18- poor feeding Flashcards Preview

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Flashcards in 18- poor feeding Deck (21):
1

organic causes of failure to thrive

Congenital heart defects
Cystic fibrosis
Gastroesophageal reflux
Neurologic disorders
Metabolic disease

2

definition of FTT

an infant is < 5th percentile for weight
an infant is < 5th percentile in weight for length, or
the rate of growth results in the infant crossing more than 2 major lines on the standard infant growth curve.

3

presentation of CHF in infant

dyspnea with feedings
diaphoresis
poor growth
an active precordium
hepatomegaly

4

regular newborn resp rate

40-60

5

are diastolic murmurs always pathologic?

yes

6

differential for hepatomegaly in infant

Congestive heart failure
Congenital infections
Inborn errors of metabolism
Anemias, and (less commonly)
Tumors.

7

most common murmur in child and in what ages

innocent murmur
3-7 yo

8

questions to ask to make sure the murmur is innocent

Is the child otherwise well?
Is the precordial activity normal?
Is the second heart sound normally split?
Is the murmur less than or equal to grade II/VI?
Is the oxygen saturation normal?

9

which murmurs are heard better as kids rather than infants?

ASD and bicuspid aortic valve

10

bicuspid aortic valve presentation

early systolic click made by the abnormal valve when it opens (occurring shortly after the first heart sound, signifying the end of isovolumic contraction when the aortic valve opens to allow left ventricular outflow)

11

heart defects that can cause CHF

VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus

12

what tests should you do to assess murmur in infant?

EKG
Echo
chest x ray

13

EKG findings in small, moderate, and large VSD

small- EKG normal

mod- LVH (LV overload)

large- RVH (RV overload- pulm HTN)

14

EKG in normal infant compared to normal adult

more right ventricular voltage, and have a more rightward axis

reason: lungs not contributing as much to ventilation --> PVR elevates--> RVH--> rightward axis

15

when do congenital heart disease infants need to be admitted?

sepsis
cyanosis
CHF

16

how does VSD cause CHF?

The infant with a VSD is supplying enough blood to the tissues to meet the body's metabolic needs, but is doing so from an elevated filling pressure (due to the left ventricular volume overload). The adequate cardiac output is achieved by creating a high adrenergic state and by activating the renin-angiotensin system. Many of the symptoms of CHF in the infant are caused by these neurohormonal changes.

17

why isn't VSD heard in the nursery?

elevated Pulm vascular resistance in newborn

18

drugs to treat CHF

furosemide- rid fluids

digoxin

enalapril- ACEI decrease SVR

19

what to do if VSD doesn't decrease by 6 months?

camrdiopulm bypass surgery to avoid eisenmengers syndrome (late cyanosis from pulm HTN)- live until 20s

20

does ASD cause CHF?

no

21

Still's murmur

most common innocent murmur

vibratory, musical, low pitched

heard at lower left sternal border