Transient intrauterine moms hormones o Best diagnosed 4 6 days right before

Transient intrauterine moms hormones o best diagnosed

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Transient: intrauterine (mom’s hormones) o Best diagnosed 4-6 days (right before discharge) Clinical Manifestations o Poor feeding, Lethargy o Prolonged newborn jaundice o Respiratory difficulty o Cyanosis o Forced cry o May not be seen early because of mom o Bradycardic o Large fontanels S/S after 6 weeks (screen 2-4days) o Short forehead o Depressed nasal bridge o Puffy eyelids o Large tongues o Thick, dry, cold, mottled skin o Coarse, dry hair o Abdominal distention o Hyporeflexia o Hypothermia Hyperbilirubin o Jaundice is common in newborns since it is formed at high levels during this time and not cleared as well as in adults o Hyperbilirubinemia puts infant at increased risk for encephalopathy and kernicterus Risk Factors: o Major risk factors for infants > = 35 weeks’ gestation: predischarge total bili in the high risk zone Jaundice in first 24 hours, positive DAT or known hemolysis gestational age 35-36 weeks previous sibling received phototherapy cephalohematoma or significant bruising exclusive breastfeeding East Asian race o Minor risk factors: predischarge total bili in the high intermediate risk zone, gestational age 37-38 weeks
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jaundice observed before discharge previous sibling with jaundice macrosomic infant of diabetic mother maternal age > 25 years, male gender Clinical Manifestations o Appearance of jaundice begins in the face and progresses to the chest, abdomen, arms, and then legs o Jaundice within first 24 hours of life is worrisome o Jaundice developing in 72-96 hours is physiologic and resolves in 1-2 weeks o “Breast milk jaundice” begins in the first week after birth, peaks at 2 weeks, and then declines; it is not dangerous and is probably due to the infant’s immature liver and intestines Screening o Usually done routinely at time of metabolic screening prior to discharge (USPSTF grade I) infants with total bili > 95th percentile are at increased risk o Routine follow-up appointments after discharge are timed to assess developing jaundice Management o Calculate risk zone of infant based on risk factors and total bili values o Admit for phototherapy if needed o Admit for exchange transfusion if needed initiated when phototherapy has failed or infant has signs of neuro dysfunction o Home measures for low-risk infants: increasing frequency and efficacy of breastfeeding supplementing inadequate breastfeeding with formula POISONING Ingestion of Injurious Agents Plants Foreign Bodies, toys Hydrocarbon [gasoline] Medication Cleaning products Cosmetics and personal care products Emergency Treatment o Poison control center o Assessment – treat the child first o Gastric decontamination Induce vomiting o Prevent – education
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Common Substance that cause Poisoning: o Aspirin [salicylate] S/E – Tinnitus, sweating, nausea, dizziness/headache Change in mental status Bleeding, hypovolemic Toxicity begin at doses of 150 – 200mg/kg – 400 mg = FETAL children Hyperventilation [respiratory alkalosis] + increased temp Metabolic acidosis – hypokalemia, dehydration, kidney failure
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  • Spring '16
  • Intracranial pressure, Traumatic brain injury, Human skin color, clinical manifestations, Neonatal jaundice, vp shunt

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