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Flashcards in Neonate, Misc + CDB Deck (240):
1

60% of newborns are jaundiced b/c spleen removes excess RBCs carrying HbF -> hemolysis -> high blood Hb -> high bilirubin

Transient hyperbilirubinemia of the newborn

2

when is jaundice in the newborn considered pathologic

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

whats the most serious complication of pathologic jaundice in the newborn

kernicterus

4

how to treat pathologic jaundice in the newborn

-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

Icteric sclera, bilirubin level

> 2 mg/dL

6

AKA retrolental fibroplasia; ↓ vascularity of retina

ROP

7

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.

Crigler Najjar

8

Milder form of Crigler Najjar

Gilbert

9

___-->↑ UGDP enzyme-->↑ conjugation of bilirubin-->↓ unconjugated bilirubin; can help ↓ neonatal jaundice

Phenobarbital

10

Peak B1 at 12 mg/dL at 3rd DOL or 15 mg/dL at 5th DOL for premature infants

Physiologic jaundice

11

Criteria for physiologic jaundice

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

Jaundice is ALWAYS pathologic if

Bilirubin >15mg/mL; at first day of life

13

What are the two inborn disorders of metabolism that lead to an UNCOJUGATED hyperbilirubinemia?

Gilbert's and Crigler-Najjar

14

Physiologic hyperbilirubinemia is seen ___, peaks at ___, and resolves over ___

After the first 24 hours of life, 3 days, 2 weeks

15

What are the Danger Signs in Jaundiced Infants?

(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

MCC of jaundice?

Unconjugated hyperbilirubinemia (indirect): physiologic and breastfeeding associated

17

Management for breast milk jaundice

stop breast feeding for 2-3 days, using formula instead; then resume nursing

18

Type of bilirubin increased in breast milk jaundice

Unconjugated

19

Onset of breastfeeding jaundice

3-4 DOL

20

Onset of breastmilk jaundice

7th DOL

21

Increases risk of physiologic jaundice

Preterm, diabetic mother, asian

22

Bilirubin levels drop rapidly when breastfeeding stops

Breastmilk jaundice

23

Causes of pathologic jaundice

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

To reduce incidence of breastfeeding jaundice

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 β†’ do US

Barlow maneuver

179

discrepancy btw chronological age & mental age

MR

180

Touch cheek β†’ 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