pediatrics 4

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pediatrics 4
2013-03-01 19:15:59

spring 2013
Show Answers:

  1. what's the technical name for the soft spot on a baby's head, and how long does it last?
    • anterior fontanelle
    • should close by 12-18 months, but can stay open until 3-5 years (though that seems abnormal)
    • it's trouble if it's closed at 6 months
  2. apgar stands for what?
    • appearance (skin color)
    • puylse (HR)
    • grimace (reflex irritability)
    • activity (muscle tone)
    • respiration
  3. apgar norms
    8-9 out of 10
  4. if a baby is born at 28-32 weeks there's a big risk of neurologic complications. Name 3 types
    • intraventricular hemorrhage --> spastic hemiparesis, quadriparesis, cog defects
    • periventricular leukomalacia
    • seizures
  5. 3 types of respiratory complications seen in premature babies
    • respiratory distress syndrome (RDS)
    • bronchpumlonary dysplasia (BPD)
    • apnea
  6. describe the apnea seen in premature babies
    • lack of breathing for > 20 sec 2/2 system immaturity... may indicate systemic medical problems
    • happens in as many as 90% of infants who weigh less than 1000g at birth
  7. rel between apnea and SIDS?
  8. what's an easy tx for apnea
    caffein minimizes frequency of apnea episodes
  9. what is respiratory distress syndrome? - overview from a website
    • breathing disorder, seen in infants > 6 weeks premature / earlier than 28 weeks
    • develops in first 24 hrs after birth
    • it's due to a lack of surfactant, which would help keep the lungs open
    • baby has to work harder to get oxygen if lungs are collapsed, and parts of body may get ischemic
    • RDS could be an early phase of bronchopulm displasia (BPD), and some tx for RDS cause BPD
  10. RDS nickname
    • (respiratory distress syndrome)
    • hyaline membrane disease

    seen in premies younger than 34 weeks -- the numbers seem to vary, but I guess younger than 34 is a risk, younger than 32 it's pretty likely, younger than 28 it's guaranteed
  11. what does surfactant do?
    decreases surface tension of smaller airways so alveoli don't collapse
  12. when does the surfactant apparatus get made?
    • starts at 28 weeks
    • fully formed at 32
  13. 3 treatments for RDS/hyaline membrane disease
    • surfactant replacement
    • O2
    • in some cases, mechanical ventilation
  14. what babies get BPD (bronchopulmonary disorder)?
    • babies that required supplemental 2 a/o mechanical ventilation
    • babies born more than 10 weeks early
    • wt less than 2 lbs (about 1,000 grams)
    • babies with hx of RDS
  15. what happens in BPD?
    walls of lung thicken, making O2/CO2 exchange difficult ... actually, I can't tell if this happens because kid has BPD, or if this is one of the things that leads to BPD
  16. 2 consequences of BPD
    • limited physical activity tolerance, which'll lead to dev delays
    • chronic upper respiratory problems¬†/ chronic lung disease
  17. cardiac complications seen in premature babies
    • patent ductus arteriosus
    • heart murmur
    • bradycardia
  18. how much tummy time does a baby need? simple answer, and more detailed answer
    • 81 minutes per day
    • doesn't have to be consecutive

    • begin placing infant in prone when a few days old (and awake)
    • start w a few min/day, work up to an hour/day by end of 3rd month
    • place kid prone after each diaper change and each bath
    • play in prone
    • roll up a towle and palce the infant prone over it
  19. first leading cause of death in infants in first year of life?
    sudden infant death syndrome (SIDS)
  20. risk factors for SIDS
    • prone sleeping
    • sleeping on a soft surface
    • smoking during pregnancy
    • second hand smoke
    • overheating
    • late or no prenatal care
    • young maternal age
    • premature birth or low birth weight
    • male
  21. not getting tummy time can lead to...?
    • gross motor delay
    • and also contributes to SIDS
  22. plagiocephaly
    abnormal shape of head
  23. plagiocephaly can be due to abnorlal forces on the skull before or after birth. 4 ways to happen pre-birth
    • when baby descends into pelvis
    • abnormally shaped uterus
    • fetus in an odd position
    • twins, triplets (it's crowded)
  24. resolution of plagiocephaly if it's due to abnormal forces on the skull pre-birth
    usually goes to normal shape in about 6 weeks after birth

    however, localized occiput flattening at birth might also be a precursor to deformational plagiocephaly
  25. risk factors for plagiocephaly (the pre-birth kind)
    • assisted vaginal delivery (tongs)
    • prolonged labor (baby's stuck in canal longer)
    • unusual birth position
    • multiparity (more babies inside)
    • male gender
  26. what causes deformational plagiocephaly?
    pressure on occiput of growing skull causing the occiput to flatten
  27. where is plagiocephaly most common?
    • flattening on right side > left
    • boys more than girls
  28. name for plagiocephaly if it hits the face?
    craniofacial asymmetries (esp in eyes)
  29. craniosynostosis
    • premature closure/ossification of sutures in skull
    • (this is different from plagiocephaly and craniofacial asymmetries)
  30. how does prematurity raise the risk of plagiocephaly?
    • in the last 10 weeks of pregnancy the cranial bones become stronger and harder
    • in NICU on a respirator their heads are maintained in a fixed position
  31. developmental delay rel to plagiocephaly
    chicken and the egg
  32. can torticollis cause plagiocephally
    you bet