Neonate, Misc + CDB Flashcards
1
Q
60% of newborns are jaundiced b/c spleen removes excess RBCs carrying HbF -> hemolysis -> high blood Hb -> high bilirubin
A
Transient hyperbilirubinemia of the newborn
2
Q
when is jaundice in the newborn considered pathologic
A
Any of the following:
1) if appears on 1st day of life or after 1st 2 wks or persists after 2 wks
2) total bilirubin >5 mg/dL/day or >0.5 mg/dL/hr
3) total bilirubin >15 mg/dL
4) direct bilirubin >10% of TB
5) Persists beyond 1 week in term and 2 weeks in preterm
3
Q
whats the most serious complication of pathologic jaundice in the newborn
A
kernicterus
4
Q
how to treat pathologic jaundice in the newborn
A
- phototherapy w/ blue-green light (12-20 mg/dL; 270 nm breaks down bilirubin to prevent kernicterus, toxic to retina)
- exchange transfusion: if bilirubin >20-25 mg/dL
5
Q
Icteric sclera, bilirubin level
A
> 2 mg/dL
6
Q
AKA retrolental fibroplasia; ↓ vascularity of retina
A
ROP
7
Q
Absence of UGDP causing an increase in indirect bilirubin. These infants present in the first 24 hrs and die within the 1st yr of life.
A
Crigler Najjar
8
Q
Milder form of Crigler Najjar
A
Gilbert
9
Q
___–>↑ UGDP enzyme–>↑ conjugation of bilirubin–>↓ unconjugated bilirubin; can help ↓ neonatal jaundice
A
Phenobarbital
10
Q
Peak B1 at 12 mg/dL at 3rd DOL or 15 mg/dL at 5th DOL for premature infants
A
Physiologic jaundice
11
Q
Criteria for physiologic jaundice
A
1) after 48 hrs of life 2) TB not increasing > 5 mg/dL/day 3) DB less than 10% of TB 4) Resolves by 1 week in term and 2 weeks in preterm
12
Q
Jaundice is ALWAYS pathologic if
A
Bilirubin >15mg/mL; at first day of life
13
Q
What are the two inborn disorders of metabolism that lead to an UNCOJUGATED hyperbilirubinemia?
A
Gilbert’s and Crigler-Najjar
14
Q
Physiologic hyperbilirubinemia is seen ___, peaks at ___, and resolves over ___
A
After the first 24 hours of life, 3 days, 2 weeks
15
Q
What are the Danger Signs in Jaundiced Infants?
A
(1) Family history of significant hemolytic disease, (2) Vomiting, (3) Lethargy, (4) Poor feeding, (5) Fever, (6) Onset of jaundice after the third day, (7) High-pitched cry
16
Q
MCC of jaundice?
A
Unconjugated hyperbilirubinemia (indirect): physiologic and breastfeeding associated
17
Q
Management for breast milk jaundice
A
stop breast feeding for 2-3 days, using formula instead; then resume nursing
18
Q
Type of bilirubin increased in breast milk jaundice
A
Unconjugated
19
Q
Onset of breastfeeding jaundice
A
3-4 DOL
20
Q
Onset of breastmilk jaundice
A
7th DOL
21
Q
Increases risk of physiologic jaundice
A
Preterm, diabetic mother, asian
22
Q
Bilirubin levels drop rapidly when breastfeeding stops
A
Breastmilk jaundice
23
Q
Causes of pathologic jaundice
A
1) Extrahepatic cholestasis (biliary atresia, choledochal) 2) Intrahepatic cholestasis (neonatal hepatitis, inborn errors of metab, TPN cholestasis) 3) Dubin-Johnson 4) Rotor 5) TORCH
24
Q
To reduce incidence of breastfeeding jaundice
A
Frequent breastfeeding (>10/24h), discourage 5% dextrose or water
25
Bilirubin level if breastfeeding is continued in breast milk jaundice
Gradually decreases but may persist up to 10 weeks at lower levels
26
Type of bilirubin increased in breastfeeding jaundice
Unconjugated
27
Metabolic causes of direct hyperbilirubinemia
DiRect: Dubin Johnson and Rotor
28
Enzyme responsible for conjugation in liver
UDP glucuronyl transferase
29
Inherited form of non-hemolytic jaundice
Crigler-Najjar syndrome
30
More severe type of Crigler-Najjar syndrome
Type I
31
Crigler-Najjar syndrome, arias syndrome
Type II
32
Autosomal recessive disorder that causes increase of conjugated bilirubin without elevation of liver enzymes
Dubin-Johnson
33
MC hereditary cause of increased bilirubin
Gilbert
34
Non-itching jaundice
Rotor
35
Mechanism of phototherapy for jaundice
Geometric photoisomerization of unconjugated bilirubin (lumirubin)
36
Inhibits heme oxygenate hence may be used in treatment of hyperbilirubinemia
Metalloporphyrins
37
In exchange transfusion ___% of circulating RBCs is replaced when an equivalent of 2 neonatal blood volumes is used
85%
38
T/F Hyperbilirubinemia in neonates is benign in most cases
T
39
Absence or reduction in number of bile ducts; results from progressive destruction of the ducts
Alagille syndrome
40
Jaundice, approximate levels for involvement: 4 to 8 mg/dL
Head and neck
41
Jaundice, approximate levels for involvement: 5-12 mg/dL
Upper trunk
42
Jaundice, approximate levels for involvement: 8-16 mg/dL
Lower trunk and thighs
43
Jaundice, approximate levels for involvement: 11-18 mg/dL
Arms and lower legs
44
Jaundice, approximate levels for involvement: 15 mg/dL
Palms and soles
45
```
Unconjugated hyperbilirubinemia (indirect): When an infant’s indirect (unconjugated )serum bilirubin level is >
___
```
10 mg/dL
46
Serious sequelae of NEC
Intestinal strictures, malabsorption, fistulae, and short bowel syndrome (in case of surgery)
47
Caused by proliferation of immature retinal vessels due to excessive use of oxygen; Can lead to retinal detachment and blindness in severe cases
ROP
48
Male vs female infants, more susceptible to neonatal infections
Male
49
Sepsis that may be seen from birth to 7 days, transmitted vertically or from the mother's genital tract
Early-onset
50
Sepsis that may be seen from 8-28 days, transmitted vertically or from the postnatal environment
Late-onset
51
Sepsis with a fulminant course and associated with multi system pneumonia
Early-onset
52
Sepsis with a more insidious course and associated with focal infection (meningitis common)
Late-onset
53
Common risk factor for early and late onset sepsis
Prematurity
54
Sepsis that occurs most commonly among low birth weight infants
Nosocomial sepsis
55
Transplacentally transmitted infections
CMV, rubella, listeria, T. pallidum
56
Route of vertical transmission
Ascending or from passage through birth canal
57
Predominant pathogens in late-onset sepsis
S. aureus, coagulase negative staph, fungal infection, enterococcus, G- enteric bacilli
58
what are the TORCH organisms in congenital infections
- T: toxoplasmosis
- O: others; like syphilis, HepB, varicella
- R: rubella
- C: cytomegalovirus
- H: herpes simplex
59
presentation of congenital toxoplasmosis
TRIAD:
- chorioretinitis
- hydrocephalus
- multiple ring-enhancing lesions on CT (calcification)
60
how to dx congenital toxoplasmosis
- IgM to toxoplasma(initial)
| - PCR(accurate)
61
how to treat neonatal sepsis
-ampicillin + gentamicin
62
What is the main cause of Gram (-) sepsis and meningitis in the newborn?
E. coli
63
how to treat congenital toxoplasmosis
-pyrimethamine & sulfadiazine (with leucovorin for 1 year)
64
___ is given to patients treating with toxoplasmosis to counteract bone marrow depression in patients taking pyrimethamine and sulfadiazine
folinic acid
65
during what trimester is toxoplasma causes severe disease
1st trimester
66
test for toxoplasmosis
sabin felman dye test
67
Only in ___ can T. gondii complete its life cycle and produce oocysts
Cats
68
Transmission of T. gondii
Transplacentally during first trimester (17%, more severe); 3rd trimester (65%, transplacental or vaginal delivery, mild or inapparent)
69
Asymptomatic patients with toxoplasmosis are still at high risk of developing abnormalities especially ___
Chorioretinitis
70
T/F Treatment with TMP-SMX in toxoplasmosis will eradicate encysted parasite
F
71
- rash on palms & soles
- snuffles
- frontal bossing(prominent forehead)
- hutchinson triad: 8th nerve deafness + interstitial keratitis(corneal scarring) + hutchinson's teeth
- saddle nose
Congenital syphilis
72
how to dx congenital syphilis
- VDRL/RPR (initial)
| - FTA-ABS/dark field microscopy (accurate)
73
Olympian brow
-congenital syphilis: Frontal bossing
74
Higoumenaki's sign
-congenital syphilis: Unilateral or bilateral thickening of the sternoclavicular portion of the clavicle
75
Mulberry molars
-congenital syphilis: Abnormal 1st lower molar
76
Rhagades
Congenital syphilis - linear scars on mouth, anus, genitals
77
Clutton joint
Congenital syphilis - painless knee joint swelling with sterile synovial fluid
78
Pseudoparalysis of Parrot
Congenital syphilis - Refusal to move involved extremity
79
Earliest manifestation of congenital syphilis
Snuffles
80
Transplacental transmission of syphilis can occur as early as as
6 weeks AOG
81
Phase of maternal syphilis wherein infection can most likely be transmitted
Primary or secondary, rather than latent disease
82
T/F Majority of affected live-born infants who have congenital syphilis are asymptomatic at birth
T
83
Early signs of congenital syphilis appear during
First 2 years of life
84
Early signs of syphilis is analogous to ___ phase of acquired syphilis
Secondary
85
Late signs of syphilis appear during
First 2 decades of life
86
Early vs late sign of syphilis: Periostitis of long bones
Early
87
Early vs late sign of syphilis: Renal involvement
Early
88
Early vs late sign of syphilis: CNS involvement
Early
89
Early vs late sign of syphilis: Mucous patches and condylomatous lesions
Early
90
Late signs of syphilis
Olympian brow, Saber shin, Hutchinson teeth, mulberry molars, saddle nose, rhagades, juvenile paresis, juvenile tabes, 8th nerve deafness, Clutton joint
91
Teeth manifestations of syphilis erupt when
6 y/o
92
Asymptomatic infants considered at risk for congenital syphilis should be evaluated if
1) Maternal treatment was inadequate, unknown, or undocumented 2) Maternal treatment was less than or equal to 30 days before delivery 3) Mother was treated with erythromycin or neopenicillin regimen 4) Maternal treponemal tigers did not decrease sufficiently to demonstrate a cure four-fold or greater
93
T/F Varicella infection is a contraindication to breatfeeding
T
94
Treatment for immunocompromised child/newborn exposed to varicella
VZIG
95
if the mother has varicella __ days prior to delivery she may pass the virus to the child but it is attenuated since there is Ab of the mother passed also.
more than 5 days
96
maternal varicela IgG can pass through the placenta at what aog
by 30 wks
97
neonate with cicatrical skin scarring with limb hypoplasia and neurologic manifestation
congenital varicella syndrome
98
varicella vaccine is given when
total of 2 dose on 12-15 months and 4-6 year old
| pag catch up na less than 12 -- 2 dose 3 months apart and pag more than 12, 2 dose na 1 months apart
99
new borns whose mother has varicella 5 days before delivery or 2 days after delivery should be given
1 vial of Varicella Ig
100
Mode of admin of varicella vaccine
SC
101
Content of varicella vaccine
Cell-free, live attenuated varicella virus
102
Vaccine contraindicated in patients with anaphylactic reaction to vaccine, neomycin, or gelatine and those with altered immunity
Varicella vaccine
103
Congenital Varicella Syndrome is caused by maternal varicella infection in ___ weeks of pregnancy
first 20 (VZV embryopathy) or last 3
104
T/F Maternal varicella may cause premature delivery and miscarriage
T
105
Congenital varicella causes ___ during 6-12 weeks AOG
Interruption of limb development
106
Congenital varicella causes ___ during 16-20 weeks AOG
Eye and brain involvement
107
T/F Varicella can congenitally cause ophthalmologic problems including Horner syndrome
T
108
Treatment for infants with severe varicella
Acyclovir
109
T/F, VZIG is not beneficial after clinical disease has developed
T
110
Neonate
- microcephaly
- cataracts
- sensorineural hearing loss
- hepatosplenomegaly
- thrombocytopenia
- blueberry muffin rash
- hyperbilirubinemia
Congenital rubella
111
Congenital heart disease associated with rubella
PDA (other: pulmonary artery stenosis
112
how to treat congenital rubella
supportive
113
Dx test Rubella
Maternal IgM in neonatal serum
114
in congenital rubella infection, what trimester results in severe defects (congenital rubella SYNDROME)
1st 8 wks of pregnancy
115
Majority of infants acquire maternal rubella infection before ___ weeks
11
116
MC clinical manifestation of rubella
Sensorineural hearing loss (then cataracts and glaucoma)
117
Neonate
- intracranial (periventricular) calcifications
- microcephaly
- chorioretinitis
- hearing loss
- petechiae
CMV (cytomegalic inclusion disease)
118
how to dx congenital CMV
- urine & saliva viral titers (initial)
| - urine/saliva PCR (BEST)
119
how to treat congenital CMV
-ganciclovir: if signs of end organ damage (not for asymptomatic infants due to side effects)
120
Occurs when a mother has a primary CMV infection in the 1st trimester of pregnancy-->death of baby; greater risk of feral infection
Symptomatic congenital disease
121
Occurs in the event of reactivation of CMV infection during pregnancy, maternal IgG passes transplacentally, protecting the infant from serious infection; less risk of feral infection
Asymptomatic congenital disease
122
MCC of congenital infection
CMV
123
MC manifestation of CMV
Chorioretinitis
124
T/F Majority of infants with congenital CMV are asymptomatic at birth
T
125
T/F Majority of congenital CMV develop long term complications (learning and hearing deficits)
T
126
___ antibody test is of little diagnostic value in congenital CMV because it also reflects maternal Abs
IgG
127
Negative ___ antibody test excludes diagnosis of CMV
IgG
128
___ antibody test lacks sensitivity and specificity and unreliable for diagnosis of congenital CMV
IgM
129
Neonate
- skin eye mouth infections
- CNS/systemic infection
HSV
130
Treatment for congenital HSV
-acyclovir + supportive (14 days if limited to skin, eye, and mouth; 21 days if disseminated or localised in the CNS)
131
CMV transmitted intrapartum, through infected blood or through breast milk, is not associated with ___ deficits
neurologic
132
how to prevent conjunctivitis in a newborn (ophthalmia neonatorum) & who takes this precaution
- erythromycin/tetracycline ointment + silver nitrate solution
- given in delivery room to ALL newborns
133
what are the 2 most common causes of ophthalmia neonatorum
- n gonorrhoeae
| - chlamydia trachomatis
134
how to dx congenital herpes
- tzanck smear(initial)
| - PCR(accurate)
135
presentation of congenital herpes by week
- week 1: shock & DIC
- week 2: vesicular skin lesions
- week 3: encephalitis
136
```
Conjunctivitis, Most Likely Cause if symptoms start at:
Day 1-
Day2-7-
>7 Days-
>3 weeks-
```
Day 1- chemical irritation
Day 2-7- Neisseria gonorrhea
>7 Days- Chlamydia trachomatis
>3 weeks- herpes
137
HSV is primarily transmitted through
Maternal genital tract from passage through birth canal
138
Plan of delivery if primary herpes is detected in the 3rd trimester
Planned CS offered
139
Plan of delivery if (+) herpes but no active lesions
Vaginal
140
Hallmark of neonatal herpes
Vesicular rash present at birth or shortly thereafter
141
Gold standard for diagnosis of HSV encephalitis
PCR
142
T/F Serology is useful in neonatal HSV
F
143
____ are very effective in reducing head injury by 85%
Helmets
144
Pedestrian injury occurs during the day and peaks on
The afterschool period
145
Major street should not be crossed until the child is ___ yrs old
10
146
Begins at birth and includes the 1st mo of life
Newborn/neonatal period
147
The average length and head circumference in a newborn
50 cm (20inch) and 35cm (14inch)
148
low birth weight infants is defined as infants weighing less than ___
2.5 kg
149
very low birth weight infants weighs ___
less than 1.5kg
150
when fetal growth stops and over time decline to less than the 5th percentile of growth for gestational age or when growth proceeds slowly but absolute size remains less than 5th percentile
IUGR
151
the first audible heart tones by fetoscope are detected at
18-20 weeks
152
___ a rare cause of vomitting in infants that is demonstrated as obstruction at the cardiac end of the esophagus without organic stenosis
infantile achalasia ( cardiospasm)
153
absence of rectal gas at 24 hours is abnormal. True or False?
TRUE
154
a common early GI sign of Hirschsprung disease
vomiting with obstipation (severe or complete constipation)
155
if there is increased indirect bilirubin with (+) Coombs test what is the possible diagnosis
Rh, ABO, other blood group
156
jaundice in breastfed infants seen after the 7th day of life with maximal concentrations as high as 10-30mg/dl
breastfeeding jaundice
157
breastmilk jaundice is attributed to the presence of ___ in some breast milk causing an increase in intestinal absorption of bilirubin
glucoronidase (pregnanediol: milk glucuronidase)
158
kernicterus results from the deposition of un conjugated bilirubin in the ____
basal ganglia and basal nuclei
159
what are the common initial signs of kernicterus
lethargy, poor feeding and loss of Moro
160
dark greyish brown skin discoloration in infants undergoing phototherapy
bronze baby syndrome
161
90% of Rh incompatibility is __ type
D type
162
in Rh incompatibility the mother is Rh __ and the infant is Rh ___
mother is Rh (-) and child is Rh (+)
163
injection of ____ into the mother immediately after the delivery of Rh + infant is successful in reducing Rh hemolytic disease
anti-D gamma globulin
164
__ is performed to determine fetal hemoglobin levels and to transfuse packed RBC in serious fetal anemia
percutaneous umbilical blood sampling
165
what is the treatment of choice for fetal anemia
intravascular (umbilical vein) transfusion packed RBC
166
what are the indications for umbilical vein transfusion
hydrops
167
Blue with feed
Choanal atresia
168
Blue with cry
Tetrology of Fallot
169
d/t estrogen withdrawal from mom
Newborn vaginal bleeding
170
Sacral hair
Spina bifida occulta
171
Acrochordon
Skin tag
172
Midline cyst
Thyroglossal cyst (thyroid comes down from tongue)
173
Lateral cyst
Branchial cleft cyst
174
Extra nipples are always on ___ line
vertical
175
Umbilical stump bleeding
Factor 13 deficiency
176
Delayed umbilical cord separation (6 wk)
Leukocyte adhesion deficiency
177
Congenital hip dislocation, spread both hips Out, feel for clunk
Ortolani [OUTolani]
178
Congenital hip dislocation, bend knee & hip, feel for clunk w/ middle finger → do US
Barlow maneuver
179
discrepancy btw chronological age & mental age
MR
180
Touch cheek → they turn toward it
Rooting
181
spread arms symmetrically when startled
Moro
182
Used to support self on a surface, "fencing reflex
Tonic-Labyrinthine reflex
183
what is the indication for intubation & ABG for a newborn
-if RDS or not breathing
184
what are the normal newborn vitals(RR, HR)
- RR: 40-60
| - HR: 120-160
185
what is the purpose of apgar score & when is it done?
- quantifiable measure whether or not theres need for resuscitation
- 1 min after birth(evaluates labor/delivery) & 5 min after birth(evaluates resuscitation response)
186
is a low apgar score assoc w/ risk of cerebral palsy
no
187
what is the apgar criteria
- appearance(skin color): 0 = body is blue; 1 = normal except extremities; 2 = normal
- pulse: 0 = 100
- grimace(reflex irritability): 0 = no response; 1 = feeble cry; 2 = sneeze/cough
- activity(tone): 0 = none; 1 = minor flexion; 2 = active movement
- respiration: 0 = absent; 1 = weak/irregular; 2 = strong
188
what is the most common complication that occurs to newborns who didn't receive routine newborn care
-vit K deficiency: example = bright red blood per rectum/urine/umbilicus or intracranial bleeding(lethargy)
189
does breast milk have vit K?
not enough
190
what in the colon flora is required to produce sufficient vit K & what clotting factors need vit K
- e coli
| - 2, 7, 9, 10, C, S
191
what prevention routine is taken in newborns to prevent vit k def bleeding
-single intramuscular vit K
192
during hearing test in newborn, what is does this test exclude?
-congenital sensory-neural hearing loss: necessary for early detection to maintain speech & assess need for cochlear implants
193
how to dx cystic fibrosis in newborn
- sweat chloride test(initial): elevated sweat chloride
| - genetic analysis of CFTR gene(accurate)
194
what normal finding in the newborn is indicative of transient polycythemia of the newborn
-splenomegaly
195
-hypoxia during delivery -> stimulates erythropoeitin -> highered RBC's -> first breath -> highered O2 -> lowered erythropoeitin -> Hb normalization
transient polycythemia of the newborn
196
if transient tachypnea of the newborn lasts >4 hrs, what is the new dx? and what must you do to evaluate it?
- sepsis until proven otherwise
| - blood & urine cultures
197
if transient tachypnea of the newborn lasts >4 hrs, & pt also has presents w/ neuro signs, what tests must you order
-besides blood & urine cultures for sepsis eval: LP(CSF & culture)
198
-benign minute hemorrhages caused by rapid intrathoracic pressure as chest compressed thru birth canal
subconjunctival hemorrhage of the newborn
199
MC skull fracture in newborn
Linear
200
Most fatal skull fracture in newborn
Basilar
201
Skull fracture in newborn that needs surgery
Cortical
202
swelling of soft tissues of scalp that crosses suture lines
caput succedaneum
203
subperiosteal hemorrhage that does not cross suture lines
cephalohematoma
204
the incidence of brachial palsy of the newborn is most common in
macrosomic infants of DM mothers
205
how to treat any type of brachial palsy of the newborn
immobilization
206
what is the most common newborn frx due to shoulder dystocia
clavicular
207
what is the most common cause of facial nerve palsy of the newborn
-forcep trauma of the facial nerve during delivery
208
how to treat facial nerve palsy of the newborn
-no treatment: recovers in time
209
no abdominal muscles -> no urination
prune belly
210
what is the most common cause of elevated AFP
-incorrect dating
211
what congenital disease is omphalocele highly assoc w/
-edwards syndrome(trisomy 18)
212
what congenital disease is umbilical hernia highly assoc w/
-congenital hypothyroidism
213
when is surgical intervention indicated for umbilical hernia & why
- after age 4: most spontaneously close at age 3
| - prevent bowel strangulation & necrosis
214
Most common causative agent of neonatal conjunctivitis
Chlamydial conjunctivitis
215
When to not breastfeed
HIV infection, active pulmonary TB, malaria, typhoid fever, septicemia, women undergoing cancer tx, lithium, most Ab (except tetra); Very few contraindications. Everything else, BREASTFEED.
216
Crying makes respiration better (improvement of cyanosis) b/c they use their mouths
choanal atresia
217
Newborns lose weight right after birth, when do they regain their birth weight?
by 2 wks of age.
218
PALMAR GRASP, when does it disappear?
by 2-3 months
219
MORO reflex, when does it disappear?
4 MONTHS
220
schwarzeneggar pose (passively turning the child's head to one side causes the ipsilateral arm to extend and the contralateral arm to flex at the elbow )
Asymmetric Tonic Neck Reflex
221
Asymmetric Tonic Neck Reflex, when does it disappear?
6 months
222
must disappear before walking possible
plantar grasp reflex
223
BABINSKI, when does it disappear?
persists up to 1-2 years
224
most sensitive test for detecting developmental dysplasia of the hip
UTZ
225
What age do most children start sleeping through the night?
4-6 months
226
By what ages do children double and triple their birthweight?
double at 5mo, triple at 12mo.
227
When do most children reach double their birth length?
4 years
228
What are some possibilities when you cannot elicit the red reflex on eye exam?
ataracts, glaucoma, retinoblastoma and chorioretinitis
229
postdates, grunting respirations, meconium staining, signs of air trapping, RR>100
meconium aspiration
230
Most common cause of abdominal mass in a newborn?
enlarged kidney
231
Infants above how many Kg are considered Macrosomic?
4kg
232
What is considered Small for Gestational Age (SGA)?
birth weight
233
How many blood vessels are in a normal umbilical cord? What are they?
2 arteries, 1 vein
234
What are brushfield spots?
"salt and pepper" speckling (white spots) on the iris seen in downs
235
What might a large fontanelle imply?
hypothyroidism, Osteogenesis imperfecta, chromosomal anomalies
236
Maternal LUPUS (SLE) might lead to what in the neonate?
FIRST degree AV block
237
When should stool switch from meconium and to what do they switch?
By the 3rd day of life, they should begin to appear yellow.
238
How often/day and for how long do babies typically nurse
Babies usually nurse 8-12 times in 24 hours, and the feedings may initially range from 20 to 60 minutes (although consistently lengthy feeds may indicate a problem)
239
Primitive reflexes
Palmar, rooting, moro, parachute
240
Important risk factor for congenital hip dislocation
Female sex
