Transient intrauterine moms hormones o best diagnosed

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

 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


 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