 59

Do NOT give before 12 months.

Answer 60

any vaccine that has a time range does not appear on exam Ex: - 3rd dose of inactivated polio (IPV) can be given from 6-18 months - 3rd dose of Hep B can be given b/w 6-18 months - Vaccine table here only contains childhood vaccines that must be given by a definite age (no "wiggle" room)

Answer 61

- Strong primitive reflexes (e.g., Moro, rooting, fencing) - Head lag - Grasps finger tightly if placed on baby's hand (grasp reflex) - Seedy yellow stool after each feeding (if breastfed) - Eats Q2-3 hrs or nurse 8-10 x daily - Does not produce tears when crying; tear ducts are not mature at birth - Sleeps 16 hrs daily - Report high-pitched cry, "catlike" cry → hypotonic microencephaly

Answer 62

- follows objects past midline - Coos vowels (e.g., "aa") and makes gurgling sounds - lifts head 45º when prone - Smiles in response to another

Answer 63

- Smiles spontaneously (social smile) - Begins to babble Fine Motor: - Brings hands to mouth - Can swing by dangling toys Gross Motor: - Holds head steady and unsupported - Rolls from front to back (supine to prone)

Answer 64

Fine Motor: - has palmar grasp of objects - Reaches for toys using palmar grasp - Brings things to mouth - Starts to pass things from one hand to the other Gross Motor: - Begins to sit up independently w/out support - Rolls over in both directions (back/supine to stomach and stomach to back/supine) Language: - Starts to say consonants (e.g., "da-da," "ba-ba") - Is very curious and will look around environment Report failure to follow objects pas midline (180º), poor eye contact

Answer 65

Fine Motor: - Pincer grasp starts and can pick up things (e.g., food) b/w thumb and forefinger - waves "bye-bye" - May clap hands and play clapping games (e.g., pat-a-cake) Gross Motor: - Pulls self up to stand - Crawls and "cruises" - Bears weigh well Language: - Plays peek-a-boo - "stranger anxiety" very obvious Report absence of babble, inability to sit alone, strong primitive reflexes such as Moro (startle reflex) or fencing (tonic neck reflex)

Answer 66

Fine Motor: - can use "sippy" cup Gross Motor: - stands independently - May walk independently - starts to cruise (moves from one piece of furniture to the next for support) Language: - can say 1-2 words other than repetitive sounds (e.g., mama, dada) - can say exclamations, such as "uh oh!" - knows first name Other: - Growth rate slows down - Follows simple directions such as "pick up toys" - report absence of weigh bearing, inability to transfer objects hand to hand

Answer 67

Fine Motor: - feeds self w/ spoon - can drink from a cup Gross Motor: - Walks independently for longer distances Language: - follows commands w/ gestures - vocabulary of 4-6 words

Answer 68

Fine Motor: - Turns pages of book Gross Motor: - Can walk up steps Language: - Can point to 4 body parts - Vocab of 10-20 words

Answer 69

- Advise pt to learn infant CPR/BLS - Avoid heating formula in microwave - Do not leave baby on changing station (e.g., to answer phone) - Do not position cribs next to strings/cords → when child is crawling, hide electrical cords - Close toilet seats (safety locks); lock bathroom doors; lock cabinets w/ cleaning products - Turn pot handles away from edge of stove; use rear burners on stove - Use safety locks for stove handles, low cabinets and doors

Answer 70

- Remove objects smaller than 2 inches - Cut up foods into smaller pieces (e.g., hot dogs, carrots, grapes) Examples of choking sources: - grapes - raw carrots - hot dogs - latex balloons - coins - buttons - Avoid giving hard candy to children <6 years - Encourage at least 1 parent to attend infant/child BLS course

Answer 71

- Infants and toddlers up to 2 years should be in rear-facing car seat - Safest plan in car for infant/child <13 years is back seat - Avoid used infant safety seat if its parts are missing or damaged - Air bags in cars can cause serious brain injury if they hit child's head or neck area - Turn off air bag on front seat if person who is using seat is under weight limit; usually set at 100 lb (check car manual)

Answer 72

Type of seat: - Rear-facing care seat w/ harness system until 2 years - convertible car seats can be used as rear- and front-facing car seats Notes: - Children <2 years are 75% less likely to be killed or injured in car crash if they are in rear-facing seat

Answer 73

Type of Seat: - Safest if rear-facing seat up to 2 years - forward-facing care seat w/ harness system - Weight-limit ranges from 80-100 lb (depends on brand) Notes: - Children ≥2 years (or if over the weight/height limit for rear-facing car seat) until they have reached weight limit

Answer 74

Type of seat: - Booster seats (belt-positioning booster seats) Notes: - Use until child has reached 4'9" or is 8-12 years - Shoulder belt should cross middle of child's chest/shoulders

Answer 75

type of seat: - seat belt w/ lap belt Notes: - All children ≤13 years should sit in back seat and use seat belt w/ lap belt

Answer 76

chronic exposure to second-hand smoke ↑ risks for: - SIDS - otitis media - bronchitis - pneumonia - wheezing - coughing - Also affects lung development and exacerbates asthma

Answer 77

- elevation d/t ↑ breakdown of fetal RBCs exceeding infant's liver capacity to conjugate bilirubin - Free, unbound, unconjugated bilirubin (breakdown product from old RBCs) is toxic to cells and can be deposited in tissue (e.g., brain, nerve cells) → necrosis - ↑ conjugated hyperbilirubinemia may indicate underlying ds but is NOT toxic to CNS Pathologic: - Jaundice w/in first 24 hrs of life → ALWAYS pathologic! - Evaluate for sepsis, congenital TORCH infections, occult hemorrhage, or erythroblastosis fetalis - Caucasian infant's color is yellow/orangish tinge or soles of feet are yellow - jaundice more difficult to detect visually in infants w/ darker skin, so blood tests should be done Jaundice of full-tern infant after 2 weeks of age: - Requires evaluation → consider sepsis, hemolytic ds, metabolic ds, intestinal obstruction - Bilirubin level ↑ too rapidly (>5 mg/dL daily) - Total bilirubin levels >17 mg/dL Nonpathologic: - Physiologic and breastfeeding jaundice most common - Consider breast milk jaundice if full-term exclusively breastfed infant w jaundice after 3 weeks of age

Answer 78

AKA neonatal unconjugated hyperbilirubinemia or neonatal icterus - jaundice appears when bilirubin level is ≥ 5 mg/dL - Jaundice first appears on head/face (sclera is yellow) and progresses down to chest, abdomen, legs, and soles o feet - Caucasian infant's color is yellow or orangish tinge, or soles of feet are yellow - Jaundice more difficult to detect visually in darker skin, so blood tests should be done - usually starts after 24 hrs and will usually clear up within 2-3 weeks - total bilirubin levels in Caucasians and African American infants can peak at 7-9 mg/dL, but Asian infants have higher peak values (10-14 mg/dL)

Answer 79

- onset is later than physiologic jaundice - usually starts to show after 4-5 days of life - peaks at 7-14 days - can take >1 month to clear - thought to be caused by a substance in breast milk that inhibits hepatic conjugation of bilirubin - bilirubin levels may exceed 20 mg/dL - often a brief (12-hr) period of breastfeeding cessation w/ pumping to maintain milk supple and fluid and caloric supplementation for infant will ↓ bilirubin levels enough to resume breast milk as sole nutritional source - some infants will also need phototherapy

Answer 80

- in contrast to breast milk jaundice, this is actually downstream sequelae of poor intake of calories and failure to produce stool - can also occur in bottle-fed infants w/ poor intake (less common)

Answer 81

2. - Check bilirubin level; use noninvasive methods first (transcutaneous bilirubin testing) - If suspect pathologic jaundice, order serum fractionated bilirubin level, Coombs test, CBC, reticulocyte count, and peripheral smear - Med intervention usually not needed unless total bilirubin levels are approaching or exceeding hour-specific values on a risk-based nomogram - Keep baby well-hydrated w/ breast milk or formula → feed infant Q2-3 hrs (10-12x daily) First-line tx: Phototherapy - light in blue spectrum is most effective wavelength - Skin converts bilirubin into nontoxic water-soluble form so it is excreted in urine - All newborns should be seen for follow-up within first 5 days of life to check for jaundice

Answer 82

3. Bilirubin encephalopathy/kernicterus: - neurologic ds caused by high levels of unbound bilirubin in circulation, damages infant's CNS - associated w/ severe intellectual disability and seizures

Answer 83

- Hgb ↓ at lowest level in life (nadir) at 8-12 weeks of age - Full-term infants' hgb ↓ to 9-11 g/dL - # of Hgb ↓ after birth d/t ↑ in oxygen availability and ↓ in erythropoietin production by kidneys - When hgb is at the lowest, O2 needs exceed body's ability to deliver it → stimulating erythropoietin production and RBC production from bone marrow

Answer 84

1. - AKA congenital nasolacrimal duct obstruction - occurs in approx 6% of newborns - usually resolves spontaneously w/in 6 months in majority of infants (90%) 2. Infant's mother c/o infant having: - persistent tearing - eyelash matting in morning on 1-2 eyes - no conjunctival erythema PE - when lacrimal duct is palpated, reflux of mucoid discharge or tears may be seen - yellow- to green-colored purulent eye discharge is abnormal in absence of other signs of infection → R/O acute dacryocystitis - can occur w/ chronic dacryostenosis - suggestive of bacterial overgrowth in lacrimal sac 3. - short course of topical antibiotics can be beneficial if copious or extremely bothersome - Lacrimal sac massage/compression → place clean finger on lacrimal sac, apply moderate downward pressure over lacrimal sac for 2-3 secs; perform maneuver 2-3 x daily 4. Acute Dacryocystitis - Look for redness, warmth, tenderness, and swelling in 1 of lacrimal ducts - occurs commonly w/ dacrocystoceles - culture discharge - tx w/ systemic antibiotics for 7-10 days to prevent complications of preseptal or orbital cellulitis - usually caused by streptococcal or staphylococcal organisms

Answer 85

- Goal when evaluating infant w/ colic is R/O conditions causing pain/discomfort, infections, environmental, and formula "allergy" Rule of 3's - Crying for no apparent reason lasting ≥3 hrs/daily in infant <3 months; crying usually occurs at same time each day - Crying occurs >3 days a week - Excessive crying usually resolves by 3-4 months

Answer 86

1. Congenital narrowing of a portion of aorta - most commonly coarctation is distal o subclavian artery - typically noted in area where ductus arteriosus attaches - NB may be asymptomatic if mild case of PDA (patent ductus arteriosus) - severe cases will have HF or shock w/ PDA closes - up to 30% of infants w/ this have Turner's syndrome - Female infants noted to have coarctation should get a karyotype analysis 2. - compare femoral and brachial pulses simultaneously - absence or delay of femoral pulse when it compared w/ brachial pulse is diagnostic S/Sx - neonate is pale, irritable, dyspneic, and diaphoretic Labs: - If abnormal, order cardiac echocardiogram, EKG, and CXR 3. May be asympatomatic - Take BP of both arms and thighs Normal: SBP higher in legs than in arms Abnormal: SBP higher in arms than thighs → palpate pulse in all 4 extremities; there is a delay or change in amplitude of pulses - bounding radial pulses are compared w/ femoral pulses

Answer 87

1. RF: - breech births - female - family hx - oligohydramnios 2. - look of asymmetry in creases of legs - examine infant front and back w/out diapers - check that gluteal, thigh, and popliteal folds match * if asymmetry of thigh/gluteal folds → R/O congenital hip dysplasia or hip fracture 3. - Barlow Maneuver/Test - Ortolani Maneuver/Test * Avoid performing both tests to many times pe visit, because hip ligaments can become damaged 4. - If either screening exam is positive, refer to pediatric orthopedist - Order US of hips 5. - Continue to perform Barlow and Ortolani maneuvers until child is fully weight bearing/walking - Look for leg that is turned outward - One femur appears shorter when infant is supine (Galeazzi sign) - hip has limited range of motion Abnormal: If preceding findings are present, order hip US and refer to orthopedic specialist

Answer 88

One femur appears shorter than infant is supine (in Dysplasia of the hip)

Answer 89

- Place index and middle finger over greater trochanter - Gently push both knees together at midline downward, then pull upward - will hear "clunk" sound when trochanter slips back into acetabulum (reducible dislocated hip) POSITIVE: "Clunk" sound or palpating trochanter being displaced by index/middle finger → Positive testing indicates that the femoral head is partially or completely dislocated from the acetabulum

Answer 90

- Hold each knee and place middle finger over greater trochanter (outer thigh over hips) - rotate hips in frog leg position (abduction, then adduction) - during abduction, resistance may be felt at 30-40º POSITIVE: "click" or "clunk" sound and/r if examiner palpates trochanter being displaced (temporarily) from hip socket → Positive testing indicates that the femoral head is partially or completely dislocated from the acetabulum