Step 2: Pediatrics

Ortalani maneuver

relocating hip

significance of "scaphoid abdomen"

respiratory distress from diaphragmatic hernia

kernicterus, sequelae?

unconjugated deposits of bili in brain --> choreoathetosis, gaze abnormalities

presentation of neonatal polycyhtemia

"ruddy" or red color skin, resp distress, poor feeding, +/- hypoglycemia *assoc w/ maternal HTN, smoking, DM, preE*

diseases on newborn screen

*PKU, *hypothyroidism, galactosemia, biotinidase deficiency, hemoglobinopathy, maple syrup urine disease, homocysteinuria, CAH, CF, G6PD, toxoplasmosis

tx for neonatal hypoglycemia

- asymptomatic: milk feeding (formula or breast) first (PO or NG), then initiate IV dextrose if not >40 - symptomatic: IV dextrose right away

corresponding levels of jaundice in newborn: face? below knees?

- face: 4-5 mg/dL - below knees: 10-15 mg/dL

describe Mongolian spots

- flat, blue-grey patches - lower back and buttocks - African, Asian, Hispanic, Native American - fade spontaneously in first decade

workup of suspected NEC, findings?

- labs: metabolic acidosis, low Na, high WBC - AXR: air in bowel wall, distention, free air

intrauterine factors affecting fetal growth

- maternal: poor weight gain in 3rd tri, poor nutrition, preE, prescription/ilicit drug use, infections, uterine abnormalities, asthma - placenta: previa, abrusption, abnormal umbilical vessel insertion - fetal: malformations, metabolic disease, chromosomal abnormalities, infections, twins

management of NEC

- no perf: bowel rest (TPN), NG decompression, abx, serial AXRs - perf: surg consult and exlap

benefits of breastfeeding for baby

- stimulates GI growth/motility - decreases risk of acute illness - lower rates of diarrhea, OM, and UTIs - reduction in obesity, cancer, adult CAD, allergies, T1DM, IBD - cognitive and motor devo

what does APGAR score reflect?

transition from intrauterine to extrauterine life

5 parts of newborn screening system

1. newborn testing 2. follow-up of abnormal results 3. diagnostic testing 4. disease management 5. evaluation and improvement of system

when is the Ballard assessment most accurate?

12-24 hours of life

normal newborn HR and RR

120-160 HR, 40-60 RR

vitals in first hour of life? second?

1st: HR 160-180, RR 60-80 2nd: HR 120-160, RR 40-60

diameter of anterior fontanelle

2.5-5 cm

rate of HIV infection for babies born to moms with HIV

25-30%

urine

3rd day of life: 3-4x per day 1 week of life: 6+ times per day

define microcephaly

<10th percentile for GA

level of bili when you start worrying about kernicterus

>20

inheritance pattern of polydactyly

AD

diagnostic test for bloody emesis or stool in a newly born child

Apt-Downey test to differentiate adult from fetal Hgb

jaundice, chorioretinitis, hearing loss, intracranial calcifications

CMV

which TORCH infection can be asymptomatic?

CMV

problems associated with LGA

CS, forceps/vacuum, birth injuries (clavicle fx, brachial plexus, facial nerve palsy), hypoglycemia

common prenatal labs

HIV, HBsAg, Rubella IgG, type and screen

low AFP signifies

Down syndrome

facial abnormalities, growth deficiencies, MR, poor motor skills and hand-eye coord, memory attention judgement problems

FAS

vit K dependent factors

II, VII, IX, X

RFs for NEC

LBW, prematurity

things associated with premature closure or small fontanel

microcephaly, craniosynostosis, hyperthyroidism, normal variant

general symptoms of TORCH infection

microcephaly, organomegaly, rash

define SGA, AGA, and LGA

SGA: <10th percentile on intrauterine growth curve AGA: 10-90th LGA: >90th

syndromes with large for GA

Sotos, Beckwith-Weidemann

workup for lethargy in newborn

T4, TSH, glucose, Na, K, ammonia

things to do to decrease risk of vertical HIV transmission

triple HAART, CS prior to labor onset and membrane rupture, no breastfeeding

TORCH infections

Toxo, Other (HIV, HBV, parvo, syphilis), Rubella, CMV, HSV2

holoprosencephaly, polydactyly, small for GA

trisomy 13

rocker bottom feet, clenched fists, small for GA

trisomy 18

define apneic episodes

absence of respirations for >20sec, +/- bradycardia and cyanosis

tx for congenital CMV

antivirals ONLY for immunocompromised patients

APGAR Score

appearance (color), pulse, grimace (reflex irritability), activity, respiration

ddx for hypotonia in newborn

benign neonatal hypotonia, Down, Zellweger (peroxisomal d/o) (perinatal asphyxia, metabolic abnormality, maternal medications, chromosomal abnormality, sepsis, CNS abnormality)

causes of direct hyperbili

biliary atresia, sepsis, galactosemia, hypothyroid, choledochal cyst, CF, Dubin-Johnson (black liver), Rotor (no black liver)

further newborn resuscitation

blow-by O2, positive pressure ventilation with O2 (if low HR and O2 sat), chest compressions (if HR <60), medications

pulse to use as frame of reference during exam

brachial, not femoral bc of coarctation; compare the two

increased risk for hip dislocation

breech delivery

edematous swelling over presenting portion of scalp of infant, crosses suture lines

caput succedaneum

subperiosteal hemorrhage, doesn't cross suture lines

cephalohematoma

conjunctivitis within 6-12 hrs of birth-- tx?

chemical, from silver nitrate (less common now) -- self-limited

significance of direct hyperbilirubinemia

cholestasis

most common fractured bone in kids

clavicle

define periodic breathing

common in LBW babies.. recurrent pauses of 3-10sec

HSM, jaundice, petechiae, purpura, microcephaly

congenital CMV

SGA neonates are at higher risk for...

congenital anomalies, future growth retardation

what diseases are included in the newborn metabolic screen?

congenital hypothyroidism, CAH, hemoglobinopathies, biotinidase deficiency, galactosemia, PKU, CF

ddx of lethargy in newborn

congenital hypothyroidism, Down, CAH, hypoglycemia (sepsis, botulism, shaken baby, HIE, polycythemia)

quick way to identify choanal atresia

try to pass an NG through the nose

neonatal hypermagnesemia

decreased muscle tone, floppiness

benefits of breastfeeding for mom

decreased risk of breast and ovarian cancer, osteoporosis

sunken fontanel?

dehydration

Barlow maneuver

dislocating hip back and down

what are the timeline recommendations for breastfeeding?

exclusive breast milk for first 6 months, then breast milk + complementary food until 12 months

presentation of NEC

feeding intolerance, distended abdomen, bilious vomiting, grossly bloody stool, shock

ear cartilage changes

flops back right away at term, slower if earlier GA

signs of increased IC pressure

full fontanelle while lying, persistent while sitting up

tests for hypoglycemia

glucometer is SCREENING only confirm with serum glucose level

management of neonatal hypoglycemia -- goal? when to intervene?

goal between 41-50 intervene when <35 for asymptomatic and <45 for symptomatic (jittery, lethargic

problems associated with SGA

hypoglycemia, hypothermia, hypoxia, polycythemia

most common finding in trisomy 21 babies

hypotonia

when to administer VZIG to infant with maternal infection

if onset within 5 days prior to OR 48 hrs after delivery

cause of apnea in otherwise well premature infant

immature respiratory center

posture in newborns

increased flexor tone

congenital <3 disease, NTDs, small left colon, hypoglycemia, hypoCa, hypoMg

infant of diabetic mother

tests for ambiguous genitalia

karyotype and US

tobacco effects on fetus

low birth weight

absolute CI's to breastfeeding

maternal HIV or TB infection, active maternal drug abuse, infants w/ galactosemia

bulging fontanel?

meningitis, hydrocephalus, subdural hematoma, lead poisoning

factors that increase entry of bilirubin into the brain

metabolic acidosis (reduces binding of bili) sepsis (interrupts BBB) hypoalbuminemia

tx of clavicle fx

none for neonates, figue-of-8 sling

lab evidence of hemolysis in ABO incompatibility

normal Hct, high retic count, +nucleated RBCs, microspherocytes, weakly positive OR negative Coombs

sequelae of classic galactosemia

ovarian failure, reduced bone mineral density, devo delay

tx for hyperbili? then what?

phototherapy, double exchange

neonatal findings in preE?

polycythemia and hypoglycemia

risk factors for neonatal medical problems

poverty, poor/no prenatal care, maternal illness (physical/mental), maternal drug use or unprotected sex, family history of congenital/genetic disorders, poor nutrition, premature delivery

tx for ductus-dependent heart disease

prostaglandins

sign of single S2 and blue baby?

pulmonary atresia

things associated with large fontanel

rickets, osteogenesis imperfecta, Down syndrome, hypothyroidism, malnutrition, increased ICP, shaken baby syndrome

complications of neonatal hyperviscosity

seizure, renal vein thrombosis, NEC, tachypnea

how often should moms nurse?

signs of hunger, 8-12x/day

eye treatment at birth

silver nitrate or erythro, for GC/Ch

postterm skin

thicker, peeling, cracked

management of galactosemia

use soy or casein hydrolysate formula

cocaine effects on fetus

vasoconstriction --> placental insufficiency and low birth weight, cognitive deficits later

high AFP signifies...

ventral wall or neural tube defect

general newborn resuscitation

warm and dry infant, stimulate to assist in vigorous cry to clear lungs, suction amniotic fluid from nose and mouth

marijuana effects on fetus

withdrawal-like syndrome (high-pitched cry and tremulousness)

stool

yellow by third day (no more meconium), 3-4 per day by 1 week of life