PEDs other abnormalities

• Restless
• Cyanosis (circumoral)
• Cough
• Dyspnea
• tachycardia
• Grunting
• Retractions
• Intercostal bulging
• Stridor
• head bobbing
• flaring of nares
• Clubbing (late sign)
• Chest pain

• lack of surfactant in premature infants
• Smaller Airway and underdeveloped cartilage
• Obligatory nose breather (infant)
• Less well developed intercostal muscles
• brief period of apnea (normal is <10 sec interval)
• Faster resp Rate
• Increased metabolic needs
• Eustachian tubes relatively horizontal
• Tonsilar tissue enlarged
• More flexible larynx (higher risk for collapse)

• TH LEADING CAUSE OF RESPIRATORY FAILURE IN PRETERM INFANTS
• Infant is unable to keep lungs expanded and aleveoli open due to lack of surfactant
• Due to increase in pulmonary vascular resistance, the fetal circulation continues to shunt through the foramen ovale

• Appear shortly after birth, worsen over the first 1-2 days and then gradually improves
• CXR shows a ground glass appearance
• Apnea is seen as lung function worsens
• Hypoxemia and Hypercapnea
• Metabolic Acidosis & respiratory Acidosis
• Inspiratory or seasaw respirations
• Nasal flaring, expiratory grunt, inspiratory crackles, cyanosis, tachypnea

• Supportive care: adequate nutrition and hydration, neutral thermal environment, minimize heat and fluid loss
• Respiratory care: O2 Therapy with possible ventilation, maintain acid-base balance, administer Baractant through ET tube, intermittent suctions (<5sec at a time, monitor pulse ox
• If baby survives >96 hrs, survival rate is good

• Develops in premature infants following a period of intensive respiratory therapy thru mechanical ventilation
• Incidence is increased because of increased survival rates by premies onvents

• Most infants display signs of respiratory distress
• May present with barrel chest
• CXR shows hyperinflation and opacities
• Infants will need vent support and supplemental O2 therapy for more than 28 days

• Treatment is really PREVENTION of the factors contributing to BPD
• -Reduce incidence of preterm delivery
• -use oscillating vent
• -get off vent ASAP
• *Also, monitor for infection, vent and suction frequently, and feed high caloric foods

• Hypospadias-urethra terminates on the underside (ventral) surface of the penis
• Epispadias- urethral opening is on the top of the penis (dorsal)
• Chordee-pulls the penis downward in an arc, interfering with urination
• *all three are surgically treated within 6-15 mo of age (circumcision should wait until repair is complete)

• The anterior surface of the urinary bladder lies open on the lower abdomen allowing direct passage of urine to the outside
• *The main concerns are infection and trauma to the bladder!! Surgical repair should be done within 48 hrs (this condition is often accompanied by other anomalies

• Cleft Lip: 4-7 wks gestation
• Clef palate: 7-12 wks gestation
• *Cleft lip is more common

cause is unknown, although alcohol, smoking and teratrogenics may be a cause

• The main complication is trouble feeding, as the food may go into the nasopharynx with cleft palate, leading to aspiration and infection
• For children with cleft lip, it may cause difficulty feeding leading to poor growth
• Otitis media is common

Multidisciplinary Surgical repairs are done within the first year of life

• Do not suction by mouth
• Logan's bar across lip to hold it in place and prevent stretching
• Elbow restraints (called no nos) to keep hands away from face and mouth (may be restrained for 2-3 weeks)
• A breck feeder may be used to feed the infant orally past the incision

• Mechanical functions are immature at birth: 
• -No voluntary swallowing until 6 weeks
• –Decreased stomach capacity
• –Increased peristalsis; faster emptying time
• –More prone to diarrhea
• –Relaxed cardiac sphincter contributes to tendency to regurgitate food
• -Gastric acidity in infants
• -Decreased saliva leads to decreased ability to digest starches
• -Liver functions immature thru out infancy

• What is the presenting problem?
• Vomiting- type, color, amount, pattern 
• Abnormal bowel habits
• Wt loss or growth problem
• Food intolerances and normal feeding schedule
• Pain & its effect on sleep, play, feeding
• Parental Concerns

• Bowel sounds (should be q10-30sec)
• Liver margins (1-2 cm right costal border)
• Pancreas (1-2 cm left costal border)

• Use an infusion pump for continuous feedings
• If using gravity feedings, use correct height to time feedings about 20-30 min per feed
• Check the tube placement by auscultating air input q4hr
• Check residuals and refeed q3-4hr

• Use central venous line for high glucose solutions
• Check infusion rate q30 min as infants overload quickly
• Monitor urine glucose & ketones q4hrs for the first 24 hrs after solution change, then q8hrs
• Monitor for hyperglycemia (N/V, dehydration)
• Provide with pacifier to satisfy sucking needs
• Sterile dressing changes as per agency protocol

• Necrotizing Enterocolitis is an acute inflammatory disease of the bowel in preterm and high risk infants
• Occurs when the GI tract suffers vascular compromise
• Factors contributing to NEC include: prematurity, intestinal ischemia, colonization of pathogenic bacteria, substrate in the intestinal lumen (residual feedings in intestines)

• X Ray: appears like sausage dilation of the intestine with a bubbly appearance and thickened bell wall
• Lab Studies: anemia, leukopenia, metabolic acidosis, electrolyte imbalances, decreased platelet count
• DIC

• Apnea and bradycardia
• Temp instability
• Lethargy
• Abdominal distention
• Bile-stained emesis or gastric residuals
• Bloody Stools
• Visibly distended bowel loops
• Decreased or absent Bowel Sounds
• Abdomen tender under palpation
• Hypotension or shock

• NPO for 24-48hrs if birth asphyxiated and/or VLBW, ELBW
• Breast milk is the preferred feeds for PO foods as it contains IgA immunities, macrophages, and lysozymes
• NG tube for decompression
• IV antibiotics, parenteral fluids, TPN
• Bowel resection if perforation occurs

Most interfere with normal nutrition and digestions that are essential to normal growth and development

• Esophageal atresia is when the esophagus ends in a blind pocket and is not connected to the stomache
• Tracheoesophageal fistula is when the esophagus and trachea lead to the wrong part (ex:trachea leads to stomach, esophagus leads to lungs, esophagus leads to both stomach and lungs)

Proximal part of the esophagus ends in a closed pouch and the distal part communicates with the trachea at a bifurcation

• Choking- due to blind pockets and fistulas leading to lungs or stomach
• Cyanosis- due to resp distress
• Coughing- oral secretions accumulate quickly

Hypertrophy of the circular muscle of the pylorus in stomach leading ti a obstruction at the distel end of stomach

• Presents around 3 weeks of life
• Projectile vomiting (key)
• No bile
• Ravenously hungry
• Constipation
• Gastric peristaltic waves from left to right
• Irritable, weight loss, dehydrations

• Diagnosed by ultrasound/xray/barium swallow
• Treated surgically with a pyloromyotomy

Also called obstinate constipation, its the absence of parasympathetic ganglion cells (nerves) within the muscular all of the distal colon and rectum

• s/s include absence of meconium within 24 hrs and constipation along with a distended abdomen
• Treated by surgical resection of the nerveless portion of bowel, with possible colonoscopy

• The most common congenital malformation of the GI tract which is a remnant of fetal omphalomesenteric duct resulting in a fistula connecting the small intestine to the umbilicus
• This can cause bleeding (red currant jelly stools), intussusception, intestinal obstruction, diverticulitis, and perforation
• Diagnosed by a meckel scan and treated by surgical removal of the diverticulum

• Invagination or telescoping of portion of bowel ileum and colon (from above downward)
• This is most frequent cause of abdominal obstruction
• S/S include currant jelly stools, vomiting, and shock

• Diagnosed by symptoms and sausage shaped mass in the abdominal wall
• EMERGENCY!!
• Treated by a simple reduction or resection, sometimes reversed by an air or barium enema

• Malrotation of the intestine around the superior mesenteric artery
• s/s include intermittent vomiting, recurrent abd pain, distention, lower GI bleed
• May twist around itself and cause a volvulus, leading to necrosis, peritonitis, perforation and death
• Surgically treated to remove affected area, may result in short gut syndrome

• Rectal pouch ends blindly at a distance above the anus and there is no anal orifice
• *Main s/s is no meconium within 24 hrs and abd distention
• Repaired surgically and may need a colostomy between procedures

• Diaphragmatic: abdominal organs are displaced into the chest through an opening in the diaphram
• -rapid labored respirations with cyanosis and rapidly worsening respirations
• -this requires emergency surgery and has a poor prognosis
• Hiatial: stomach pushes up into the diaphragm through the hiatial opening leading to reflux with small feedings. Treated with surgery
• Omphalocele: abdominal contents protrude through the root of umbilical cord and form sac on the abdomen.  
• -Needs surgical treatment. Greatest concern is trauma and infection.
• -Maintain with wet sterile gauze
• Umbilical: usually close by age 3, can be detected if hard area larger than 2 cm around umbilicus. May be surgically treated
• Inguinal (male): small sac or peritoneum surrounding the testes fails to close off after testes descend from abd sac into scrotum
• -intestine slips into the inquinal canal and can cause swelling and strangulation of intestine leading to necrosis

• Congential Clubfoot
• Can be bilateral or unilateral
• Can be positional or syndromic

• Serial Casting called Ponseti casting where the cast is changed every week for the first 23 weeks of life
• Denis Browne bar splint may be used

• Lengthening of the achilles tendon
• Capsulotomy of the ankle joint
• Release of strictures

• Dislocation of the hip due to defective development of the acetabulum
• It can be diagnosed prior to the infant walking by the physician performing the Ortlani test and hearing an audible click or performing the Barlow test and the hip dislocates
• Also detected if the gluteal fold are asymmetric

• Treated by manipulating the femur into place and applying a brace
• Pavlivks harness needs to be adjusted weekly by a physician
• Frejka splint keeps the legs abducted
• Baby may be double diapered
• If the baby is 6-18 mo old, they may have an open reduction and a spica cast

• Spina Bifida: defect in the neural arch, generally in the lumbosacral region, leaving an opening through which the spinal meninges an spinal chord may protrude
• Spina Bifida Occulta: asymptomatic and presents no problems-dimple in the skin or tuft of hair over site may indicate its presence

• Meningocele: portion of the spinal meninges protrude through the bony defect and forms a cystic sac
• -no nerve roots involved and no paralysis or loss of sensation below area
• -Surgical removal of the sac is indicated
• Myelomeningocele: protrusion of spinal cord and the meninges, with nerve roots embedded in the wall of the cyst
• -sensory loss or paralysis below lesion

Banana, avocado, kiwi, & chesnuts

Ditropan can help the bladder to extend further in order to adherance to a cathing schedule

An elevated alphafetoprotein is associated with neural tube defects

• Excess CSF within the ventricular and subarachnoid space in the cranial cavity
• Non communicating is obstructive hydrocephalus
• Communicating is when the flow between the ventricles is not blocked

• excessively large head
• bulging fontanels
• rapidly enlarging suture lines with McEwen's signs (sounds like a broken pot when tapped)
• Scalp shiny with distended veins
• Eyes appear pushed downward (setting sun sign)
• S/S of ICP

• ICP treated with manitol & dexamethasone (given with antacid)
• Shunting procedure to reroute extra CSF
• -Ventriculoperitoneal shunting
• -Ventriculoatrial shunting
• *increases risk of infection and onstruction

• Usually a sign of a larger underlying cause
• Typically hypoxic ischemic encephalopathy
• Rarely organized tonic clonic seizures, although lip smacking and bicycle kicking may be evident
• May be caused by: metabolic imbalances, toxic syndromes, infections, trauma at birth, hypoglycemia, drug withrawal

• Serum electrolytes, CBC, blood glucose woll be taken
• EEG may be done
• CT and/or echoencephalogram
• Detailed neuro exam

• Treat the underlying cause
• Respiratory support with 02
• Medications such as Phenobarbitol, dilatin, lorazapam, diazapam
• Document: length of seizure, body parts involved, type of movement, LOC, effect on color an resp status, post ictal condition

• Bacterial: meniniococcus, pneumococcus, haemophilus influenza B, e-coli
• Tuberculous: caused by tubercle bacillus
• Viral: aseptic and caused by a variety of viruses

• Elevated WBCs in blood and spinal tap (lumbar puncture) due to infection
• Decreased glucose and elevated protein in CSF

• Fever
• poor feeding
• vomiting
• irritability
• frequent seizures
• Bulging fontanels
• Nuchal rigidity
• May have purpura or petechial rash

• Should be on resp isolation 24 hrs past the start of antibiotics
• Admin antibiotics as soon as ordered
• Dexamethasone to decrease sequelae and prevent deafness
• Control seizures, fever and other complications such as shock and DIC

• The prognosis is dependent on the age, type fof rganism, and duration of illness prior to tx
• *highest mortality rate with pneumococcal
• Possible hearin loss due to damage to the 8th cranial nerve. This is assessed again at the 6mo follow up
• *preventable with Hib, pneumococcal, and meningococcal immunizations

• Maintain isolation and quiet environment
• Elevate the HOB and avoid flexion of neck
• Seizure precautions
• Baseline HC at daily intervals
• VS, LOC, neuro signs and I/O q 1-2hrs
• Monitor for siadh
• Monitor daily weights

• Infants: bulging fontanel, irritability, high pitched cry, increased HC, distended scalp veins, changes in feedings
• Older Child: H/A, N/V, blurred vision, seizures, memory loss, lethargy
• Late Signs: bradycardia, decreased LOC and motor response, coma, cheyne stokes resp, changes in pupils

• Withdrawal symptoms after birth due to exposure to addictive substances in utero
• Diagnosed by sample of hair, urine, or meconium to determine the substance (Screen on mother done as well)

• Narcotics: loose stools, tachycardia, fever, projectile vomiting, sneezing, sweating
• Cocaine: neurobehavioral depression or excitability, IUGR and develop delays
• Nicotine: LBW, SGA
• Fetal alcohol syndrome: persistent growth retardation, malformations of face and skull, mental retardation

• early identification and intervention
• Drug therapy to reduce withdrawal
• Supportive treatment
• Mild sedation
• Monitor for malnutrition, dehydration, and electrolyte imbalances
• Frequent weights, I/O, caloric supplementation

• Inherited diseases-usually caused by a lack of hormones or enzymes
• Metabolism of carbohydrates, proteins, and or fats are affected
• Includes PKU, Hypothyroidism, galactosemia

• An autosomal recessive disorder that results in CNS damage from toxic levels of phenylalanine in the blood due to a deficiency in phenylalanine hydoxylase enzyme needed to convert phenylalanine into tyrosine
• Diagnostic eval: guthrie blood test from fresh heel stick is positive if phenylalanine levels >25mg/dL
• *this is a routine for all US infants

• Vomiting, seizures, FTT, irrtability, mental delays
• Treatment includes removed phenylalanine from diet: no meat, no dairy, no nutrasweet.  This is a lifelong process
• Special formula may be used or the baby may continue to breast feed

• ABO and Rh incompatibility with the mother
• The maternal antibody responds to antigens in the fetal blood, which leads to destruction of fetal RBCs and anemia
• Mother has O blood, baby has A, B, or AB
• Mother has Rh-blood, baby has Rh +

• Jaundice appearing within the first 24hrs
• Anemia
• Hepatosplenomegaly
• Hydrops fetalis
• Treatment includes exchange transfusions for the baby (Can be done intrauterine)
• Transfusion reaction s/s include tachycardia, bradycardia, change in BP, rash, temp instability
• RhoGam can be given to mother at 28 weeks gestation to prevent Rh antibodies

• Livers inability to bind bilirubin for excretion
• High bilirubin levels can penetrate and damage brain cells causing encephalopathy and death (called Kernicterus)

• Physiologic jaundice: appears first in the face, then the torso
• Breast feeding jaundice: occurs within 2-4 days of age
• Jaundice due to blood incompatibility: occurs within 24 hrs
• Early clinical signs include lethargy or irritability

• Blood specimen by heal stick (be sure to turn off bili lights when taking specimen)
• Once bilirubin levels >5, you can start to see it in the face. Blanche skin to assess for jaundice
• Sclera, conjunctiva, oral mucosa in dark skinned infants may be assessed
• Treatment is usually started for bilirubin levels >14.6mg/dL

• Phototherapy with either bili lights or bili blankets
• Be sure to cover eyes if using bili lights
• Infant should be placed nude under lights without lotions
• Be sure to turn frequently and monitor thermoregulation
• Monitor fluid intake- baby may breast feed if bili levels <20