Peds 1

Question 1

What 3 risks should you consider for an SGA baby?

Answer 1

Hypoglycemia, Hypothermia, Polycythemia (increased hemoglobin/hematocrit)

Question 2

Treatment for Infants weighing more than 2000 grams born to mothers positive for hepatitis B surface antigen (HBsAg)?

Answer 2

• hepatitis B vaccine
• hepatitis B immune globulin (HBIG) within 12 hours of delivery, regardless of antenatal anitviral treatment.
• routine series of the vaccine beginning at age 1 month.

At 9-18 months of age, the child should be tested for anti-HBs (antibody to Hepatitis B surface antigen) and HBsAg, and, if found to have inadequate antibody protection, should be re-immunized.

Question 3

Treatment for Infants born to mothers not tested for HBsAg?

Answer 3

• hepatitis B vaccine within 12 hours of delivery.
• For infants with a birth weight of at least 2,000 g, administer HBIG by 7 days of age or by hospital discharge (whichever occurs first) if maternal HBsAg status is confirmed positive or remains unknown.
• For infants with a birth weight of less than 2,000 g, administer HBIG by 12 hours of birth unless maternal HBsAg status is confirmed negative by that time.

Question 4

What does classical Vitamin K deficient bleeding (VKDB) present as and when?

Answer 4

Clinical manifestations: bleeding from umbilical cord, bruising

Onset: 1 - 7 days after birth

Question 5

A 33-year-old G1P0 female with a history of medically controlled seizures gives birth vaginally to a boy with IUGR at 38 weeks’ gestation. The newborn is noted to have dysmorphic cranial features and his head circumference is 28.5 cm (< 5th percentile). What is another associated abnormality you might expect to see in this newborn? What do you suspect is the cause?

Answer 5

Cardiac defects

Mom was on anticonvulsants during pregnancy.

Question 6

A 19-year-old female in her 38th week of pregnancy goes into active labor. Within the first few days following birth, her baby is noted to have a high-pitched cry, tremulousness, hypertonicity, and feeding difficulties. The baby is otherwise developmentally normal and the remainder of the physical exam also is normal. Which drug was likely abused by mother during her pregnancy? What syndrome?

Answer 6

Heroin

Neonatal abstinence syndrome

Question 7

A 19-year-old G1P0 female presents in labor to the ED at 38 gestational weeks. When taking the history, it is discovered that she has had irregular prenatal care, drank a couple of beers every weekend, and smoked 4 cigarettes a day during her pregnancy. She delivers a baby boy who is small for gestational age. On exam, it is noted the baby has microcephaly, a smooth philtrum, and a thin upper lip. What do you suspect caused these features in the baby? What syndrome?

Answer 7

Alcohol exposure

Fetal alcohol syndrome

Question 8

During pregnancy, use of cocaine and other stimulants such as amphetamines does what to the body? What risk does this increase for the fetus/newborn?

Answer 8

Vasoconstriction

Placental insufficiency and LBW

Question 9

What substances, when used during pregnancy, increase the risk of LBW?

Answer 9

Cocaine and other stimulants, tobacco

Question 10

What is the management plan for a baby born to a group B strep positive mom? Ill-appearing vs well appearing?

Answer 10

Ill appearing → CBC, blood culture, CXR, LP, IV abx

Well appearing → CBC, blood culture, close monitoring in first few days of life

Question 11

What are 4 risk factors for early onset GBS disease?

Answer 11

1. Rupture of membranes > 18 hours
2. prematurity (<37 weeks)
3. intrapartum fever (>38C)
4. previous delivery of infant who developed GBS disease

Question 12

Newborn presents with microcephaly, cataracts/glaucoma, sensorineural hearing loss, and blueberry muffin rash. What congenital infection do you suspect? What’s the diagnostic tool?

Answer 12

Rubella

Dx w/ detection of rubella-specific IgM antibodies and stable/increasing rubella IgG monitored over several months

Question 13

Newborn presents with diffuse intracranial calcifications, hydrocephalus, and chorioretinitis? What congenital infection do you suspect? What’s the diagnostic tool?

Answer 13

Toxoplasmosis

Dx w/ positive toxoplasma-specific IgM, IgG, or IgA assay; increasing IgG titers in first year

Question 14

Newborn presents with microcephaly, cataracts, petechiae/purpura, hepatosplenomegaly, and thrombocytopenia. What congenital infection do you suspect? What’s the diagnostic tool?

Answer 14

CMV

Dx w/ urine or saliva culture that is positive for CMV (PCR or any other body fluid culture is okay)