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Block 4 POM Exam -- Pediatrics Lectures


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What is oligohydramnios?

What abnormalities is it a risk factor for (3)?
Too little amniotic fluid

Severe renal abnormalities, pulmonary hypoplasia, limb abnormalities
Labor at how far along in gestation qualifies as preterm labor?
Before 37 weeks gestation
How long qualifies as prolonged rupture of membranes?

What is prolonged rupture a risk factor for (2)?
> 24 hours

Chorioamnionitis, Neonatal infection
Treating a mother with Mg may result in what for the fetus?

What are the signs?

CNS depression, respiratory depression, hypotonia
What is a nuchal cord?
Cord wrapped around the neck
When do variable fetal decelerations occur?

What are they associated with?
Occur and end with contraction

Assoc. w/ cord compression during contraction
When do late fetal decelerations occur?

What are they associated with?
Occur repetitively after a contraction

Assoc. w/ fetal hypoxia
At what times after birth are Apgar scores calculated?
1 minute, 5 minutes, 10 minutes
What does an Apgar score of 0-3 suggest?
Breakdown of the mnemonic APGAR
A -- appearance
P -- pulse
G -- grimace
A -- activity
R -- respiratory effort
What is the average weight of newborns?
3.4 kg -- 7.5 lbs
How long after birth should newborns return to birth weight?
About 2 weeks
Whay do babies lose weight the first few weeks after birth?
Loss of excess extravascular fluid
Poor intake
What is the definition of Small for Gestational Age?

What are some causes?
Being below 10th percentile for gestational age

Maternal causes often due to decreased uterine blood flow
(HTN, diabetes, cardiac/renal disease)

Fetal causes include multiple gestation, infection, chromosomal, etc.
What is the definition of Large for Gestational Age?

What maternal issue is it associated with?
Being above 90th percentile for gestational age

Associated with maternal diabetes
What is the average length of newborns?
50 cm -- 20 in
What is the average head circumference of newborns?
35 cm -- 14 in
What does the Dubowitz(Ballard) exam assess?

What is the optimal age for it being done?
Gestational age of the infant
(uses physical and neuro criteria)

12 - 48 hours old
What is the normal range for respiratory rate in newborns?
30 - 60 breaths/min
What is the normal range for HR in newborns?
90 - 180 beats/min
(average is 120 - 160)
What does plethoric skin in a newborn suggest?
Possibility of polycythemia
What is lanugo?
Fine, soft, immature hair of scalp/brow
(often seen in premature babies)
Comparison of skin between premies and post-date infants
Premature -- thin, transparent skin

Post-date -- leathery, dry, cracking
What are milia?
White papules on nose/chin
What is erythema toxicum neonatorum?

What does it contain?

Is it benign or malignant?
Red splotch w/ whitish/yellow papule in center
(may last one week)

Contains eosinophils

What is transient neonatal pustular melanosis?

What group of infants is it common in?
Vesiculopustular lesions on back, chin, neck, extremities, palms, soles
(lasts 2-3 days)

Common in African american infants
How do salmon patches present?
"stork bite" on nape of neck
"angel kisses" on eyelids

Often symmetric
What is dermal melanosis?

What groups of infants is it commmon in?
Blue-gray pigmentation usually on lower back and buttock
(fade during 1st year)

More common in pigmented babies
What is caput succedaneum?

What causes it?
Boggy, edematous subcutaenous tissues

Results from pressure against maternal pelvic bones
What is cephalohematoma?

How is it differentiated from caput succedaneum?
Subperiosteal bleeding

What bone do cephalohematomas typically involve?
Parietal bone
What is hypertelorism?
Increased distance between orbits
What is leukokoria?
Absence of the red reflex
Dull gray tympanic membranes are a sign of what?
Serious otitis media
What are Epstein's pearls?

What groups of infants are they found in?
White inclusion cysts around midline of hard palate

Found in most newborns
What is torticollis?
A "positioning defect"

Shortening of the SCM causes head to tilt unnaturally
What do widely shaped nipples on a shield-shaped chest suggest?
Turner's syndrome
What is transient tachypnea of the newborn due to?

What factors predispose infants for this (3)?
Due to residual amniotic fluid

Diabetic mothers, precipitous delivery, C-section
How long after birth does the PDA murmur usually resolve?
1 - 2 days
What does a small VSD sound like on chest exam?
Harsh systolic murmur at LLSB
What is a scaphoid abdomen?

What is it suggestive of?
"Boat-shaped" abdomen

Suggests diaphragmatic hernia
How many vessels does the umbilical cord normally have?
What groups of infants are umbilical hernias common in?
African american and low birthweight infants

NOTE: most resolve within 1 yr of birth
What is omphalitis?
Serious infection/cellulitis aroudn the umbilicus

NOTE: can proceed to life-threatening sepsis (treat w/ anti-biotics)
What is the definition of gastroschisis?
Defects lateral to the umbilicus
Inguinal hernias are common in what type of infants?
Preterm infants
What is a hydrocele?
Fluid-filled sac in scrotum

Due to remnants of proccessus vaginalis
What is Erb-Duchenne Palsy due to?

What is the prognosis?
Excessive lateral traction on the brachial plexus

Generally, palsy resolves spontaneously
What is the Moro reflex?

It is absent in what condition?
Head extension causes extension and then flexion of extremities

Absent on affected side in Erb-Duchenne palsy
What types of infants is developmental dysplasia of the hip more common in (3)?
Females, First-born, Breech delivery
What is a breech delivery?
"Butt first" pregnancy
What is metatarsus adductus?
In-toeing of the forefoot due to intrauterine positioning

Foot is kidney bean shaped
What is talipes equinovarus?
Clubfoot deformity due to contractures in utero
What is the difference between metatarsus adductus and talipes equinovarus?
(with regards to therapy)
Metatarsus adductus -- foot can easily be put into neutral position

Talipes equinovarus -- Foot cannot be put into a neutral position
What is calcaneovagus?

Can this be easily repaired?
Thin, "banana-shaped" foot
Able to fold onto anterior tibia

What does absence of the Moro reflex imply?
Significant CNS abnormality
When does the root/suck reflex go away?

How about the palmar grasp?
The Moro?
The stepping?
Root/suck -- 4-6 months
Palmar grasp -- 4 months
Moro -- 6 months
Stepping -- 2 months
How does the infant Babinski compare to the adult?
It is the opposite
How many calories do infants typically need by the end of the 1st week?
100 - 120 kcal/kg/day
How may calories per ounce do breast milk and formula contain?
20 kcal/oz.
Describe breast milk stools

How do they compare to formula stools?
Loose, mustard colored

Formula -- darker, firmer, smellier, less frequent
What disease is meconium ileus assoc. w/?
Cystic Fibrosis
Deficiency of what enzyme causes physiologic jaundice?
Glucuronyl transferase
How long after birth do signs of kernicterus typically show up?
2 - 5 days
How long is the lifespan of RBCs in infants?
70 - 90 days
When does breast feeding jaundice occur?
First week of life

Managed by more frequent breast feeding
When does breast milk jaundice occur?
Develops AFTER day 7

May persist for 2-3 weeks
When does physiologic jaundice occur?
Between days 3-6 of life
What is the most common cause of hemolytic disease of the newborn?
ABO incompatibility

Mother is usually O and infant A or B
What type of hyperbilirubinemia is assoc. w/ kernicterus?
UNCONJUGATED hyperbilirubinemia
What is the most common cause of neonatal conjuctivitis?

Treated w/ ORAL erythromycin
What is erythromycin ophthalmic ointment given for?
Prevention of gonococcal ophthalmia neonatorum
Why are newborns more susceptible to hemorrhage?
Transient vitamin K deficiency
Supplementation of which vitamin is recommended for breast-fed infants?
Vitamin D
Date range for term neonate?
For infant?
For toddler?
For pre-schooler?
Neonate -- 0-28 days
Infant -- 1-12 months
Toddler -- 1-3 years
Pre-schooler -- 3-5 years
Normal range of BP for a newborn infant
(50-70) / (30-50)
When is the diagnosis of failure to thrive given?
If child's growth drops across 2 percentile curves
OR, if growth is less than 3rd percentile
What is the classical pattern of growth "fall-off" in failure to thrive?
First drop in percentile for weight
Then, drop in percentile for height
Finally, drop in percentile for head circumference
What is the most common cause of failure to thrive?
Caregiver is giving insufficient calories
What is the best test to determine etiology of failure to thrive?
Thorough H&P
What are the five domains used in assessing development?
Gross Motor
Fine Motor
What is global developmental delay?
Scores at least 2 s.d's below mean in at least 2 of 5 domains
What is the best predictor of intelligence?
Who is at more risk for speech development delays, boys or girls?
Boys (3x higher risk)
Most likely causes of newborn meningitis?

Of child > 4 months old?
Newborn -- Group B strep, gram-negatives

> 4 months -- Strep pneumo, H. influenzae, N. meningitidis
What sleeping position is thought to help prevent SIDS?
Supine sleeping position
Significant milestones hit by 6 months of life?
Able to lift chest and head while on stomach
Able to sit high in a chair w/ straight back
Able to roll from back onto abdomen
Able to pick up dropped object

Beginning of teething
Starts to imitate sounds
Begins to fear strangers
Significant milestones hit by 9 months of life?
Is able to crawl
Can pull self to standing position
Has a pincer grip between thumb and index finger

Develops depth perception
Develops "object constancy"
Can respond to simple commands (understands "no")
Significant milestones hit by 12 months of life?
Nearly-closed anterior fontanel
No longer have a Babinski
Can often walk independently
Can say momma, poppa, and at least 2 other words
Experiences separation anxiety
When do the fontanelles usually close by?
Posterior -- often by 6 weeks of age

Anterior -- often by 18 months of age

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