mc cause of pneumonia in cystic fibrosis kid
Pseudomonas
Caput seccundaneum
conehead baby DOES cross suture lines
Cephalohematoma
does NOT cross suture lines subperiosteal hemorrhage ddx: depressed skull fx
Kawasaki’s: dx criteria
Fever >4 days +4/5 of these:
- b/l conjunctival inj
- mucus membr involvement
- distal extrem changes (peeling, edema) -
- cervical lymphadenopathy
- rash
Kawasaki’s tx:
IVIG, ASA
after receiving IVIG patients need to wait 3 months for this
Live vaccines
- MMR
- varicella (herpes)
- zoster (herpes)
- flu mist
- yellow fever
- (rotavirus?)
APGAR stands for?
- Appearance (color)
- Pulse (>100 = 2pt)
- Grimace (do they pull away from stimulation? cough with suction?)
- Activity (muscle tone?)
- Respirations
Max of 2pts each
Nevus sebaceous
- area of alopecia with orange/nodular skin
- need to remove it before adolesence bc it can become malignant
Galactosemia vs PKU
galactosemia you will see signs right away bc galactose can x-placenta
PKU - musty odor, athetosis
Galactosemia - at risk for Ecoli sepsis
Galactosemia
- see: MR, direct hyperbili, jaundice, cataracts, low glucose/seizures
- high risk of E.coli sepsis
- tx: lactose free diet
PKU
- see MR, vomiting, seizures, athetosis (writhing hand mvmt)
- signs develop over the first few months of life
- musty odor
Physiologic Jaundice
- bili = 10, i-bili 0.5
- baby eating and pooping well
- bc liver conjugation is not yet mature
Breast feeding vs Breast Milk jaundice
- Breast feeding = baby not getting enough feeding; signs of dehydration, not gaining weight
- Breast milk = bc of the glucuronidase in breast milk, this deconjugates bilirubin; no signs of dehydration
Pathologic Jaundice
1 day old, if you see bili greater than 12 or direct bili greater than 2 (do not need both to qualify)
- next best test = Coombs test
- (+) = antibodies on baby’s RBC is the problem
- Rh, ABO incompatibility
- (-) = twin/twin or baby/mom transfusion, spherocytosis, G6PD defic
Biliary atresia
ex: bili @12, d-bili @ 8, incr LFTs
- Why? bile ducts cannot drain
- will need surgery
What do you need to do if you see high d-bili in a baby?
rule out sepsis. Its as if baby has a fever. May even want to do LP
Inherited Indirect Hyperbilirubinemia
- Gilberts - decr in glucoronyl transferase
- Crigler-Najjar - total glucoronyl transferase deficiency
Inhereted Direct Hyperbilirubinemia
- Dubin Johnson (black liver)
- Rotor (liver normal looking)
Ananomalies assocaited with TE fistula
VACTERL
- vertebral
- anal atresia/imperforate
- cardiac
- TE fistula
- renal
- limb anomalies/agenesis
Anomalies asocciated with choanal atresia?
Choanal atresia - baby can’t breathe out of their nose
CHARGE
- Coloboma
- heart defects
- atresia of choanae
- retarded growth
- GU anomalies
- ear anomalies/deafness
When to give surfactant? Ratio that tells you how surfactant is doing?
- 24-34 weeks
- if L:S ratio is less than 2; high risk for RDS
(remember to check LS ratio on infants born to DM moms bc insulin interferes with cortisol/surfactant)
You suspect a baby had meconium aspiration. Next best step?
Suction or intubate prior to drying/stimulating to prevent further aspiration
Ear pits think?
Beckwith Wiedemann syndrome
- large tongues
- large babies
- hypoglycemia
big tongue baby ddx?
- Beckwith Wiedemann
- hypothyroidism
- infant with DM mom
