newborns and infants Flashcards
Faillure to Thrive
definition
causes
Defined as weight for age that falls below 3rd to 5th percentile for gestation-corrected age
Also, infants whose rate of weight change decreases over two or more major percentile lines:
–(90th, 75th, 50th, 25th, and 5th)–
exhibit failure to thrive
(FTT; e.g., a child at the 50th percentile goes down to 5th percentile over a few months).
causes are usually
-inadequate dietary intake
-diarrhea
-malabsorption (celiac disease, cystic fibrosis, food allergy)
-poor maternal bonding
-frequent infections.
Fetal Alcohol Syndrome
Classic fetal alcohol syndrome (FAS) :
-small head (microcephaly)
-shortened palpebral fissures (narrow eyes)
-epicanthal folds
-flat nasal bridge
-thin upper lip
-no vertical groove -above the upper lip (smooth philtrum).
-Ears are underdeveloped.
Cryptorchidism
what is it?
most common in who?
tx?
risk factor for
what is it?
Undescended Testicle
most common in who?
premature infants
tx?
most resolve by 6mo. If not, refer to urology
risk factor for:
testicular cancer and infertility
Gonococcal Ophtalmia Neonatorum
what is it?
s/s?
tx?
risk factor for
what is it?
congenital gonorrhea infection usually acquired during delivery
s/s?
-injected (red) conjunctiva
-PROFUSE PURULENT DISCHARGE
-swollen eyelids.
risk factor for: Infection can rapidly spread, causing blindness
tx?
Order
-Gram stain, gonococcal culture (Thayer–Martin media) or
-polymerase chain reaction (PCR) test for Neisseria gonorrhoeae
-herpes simplex culture, and PCR for Chlamydia trachomatis of eye exudate.
Hospitalize and treat with high-dose intravenous or intramuscular cefotaxime. Preferred prophylaxis is with topical 0.5% erythromycin ointment (1-cm ribbon per eye) immediately after birth. Test (and treat) mother and sexual partner for STDs/sexually transmitted infections (STIs).
“COCka! gross purulent discharge”
Chlamydial Ophthalmia Neonatorum (Trachoma)
Symptoms will show 4 to 10 days after birth.
-Eyelids become edematous and red with profuse WATERY DISCHARGE INITIALLY THAT LATER BECOMES PURULENT.
-When obtaining a sample, collect not only the exudate but also conjunctival cells.
-Rule out concomitant chlamydial pneumonia.
-Treated with systemic antibiotics such as oral erythromycin base or erythromycin ethylsuccinate QID × 14 days.
Chlamydial Pneumonia
In infants with ophthalmia neonatorum, also rule out concomitant chlamydial pneumonia. Obtain nasopharyngeal culture for chlamydia.
-Infant will have frequent cough with BIBasilar rales, tachypnea, hyperinflation, and diffused infiltrates on chest x-ray.
Treated with erythromycin QID × 2 weeks. Daily follow-up. Reportable disease.
“BIB rales for the clammy baby”
Signs of severe dehydration
(>10% weight loss)
-weak and rapid pulse,
-tachypnea or deep breathing
-parched mucous membranes
-anterior fontanelle that is markedly sunken
-skin turgor showing tenting
-cool skin
-acrocyanosis
-anuria
-change in LOC (lethargy to coma).
Congenital Dermal Melanocytosis
AKA:
Look like?
usually occur?
TX?
keep in mind
AKA: (Mongolian Spots)
Look like?
-Blue/Grey birthmark
usually occur?
-Lumosacral area
-Asian decent
TX?
fades by 2-3 years
keep in mind:
-not bruises/ not abuse
(sitting on a grey/ blue slate)
Milia, Miliaria, or “Prickly Heat”
Most common in neonates.
Multiple white 1- to 2-mm papules located mainly on the forehead, cheeks, and nose. Due to retention of sebaceous material and keratin. Resolves spontaneously.
Erythema Toxicum Neonatorum
Small pustules (whitish-yellow color) that are 1- to 3-mm in size and surrounded by a red base.
Erupt during the second to the third day of life.
Located on the face, chest, back, and extremities.
Last from 1 to 2 weeks and resolve spontaneously.
“sounds like an evil spell… relax its just baby acne’
Seborrheic Dermatitis
(“Cradle Cap”)
Excessive thick scaling on the scalp of younger infants.
-Treated by softening and removal of the thick scales on the scalp after soaking scalp a few hours (to overnight) with vegetable oil or mineral oil.
Shampoo scalp and gently scrub scales with soft comb.
-Self resolving
Faun Tail Nevus
Tufts of hair overlying spinal column usually at lumbosacral area.
May be a sign of neural tube defects (spina bifida, spina bifida occulta).
Perform neurologic exam focusing on lumbosacral nerves (fecal/urinary incontinence, problems with gait).
Order ultrasound of lesion to rule out occult spina bifida.
“the Faun said… im NErVUS if I have spina bifida”
Café Au Lait Spots
-Flat light-brown to dark-brown spots >5 mm (0.5 cm).
-** If six or more spots larger than 5 mm (0.5 cm) in diameter are seen, rule out neurofibromatosis or von Recklinghausen’s disease
(e.g., neurologic disorder marked by seizures, learning disorders).
-Refer to pediatric neurologist if the spots meet the same criteria to rule out neurofibromatosis.
“meet me at 6, order the Cafe O’Lay from von reckinghousanz… um ok… is that a real thing?
did I mention my BF is a neuro major…
thats a FIB BRO
Vascular Lesions
Salmon Patches (Nevus Simplex)
“stork bites” or “angel kisses.” Flat pink patches found on the forehead, eyelids, and nape of neck
-Blanchable
-Typically fade by 18 months
Port Wine Stain (Nevus Flammeus)
pink-to-red, flat, stain-like skin lesions located on the upper and lower eyelids
(or on the V1 and V2 branches of the trigeminal nerve (CN V) should be referred to a pediatric ophthalmologist to rule out congenital glaucoma.)
- Blanches to pressure.
-Irregular in size and shape.
-Usually unilateral.
**The lesions do not regress and grow with the child. These lesions can be treated with pulse-dye laser (PDL) therapy.
-Large lesions located on half the facial area may be a sign of trigeminal nerve involvement and Sturge–Weber syndrome (rare neurologic disorder).
(STURDLY! find that soundbite or ill slap half your face)
Hemangioma (Strawberry Hemangioma)
bright red in color and feel soft to palpation.
-Usually located on the head or the neck.
-The lesions often grow rapidly during the first 12 months of life
-majority will involute gradually over the next 1 to 5 years.
-Watchful waiting is the usual strategy. Can be treated with PDL therapy.
During the first 2 months, the infant’s eyes may appear _________ at times (normal finding).
If one eye is consistently turned in or turned out,_____
Newborns do not shed tears, because _____
crossed (or wander)
refer to pediatric ophthalmologist.
the lacrimal ducts are not fully mature at birth.
Uncorrected strabismus can result in
common cause of
permanent visual loss and abnormal vision such as diplopia (double vision).
amblyopia
Esotropia
Misalignment of one or both eyes (“cross-eyed”).
Infants (<20 weeks) may have intermittent esotropia, which usually resolves spontaneously.
“Ey SO….. are ju lookin ah mee or…”
(HEARS) for High-Risk Factors for Hearing Loss
H (hyperbilirubinemia)
E (ear infections that are frequent)
A (Apgar scores low at birth)
R (rubella, cytomegalovirus [CMV], toxoplasmosis infections)
S (seizures)
Premature infants and infants admitted to NICUs have a higher incidence of hearing loss compared with full-term infants.
Breastfeeding
Give vitamin D drops (400 IU of vitamin D) starting in the first few days of life
Cow’s Milk
Avoid cow’s milk the first year of life (causes gastrointestinal [GI] bleeding)
Common cause of iron-deficiency anemia in babies and young children
