LEIK Pediatric Review Newborns Questions
with Answers
Down's Syndrome - Correct Answer A genetic defect caused by trisomy of
chromosome 21 (three copies instead of two). The most common chromosomal
disorder; the average lifespan is 60 years in the United States. Round face that appears
"flat" (decreased anterior-posterior diameter), accompanied by upward-slanting eyes
(palpebral fissures), and low-set ears. Chronic open mouth caused by enlarged tongue
(macroglossia). Shorter neck with short broad hands with transverse palmar crease
(simian crease). Newborns with hypotonic and poor Moro reflex. Higher risk of
congenital heart defects (50%), congenital hearing loss, visual problems, cataracts,
sleep apnea, and early onset of Alzheimer's disease (average age 54 years). Educate
parents about high-risk sports (risk of spinal cord injury): contact sports (football,
soccer), trampoline, or gymnastics. Avoid trampoline use especially before age of 6
years.
Failure to Thrive (FTT) - Correct Answer Defined as weight for age that falls below 3rd
to 5th percentile for gestation- corrected age and gender when plotted on appropriate
growth chart (on more than 1 occasion). also, infants whose rate of weight change
decreases over two or more major percentiles lines. Use WHO growth charts until 2yo
and then CDC. Causes are usually inadequate dietary intake, diarrhea, malabsorption,
poor maternal bonding, frequent infections, and others.
Fetal Alcohol Syndrome (FAS) - Correct Answer Classic FAS facie is a small head
(microcephaly) with shortened palpebral fissures (narrow eyes) with epicanthal folds
and a fl at nasal bridge. There is a thin upper lip with
no vertical groove above upper lip (smooth philtrum). Ears are underdeveloped. Also
known as Fetal Alcohol Spectrum Disorder, and can range from severe disease with
mental retardation to mild developmental defects that may not be obvious until
adolescence (i.e., attention defy city disorder [ADD]). There is no safe dose or time for
alcohol during pregnancy. Alcohol adversely affects the central nervous system (CNS),
somatic growth, and facial structure development.
Cryptorchidism (Undescended Testicle) - Correct Answer Empty scrotal sac(s). Most
cases involved undescended testicles. One or two testicles may be missing. Testis does
not descend with massage of the inguinal area. Majority
of cases (90%) of cryptorchidism are associated with patent processes vaginosis. Infant
should be sitting and the exam room should be warm to relax muscles when massaging
the inguinal canal. Another option is to examine child after a warm bath. Increased risk
of testicular cancer if testicles are not removed from the abdomen. Surgically corrected
within the fi rest year of life if it does not spontaneously descend
,(orchiopexy).
Gonococcal Ophthalmic Neonatorum - Correct Answer Symptoms usually show within
2 to 4 days after birth. Infection can rapidly spread causing blindness. Do not delay
treatment by waiting for culture results. Symptoms
includes injected (red) conjunctiva with profuse purulent discharge and swollen eyelids.
Majority of cases of congenital gonorrhea infection acquired during delivery
(intrapartum). Any neonates with acute conjunctivitis presenting within 30 days or less
from birth should be tested for chlamydia, gonorrhea, herpes simplex, and bacterial
infection.
Order GC culture (Thayer-Martin), herpes simplex culture, and chlamydial PCR with
Gram stain of eye exudate. Hospitalize and treat with high-dose intravascular (IV) or
intramuscular (IM) ceftriaxone. Preferred prophylaxis is with topical 0.5% erythromycin
ointment (1 cm ribbon per eye). Test (and treat) mother and sexual partner for sexually
transmitted diseases (STDs).
Chlamydial Ophthalmic Neonatorum (Trachoma) - Correct Answer Symptoms will
show within 4 to 10 days after birth. Eyelids become edematous and red with profuse
watery discharge initially that later becomes purulent. When obtaining
a sample, collect not only the exudate, but also conjunctiva cells as well. Rule out
concomitant chlamydial pneumonia. Treated with systemic antibiotics such as
azithromycin IM or oral erythromycin base or erythromycin ethyl succinate syrup QID ×
14 days. Treatment only 80% effective. May need second course. Use only systemic
antibiotics. Prophylaxis is with topical 0.5% erythromycin or tetracycline ointment
(1 cm ribbon per eye). Reportable disease. Test (and treat) mother and sexual partner
for STDs.
Chlamydial Pneumonia - Correct Answer In infants with ophthalmic neonatorum, also
rule out concomitant chlamydial pneumonia. Obtain nasopharyngeal culture for
chlamydia. Infant will have frequent cough with
bibasilar riles, tachypnea, hyperinfl action, and diffused infiltrates on chest x-ray.
Treated with erythromycin QID × 2 weeks. Daily follow-up. Reportable disease.
Sudden Infant Death Syndrome (SIDS) - Correct Answer Unexplained and sudden
death in apparently healthy infants younger than 12 months. Higher risk with
prematurity, low birth weight, maternal smoking and/or drug use, and
poverty. Cause unknown; theories range from CNS abnormalities, cardiac arrhythmias,
suffocation from soft, thick bedding, and so on. To decrease risk, position infants on
their back (supine) only. Avoid side-lying and prone positions. Avoid "overheating" infant
and use of thick quilts, soft beds, pillows, and so on.
Excessive Weight Loss (More Than 10%) - Correct Answer Newborns are expected to
lose weight during the first few days of life. wt. loss can vary by feeding delivery and
type. C section infants tend to lose a larger % of birth wt than vaginal babies. Formula-
fed infants may lose up to 5% and BF up to 7-10%. Any wt. loss of birth weight should
be regained within 10 to 14 days. Weight loss beyond 10% in neonates is considered
, abnormal. Assess the infant for dehydration, electrolyte disturbances, and
hyperbilirubinemia. And the mother and infant for lactation difficulties.
Congenital Dermal Melanocytes (Mongolian Spots) - Correct Answer The most
common type of pigmented skin lesions in newborns. Present in almost all Asians (85%
to 100%) and in more than half of Native American, Hispanic, and Black neonates.
Blue- to black-colored patches or stains. A common location is the lumbosacral area
(but can be located anywhere on the body). May be mistaken for bruising or child
abuse. Usually fades by age 2 to 3 years.
Milia, Malaria, or "Prickly Heat" - Correct Answer Most common in neonates. Multiple
white 1-2 mm papules located mainly on the forehead, cheeks, and nose. Common
locations on forehead, cheeks, and nose. Due to the retention of sebaceous material
and keratin. Spontaneous resolution.
Erythema Toxicum Neonatorum - Correct Answer Small pustules (whitish-yellow color)
that are 1 to 3 mm in size and surrounded by a red base. Erupts during the second to
the third day of life. Located on the face, chest, back, and extremities. Lasts from 1 to 2
weeks and resolves spontaneously.
Seborrhea Dermatitis ("Cradle Cap") - Correct Answer Excessive thick scaling on the
scalp of younger infants. Treated by softening and removal of the thick scales on the
scalp after soaking scalp a few hours (to overnight) with vegetable oil or mineral oil.
Shampoo scalp and gently scrub scales with a soft comb. Prevention is by frequent
shampooing with mild baby shampoo and removing scales
with soft brush or comb. Self-limiting condition and resolves spontaneously within a few
months.
Faun Tail Nevus - Correct Answer Tufts of hair overlying spinal column usually at the
lumbosacral area. May be a sign of neural tube defects (spine bifida occult). Perform
neuron exam focusing on lumbosacral areas (fecal/urinary incontinence, problems with
gait). Order an ultrasound of the lesion to rule out occult spine bifid da.
Café au Laity Spots - Correct Answer Flat, light brown to dark brown spots greater
than 5 mm (0.5 cm). If six or more spots larger than 5 mm (0.5 cm) in diameter are
seen, rule out neurofibromatosis or von Recklinghausen's disease (a neurological
disorder marked by seizures, learning disorders, etc.). Refer to pediatric
neurologist if the spots meet the same criteria to rule out neurofibromatosis.
VASCULAR LESIONS
"Port Wine" Stain (Nevus Flames) - Correct Answer Neonates with pink to red fl at
stain-like skin lesions located on the upper and lower eyelids or on the V1 and V2
branches of the trigeminal nerve should be referred to a pediatric ophthalmologist to
rule out congenital glaucoma. Blanches to pressure. Irregular in size and shape. Large
lesions located on half the facial area may be a sign of trigeminal nerve involvement
with Answers
Down's Syndrome - Correct Answer A genetic defect caused by trisomy of
chromosome 21 (three copies instead of two). The most common chromosomal
disorder; the average lifespan is 60 years in the United States. Round face that appears
"flat" (decreased anterior-posterior diameter), accompanied by upward-slanting eyes
(palpebral fissures), and low-set ears. Chronic open mouth caused by enlarged tongue
(macroglossia). Shorter neck with short broad hands with transverse palmar crease
(simian crease). Newborns with hypotonic and poor Moro reflex. Higher risk of
congenital heart defects (50%), congenital hearing loss, visual problems, cataracts,
sleep apnea, and early onset of Alzheimer's disease (average age 54 years). Educate
parents about high-risk sports (risk of spinal cord injury): contact sports (football,
soccer), trampoline, or gymnastics. Avoid trampoline use especially before age of 6
years.
Failure to Thrive (FTT) - Correct Answer Defined as weight for age that falls below 3rd
to 5th percentile for gestation- corrected age and gender when plotted on appropriate
growth chart (on more than 1 occasion). also, infants whose rate of weight change
decreases over two or more major percentiles lines. Use WHO growth charts until 2yo
and then CDC. Causes are usually inadequate dietary intake, diarrhea, malabsorption,
poor maternal bonding, frequent infections, and others.
Fetal Alcohol Syndrome (FAS) - Correct Answer Classic FAS facie is a small head
(microcephaly) with shortened palpebral fissures (narrow eyes) with epicanthal folds
and a fl at nasal bridge. There is a thin upper lip with
no vertical groove above upper lip (smooth philtrum). Ears are underdeveloped. Also
known as Fetal Alcohol Spectrum Disorder, and can range from severe disease with
mental retardation to mild developmental defects that may not be obvious until
adolescence (i.e., attention defy city disorder [ADD]). There is no safe dose or time for
alcohol during pregnancy. Alcohol adversely affects the central nervous system (CNS),
somatic growth, and facial structure development.
Cryptorchidism (Undescended Testicle) - Correct Answer Empty scrotal sac(s). Most
cases involved undescended testicles. One or two testicles may be missing. Testis does
not descend with massage of the inguinal area. Majority
of cases (90%) of cryptorchidism are associated with patent processes vaginosis. Infant
should be sitting and the exam room should be warm to relax muscles when massaging
the inguinal canal. Another option is to examine child after a warm bath. Increased risk
of testicular cancer if testicles are not removed from the abdomen. Surgically corrected
within the fi rest year of life if it does not spontaneously descend
,(orchiopexy).
Gonococcal Ophthalmic Neonatorum - Correct Answer Symptoms usually show within
2 to 4 days after birth. Infection can rapidly spread causing blindness. Do not delay
treatment by waiting for culture results. Symptoms
includes injected (red) conjunctiva with profuse purulent discharge and swollen eyelids.
Majority of cases of congenital gonorrhea infection acquired during delivery
(intrapartum). Any neonates with acute conjunctivitis presenting within 30 days or less
from birth should be tested for chlamydia, gonorrhea, herpes simplex, and bacterial
infection.
Order GC culture (Thayer-Martin), herpes simplex culture, and chlamydial PCR with
Gram stain of eye exudate. Hospitalize and treat with high-dose intravascular (IV) or
intramuscular (IM) ceftriaxone. Preferred prophylaxis is with topical 0.5% erythromycin
ointment (1 cm ribbon per eye). Test (and treat) mother and sexual partner for sexually
transmitted diseases (STDs).
Chlamydial Ophthalmic Neonatorum (Trachoma) - Correct Answer Symptoms will
show within 4 to 10 days after birth. Eyelids become edematous and red with profuse
watery discharge initially that later becomes purulent. When obtaining
a sample, collect not only the exudate, but also conjunctiva cells as well. Rule out
concomitant chlamydial pneumonia. Treated with systemic antibiotics such as
azithromycin IM or oral erythromycin base or erythromycin ethyl succinate syrup QID ×
14 days. Treatment only 80% effective. May need second course. Use only systemic
antibiotics. Prophylaxis is with topical 0.5% erythromycin or tetracycline ointment
(1 cm ribbon per eye). Reportable disease. Test (and treat) mother and sexual partner
for STDs.
Chlamydial Pneumonia - Correct Answer In infants with ophthalmic neonatorum, also
rule out concomitant chlamydial pneumonia. Obtain nasopharyngeal culture for
chlamydia. Infant will have frequent cough with
bibasilar riles, tachypnea, hyperinfl action, and diffused infiltrates on chest x-ray.
Treated with erythromycin QID × 2 weeks. Daily follow-up. Reportable disease.
Sudden Infant Death Syndrome (SIDS) - Correct Answer Unexplained and sudden
death in apparently healthy infants younger than 12 months. Higher risk with
prematurity, low birth weight, maternal smoking and/or drug use, and
poverty. Cause unknown; theories range from CNS abnormalities, cardiac arrhythmias,
suffocation from soft, thick bedding, and so on. To decrease risk, position infants on
their back (supine) only. Avoid side-lying and prone positions. Avoid "overheating" infant
and use of thick quilts, soft beds, pillows, and so on.
Excessive Weight Loss (More Than 10%) - Correct Answer Newborns are expected to
lose weight during the first few days of life. wt. loss can vary by feeding delivery and
type. C section infants tend to lose a larger % of birth wt than vaginal babies. Formula-
fed infants may lose up to 5% and BF up to 7-10%. Any wt. loss of birth weight should
be regained within 10 to 14 days. Weight loss beyond 10% in neonates is considered
, abnormal. Assess the infant for dehydration, electrolyte disturbances, and
hyperbilirubinemia. And the mother and infant for lactation difficulties.
Congenital Dermal Melanocytes (Mongolian Spots) - Correct Answer The most
common type of pigmented skin lesions in newborns. Present in almost all Asians (85%
to 100%) and in more than half of Native American, Hispanic, and Black neonates.
Blue- to black-colored patches or stains. A common location is the lumbosacral area
(but can be located anywhere on the body). May be mistaken for bruising or child
abuse. Usually fades by age 2 to 3 years.
Milia, Malaria, or "Prickly Heat" - Correct Answer Most common in neonates. Multiple
white 1-2 mm papules located mainly on the forehead, cheeks, and nose. Common
locations on forehead, cheeks, and nose. Due to the retention of sebaceous material
and keratin. Spontaneous resolution.
Erythema Toxicum Neonatorum - Correct Answer Small pustules (whitish-yellow color)
that are 1 to 3 mm in size and surrounded by a red base. Erupts during the second to
the third day of life. Located on the face, chest, back, and extremities. Lasts from 1 to 2
weeks and resolves spontaneously.
Seborrhea Dermatitis ("Cradle Cap") - Correct Answer Excessive thick scaling on the
scalp of younger infants. Treated by softening and removal of the thick scales on the
scalp after soaking scalp a few hours (to overnight) with vegetable oil or mineral oil.
Shampoo scalp and gently scrub scales with a soft comb. Prevention is by frequent
shampooing with mild baby shampoo and removing scales
with soft brush or comb. Self-limiting condition and resolves spontaneously within a few
months.
Faun Tail Nevus - Correct Answer Tufts of hair overlying spinal column usually at the
lumbosacral area. May be a sign of neural tube defects (spine bifida occult). Perform
neuron exam focusing on lumbosacral areas (fecal/urinary incontinence, problems with
gait). Order an ultrasound of the lesion to rule out occult spine bifid da.
Café au Laity Spots - Correct Answer Flat, light brown to dark brown spots greater
than 5 mm (0.5 cm). If six or more spots larger than 5 mm (0.5 cm) in diameter are
seen, rule out neurofibromatosis or von Recklinghausen's disease (a neurological
disorder marked by seizures, learning disorders, etc.). Refer to pediatric
neurologist if the spots meet the same criteria to rule out neurofibromatosis.
VASCULAR LESIONS
"Port Wine" Stain (Nevus Flames) - Correct Answer Neonates with pink to red fl at
stain-like skin lesions located on the upper and lower eyelids or on the V1 and V2
branches of the trigeminal nerve should be referred to a pediatric ophthalmologist to
rule out congenital glaucoma. Blanches to pressure. Irregular in size and shape. Large
lesions located on half the facial area may be a sign of trigeminal nerve involvement
