Peds Exam Lecture 1 Flashcards
Chelation used for lead poisoning
Succimer 10mg/kg PO x 5 days, then Q12hrs for 14 days
RF for dyslipidemia
Obesity Fhx DM HTN Polycystic ovarian disease Hypothyroidism Smoker
MC used formula
Cow’s milk protein
What are hydrolyzed formulas good for?
Good for babies with fat malabsorption
What is lactose intolerance?
Intolerance of lactose (milk sugar)
Which infants MC have problem w/lactose?
Premature babies have decr level of enzyme to breakdown lactose
When is 2ndary lactose intolerance common?
After gastroenteritis and in celiac disease
When should solids be initiated?
A
What does folate deficiency cause?
A
What does vitamin C deficiency cause?
A
If you don’t have skin sx, is it considered anaphylaxis?
Yes
Where is Epi admin?
Lateral thigh
How are steroids used in anaphylaxis?
THEY’RE NOT
3 principles of determining an allergic reaction
- Objective
- Immediate
- Reproducible w/every exposure
Which allergies typically remain for life?
Peanuts, tree nuts, seafood
For which food allergies do children usu develop tolerance by school age?
Milk, egg, wheat, soy
T/F: Sensitivity incurs allergy
False
What must be evaluated for in a child w/biliary emesis?
Volvulus
Classic triad of intussusception
- Abd pain
- Vomiting
- Currant jelly stools
What causes the problems when infected with diphtheria?
Toxin from corynebacterium diphtheriae
What does the DTaP vaccine contain?
A
When is the DTaP vaccine given?
A
How many doses of DTaP are needed for protection?
A
What is the CI to Tdap?
Anaphylaxis after receiving Tdap components
Tdap vaccine admin in pregnancy
Need a new Tdap for each pregnancy (passive immunity)
what are the main principles of newborn care?
- smooth transition
- screening
- parental education/anticipatory guidance
what is considered the transition period for a newborn?
1st 4-6 hours of life
what normal physiologic changes happen as soon as the cord is cut?
- decr pulmonary vascular resistance
- incr blood flow to the lungs
- lung expansion with clearance of alveolar fluid
- closure of DA
what is the ductus arteriosus essentially a substitute for?
fetal lungs
mechanisms of heat loss in newborn
conduction, convection, evaporation, radiation
why do newborns where hats?
head is where they lose the most of their body heat
what is the normal newborn temp range?
97.7 - 99.5
how to prevent heat loss in newborn
remove wet linens, skin to skin contact, hat, swaddling
why is a preterm baby less able to regulate its body temp
doesn’t have as much brown fat and glycogen stores which is put on in the third trimester (esp last month)
what factors impact newborn blood glucose after cord is cut
- inadequate glycogen stores
- hyperinsulinemia
- increased glucose use
how does a DM mother impact a newborn’s glucose control?
baby sees the excess blood glucose causing it secrete more insulin - results in hyperinsulinemia and hypoglycemia
does a baby born to DM mother automatically get DM?
no
how does a hypoglycemic newborn present?
- lethargy
- poor feeding
- tachypnea
- jitteriness
- hypothermia
glucose screening guidelines for asx newborns at risk for hypoglycemia
- glucose w/i first 30-60 minutes of life (post first feed)
- baby should be fed frequently w/prefeeding glucose measured every 3-6 hours for first 24-48 hours
what should happen to HR if you flick a newborn’s heel?
its should increase
what is a normal newborn HR?
120-160
what is a normal newborn RR?
40-60
what can cause apnea in a newborn?
- maternal meds (mag sulfate which is used to slow delivery)
- neurological impairment
- sepsis
what is the difference between central cyanosis and acrocyanosis?
- central cyanosis (lips, tongue, trunk) may indicate disease
- acrocyanosis is normal w/i first 48 hours
how can you differentiate between a pulmonary and cardiac cause of central cyanosis
if you give baby 100% O2 - it does not correct
when is the APGAR score recorded?
1min and 5min
what is the APGAR used for?
can predict neurological outcomes (NOT predictor of neonatal mortality)
what is a newborn given in the delivery room?
vitamin K and erythromycin ophthalmic
what is vitamin used a ppx for?
vitamin K deficient bleeding (hemorrhagic disease of the newborn) in the first few weeks of life (all newborns born with low vitamin K)
what does a newborn need synthetic vitamin K?
- doesn’t transfer from mom to baby
- liver can’t produce clotting factors yet
- vitamin K is produced by gut flora which isn’t full developed yet
what is vitamin K deficient bleeding characterized by?
- bruising
- mucosal bleeding
- bleeding at umbilicus or circumcision
- intracranial hemorrhage
when and how is vitamin K administered?
first hours after birth
IM
why is erythromycin ophthalmic used?
to prevent gonococcal and chlamydia ophthalmia neonatorum
what is considered fill term?
39-40 weeks
early term
37 0/7 weeks - 38 6/7 weeks
what is chronological age?
time since birth
what is post-menstrual age?
gestational plus chronological age
what is gestational age?
time between LMP and delivery
what is the corrected age?
chronological age minus # weeks premature
RFs for birth injuries
- macrosomia (large infant > 4000gm)
- maternal obesity
- abnormal presentation (breech)
- operative vaginal delivery (forceps or vacuum)
- small maternal stature
- precipitous delivery (delivery w/i 3 hrs of contractions starting)
what is caput succedaneum?
- benign edema above the periosteum after prolonged fetal head engagement or vacuum
- soft swelling that extends over suture lines
- resolves within days
what is cephalohematoma?
- hemorrhage under the periosteum which is more common w/forceps of vacuum
- firm enlargement with distinct margins that do not cross suture lines
what is the course of cephalohematoma?
can increase for 12-24 hours after birth and then decreases over 2-3 weeks
what is a subgaleal hemorrhage?
- hemorrhage below the aponeurosis above the periosteum which is more common with vacuum
- diffuse fluctuant fluid waves that can go from the orbital ridges to the upper neck
what is the course of a sugaleal hemorrhage?
can increase steadily, usually resolves in 2-3 weeks
how is subgaleal hemorrhage treated?
blood products and volume (d/t decrease in HCT)
which brain injury is associated with erythema and bruising?
caput succedaneum
what is shoulder dystocia?
post delivery of the head
anterior shoulder cannot pass easily below the pubic symphysis
most cases = unilateral
complications of shoulder dystocia
- brachial plexus injury
- clavicular injury
- humerus fracture
- hypoxic-ischemic encephalopathy
- death
how is shoulder dystocia managed?
physical therapy weekly for at least 3 months
how can clavicular fracture appear on exam and what is done to manage it?
crepitus over clavicle sx treatment (warn parents calcium deposits can develop)
criteria for discharge of well term newborn
- stable vitals > 12hrs
- urine output regular
- spontaneous stool once
- no excessive circumcision bleeding >2 hrs
- screening for hyperbilirubinemia
- evaluate sepsis risk
- Hep B vaccine and review maternal vaccines
- blood spot, hearing, CCHD
- car seat
- F/U identified
- family education
- RF for safe home assessed
what are the characteristics of the meconium stool?
dark, sticky, odorless
when does the meconium stool typically occur?
first 48 hours
when should transitional stool start by and what does it look like?
occurs by day 4
lighter mustard colored, sesame seed stool
what should be considered with a delayed meconium?
- Hirschprung disease
- meconium ileum = likely CF
- imperforate anus or other obstruction
when does the first urination typically occur?
within first 24 hours
how should anuria be assessed?
- pregnancy eval (oligohydramnios?)
- assess feeding adequacy
- GU, Abd, spine exam
- cath, hydration, bladder & renal US
what are urate crystals?
orange pink substance often mistaken for blood common in first week of life
what is vaginal discharge a result of?
transmission of maternal hormones
when does newborn vaginal discharge typically occur?
3rd day of life and lasts a few days
weight fluctuation in newborns
can lose weight initially
most are back to birth weight by 2 wks
when is jaundice considered normal versus pathologic?
normal peaks at 3-4 days and resolves by week 1 or 2
pathologic in first 24 hours of life
when do premature infants usually have physiologic jaundice?
day 5
what is the main concern with neonatal hyperbilirubinemia?
BIND (bilirubin induced neurological dysfunction
acute bili encephalopathy, kernicterus
what are the causes of pathological jaundice?
hemolysis: immune mediated (ABO, Rh) membrane defects, enzyme defects, sepsis
polycythemia, cephalohematoma
decreased clearance or excretion: Crigler-Nijjar, Gilbert syndrome, hypothyroidism, galactosemia
intestinal obstruction
in which cases should early bilirubin monitoring occur?
if antibody positive (mother or infant) or if there is excessive infant jaundice
what are the major risk factors for excessive hyperbilirubinemia that may necessitate intervention
- early jaundice
- positive ab screen
- GA 35-36 weeks
- sibling who needed phototherapy
- exclusive breastfeeding
- East Asian
how does phototherapy help infant jaundice?
converts the unconjugated bili into water soluble byproducts which can be excreted in urine and feces
treatment options for bilirubin management
- phototherapy
- hydration
- IVIg
- exchange transfusion
what are the 3 components of the newborn screen?
- hearing screen
- heel stick blood sample
- pulse ox
what is the difference b/w breast feeding jaundice and breastmilk jaundice?
breast feeding: related to not getting enough calories, self limiting (improves with incr in milk production)
breastmilk: related to substance in breastmilk that inhibit UGTA and cause decr in bili conjugation)
what is the difference in timeline b/w breast feeding jaundice and breastmilk jaundice?
breast feeding: 2-4 days of life
breastmilk: 4-7 days of life, peaking in 1-2 weeks
when is blood spot screening performed?
in first 24-48 hours (after first feeding) - b/c some dz can not present until after feeding
what types of cardiac dz represent CCHD (critical congenital heart disease?
cyanotic lesions
ductal-dependent lesions
when should CCHD be screened for? why?
after 24 hours of life b/c requires intervention in first year of life
how is CCHD assessed?
pulse ox in right hand and foot
repeat 3 times, 1 hour apart
why is the right hand and right food specifically used to assess for CCHD?
right hand = pre-ductal
right foot = post-ductal
what type of hearing loss is most often present in newborns?
sensorineural
how is newborn hearing screened?
ABR (auditory brainstem response) or BAER or OAE (otoacoustic emissions)
what is considered a positive CCHD screen?
- O2 <90% in either place on 1 scans
- O2 90-94% in both places on 3 scans
- difference >3% between both places on 3 scans
how long does it take the umbilical cord to fall off?
10-14 days
newborn skin care
- sponge bath until cord detaches
- no need for frequent baths (every other day)
- avoid powders and direct sunlight
what is the typical timeframe for breastfeeding on demand?
Q2-3 hours
in terms of feeding what should be avoided in baby?
water, sugar water (d/t electrolyte disturbances
soothing techniques for crying
- reposition
- repeat/rhythm (sight, sound, touch)
- white noise
- closeness
when does crying peak?
2 months
when is crying more common?
late afternoon and evening
how long does an infant need to be rear-facing?
until 2 y/o or max height/weight
when is minimum discharge criteria typically met?
48 hours
