Question & Answer
in Newborn
Mohammad H.
Soltanzadeh , MD,ID
Professor of Pediatrics, Shaheed Beheshti
University
Of Medical Sciences , Tehran ,
IRAN
Question ?
•
Do infants receiving
phototherapy require additional fluids
Answer
•
Unless there is
evidence of dehydration
•
Routine IV or other
supplementation of term & near term is not necessary
•
Preterm
infants < 1500 gr. Should receive a 25% increment while receiving
phototherapy
Question ?
•
You are informed
during sign-out rounds that a newborn is suspected of having
Funisitis
. Where should you look for that infection
?
Answer
•
Funisitis is
inflammation of the umbilical cord vessels & Wharton’s
jelly , & it has been described as either an acute exudative or
subacute necrotizing process that accompanies chorioamnionitis
•
The predominant
organisms that have been identified as
etiologic agents are gram-negative bacteria , including :
•
E-coli
•
Klebsiella
•
Pseudomonas
•
Gram- positive
organisms e.g.Srep,Staph & Candida
Question ?
•
Which infants require
ophthalmologic evaluation for Retinopathy of prematurity ( ROP )
Answer
•
The AAP
recommends that an individual experienced
in neonatal ophthalmology & indirect ophthalmoscopy examine the
Retinas of all neonates
with a birth weight of < 1500 gr or a G.A. of < 28 wks & of those :
•
Selected infants
weighing between 1500-2000 gr who have had unstable clinical courses
placing them at increased Risk.
•
Unless full Retinal
vascularization is noted on examination.
•
All infants
should undergo two examinations :
•
1st performed
at 4-6 wks postnatal age or 31-32 wks postconceptional
age whichever is later
Question ?
•
What are the
manifestations of drug withdrawal in the neonates ?
Answer
•
W = Wakefulness
•
I = Irritability
•
T = Tremulousness,
Temperature variation, Tachypnea
•
H = Hyperactivity, High
–
pitched persistent cry, Hyperacusis, Hyperreflexia, Hypertonus
•
D= Diarrhea, Diaphoresis,
Disorganized suck
•
R = Rub marks,
Respiratory distress, Rhinorrhea
•
A = Apneic attacks,
Autonomic disfunction
•
W = Weight loss or
failure to gain weight
•
A = Alkalosis (
respiratory )
•
L = Lacrimation
Question ?
•
What bone is the most
frequently fructured in the Newborn ?
Answer
•
The clavicle
•
This injury which stems
from excessive traction during delivery
•
Generally results in a
greenstick fructure
Question ?
•
Should palpable lymph
nodes in a newborn be considered pathologic ?
Answer
•
NO
•
Up to 25% of newborns
have palpable nods
•
Particularly in the
inguinal & cervical regions
•
By 1 month of age
prevalence is nearly 40%
Question ?
•
How valuable is the foot
printing of newborns for the permanent medical record ?
Answer
•
This is a time-honored
tradition that is , alas a minimal benefit
•
Although the AAP
recommended discontinuing the practice in 1983 as a result of the
fact that in nearly 80% of cases
•
The quality was so poor
as to render the print useless
•
Up to 80% of the U.S.
hospitals continue foot printing as a means of identification.
•
Foot printing is legally
mandated only in New York state
•
Recently, DNA
fingerprinting has been introduced
•
But it is primarily
available through private commercial ventures
Question ?
•
Mothers must stop BF
if:
•
They have mastitis
•
They are engorged with
milk
•
The baby has thrush
Answer
•
None of the above
•
Frequent BF will
actually help both mastitis & engorgement
•
Should not be
discouraged
•
Thrush is a mild
infection
•
Not reason to stop BF
Question ?
•
Babies
need vitamin D if :
•
They are BF exclusively
•
They are Premature
•
They are Formula fed
Answer
•
All of the above
Question ?
•
How soon should infants
be evaluated for jaundice after discharge ?
Answer
•
All infants discharged
before the age of 24 hrs
•
should be seen by 72 hrs
of age
•
Infants discharged
between 24-48 hrs
•
Should be evaluated by
96 hrs
•
Those discharged after 48
hrs
•
Should be seen by 120
hrs
Question ?
•
What factors suggest
hemolytic disease as a cause of jaundice in the newborn ?
Answer
•
Family history of
hemolytic disease
•
Bilirubin rise of > 0.5
mg /dl/hr
•
Failure of phototherapy
to lower serum bilirubin levels
•
Ethnicity suggestive of
inherited disease
•
e.g. G6PD
•
Onset of jaundice before
24hrs of age
•
Reticulocytosis > 8% at
birth
•
> 5% during 1st
2-3 days
•
> 2% after 1st
wk
•
Changes in peripheral
smear: microspherocytosis,anisocytosis, target cells
•
Significant decrease in
hemoglobin
•
Pallor &
Hepatosplenomegaly
Question ?
•
What are the
complications of exchange transfusions in the newborn ?
Answer
•
Acute:
•
Hypocalcemia ( binding
of ca by citrate )
•
Thrombocytopenia
•
Hyperkalemia
•
Hypovolemia
•
Diminished oxygen delivery ( blood
stored >5-7 days)
•
Late: Anemia, Graft-versus-host
disease
Question ?
•
Is the ESR or CRP more
helpful in the management of osteomyelitis ?
Answer
•
The ESR was significantly
elevated on they 2-5
•
ESR
slowly returned to normal within 3 wks of therapy
•
CRP
rises within 6-12 hrs of a triggering stimulus
•
Returns to normal within
a wk of therapy
•
Secondary rise in either
ESR or CRP could be a sign of recrudescence
Question ?
•
What is the presentation
of Maxillary Osteomyelitis ?
Answer
•
Early edema & redness of
the Cheeks
•
Unilateral Nasal
Discharge
•
Swelling of the eyelid
with conjunctivitis
|
