TTN tx
supportive, sup O2, CPAP, self-limited course
Prevent by avoiding elective c-section <39 wks
RDS tx
Mild cases may respond to CPAP
More severe require mechanical ventilation
Diuresis
No clear guidelines regarding when to administer exogenous Surfactant
Prevention- Reduce pre-term births, provide antenatal steroids
MAS tx
O2 sup, CPAP/mech vent., surfactant, ECMO if severe
Suction does NOT help to prevent
PPHN tx
mechanic ventilation, cardiotonic therapy, inhaled nitric oxide, ECMO
Apnea of prematurity tx
usually resolves by 36-40 wks, CPAP, methylxanthine (theophylline and caffeine)
Congenital Diaphragmatic Hernia yx
mech vent, treat pulm HTN, consider ECMO, surgical repair
Tx for neonatal sepsis
empiric therapy for early-onset sepsis combo against G and G-
Management of down syndrome
well child care, devel & behavior, audiology, vision, thyroid, neck, sleep, heme-onc (↑ risk leukemia - AML b4 1, ALL for older)
Echocardiogram, thyroid screen, audiology, dental care, diet
Turner Syndrome tx
Renal US to ID anomalies, cardio (coarct of aorta), EENT (structural abnormal), endocrine (autoimmune d/o), estrogen in early teen yrs to stim secondary sex characteristics
Positional Plagiocephaly tx
↑ “tummy time” while awake, repositioning in crib, sleep on backs but while away be on tummy
PT: repositioning head with neck
ROM
Helmets therapy (can start as late as 18 mo)
Craniosynostosis tx
Surgical
Lead posioning tx
Chelation for BLL ≥45 mcg/dL (succimer 10 mg/kg PO every 8 hours x 5 days, then every 12 hours for 14 days)
Food protein proctocolitis tx
resolves within days to 2 weeks fo removing agent (if breast feeding have mom avoid milk proteins)
will resolve fully by 12 mo of age and will not have to avoid
Food Protein Induced Enterocolitis Syndrome (EPIES) tx
Can be medical emergency- fluid resuscitation and anti-emetics
Long term—avoid offending food
Can outgrow after several months to years
What is the first line therapy for allergic rxn?
epinephrine into lat aspect of thigh
What is the dose of epi?
- 15 mg ≤ 25 kg
- 3 mg ≥ 25 kg
or 0.01 mg/kg (Max 0.5 mg) every 5 minutes
as needed to control symptoms
What is second line therapy for anaphylaxis?
antihistamines
How long should pt be observed in ED after allergic exn?
4-8 hrs or when sx fully resolved
if >1 dose epi, hypotensive, laryngeal edema, severe asthma, ingestion as trigger then admit
Tx for GER
reassurance but if sx persist >18 mo refer to ped GI
Tx for GERD
PPI for 8-12 wk but if no improvement after 2-4 wk or relapse after tx then d/c and refer
Methods to prevend GER
thicken formula with rice cereal, consider acid suppression therapy
Pyloric Stenosis tx
Correct dehydration and alkalosis
Surgical Correction with pyloromyotomy
Malrotation tx
Require emergent diagnosis and repair: Ladd’s procedure
volvulus tx
Surgical consultation and operative intervention are essential
Intussusception tx
Fluid resuscitation
Antibiotics
Surgical consultation
Options include air-contrast enema or exploration
Meckel’s Diverticulum tx
Stabilization (may need PRBCs if significant bleed)
Surgical consult
Hirschprung’s Disease tx
Surgical resection of aganglionic segment
Colostomy followed by endorectal pull-through at later date
Complications of Hirschprung’s Disease
Hirschsprung’s associated enterocolotis
Constipation
Stricture
Fecal incontinence
Constipation tx
Assess for large volume of stool in rectum—disimpact via oral or rectal “clean out” before
starting tx
PEG-3350 (Mitalax)
Prune juice for infants
Behavioral therapy
How long should you continue maintenance meds for constipation?
> 2 months and should not be stopped until
symptoms resolved for >1 month
should continue until toilet training well established
Encopresis tx
stool softeners
timed sitting after meals in conj with oral laxative
Cryptorchidism tx
Most descend spontaneously within 1st 3 months of life
If still undescended by 4 months—likely permanent
Surgery at 6 mo NO later than 9-15 mo of age
Hormonal tx
Consequences of Cryptorchidism
Infertility
Testicular malignancy
Associated hernia (usually indirect)
Torsion of cryptorchid testis
Micropenis tx
Most will have satisfactory sexual function
Androgen Rx controversial—may limit growth potential in pre-pubertal boys
Hypospadias tx
Surgical repair for all 2nd and 3rd degree to correct functional and cosmetic deformities
Some boys with 1st degree may not have functional abnormality
Non-specific vulvovaginitis tx
Keep area dry and aerated
Decease irritants
Sitz baths twice daily with 3 tablespoons of baking soda while symptomatic, may continue for prevention
Distraction/redirection
Labial Adhesions tx
Often resolve spontaneously
Gentle traction to separate labia
Hormonal cream
Occasionally surgery by pediatric urologist
Complications of Febrile Urinary Tract Infection (UTI)
Urosepsis
Abscess formation
Renal scarring
Treatment of febrile UTI in 2-24 month old
Oral abx for 7-14 days
Cephalosporin, Amoxicillin, Amoxicillin-clavulanate, Trimethoprim-Sulfamethoxazole
What is recommended after febrile UTI?
US to ID anatomic anbnormalities
Who is Voiding cystourethrogram (VCUG) recommended for after UTI?
recommended for children (not yet toilet trained) if urinary dilatation, scarring, or findings suggestive of vesicoureteral reflux or bladder outlet obstruction on ultrasound or recurrence
or atypical sx
Antibiotic Prophylaxis for VUR
Trimethoprim-Sulfamethoxazole 2-4 mg/kg once daily
Enuresis Treatment
Behavioral modification limit fluid intake before bed dry bed training-wake at night to urinate bladder stretching exercises bed alarm therapy-most effective
pharm only if >7 yo and if other therapy unsuccessful - DDAVP