Peds High Yield Info Quiz 1

gestational weeks

Measurement of pregnancy duration in weeks.

based on the maternal last menstrual period

first ____ are considered the most critical

13 weeks

when is the highest risk of miscarriage

first 13 weeks

fertilization

union of 2 germ cells > zygotes > blastomere > morula (16 cells) > blastocyst

occurs in fallopian tube

organogenesis occurs during

embryonic period

endoderm

-inner layer

-GI tract, liver, pancreas, gallbladder, thyroid, parathyroid, bladder, urethra

mesoderm

-middle layer

ectoderm

-forms neural tube

neural tube formation

-3-4 weeks

-gives rise to the spinal cord and nervous system

what supplement do we give to prevent neural tube defect

-folic acid

what happens in the respiratory development during week 24-28

-extensive capillary network continues to develop and surfactant production begins

lungs grow for up to

8 years

surfactant

-substance necessary to keep terminal alveolar sacs expanded during expiration

the over rate of survival at 24 weeks barely exceeds 50% due to

pulmonary complications of prematurity

respiratory distress syndrome

-insufficient surfactant > alveolar collapse

bronchopulmonary dysplasia

-prematurity + use of ventilator therapy leads to maldevelopment of bronchopulmonary system

what happens to the heart in weeks 4-7

-undergoes extensive growth and morphological modifications, leading formation of septated chamber heart with primative valves

oxygenation in fetus occurs

in placenta

-oxygenated blood stay in fetal circulation and no in lungs

fetal circulation

-arterioles in low O2 enviroment > hypoxic pulmonary vasoconstriction > increased resistance of blood flow to arterioles > high pressure in right ventricle and atrium > overall pressure on right side being more

umbilical cord

-connection between placenta and fetus

-2 arteries and 1 vein

-keeps O2 from lungs

ductus venosus

-connection from umbilical vein to IVC

-bypass liver ciruclation

-oxygenated blood from placenta and deoxygenated blood from body gets mixed

foramen ovale

-opening between atria

'-shunts or moves blood from higher pressure righ atrium to lower pressure left atrium

-bypass lungs

ductus arteriosus

-blood vessels connecting pulmonary artery to aorta

-shunts blood from pulmonary atery to aorta

-kept open by prostaglandin

internal iliac artery gives rise to

umbilical artery

full term

-40 weeks

-3500 g or 7.7 lb

term infants

>37 weeks

late pre term

between 34-37w

moderate preterm

32-34 weeks

very preterm

28-32 weeks

extremely preterm

less than 28 weeks

birthweight classification

Extremely low birthweight= <1000g

Vey low birthweight= <1500g

Low birth weight= <2500 g

Normal Birth weight= 3500g

preterm infants lack

-corrdinate sucking, swallowing, breathing

-lack of body fat store

-pulmonary immaturity

-predisposes intraventricular hemorrhage

-compromises nutritional management

what supplement is recommended for all preterm infants

-iron

apnea

-respiratory cause lasting >20 sec

-apnea of prematurity is most common cause

hyaline membrane disease

-most common cause of respiratory distress in preterm infant

- >50% infants born at 26-28 weeks

-caused by surfactant production deficiency > poor lung compliance > trying hard to breathe > respiratory failure

CXR of hyaline membrane disease shows

-bilateral atelectasis with ground glass appearance

hyaline membrane disease prevention

-antenatal administration of corticosteroids to mother

-surfactant administration

Nectrotizing Enterocolitis

-most common acquired GI emergency

-cellular damage, cellular death, necrosis of colon and intestine

-sx: abdominal distension, heme + stool

necrotizing enterocolitis dx

-abdominal plain film series

-pneuatosis intestinalis

-tx: removal of necrotic bowel and ostomy vs end to end anastomosis

Intraventricular hemorrhage

- 50% occur before 24 hr of age and virtually all occur by fourth day

-confimed with ultrasoun

-routine scanning done at 10-14 days in all infants born before 29w

retinopathy of prematurity

-leadign cause of blindness

-all infants for <30 w or <1500 g should be screened with dilated fundoscopic exam

follow up

-outpatient follow up within 2-3days

new born period

first 28 days of life

newborn medical hx

1.maternal and parental medical and genetic hx

2.maternal past obstetric hx

3.current antepartum and intrapartum obstetric hx

APGAR score

-standardized assessment of a newborns health immediately after birth

-at 1 and 5 min of age

-normal 7-10

-requires immediate resuscitation 0-3

skin exam

-color: visible jaundice <24 hr never normal

-facial redness= polycythemia

head and face

suture lines: palpate all should be freeky mobile

mouth

-observe and palpate for any cleft palate deformities

neck and chest

asses clavicals for any evidence of fracture: crepitus, deformity, bruising

cardio

auscultate heart sounds for extra sounds, murmurs

MSK/spine

ortolani and barlow maneuvers

neurologic developmental reflex

-stepping

-startle

-sucking

-palmar grasp

-tonic neck

-plantar grasp

-babinski reflex

routine preventative measures in nursery

-prophylactic erythromycin to the eyes

-1mg vit K IM or SQ for hemorrhage

-hep B

-heel stick blood collection

-hearing screening

feeding

-healthy full term should feed every 2-3 hr on demand

-increased from 0.5-1 to 1.5-2 on day 3

what vitamin is recommended for all exclusively breastfed infants

vit D

healthy newborn should gain

1oz a day

neonatal jaundice

-65% of newborn develop visible jaundice with TSB higher than 6

-extremely high levels rare but can cause bilirubin encephalopathy and kernicterus, deafness, neuro defects

routine bilibrun screening for

ALL newborns at 24-48 hrs after birth

total bilibrun

direct (conjugated) + indirect (unconjugated)

-unconjugated most common from in neonatal period

combs test if

corn for pathologic cause of neonatal jaundice

physiologic jaundice

-unconjugated bilirubin

-after birth there is increased turnover in fetal RBC > production of more bilirubin and less clearance

-visible jaundice AFTER 24 hr

breastfeeding jaundice

-unconjugated bilirubin

-AFTER 24 hrs

pathologic neonatal jaundice

-FIRST 24 hr of life

-caused by hemolysis > unconjugated billirubinemia from RBC lysis

-serum bilirubin= elevated

-fractioned bilirubin= unconjugated hyperbilirubinemia

-coombs test= +

-RI= normal

neonatal jaundice tx

-supportive care

-phototherapy

-anemia patients need transfusions

transient tachypnea

-mild short term self limiting condition

-delayed clearance of fetal lung fluid via the circulation and pulmonary lymphatic

-resolution usually occurs within 12-24hr

meconium aspiration

-earliest stool of newborn

-MSAF newborns pass meconium during labor

maternal opiods use

-withdrawl: problem sleeping and feeding, fever, seizure

-begin 1-3 days

-4-5x risk of SIDS

maternal alcohol use

-fetal alcohol syndrome

-determined by degree and timing of ethanol exposure

-IUGR or small, feeding issue, sleep issue, delayed speech, low IQ

maternal use of tobacco

-nicotine concentration are 15% higher than in maternal blood

-infants exposed to nictoine are increased risk for preterm labor and SIDS

well child check

review basic developement: milesone, sleep, nutrition, screeing

milestone are

progressive

-childreen should not lose milestones previously accomplished

-regression can be indicative of developemnt disorder

2 mon milestone

-holds fingers closed but begins to open hands

4 mon milestone

-holds head without support, swings arm, hold toy, brings hand to mouth, pushes up on elbow

vital signs

-height

-weight

-BMI at age 2

-head circumference

-temp

-BP at age 3

-RR

-HR

growth parameters

-height and weight at every visit

-children under 2 plot weight-for-length

-children over 2 plot BMI

-head circumference

-18 mon most children tend to follow the curve

1-2w visit

-infant should be at or above birth weight

-umbilical cord should be off

chronologic age is a

poor indicator of physiologic and psychosocial development

puberty

-activation of the hypothalamic-pituitary gonadal axis in late childhood

-nutrition and general health can affect this

growth spurt

-girls: 11-12

-boys: 13-14

-last about 2-4 years and longer in men

sexual maturation in females

-first sign is growth spurt

-development of breast buds at 8-11

-menarche is usually 2 years after breast budding

-9-15

sexual maturation in males

-increase in testicular volume with reddening

-thickening of scrotal skin

-10-12

confidentiality

-adolescents are more likely to disclose sensitive information if they are assured confidentiality

-can be broken for life-threatening concerns of self or others

-offer private time w pt starting at 10

HEADSS assessment

-Home

-Education/employment

-Activities

-Drugs/diet

-Sexuality

-Suicide/depression

(for appropriate psychosocial hx)

depression screening

-starting at age 12 yearly universal screening

-PHQ-S Questionnaire

abuse and violence

-ask if there is presence and security of firearms in the home

-leading cause of death in american children and teens

pharmacological screening

-reserved for situations in which the patients behavioral dysfunction or medical condition are of sufficient concern to outweigh practical and ethical drawbacks of testing

adolescence physical exam

-vital signs, BMI, CDC, BP

-skin

-spine: scoliosis

adolescence GU exam

-important for determining puberty stage

-sextual maturity rating: Tanner Score

tanner stages female breast and genitalia

-stage 1: no development

-stage 2: breast bud

-stage 3: further enlargement

-stage 4: projection of areola and papilla

-stage 5: mature stage

tanner stage genitalia

-stage 1: vellus is over area

-stage 2: sparse growth of long, slightly pigmented

-stage 3: hair is darker and coarse

-stage 4: hair is know adult are is covered

-stage 5: hair is adult in quanility and type

male GU exam

-tanner score

-chest

-genitalia: testicle and penile

tanner stage genitalia male

-stage 1: testes and scrotum and penis same size

-stage 2: testes get larger, thickening and reddening of skin, light hair

-stage 3: growth of penis in length and width, more hair darker

-stage 4: further largening of penis and scrotum and dark hair

-stage 5: genitalia in adult size, adult hair

BP screening starts at

3 years old

BP percentiles

-prehypertension: 90-95

-stage 1: 95 to >99

-stage 2: 99 +5 mmHg

obesity screening

-screen all children ages 3-18 for obesity

-calculate BMI and plot

-BMI >95th percentile = obese

anemia screening

-all children at 12 mon of age with CBC or H/H

increased risk of IDA from

-excess or early cows milk intake >16-20ox per day

lead screening

-all children at age 1 and 2 with serum lead level

-repeat testing ages 3-6

hearing screening

-newborns

- 4,5,6,8,10 years

vision screening

-ages 3-5 refer is worse than 20/40

-ages 6+ refer if worse than 20/30