Maternal Ch 14

Hydrocephalus

Increase of CSF, can be congenital or acquired

C-section, at birth head enlarges rapidly

• Bulging fontanels, shiny scalp, looking downward eyes, helpless + lethargic, poor muscle tone, shrill and high-pitched cry, irritability, vomiting, convulsions

• barely able to raise head, delayed mental development

Hydrocephalus Tx

• Head measured daily, change positions frequently, placed side-lying after feeding

• Acetazolamide and furosemide reduces CSF

• VP shunt → fluid is absorbed in peritoneal cavity and shunt is replaced during growth, pumped to help drainage

  • Malfunction: increasing ICP, headache, lethargy

• Sunken: flat, bulging: semi-fowler’s

S/S of infection of VP Shunt

increased VS, vomiting, pupil dilation, seizures, decreased LOC

Spina Bifida Occulta

minor, tuff of hair, no treatment

Spina Bifida meningocele

contains membranes and CSF

Spina Bifida meninigomyelocele

CSF and nerves, paralysis of legs and poor control of bowel function

Spina Bifida Tx

surgical closure

habitation: learning rather than relearning

legs remain paralyzed, incontinent (Oxybutynin can increase bladder storage)

Delivery: moist, sterile dressing on sac, placed prone with pad in between legs, frequent cleansing of skin

Latex allergy: bananas, kiwis, avocados, balloons, tennis balls adhesive strips

Clubfoot

foot that is twisted inward or outwardC

Clubfoot Tx

splinting/casting, passive stretching if not effective by 3 months, surgery is indicated

Developmental Hip Dysplasia

limited abduction of affected side, knee is lower, skin folds of thigh are deeper and asymmetrical

• Ortolani/Barlow test: feel click, characteristic limp

TX: pavlik harness (2 months) → spica cast (several months). If neither works, surgery

less severe cases: double diapering. Ensure baby is kicking with both legs, neurovascular checks with cast

Phenyletonuria

genetic disorder, faulty metabolism of phenylalanine in all protein foods

Severe cognitive delay, urine test positive = brain damage has already happened

FTT, eczema, musty odor, personality disorders, seizures

PKU Diagnosis and Tx

blood test done 48-72 hrs of life

Close dietary management and frequent blood checks

Lofenalac or Phenex 1 or 2

Blood levels between 2 - 10 mg/dL

Meconium Aspiration Syndrome

newborn aspirates meconium stained amniotic fluid, can also occur if infant takes first breath before mouth/nose is suctioned

Neonatal Abstinence syndrome

fetus has prenatal exposure to drugs: opiates, amphetamines, tranquilizers etc

• Tremors, hyper-irritability, wakefulness, diarrhea, poor feeding, sneezing, yawning

Tx: Quiet environment, swaddling

Transient Tachypnea of newborn

occurs after c-section or rapid vaginal delivery

Tachypnea, chest retractions, grunting, mild cyanosis

Resolves suddenly in 3 days

Down Syndrome

screening done in 1st trimester, ultrasound of fetal nuchal fold and nasal bone, 2nd trimester blood test

Close-set upward slanted eyes, small head, protruding tongue, deep straight line across the palm, hands are short and thick, little finger is curved, loose joints

Prone to respiratory + ear infections, speech and hearing problems