PEDIA ABNORMAL BATT EXAM

85-90%

Weight at birth 1250g-1500g

20%

Weight at birth 500g-600g

before 37 weeks

Gestational age of preterm Infants

Frail, weak, limp, skin translucent, abundant vernix & lanugo

Characteristics of preterm infants

Easily exhausted, from noise and routine activities, feeble cry

Behavior of preterm infants

Inadequate respirations

Inadequate thermoregulation

Fluid and electrolyte imbalance

Assessment for preterm infants

after 42 weeks

Gestational age of post term infants

Skin – peeling, vernix sparse, lanugo absent, long fingernails

Characteristics of post term infants

Post term infants

Increase risk of meconium aspiration

Hypoglycemia

Loss of subcutaneous fat

SMALL FOR GESTATIONAL AGE

Infant whose weight is at or below the 10th %

Causes of SGA

anything restricting utero-placental blood flow, Smoking, DM, PIH, Infections

SGA

Results from failure to thrive

failure to thrive

inability to meet the recognized standard of growth

Respiratory distress syndrome

-#1 cause of death

-nyaline membrane disease

-due to lack of lung surfactant

-developed first 24 hours

Bronchopulmonary dysplasia

developed 1-2 weeks, not mature alveoli

Periventricular leukomalacia

irreversible, brain damage that affects white matter

retrolental fibroplasia

increased oxygen concentration that leads to blindness (.5 L/min O2 in NB)

Necrotizing Enterocolitis

intestinal disease that causes intestinal tissue to die.

-causes hole in intestines

SGA

Complications: Hypoglycemia, Meconium Aspiration, Hypothermia, Polycythemia

large for gestational age

Infants weight is in the 90th % for neonates same gestational age, may be pre, post, or full term

infants

maternal diabetes

most common cause of LGA

RESPIRATORY DISTRESS SYNDROME

Causes: prematurity, C/S, diabetic mothers, birth asphyxia – interfere with surfactant

RESPIRATORY DISTRESS SYNDROME

Signs & Symptoms

 Tachypnea - over 60/min

 Retractions - sternal or intercostal

 Nasal flaring

 Cyanosis- central

 Grunting- expiratory

 Seesaw respirations

 Asymmetry

RESPIRATORY DISTRESS SYNDROME

Therapeutic Management

 Surfactant replacement therapy

 Installed into the infant’s trachea

 Improvement in breathing occurs in minutes

 Doses repeated PRN

MECONIUM ASPIRATION SYNDROME

-Occurs most often among post term infants, decreased amniotic fluid /cord compression

Meconium Aspiration syndrome

Signs & Symptoms

 Tachypnea

 Cyanosis

 Retractions

 Nasal flaring

 Grunting

Meconium Aspiration syndrome

Treatment: Suction at birth, may need warmed, humidified oxygen, or ventilators

NEONATAL SEPSIS

It occurs in less than 1 % of newborns (1 out of 100), but accounts for up to 30 percent of deaths in the first few weeks of life.

30 percent of deaths

Neonatal sepsis occurs in less than 1 % of newborns (1 out of 100), but accounts for up to _______ in the first few weeks of life.

NEONATAL SEPSIS

A type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever.

bacterial blood stream infection (BSI)

Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a ________ in the setting of fever.

fever

Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of _______.

Early-Onset Sepsis (EOS)

– refers to sepsis presenting in the first 7 days of life (although some refer to EOS as within the first 72 hours of life)

Late-Onset Sepsis (LOS)

– refers to presentation of sepsis after 7 days (or 72 hours, depending on the system used).

Neonatal sepsis

is the single most common cause of neonatal death in hospital as well as community in developing country.

Pathologic Jaundice

– occurs within first 24 hours

Phototherapy

– bilirubin on skin changes into water-soluble excreted in bile & urine

Bilirubin levels in term

>12

Bilirubin levels in preterm

10-14

Most common cause of hyperbilirubinemia

– blood incompatibility of mother and fetus, Rh or ABO – only occurs with mother negative Rh or O blood

shelf life of ampicillin

30 mins

shelf life of gentamicin

24hours

shelf life of clindamycin

48hours

kernicterus

- jaundice in the brain

eye patch

during phototherapy because of retinal damage or detachment

clindamycin

Although uncommon, if anaerobic species are suspected (such as in cases where necrotizing enterocolitis or intestinal perforation is a concern, _______ is often added.

beta-lactam antibiotic (usually ampicillin), aminoglycoside (usually gentamicin) 

a common antibiotic regimen in infants with suspected sepsis is a ___________ in combination with an ____________

Side effects of phototherapy

: frequent, loose, green stools; skin changes

Exchange transfusions

– if lights not working 

Macrosomia

face round, red, body obese, poor muscle tone, irritable, tremors

jitteriness or tremors

Most frequent symptom of macrosomia:

fed, gavage or IV

treatment for macrosomia

 Hypoglycemia

occurs 15-50% of time & <40-45 mg/dl, test right after birth, q 2hX4, then q 4 hrX6 until stable

 Prenatal alcohol exposure

is the most common preventable cause of mental retardation

MOTHER WITH SUBSTANCE ABUSE

• Use of alcohol or illicit drugs.  Tobacco and alcohol are most frequent

 Opiates

• – 48-72 hours

Cocaine

– 2-3 days

Alcohol

– within 3-12 hours

INTUSSUSCEPTION

 Is a medical condition in which a part of the intestine folds into the section next to it.

small bowel

Intussusception typically involves the _______ and less commonly the large bowel.

males

In Intussusception, _______ are more often affected

6 to 18 months old

• The usual age of occurrence in intussusception

Dexamethasone

• may decrease the risk of another episode of intussusception

enema with surgery

Treatment in children for intussusception is typically by an ___________ used if this is not successful

Intussusception

is an emergency requiring rapid treatment.

adults

In ______, surgical removal of the part of the bowel is more often required.

brachial palsy

- arms extended and not moving

shoulder dystocia

-locked shoulder

hypoglycemia

if there is gestational diabetes the baby will have ________

brain damage

hypoglycemic baby may lead to _________

spinal headache

after lumbar puncture patient should be flat on bed to prevent

high dose ampicillin

after rupture of membrane to prevent infection

hypoglycemia

feed breastmilk to avoid necrotizing enterocolitis until glucose is stable

FAILURE TO THRIVE

Indicates insucient weight gain or inappropriate weight loss

weight

In children, failure to thrive is usually defined in terms of ___________

Failure to thrive

In children, it is usually defined in terms of weight, and can be evaluated either by a low weight for the child’s age, or by a low rate of increase in the weight

Endogenous (or organic)

Due to physical or mental issues with the child itself. It can include various inborn errors of metabolism

endogenous, exogenous, and mixed

Causes of failure to thrive

Exogenous (or nonorganic)

Caused by caregiver’s actions

Mixed

-A child who is not getting sufficient nutrition may act content so that caregivers do not offer feedings of sufficient frequency or volume.

-A child with severe acid reflux who appears to be in pain while eating may make a caregiver hesitant to offer sufficient feedings.

Failure to thrive

occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain.

before two years of age, when growth rates are highest.

Failure to thrive is typically present at which age?

scaling skin, spoon-shaped nails, and neuropathy

may indicate potential vitamin and mineral deficiencies.

Wasting

deceleration in stature >2 standard deviations from median weight-for-height.

Stunting

drop of >2 standard deviations from the median height-for-age.

REFEEDING SYNDROME

is caused by a shift in fluid and electrolytes in a malnourished person as they receive artificial refeeding. It is potentially fatal, and can occur whether receiving enteral or parenteral nutrition (TPN).

SUDDEN INFANT DEATH SYNDROME

“Crib Death” is the sudden death of an infant, usually under 1 year of age, which remains unexplained after a complete postmortem investigation, including an autopsy, examination of the death scene and review of the case history

Child abuse

-Major cause of death in infants after 1st month of life

− Sudden & silent in an apparently healthy infant

− Unpredictable & unpreventable

− Quick death with no signs of suffering - usually during sleep

60%

percentage of child abuse in male

40%

percentage of child abuse in female

COLIC

is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child between the ages of two weeks and four months.

crib death

other term for sudden infant death syndrome

infantile colic

other term for colic

two weeks to four months

infant colic’s age of occurrence

evening

In infant colic, often crying occurs in the ________

unknown

The cause of colic

blood work, X-rays, or other tests.

Based on the information gained from the history and physical examination, a workup can then be conducted, in which possible sources of FTT can be further probed through:

Less than 10%

of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease.

over two hours a day, with the duration peaking at six weeks.

infants normally cry an average of just

TRISOMY 21

A genetic disorder caused by the presence of all or part of a third copy of chromosome 21.