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


    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 ?


    Funisitis is inflammation of the umbilical cord vessels & Whartons 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 :




     Gram- positive organisms e.g.Srep,Staph & Candida

Question ?

   Which infants require ophthalmologic evaluation for Retinopathy of prematurity ( ROP )


     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 ?


    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 ?


  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 ?



     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 ?


   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


    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


 All of the above

Question ?

  How soon should infants be evaluated for jaundice after discharge ?


     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 ?


     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 ?



     Hypocalcemia ( binding of ca by citrate )




     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 ?


   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 ?


   Early edema & redness of the Cheeks 

   Unilateral Nasal Discharge

   Swelling of the eyelid with conjunctivitis 


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