Pulmonary Peds Flashcards
what to observe in newborns
gender respiratory effort assessment of color deformation or malformation assessment of movement
what does lanugo mean?
fine hair all over the body
preterm baby has more
more muscular tone and hyper-reflexia
cradle crap
seborrhea (all over body)
- usually self limiting
- emollient, gently exfoliation with soft brush
- use topical ketoconazole cream or low potency steroid
salmon patches
“stork bites”
- benign
- nervus simplex
angle kisses
capillary malformations
-benign
facial infantile hemangioma
fade with time
-benign
transient neonatal pustular melanosis
- lesions eventually fade
- no treatment needed
- small rashes, fade after days-weeks
- can have some hyper-pigmentation after pustules fade, does go away
sicking blisters
vesicles or bullar at sites of excessive suckling
- mongolian spot
- don’t fade over time
acropustulosis of infancy
pustules on extremities
- hands and feet
- benign
- can use steroids topically
milia
very common
- pearly spots across nose
- retention of keratin in pilosebaceous units
cutis marmorata
vascular response to cold
erythema toxicum
diffuse rash, over face and trunk
-appears 24-48 hours, disappears 5-7 days later
no treamtent
neonatal acne
appears 3 weeks of age
- resolves by 4 months
- gently cleansing only needed
port wine stain
large macuole across face
-if across V1 distribution across face-> Sturge Weber syndrome
cephalohematoma
sub-periosteal hematoma does not cross suture lines
-may calcify
caput secundum
- edema superficial to periosteum extends across suture lines
- can see jaundice if have a bilirubin problem
congenital glaucoma
increased IOP, abnormal angle
white pupillary reflex
leukocoria
-retinoblastoma, congenital cataract
ear normal set?
line from inner epicanthal fold should transect top third of the ear
choanal atresia
one nares not open
bite in uvela
submucosa cleft palate
epsteins pearls
benign inclusion cysts on palate
webbing of neck is common in
turner’s syndrome
what are signs of distress in newborns
tachypnea nasal flaring subcostal retractions grunting cyanosis
ground glass syndrome
respiratory distress syndrome
HMD
most common mass felt in newborns
hydropnephrosis
kids that are born breach most likely will have
hip dysplasias
trisomy 21
epicanthal folds, upslanted palpebral fissures, flat nasal bridge, protruding tongue, low set ears, brushfield spots, simian crease on palm, space between first and second toes (sandal gap), excess skin at nape of neck, hypotonia
second most common trisomy
trisomy 18
Edwards syndrome
trisomy 18
prominent occiput, low set ears, clenched hand, rocker bottom feet, severe congenital heart defects
-survival into school age possible
trisomy 13
patau syndrome
- cleft lip, clenched hand, overlapping fingers, polydactyl, clubfoot, aplasia cutis congenita, congenital heart defects
- usually survive to 6 months
risk factors for trisomy 21
advancing maternal age
most important things to look for in newborn screening?
congenital adrenal hyperplasia
congenital hypothyroidism
cystic fibrosis
sickle cell disease
clinical jaundice is first noted in
sclera and face
upper limit of normal adult bilirubin
1mg/dL
direct bilirubin is
conjugated
-can’t be absorbed my intestinal cells, broken down by intestinal bacteria enzymes
indirect bilirubin is
un-conjugated
hyperbilirubinemia in newborns
increased supply: life span of fetal RBC only 85 days
decreased metabolism: bilirubin clearance decreased in newborns and increased enterohepatic circulation
infants have what kind of intestine?
sterile
- no bacteria present to convert conjugated bilirubin to urobilirubin
- beta glucuronidase in intestinal wall deconjugates bilirubin, which is then reabsorbed
BIND
bilirubin induced neurological dysfunction
- total bili >25-30 mg/dL
- basal ganglia and brainstem nuclei for auditory and oculomotor function most affected
ABE
acute bilirubin encephalopath
- infant initially sleepy but arousable, mild hypotonia, high pitched cry
- difficult to console, hypertonia with arching neck and trunk. Seizure, respiratory failure
Kernicterus
chronic and permanent sequelae and BIND -first year after birth cognitive function relatively spared choreoathetoid cerebral palsy (dystonia, tremor, chorea) sensorineural hearing loss limitation of upward gaze
