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Block 4 - Peds > Clin Med - Developmental Peds > Flashcards

Clin Med - Developmental Peds Flashcards

(46 cards)

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1
Q

For age 1wk to 1 month: amount/feeding & times/day

A
  • 2 to 4 oz
  • 7 to 8 (more for breastfed babies)
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2
Q

For age 1- 3 month: amount/feeding & times/day

A
  • 5 to 6 oz
  • 5 to 7 times/day
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3
Q

For age 3 - 6months: amount/feeding & times/day

A
  • 6 to 8 oz
  • 4 to 6 times/day
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4
Q

For age 6 - 12months: amount/feeding & times/day

A
  • 7 to 8 oz + incr amts of solid foods
  • 4 bottles/day & 2 to 3 meals of solid foods
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5
Q

Preventative Measure Taken @ birth

A
  • Erythromycin ointment
  • Vitamin K
  • Hep B Vax
  • newborn genetic screen
  • Congenital Heart Dz screen
  • Hearing screen
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6
Q

Contraindications to early newborn discharge (5)

A
  1. Jaundice </= 24hrs
  2. High risk for infx
  3. Known or suspected narcotic addiction or withdrawal
  4. Physical defects requiring eval
  5. Oral defects
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7
Q

Relative contraindications to early newborn discharge

A
  1. Premature or early term infant
  2. Birth weight <2700 g (6lb)
  3. Infant difficult to arouse for feeding; not demanding regularly in nursey
  4. Medical or neuro problems that interfere w/ feeding
  5. Twins or higher multiples
  6. ABO blood group incompatibility or severe jaundice in prev. kids
  7. Mother who prev. breast-fed infant w/ poor weight gain
  8. Mother w/ breast surg involving periareolar areas
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8
Q

What is considered hypoglycemia in newborns?

A
  • BG <50mg/dL @ birth - 4hrs
    OR
  • BG <45mg/dL 4-25hrs
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9
Q

RFs for hypoglycemia

A
  • LGA
  • SGA
  • IUGR
  • Preterm or post-term birth
  • Perinatal stress
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10
Q

Tx for hypoglycemia

A
  • start feedings w/n 1hr (at risk or sx neonates
  • start IV glucose (10% dextrose & H2O)
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11
Q

What are the 5 types of neonatal jaundice?

A
  • Physiologic
  • Pathologic
  • Bilirubin toxicity
  • Acute bilirubin encephalopathy
  • Chronic bilirubin encephalopathy
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12
Q

What are the main reasons for unconjugated hyperbilirubinemia? (3)

A
  • Incr bilirubin production
  • Decr rate of conjugation
  • Unknown/Multiple Factors
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13
Q

What are the 3 main causes of incr bilirubin production?

A
  • antibody mediated
  • non-antibody mediated
  • non-hemolytic
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14
Q

List the two antibody mediated causes of pathologic jaundice.

A
  • ABO incompatibility
  • RH isoimmunization
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15
Q

List the 2 non-antibody mediated causes of pathologic jaundice.

A
  • Hereditary Spherocytosis
  • G6PD deficiency
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16
Q

List the 2 causes for decr rate on conjugation.

A
  • Crigler Najjar Syndrome
  • Gilbert Syndrome
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17
Q

List the 3 reasons for unknown/multiple factors that cause pathologic jaundice.

A
  • race (east Asian)
  • prematurity
  • breast feeding
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18
Q

Causes of physiologic jaundice

A
  • low UDPGT activity
  • relatively high red cell mass
  • absence of intestinal flora
  • slow intestinal motility
  • incr enterohepatic circulation of bilirubin in the 1st days of life
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19
Q

Diagnosis of physiologic jaundice is made if…

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A
  • Visible jaundice appearing after 24hrs of age.
  • Total bilirubin rises by < 5 mg/dL (86 mmol/L) per day.
  • Peak bilirubin occurs at 3–5 days of age, w/ a total bilirubin of </= 15 mg/dL
  • Visible jaundice resolves by 1 week in the full-term infant & by 2wks in preterm infant
20
Q

Describe ABO incompatibility.

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A

Pathologic–> Incr Production–> Ab Mediated
- Mom type O, neonate w/ A or B
- Can be mild to severe, subsequent pregnancies more severe
- Can progress over the several months (mom’s Abs present)

21
Q

Describe Rh incompatibility.

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A

Pathologic–> Incr Production–> Ab Mediated
- Less common, but more serious than ABO
- Erythroblastosis fetalis is most severe form
–>life-threatening anemia
–> generalized edema
–> fetal or neonatal HF
–> can result in death if not treated
- Can req transfusions, Ig tx, phototherapy
- Tx may needed for months

22
Q

Describe hereditary spherocytosis.

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A

Pathologic–> Incr Production–> Non Immune
- d/o of the RBC membrane, leading to chronic hemolytic anemia, autosomal dominant
- RBCs aren’t able to deform & get stuck/clump together, causing hemolysis
- Splenomegaly present
- Dx by FHx & blood smear
- May req exchange transfusion

23
Q

Describe G6PD deficiency.

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A

Pathologic–> Incr Production–> Non Immune
- x-linked genetic defect–> decr activity of G6PD enzyme
- enzyme protects RBCs from oxidative injury
Jaundice appears around one week of age

24
Q

How will a neonate present w/ G6PD deficiency?

Study These Flashcards
A
  • poor feeding
  • fever
  • vomiting
25
Diagnostics for G6PD deficiency.
-Heinz bodies & bite cells on PBS - G6PD enzyme activity assay - genetic testing
26
Tx for G6PD deficiency
- avoid oxidants - control triggers - monitor S/Sx (color of urine) - folic acid during hemolytic event
27
When should you give a blood transfusion to someone w/ a hemolytic anemia?
<7g/dL
28
Describe Non-hemolytic.
Pathologic--> Incr Production--> Non Immune - Enclosed hemorrhage (cephalohematoma or intracranial hemorrhage) or extensive bruising in the skin - Polycythemia leads to jaundice by incr red cell mass, - Bowel obstruction, functional or mechanical, leads to an incr enterohepatic circulation of bilirubin.
29
Describe Crigler-Najjar Syndrome.
Pathologic--> decr conjugated - **gene mutation that codes for UDPGT** (none of the enzyme or a def.) (Bilirubin not conjugated therefore can’t be excreted, so unconjugated bilirubin builds up in the blood) - 2 types: autosomal dominant, autosomal recessive - Rare - Can cause severe bilirubin encephalopathy
30
Tx for Crigler-Najjar Syndrome.
Liver transplant is curative
31
Describe Gilbert Syndrome.
Pathologic--> Decr conjugation - mild **autosomal dominant** d/o--> **decr hepatic UDPGT activity** - higher risk of prolonged jaundice due to G6PD, breastfeeding
32
Tx for Gilbert Syndrome
NO tx needed
33
Early signs of Bilirubin toxicity
- lethargy - poor feeding - high-pitched cry - hypotonia
34
Late signs of bilirubin toxicity
- Irritability - Fever - Opisthotonos - Oculogyric crisis - Seizures - Hypertonia - Apnea
35
Chronic signs of bilirubin toxicity.
- Dental dysplasia - High-freq hearing loss - Athetoid cerebral palsy - Mild mental retardation - Paralysis of upward gaze
36
Describe findings of acute bilirubin encephalopathy
- Lethargy, poor feeding (may present as “sleepy”) - Irritability, high-pitched cry - Arching of the neck (retrocollis) & trunk (opisthotonos) - Apnea, seizures, coma (late) - Correlation b/t TSB level & neurotoxicity is poor
37
Describe findings of chronic bilirubin encephalopathy
- Extrapyramidal movement - Gaze abnormality, especially limitation of upward gaze. - Dysplasia of the enamel of the deciduous teeth - Deafness - Kernicterus
38
Tx for neonatal jaundice
- 1st line: phototherapy--> incr H2O soluble - 2nd line: Exchange transfusion--> pt blood is removed &replaced by donated blood or blood components
39
Causes of transplacental neonatal pneumonia.
- Rubella - CMV - HSV - Adenovirus - Mumps virus - Toxoplasma gondii - Mycobacterium tuberculosis - treponema pallidum - Listeria monocytogenes
40
Causes of at delivery neonatal pneumonia.
- Group B strep - E. coli - S. aureus - Klebsiella sp. - Other strep - Haemophilus influenza - Candida sp - Chlamydia tachomatis - Ureaplasma urelyticum
41
Causes of amniotic fluid neonatal pneumonia.
- CMV - HSV - Enteroviruses - Genital mycoplasma - Listeria monocytogenes - Chlamydia tachomatis - Mycobacterium tuberculosis - Group B strep - E. coli - Haemophilus influenza - Ureaplasma urealyticum
42
High Phenylalanine foods
- Beans - Eggs - Dairy - Diet Soda - Fish - Meat - Nuts & Legumes - Wheat
43
Causes of nosocomial neonatal pneumonia.
- S. aureus - S. epidermidis - Group B strep - Klebsiella sp. - Enterobacter - Pseudomonas - Bacillus cereus - Citrobacter diversus - Influenza virus - Resp syncytial virus - Enteroviruses - herpes virus - candida sp - Aspergillus sp
44
Low phenylalanine foods
- Fruits - Low-PRO foods - Special breads, cookies, crackers - Sugars - Veggies
45
Feeding Guidelines for All children
- avoid distractions during mealtimes - Maintain pleasant neutral attitude through meal - feed to encourage appetite - serve age-appropriate foods - Systematically introduce new foods (8-15 times) - Encourage self-feeding - Tolerate age appropriate mess
46
RFs for substance abuse
- FHx of substance use - Favorable parental attitudes towards the behavior - Poor parental monitoring - Parental substance use - Family rejection of sexual orientation or gender identity - Assoc. w/ delinquent or substance using peers - Lack of school connectedness - Low academic achievement - Childhood sexual abuse - Mental health issues

Block 4 - Peds (10 decks)

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