1. +
Pediatrics Rotation and Shelf Review
Nicholaus Josey

2. +
The Newborn
 APGAR
 Calculated at 1 and 5 minutes
 Appearance
 Pulse
 Grimace
 Activity
 Respiration
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3. +
The Newborn
APGAR
 1 minute reading
 Tells how the newborn tolerated labor
 5 minute reading
 Tells the newborn’s response to resuscitation
 Does NOT predict neurological outcome
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4. +
The Newborn
APGAR
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5. +
The Newborn
On Physical Exam
 Asymmetric Moro Reflex on a large for gestational
age infant and…
 Left arm extended and medially rotated
 Erb-Duchenne (C5-C6)
 Refer if not better by 3-6 mo for neuroplasty
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6. +
The Newborn
On Physical Exam
Asymmetric Moro Reflex on a large for
gestational age infant and…
Palpation of the clavicles shows crepitus
Clavicular fracture
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7. +
The Newborn
On Physical Exam
 Edema CROSSING suture lines
 Caput Succedaneum
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8. +
The Newborn
On Physical Exam
 Edema NOT CROSSING suture lines
 CephalNOhematoma
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9. +
The Newborn
On Physical Exam
 Dermatologic findings
 Mongolian Spots
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10. +
The Newborn
On Physical Exam
 Dermatologic findings
 Milia
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11. +
The Newborn
On Physical Exam
 Dermatologic findings
 Nevus Simplex
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12. +
The Newborn
On Physical Exam
 Dermatologic findings
 Seborrheic Dermatitis
 Tx: Mild shampoo
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13. +
The Newborn
On Physical Exam
 Dermatologic findings
 Nevus Sebaceous
 Tx: Remove before adolescence
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14. +
The Newborn
 Neonatal Screening
 Screening varies by state
 Two disorders checked for in every state
 Phenylketonuria
 Deficient Phenylalanine Hydroxylase
 Tx: Low phenylalanine diet
 Galactosemia
 Deficient G1P-uridyl-transferase
 Tx: No lactose for life
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15. +
The Newborn
 Neonatal Jaundice
 The following are scenarios designed to mimic patient
presentations in question stems
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16. +
The Newborn
 Yellow Babies
 Three day old
 Elevated Total Bilirubin and regular Direct Bilirubin
 Baby is eating and pooping well!
 Physiologic jaundice
 Gone by 5th day
 Liver conjugation not yet mature
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17. +
The Newborn
 Yellow Babies
 Nine day old
 Total Bilirubin less than 15 but Direct Bilirubin of 0.5
 Dry mucous membranes and no weight gain
 Breast feeding jaundice
 Inadequate feeding = dehydration
 Tx: Increase the number of feedings or duration
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18. +
The Newborn
Yellow Babies
 18 hour old
 Elevated Total Bilirubin and Direct Bilirubin
 No major complaints
 Pathologic Jaundice
 Jaundice under 24hr old is ALWAYS pathologic
 Must rule out SEPSIS or other possible causes
 Next best test: Coombs test
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19. +
The Newborn
 Yellow Babies
 Eight day old
 Normal Total Bilirubin but Markedly Elevated Direct Bilirubin
 Dark urine with pale stool
 Biliary atresia
 Bile ducts cannot drain
 Eventual liver failure
 Increased liver function tests
 Tx: Surgery
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20. +
The Newborn
 Yellow Babies
 Jaundice’s major complication?
 Kernicterus
 Bilirubin deposits in the basal ganglia and
brain stem
 Tx: for mild: Phototherapy
 Tx: for severe: Double volume exchange transfusion
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21. +
The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
 Baby born with:
 Respiratory distress
 Scaphoid abdomen
 Bowel sounds in thorax
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22. +
The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
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23. +
The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
 Biggest Complication
 Pulmonary hypoplasia
 Best Tx:
 If Dx prenatally use extracorporeal membrane oxygenation
to let lungs mature prior to surgery
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24. +
The Newborn
Respiratory Disorders
 Tracheoesphogeal Fistula
 Baby born with:
 Respiratory distress
 Excess Drooling
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25. +
The Newborn
Respiratory Disorders
 TE Fistula
 Best Dx Test:
 Observation of a coiled feeding tube on CXR
 Associated with:
 VACTERL abnormalities
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26. +
The Newborn
Respiratory Disorders
 Choanal Atresia
 Baby born with:
 Cyanosis when feeding
 Pink when crying
 Associated with:
 CHARGE syndrome
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27. +
The Newborn
Respiratory Disorders
 Neonatal Respiratory Distress Syndrome (NRDS)
 Premature baby born with:
 Dyspnea
 High respiratory rate
 Nasal flaring
 Pathophysiology
 Surfactant deficiency
 Tx: 02 therapy with nasal CPAP
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28. +
The Newborn
Respiratory Disorders
 Transient Tachypnea of the Newborn (TTN)
 LGA baby born with:
 Dyspnea
 Grunting
 Delivered via c-section
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29. +
The Newborn
Respiratory Disorders
 Transient Tachypnea of the Newborn (TTN)
 Pathophysiology
 Lung fluid not squeezed via vaginal birth
 Tx: Oxygen therapy
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30. +
The Newborn
Respiratory Disorders
 Meconium Aspiration Syndrome
 Baby born with:
 Dyspnea
 Low Oxygen saturation
 Rupture of Membranes shows greenish-brown fluid
 Next Best Step:
 Intubate and suction
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31. +
The Newborn
Respiratory Disorder Review
 Diaphragmatic Hernia
 Bowel sounds in thorax
 Pulmonary hypoplasia
 TE Fistula
 Labored breathing
 Coiled feeding tube on CXR
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32. +
The Newborn
Respiratory Disorder Review
 Choanal Atresia
 Cyanotic when feeding Pink when crying
 NRDS
 Premature Babies
 Surfactant deficiency
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33. +
The Newborn
Respiratory Disorder Review
 TTN
 Occurs in LGA infants
 Transient excess pulmonary fluid retention
 Meconium Aspiration Syndrome
 Rupture of Membranes yields a green-brown fluid
 Tx: intubation and suction
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34. +
The Newborn
GI Disorders
 Gastroschisis
 Defect lateral to the umbilicus
 No sac covering GI contents
 High maternal AFP
 Complications:
 Removal will lead to short gut syndrome
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35. +
The Newborn
GI Disorders
 Omphalocele
 Defect in the midline
 Sac covering GI contents
 High maternal AFP
 Associated with:
 Trisomies
 Beckwith-Wiedemann Syndrome
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36. +
The Newborn
GI Disorders
 Vomiting Babies
 Pyloric Stenosis
 Non-bilious and projectile
 Palpable olive mass
 Hypochloremic, hypokalemic, metabolic alkalosis
 Tx:
 Stabilize electrolyte imbalance
 Surgical myotomy
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37. +
The Newborn
GI Disorders
 Vomiting Babies
 Intestinal Atresia
 Bilious
 Pregnancy complicated by POLYhydramnios
 Associated with Down’s
 Tx:
 Surgery
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38. +
The Newborn
GI Disorders
 Vomiting Babies
 Malrotation and volvulus
 Bilious
 Baby draws legs towards abdomen
 Abdominal distention
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39. +
The Newborn
GI Disorders
Vomiting Babies
 Malrotation and volvulus
 Pathophysiology
 Gut does not rotate fully around the superior
mesenteric artery (SMA)
 Tx:
 Surgery
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40. +
The Newborn
GI Disorders
 Pooping Problems
 Meconium ileus
 Delayed passage of meconium
 Consider association with Cystic Fibrosis
 Tx:
 Gastrograffin enema is both Dx and Tx
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41. +
The Newborn
GI Disorders
 Pooping Problems
 Hirschsprung’s Disease
 Failure of neural crest cells migration
 Explosion of meconium on digital rectal exam
 Rectal biopsy is GOLD STANDARD for Dx
 No ganglia present
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42. +
The Newborn
 GI Disorders
 Pooping Problems
 Necrotizing Enterocolitis
 Common in prematurity
 Bloody diarrhea
 Pneumocystis intestinalis seen on x-ray
 Tx:
 Nil per os “nothing per mouth”
 Total parenteral nutrition
 Antibiotics and possible resection of necrotic bowel
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43. +
The Newborn
GI Disorders
 Pooping Problems
 Intussusception
 Currant jelly stool
 Sausage shaped mass in Right Upper Quadrant
 Colicky abdominal pain
 Tx:
 Barium enema
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44. +
The Newborn
GI Disorder Review
Gastroschisis
 Defect lateral to the umbilicus
 No sac covering GI contents
Omphalocele
 Defect in the midline
 Sac covering GI contents
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45. +
The Newborn
GI Disorder Review
Pyloric Stenosis
 Palpable olive mass
 Hypochloremic, hypokalemic, metabolic alkalosis
Intestinal Atresia
 Pregnancy complicated by POLYhydramnios
 Associated with Down’s Syndrome
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46. +
The Newborn
GI Disorder Review
 Malrotation and volvulus
 Bilious Vomiting
 Baby draws legs towards abdomen
 Meconium ileus
 Delayed passage of meconium
 Consider association with Cystic Fibrosis
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47. +
The Newborn
GI Disorder Review
Hirschsprung’s Disease
 Failure of neural crest cells migration
 Rectal biopsy is GOLD STANDARD for Dx
Necrotizing Enterocolitis
 Common in prematurity
 Bloody diarrhea
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48. +
The Newborn
GI Disorder Review
 Intussusception
 Currant jelly stool
 Sausage shaped mass in Right Upper Quadrant
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49. +
The Newborn
GU Disorders
 Cryptorchidism
 Male with no palpable testes
 Usually found in the inguinal canal
 Next best step: Ultrasound to confirm
 Tx: Surgery if not descended by one year
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50. +
The Newborn
GU Disorders
 Hypospadias
 Urethral opening on VENTRAL side of penis
 Do NOT circumcise
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51. +
The Newborn
GU Disorders
 Epispadias
 Urethral opening on Dorsal side of penis
 Can lead to bladder Extrophy
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52. +
The Newborn
Neonatal Fever
 Sepsis
 Less than 28 days old
 Fever greater than 100.4
 Symptoms include irritability and poor feeding
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53. +
The Newborn
Neonatal Fever
 Sepsis
 Diagnostic tests include:
 CBC with differential
 CXR
 Cultures
 LP
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54. +
The Newborn
Neonatal Fever
 Sepsis
 Most common causes:
 Group B Strep
 E. Coli
 Lysteria monocytogenes
 Empiric Tx:
 Ampicilin and gentamycin until 48 hr CXR are negative
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55. +
The Newborn
TORCH Infections
 Toxoplasmosis
 Hydrocephalus
 Intracranial calcifications
 Chorioretinitis
 Tx:
 Sulfadiazine and leucovorin
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56. +
The Newborn
TORCH Infections
 Syphilis
 Maculopapular rash on palms and soles
 Runny nose
 Periostitis
 Tx:
 Penicillin
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57. +
The Newborn
TORCH Infections
 Rubella
 Cataracts
 Deafness
 PDA or VSD
 Extramedullary hematopoeisis
 Tx:
 No treatment
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58. +
The Newborn
TORCH Infections
 CMV
 Microcephaly
 Periventricular calcifications
 Deafness
 Thrombocytopenia
 Petechiae
 Tx:
 Gancycilovir
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59. +
The Newborn
TORCH Infections
Herpes
 Encephalitis
 Herpetic lesions
 Tx:
 Acycilovir
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60. +
The Newborn
Conjunctivitis
 First – Third Day of Life
 Chemical conjunctivitis
 Red and tearing
 Caused by silver nitrate drops
 Uncommon because erythromycin now used
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61. +
The Newborn
 Conjunctivitis
 Third – Fifth Day of Life
 Gonococcal conjunctivitis
 Bilateral purulent discharge
 Can cause corneal ulceration
 Tx:
 Topical erythromycin
 IV 3rd generation cephalosporin
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62. +
The Newborn
Conjunctivitis
 Seventh Day – 2nd Week of Life
 Chlamydia conjunctivitis
 Red conjunctiva
 Mucoid discharge
 Lid swelling
 Can cause chlamydial pneumonia
 Tx:
 Oral Erythromycin
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