Quick Review - newborn Flashcards
Port Wine stain (nevus flemmus; stork bite, angel kiss)
Evaluate for Sturge-Weber syndrome (AV malformation)
-seizures, mental retardation, glaucoma
Hemangioma (red, sharply-demarcated benign tumor)
- 70% regress by 7 yo; observation
- consider underlying organ involvement if deep
Caput Succedaneum vs Cephalohematoma
Caput succedaneum: Crosses suture lines
Cephalohematoma: Does not cross suture lines
Preauricular tags/pits
Hearing loss: Hearing test
GU abnormalities: U/S of kidneys
Coloboma of iris (hole in iris)
Screen for CHARGE syndrome: CHD7 gene
Coloboma, Heart defects, Atresia of nasal choanae, Retardation (growth), GU abnormalities, Ear abnormaities
Aniridia (absence of iris)
Wilm’s tumor: WT1 chromosome 11
Screen for with abdominal U/S Q3 months until 8yo
Omphalocele
GIT protrustion WITH sac (failure of GI sac to retract)
-screen for trisomy; MC Edwards 18 (N inhibin A)
Gastroschisis
Abdominal defect lateral to midline WITH OUT sac
-Immediate surgical intervention
Umbilical Hernia
Screen with TSH; 90% close by age 3 yo
Hydrocele
-Painless, fluid filled scrotal swelling
Differentiate from inguinal hernia (reducible)
Undescended tested (cryptorchidism)
Surgical orchiopexy @ 6 months
> risk malignancy @ 1 yr.
Hypospadias (ventral)
Do not circumcise
Epispadias (dorsal)
Urinary incontinence; surgical evaluation for bladder exstrophy
Inguinal hernia (usually indirect)
Inguinal bulge or reducible scrotal swelling
-Surgery
Infant of diabetic mother
Hypoglycemia - large for GA, plethora, jittery, macrosomia
Tx: glucose, small meals
Infant of diabetic mother risks
- obesity, diabetes -truncus arteriosis
- small left colon syndrome -RDS
Erb’s paralysis (upper trunk C5 C6)
- adducted, internally rotated arm; forearm pronated
- good prognosis (80% fully recover)
- most feared risk: Phrenic N paralysis
Respiratory Distress Syndrome (RDS): testing
premature neonate within hours of birth
Best initial: CXR (ground glass appearance)
Best predictive: L/S ratio on amniotic fluid prior to birth
RDS: TX
initial: O2 + CPAP
effective: exogenous surfactant
prevent: betamethasone >24 hrs before birth or <34 wks gestation (not indicated postnatal)
Transient Tachypnea of Newborn (TTN)
-C section or rapid second stage labor
CXR: air trapping, fluid in fissures, perihilar streaking
Tx: oxygen; rapid improvement within hrs/days
> 4 hours = sepsis: evaluate with blood/urine cultures
Meconium Aspiration
CXR: patchy infiltrates, > AP diam., flattened diaphragm
Tx: +/high pressure ventilation, NO, ECMO
Prevent: ET intubation, airway suction in depressed infants
Diaphragmatic Hernia
CXR: Loops of bowel visible in chest/air fluid levels
Tx: Immediate intubation, surgical correction +/-ECMO
Meconium plugs (lower colon) Ileus (lower Ileum)
Abdominal XR
Tx: Ileus with gastrografin enema
TE fistula (nonbilous, 1st feed)
Dx: NG tube coils in chest
CXR: +/- new infiltrate (aspiration pneumonia common)
Association: VACTERL syndrome
Duodenal atresia (bilious, within 12 hours)
CXR: “double bubble” (air in stomach + in duodenum)
Tx: IVF/electrolytes; NGT decompression; Duodenostomy
Associations: Down’s, VACTERL, Polyhydraminos
VACTERL:
Vertebral defects: Anal atresia; Cardiac abn; TEF;
Renal; Limb syndrome
Necrotizing Enterocolitis (premature, bloody stools)
Abdominal XR: pneumatosis intestinalis (air in bowel wall, not lumen like normal; dilated loops with intramural air)
Tx: NPO; NGT; Broad spectrum; surgical resection
Failure to pass meconium (Hirschprung’s)
initial: rectal exam (large, voluminous passage after exam)
next step: barium enema (megacolon prox to obstruction)
confirmatory: rectal biopsy (absent ganglionic cells)
Physiologic jaundice
-undersecretion; starts day 2-3; peaks at day 5
if jaundice appears day 1 = pathological
Exaggerated physiologic jaundice (breastfeeding jaundice)
-due to dehydration, not enough milk
Tx: increase feedings 20 mins/1-2 hrs
Breast milk Jaundice
-due to factor in breast milk that > circulation of bilirubin
Tx: continue breastfeeding; usually resolves by 12th week
Jaundice: kernicterus
-Unconjugated crosses BBB -
hypotonia, seizures, choreoathetosis, SN hearing loss = immediate exchange transfusion
Bilirubin: > 10-12 mg/dL
Failure of therapy or suspected bilirubin encephalopathy
Phototherapy
Exchange transfusion
Neonatal sepsis: causes
- within first 24 hours - after 24 hours - > 1 month
within 24 hours: Pneumonia (Group B or E. Coli)
> 24 hours: Bacteremia or Meningitis (S. Aureus, E.coli)
> 1 mo:Bacteremia/Meningitis (N. meningitidis, S Pneumo)
Neonatal sepsis: Empiric treatment
< 1 month old Empiric Tx: Ampicillin + Gentamicin
< 1 month old meningitis possible: Ampicillin + Cefotaxime
> 1 month old: Cefotaxime
> 1 month old meningitis possible: Cefotaxime + Vanc
Seizures in newborn: Tx
1: Phenobarbital 2: Phenytoin + correct electrolytes
Substance abuse and neonatal withdrawal: tx
best initial if substance unknown: opioids + phenobarbital
Genetics/Dysmorphology:
Diagnosis: karyotype analysis
Turner syndrome: XO
Sporadic: no increased risk in other pregnancies
Estrogen-progesterone, GH, Vit D, Calcium
NF1
COFFINS
NF1 gene chromosome 17: autosomal dominant
Next step: opthalmologic exam (lisch nodules)
NF2
chromosome 22: autosomal recessive
- acoustic neuromas (bilateral deafness) + hypopigmented
FTT:
< 2 yrs old failure to gain weight (< 5th percentile)
first step: dietary modification (if stable)
malnutrition:
decreased weight > decrease in height
Next step: Oral rehydration w/ dobhoff tube (nasal psg)
- IVF only if pt is in shock/risk of heart failure
Diaper rash (diaper dermatitis)
Tx: oxide paste or petrolatum
Candidal infection
-involve skin folds; tomato-red plaques, satellite papules
Tx: clomitrazole cream or topical nystatin
Breastfeeding: contraindications
(1) HIV (2) CMV (3) HSV if on breast (4) HBV until vaccine
5) Breast ca. (6) substance abuse - alcohol, nicotine (7)Specific meds (8) acute disease absent in infant (TB
Infant botulism vs Adult botulism
-ingestion of spores in environmental dust (vs preformed)
Tx: Human-derived botulism immune globulin (vs equine)
Milestones: Delayed speech
Perform: Hearing/sensory test
Enuresis:
involuntary 2x/week for 3 months in > 5 yrs old
initial: UA; possible infection: culture;
recurrent: VCUG or U/S
tx: behavioral and motivational (alarms)
2nd line: tricyclic drugs, imipramine, desmopressin
Encopresis:
unintentional > 4 yo
initial: abd XR (distinguish btwn retentive and nonretentive)
Tx: Retentive (constipation) - stool softener, disimpact
Tx: Nonretentive (abuse) - behavior modification
Child abuse: Labs, Orders, Tx
initial: PT, PTT, platelets, BT, CBC; skeletal survey
severe: head CT/MRI, LFT, abd CT
Tx: treat medical/surgical issues then report to CPS
