6 Months

Category: generalpediatrics-Neonatology

Findings: hypospadias

Notes: Observe and delay circumcision and surgical treatment until 6 months to 1 year to minimize risk from general anesthesia and surgery.

Question: When should the following condition be considered for surgically treatment when found in a newborn? (immediate, 2 months, 6 months, 5 years)

ACE Inhibitor

Category: generalpediatrics-Neonatology

Findings: renal dysgenesis, bony malformations, oligohydramnios, pulmonary hypoplasia

Notes: Caused by ACE inhibitor usage during 2nd and 3rd trimesters

Question: What substance causes these findings?

Cephalohematoma

Category: generalpediatrics-Neonatology

Findings: edema that does not cross suture lines, below skull periosteum, resolves over weeks to months

Notes: This is contrasted with caput which is above periosteum, does cross suture lines. and resolves over days.

CHARGE Syndrome

Category: generalpediatrics-Neonatology

Findings: coloboma, heart defects, atresia choanae, retarded growth, genital anomalies, ear anomalies

Question: What fits these findings?

Choanal Atresia

Category: generalpediatrics-Neonatology

Findings: neonate cyanotic except when crying

Notes: Pass feeding tube through nares to check and image with CT scan.

Cocaine Abuse

Category: generalpediatrics-Neonatology

Findings: neonatal intracranial hemorrhage, placental abruption, jitteriness, tremulousness, muscle rigidity

Notes: Intracranial hemorrhages may caused long lasting effects.

Question: Which maternal disease is associated with these findings?

Contraindications To Breastfeeding

Category: generalpediatrics-Neonatology

Findings: HSV with lesions on breast, HIV, active untreated TB, chemotherapy, many recreational drugs, metronidazole, sulfa drugs, some psychotropic medications

Question: What do these conditions have in common?

Cystic Fibrosis

Category: generalpediatrics-Neonatology

Findings: meconium ileus

Notes: Perform genetic testing for cystic fibrosis if you see lower bowel obstruction from meconium.

Question: Which disease should you screen for if you see the following finding?

Cytomegalovirus (CMV)

Category: generalpediatrics-Neonatology

Findings: periventricular calcifications on MRI in neonate along with jaundice, hepatomegaly, petechiae, SGA

Notes: Classic triad is periventricular calcifications, microcephaly, and chorioretinitis

Question: Which organism causes these findings?

Dextrose IV fluids

Category: generalpediatrics-Neonatology

Findings: neonate with symptomatic hypoglycemia

Question: What is first-line treatment for this condition?

Fat

Category: generalpediatrics-Neonatology

Findings: A higher concentration of this macromolecule occurs in mature breastmilk compared to colostrum (fat, protein)

Notes: Mature breastmilk has more fat and carbohydrate but less protein compared to colostrum.

Fetal Alcohol Syndrome

Category: generalpediatrics-Neonatology

Findings: epicanthal folds, small palpebral fissures, smooth philtrum, thin upper lip, midface hypoplasia, microcephaly, micrognathia

Notes: FAS causes facial, growth, and cognitive abnormalities. Often not diagnosed until after 8 months of as facial features are more pronounced then.

Fetal Hydantoin Syndrome

Category: generalpediatrics-Neonatology

Findings: hypoplastic nails, hirsutism, cleft lip, epicanthal folds, depressed nasal bridge, microcephaly, midface hypoplasia, hypertelorism

Notes: Due to maternal use of phenytoin during pregnancy

Hemorrhagic Disease Of The Newborn

Category: generalpediatrics-Neonatology

Findings: three day old neonate with bleeding from umbilicus and diffuse bruising, born at home with midwife

Notes: Treat with vitamin K 1 mg IV injection followed by fresh frozen plasma (FFP).

Hypothyroidism

Category: generalpediatrics-Neonatology

Findings: jaundice, umbilical hernia, enlarged posterior fontanelle

Notes: Enlarged posterior fontanelle may be also seen with hydrocephalus.

IV dextrose

Category: generalpediatrics-Neonatology

Findings: blood glucose under 40 mg per dL, hypotonia or listlessness

Notes: Provide dextrose through IV or IO means to a neonate with symptomatic hypoglycemia with a 2 mL per kg D10W bolus followed by 80 mL per kg per day maintenance rate. Glucose gel or formula supplementation would be appropriate for asymptomatic neonates with hypoglycemia depending on severity of hypoglycemia.

Question: What is the treatment for a breastfed neonate with these findings? (formula supplementation, IV dextrose, oral glucose gel)

Meconium Aspiration Syndrome

Category: generalpediatrics-Neonatology

Findings: cyanosis, grunting, retractions, meconium stained skin, coarse breath sounds

Notes: Clear secretions using bulb syringe or large bore suction catheter (tracheal suction no longer recommended), continue routine drying, stimulating, and giving oxygen as needed.

Necrotizing Enterocolitis (NEC)

Category: generalpediatrics-Neonatology

Findings: air in biliary tree, bloody stools, thrombocytopenia, poor feeding, abdominal distention, emesis

Notes: Also may see gas accumulating in bowel wall submucosa. NEC may progress to abdominal wall cellulitis, gangrene, perforation, and peritonitis. It most commonly affects the distal ileum and colon.

Question: Which disease is associated with these findings?

Penicillin G

Category: generalpediatrics-Neonatology

Findings: jaundice, hepatosplenomegaly, rhinitis with mucopurulent nasal discharge, desquamating rash, chorioretinitis, bony abnormalities, maternal positive RPR

Notes: Treat with aqueous crystalline penicillin G 50000 units per kg per dose every 12 hours for 7 days, then every 8 hours for 10 days.

Question: What is the best treatment for a newborn with these findings?

Pneumothorax

Category: generalpediatrics-Neonatology

Findings: respiratory distress, displaced point of maximal cardiac impulse, meconium stained amniotic fluid

Notes: Often seen in postterm infants with meconium stained amniotic fluid

PPHN

Category: generalpediatrics-Neonatology

Findings: tricuspid regurgitation murmur, cyanosis, tachypnea, split P2

Notes: Persistent pulmonary hypertension of the newborn is caused by elevated pulmonary resistance after birth causing right to left shunting of blood across PDA and cyanosis. It may be caused by meconium aspiration, sepsis, and pulmonary hypoplasia among other causes.

Single Umbilical Artery

Category: generalpediatrics-Neonatology

Findings: trisomy 21, renal malformations, cardiac anomalies

Question: What do these conditions have in common with regards to the umbilical cord?

Subgaleal Hemorrhage

Category: generalpediatrics-Neonatology

Findings: swelling over scalp extending at times to front of ears, ears may be pushed laterally, neonatal tachycardia and paleness, increasing occipital front circumference

Notes: Bleeding behind scalp aponeurotica may cause hyperbilirubinemia, hypotension, consumptive coagulpathy. May be caused by hemophilia. Obtain UVC and UAC. Transfuse with packed red blood cells. Monitor CBC and coagulation factors.

Question: What fits these findings?

Withdrawal Of Maternal Hormones

Category: generalpediatrics-Neonatology

Findings: 2 day old newborn with vaginal discharge tinged with blood

Notes: Whitish vaginal discharge is normal for up to 2 months, and may be tinged with blood due to withdrawal of maternal hormones.

Question: What causes this finding?