Swanson _ Children and Adolescents Flashcards
Normal respiratory rate in a newborn?
RR < 60 breaths/minute
Top 3 diagnoses on the differential for respiratory stress in term infants?
(1) Transient tachypnea of the newborn (TTN)
(2) Meconium aspiration syndrome
(3) Neonatal infection/sepsis
Of note, TTN and meconium aspiration syndrome occur immediately after delivery, whereas infectious etiologies manifest hours to days after birth.
TTN pathophysiology?
TTN results from residual pulmonary fluid in the neonatal lung and is more common after precipitous ( < 3 hours) and Caesarian deliveries, when there may be delay in the prostaglandin-driven dilation of lymphatic vessels that allows for removal of lung fluid with an increase in pulmonary circulation.
Neonatal infection/sepsis - common pathogens (4)?
Group B streptococci
S. aureus
S. pneumoniae
Gram-negative rods
Empiric antibiotic therapy for neonatal infection/sepsis?
Ampicillin + gentamicin
Top 3 diagnoses on the differential for hyperbilirubinemia in the newborn?
(1) Physiological jaundice
(2) Blood group incompatibility
(3) Infection
Preventive strategies (2) against hyperbilirubinemia in newborns born at 35+ weeks gestation?
(1) Nursing 8-12 times per day for the first several days
(2) Avoidance of water or dextrose water in nondehydrated infants.
Newborns should be assessed for jaundice every ___ during the first day of life.
Every 8-12 hours
Workup of infants with clinical jaundice in the first 24 hours of life?
Total bilirubin level
Workup of infants with clinical jaundice that persists past 3 weeks of age?
Total and direct bilirubin levels to evaluate for cholestasis
Total bilirubin level of ___ or higher should be considered a medical emergency. These infants should be admitted to the hospital for ___.
Total bilirubin level of 25 mg/dL or higher should be considered a medical emergency. These infants should be admitted to the hospital for PHOTOTHERAPY.
Physiologic jaundice begins on ___ and usually resolves in ___.
Physiologic jaundice begins on DAY 2-3 of life and usually resolves in 1-2 WEEKS.
Neonatal fever is defined as a rectal temperature greater than or equal to?
38 C (100.4 F)
All infants 0 to 30 days of age with fever should be admitted to the hospital and treated with?
IV ampicillin + gentamicin
-OR-
IV ampicillin + 3rd generation cephalosporin
Laboratory studies indicated in the evaluation of infants with fever without an evident source (5)?
CBC with differential Blood culture Urinalysis Urine culture Lumbar puncture
Recommendation for breastfed babies that are not exposed to sufficient sunlight?
Vitamin D supplementation
Iron supplementation to reduce the possibility of anemia may be begun in breastfed infants at what age?
6 months of age
At what age should solid foods be introduced to the baby’s diet?
Frequency of introducing new foods?
6 months of age
Add one new food every 1 to 2 weeks
The minimum standard for the growth and development of the newborn is a weight gain of ___ per day
20 g/day
All infants should regain their birth weight by what age?
10 to 14 days of age
Measures of adequate hydration in the thriving newborn:
# of wet diapers per day? # of stools per day?
5-6 wet diapers per day
2-3 stools per day
During the first few weeks and months of life:
Ideal feeding schedule? # feedings per day?
Ideal feeding schedule is FEEDING ON DEMAND
8 to 12 feedings per day
Infants cry for a variety of reasons. Best advice is to assume that crying indicates?
Crying may or may not indicate hunger. Assume that the baby needs to be fed until proved otherwise. If the baby refuses the breast, check for other causes of crying.
The main determinant of a good milk supply?
Frequent, effective milk removal
Causal candidates (4) for decreased milk production and let-down?
Anxiety, fatigue, stress, and postpartum depression
Colostrum
Colostrum provides (1) macrophages that synthesize complement, lysozyme, and lactoferrin, and; (2) antibodies against bacteria and viruses that protect against infection through the GI tract
Antibody of particular importance in colostrum?
IgA
Maternal mastitis:
Causal organism?
Treatment?
Staphylococcus aureus
First-line is cloxacillin or dicloxacillin
Erythromycin or 1st generation cephalosporin in pen-allergics
Maternal mastitis:
Continue/discontinue breastfeeding?
Continue breastfeeding and treat the mother with symptomatic treatments, such as hot compresses and antibiotics
Frequency of BMs in formula-fed babies?
BM every 1 to 3 days is adequate
Formula-fed babies generally have fewer stools than breast-fed babies
Use of pacifiers ok in breast-fed babies?
No
Infantile colic?
Unprovoked, unrelieved crying, starting in the afternoon hours and accompanied by the child having clenched fists and pulling its legs toward the abdomen
Established cause(s) of infantile colic?
None
Infantile colic - Wessel criteria (Rule of 3s)
Child cries for at least 3 hours per day for 3 days per week for at least 3 weeks, starting before age 3 months
In the evaluation of infantile colic, after a complete history and physical, what is the 1st lab test that should be ordered?
Urinalysis
Colic is more common babies of what demographic of mothers?
Smoking mothers
Risks (4) for occult bacteremia in a 1-year-old with fever?
Fever > 40 C (104 F)
WBC < 5,000
WBC > 15,000
Positive exposure history
Most common (4) organisms associated with occult bacteremia in a 1-year-old with fever?
S. pneumoniae (most common)
group A strep (S. pyogenes)
Haemophilus influenzae
Neisseria meningitidis
Risk of T > 40 C (104 F)?
Febrile convulsions/seizures
Most common conditions (4) associated with occult bacteremia in a 1-year-old with fever?
Otitis media
Bacterial pneumonia
Streptococcal pharyngitis
Meningitis
Fever of unknown origin (FUO)?
Fever > 38 C (100.4 F) for > 3 weeks with no diagnosis after 3 outpatient visits or 3 days in the hospital
Laboratory test indicated in a child 1-year-old (or younger) with FUO to evaluate for occult bacteremia as the cause?
WBC count
Prodrome of acute meningitis in infants 3-24 months of age?
Prodromal respiratory illness or sore throat often precedes the fever, headache, stiff neck, and vomiting that characterize acute meningitis
Laboratory test(s) indicated in a child 3-24 months of age with suspected acute meningitis?
CBC with diff
Blood culture
Urine culture
Lumbar puncture
MCC of acute meningitis in children ages 3-24 months?
S. pneumoniae
Other causes include
- Haemophilus influenzae
- Neisseria meningitidis
- Mycoplasma pneumoniae
- Listeria monocytogenes
Antibiotic therapy for acute meningitis?
Ceftriaxone (3rd generation cephalosporin)
Highly effective against common meningeal pathogens in patients of ALL ages
Analgesic agent of choice in the treatment of childhood fever and mild-to-moderate childhood pain?
Acetaminophen
Pediatric use of aspirin?
Contraindicated secondary to its association with Reye’s syndrome
Treatment of a viral URI and/or nasal congestion in an infant or young child?
Reassurance; supportive therapy with humidified air (cool steam) and/or nasal saline drops (nasal congestion) and bulb syringe suctioning of nasal passages
Antihistamines do not alleviate the symptoms of a viral URI to a clinically significant degree, especially in the pediatric population
Young children may develop seizures when given antihistamine doses that are meant for older children (on a mg/kg basis)
Centrally acting cough suppressants (dextromethorphan) recommended for treatment of cough associated with viral illnesses?
No
Adverse effects of cough suppressants in infants and young children?
Drowsiness, respiratory depression, abnormal limb movements, and coma in infants and children
Treatment of viral gastroenteritis in infants and young children?
Maintenance of hydration
Antimotility agents and antiemetics should not be used for the treatment of n/v symptoms
Teething begins at ___ and continues until ___.
Begins at 6-8 months of age
Continues until 2 years of age
