ITEMS IN AFP WITH MESH TERM:
ABSTRACT: Newborn infants may be transferred to a special care nursery because of conditions such as prematurity (gestation less than 37 weeks), prolonged resuscitation, respiratory distress, cyanosis, and jaundice, and for evaluation of neonatal sepsis. Newborn infants' core temperature should be kept above 36.4 degrees C (97.5 degrees F). Nutritional requirements are usually 100 to 120 kcal per kg per day to achieve an average weight gain of 150 to 200 g (5 to 7 oz) per week. Standard infant formulas containing 20 kcal per mL and maternal breast milk may be inadequate for premature infants, who require special formulas or fortifiers that provide a higher calorie content (up to 24 kcal per mL). Intravenous fluids should be given when infants are not being fed enterally, such as those with tachypnea greater than 60 breaths per minute. Hypoglycemia can be asymptomatic in large-for-gestational-age infants and infants of mothers who have diabetes. A hyperoxia test can be used to differentiate between pulmonary and cardiac causes of hypoxemia. The potential for neonatal sepsis increases with the presence of risk factors such as prolonged rupture of membranes and maternal colonization with group B streptococcus. Jaundice, especially on the first day of life, should be evaluated and treated. If the infant does not progressively improve in the special care nursery, transfer to a tertiary care unit may be necessary.
Congenital Toxoplasmosis - Article
ABSTRACT: Approximately 85 percent of women of childbearing age in the United States are susceptible to acute infection with the protozoan parasite Toxoplasma gondii. Transmission of T. gondii to the fetus can result in serious health problems, including mental retardation, seizures, blindness, and death. Some health problems may not become apparent until the second or third decade of life. An estimated 400 to 4,000 cases of congenital toxoplasmosis occur in the United States each year. Serologic tests are used to diagnose acute T. gondii infection in pregnant women. Because false-positive tests occur frequently, serologic diagnosis must be confirmed at a Toxoplasma reference laboratory before treatment with potentially toxic drugs is considered. In many instances, congenital toxoplasmosis can be prevented by educating pregnant women and other women of childbearing age about not ingesting raw or undercooked meat, using measures to avoid cross-contamination of other foods with raw or undercooked meat, and protecting themselves against exposure to cat litter or contaminated soil.
The Abnormal Fontanel - Article
ABSTRACT: The diagnosis of an abnormal fontanel requires an understanding of the wide variation of normal. At birth, an infant has six fontanels. The anterior fontanel is the largest and most important for clinical evaluation. The average size of the anterior fontanel is 2.1 cm, and the median time of closure is 13.8 months. The most common causes of a large anterior fontanel or delayed fontanel closure are achondroplasia, hypothyroidism, Down syndrome, increased intracranial pressure, and rickets. A bulging anterior fontanel can be a result of increased intracranial pressure or intracranial and extracranial tumors, and a sunken fontanel usually is a sign of dehydration. A physical examination helps the physician determine which imaging modality, such as plain films, ultrasonography, computed tomographic scan, or magnetic resonance imaging, to use for diagnosis.
ABSTRACT: Treatment for infants with bronchiolitis caused by respiratory syncytial virus (RSV) includes supplemental oxygen, nasal suctioning, fluids to prevent dehydration, and other supportive therapies. High-risk children who should be hospitalized include those younger than three months and those with a preterm birth, cardiopulmonary disease, immunodeficiency, respiratory distress, or inadequate oxygenation. Inhaled beta2-agonist bronchodilators, the anticholinergic agent ipratropium bromide, and nebulized epinephrine have not been shown to be effective for treating RSV bronchiolitis. However, the Agency for Healthcare Research and Quality states that nebulized epinephrine and nebulized ipratropium bromide are possibly effective. The appropriate use of corticosteroids remains controversial. They may provide some benefit but meta-analyses of clinical trial results are inconsistent. Prophylaxis with RSV intravenous immune globulin or palivizumab, a human monoclonal antibody, can reduce hospitalization rates in high-risk patients, although difficulties with administering the medications and high costs may preclude their widespread use. The use of common infection-control measures can reduce nosocomial transmission of RSV infections.
The Newborn Foot - Article
ABSTRACT: An examination of the feet is an essential component of an evaluation of a newborn. A thorough examination can be performed quickly. Despite its small size, the newborn foot is a complex structure. Most deformities can be diagnosed easily with physical examination alone, using few diagnostic studies. A thorough examination includes assessment of vascular, dermatologic, and neurologic status of the lower extremities, and observation, palpation, and evaluation of joint range of motion in both feet. Common newborn foot abnormalities include metatarsus adductus, clubfoot deformity, calcaneovalgus (flexible flatfoot), congenital vertical talus (rigid flatfoot), and multiple digital deformities-polydactyly, syndactyly, overlapping toes, and amniotic bands. Most treatments include conservative measures, such as observation, stretching, and splinting, which can be performed easily in the family medicine setting. Cases that require surgical correction should be referred to a subspecialist with expertise in correcting lower extremity deformities in children. When surgery is indicated, procedures generally are postponed for six to nine months so that the child will better tolerate anesthesia.
Shoulder Dystocia - Article
ABSTRACT: Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. Calm and effective management of this emergency is possible with recognition of the impaction and institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant. The "HELPERR" mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for addressing this emergency. Although no ideal manipulation or treatment exists, all maneuvers in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the maternal pelvis through cephalad rotation of the symphysis and flattening of the sacrum; collapsing the fetal shoulder width; or altering the orientation of the longitudinal axis of the fetus to the plane of the obstruction. In rare cases in which these interventions are unsuccessful, additional management options, such as intentional clavicle fracture, symphysiotomy, and the Zavanelli maneuver, are described.
Craniosynostosis - Article
ABSTRACT: Skull deformity in infants continues to be a diagnostic and therapeutic challenge. Deformational plagiocephaly is a common and somewhat benign cause of skull deformity in infants that must be distinguished from the more serious craniosynostosis, which occurs alone or as a syndrome. Examining an infant's head from above can help the physician distinguish true lambdoid synostosis from deformational plagiocephaly. In infants with lambdoid synostosis, the posterior bossing is in the parietal area contralateral to the flat part of the head. Deformational plagiocephaly causes frontal bossing ipsilateral to the flat part of the head. In infants with lambdoid synostosis, the ear is displaced posteriorly toward the fused suture. In infants with deformational plagiocephaly, the ear is displaced anteriorly. Isolated sagittal synostosis is the most common type of craniosynostosis. Of the more than 150 craniosynostosis syndromes, Crouzon's disease and Apert's syndrome account for the majority of cases. The diagnosis of craniosynostosis relies on physical examination, plain radiography, and computed tomography. Untreated progressive craniosynostosis leads to inhibition of brain growth, and an increase in intracranial and intraorbital pressure. Infants should be evaluated as soon as they are diagnosed.
Infantile Colic - Article
ABSTRACT: Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the 'rule of three': crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the crying, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already.
ABSTRACT: Community-acquired pneumonia is one of the most common serious infections in children, with an annual incidence of 34 to 40 cases per 1,000 children in Europe and North America. When diagnosing community-acquired pneumonia, physicians should rely mainly on the patient's history and physical examination, supplemented by judicious use of chest radiographs and laboratory tests as needed. The child's age is important in making the diagnosis. Pneumonia in neonates younger than three weeks of age most often is caused by an infection obtained from the mother at birth. Streptococcus pneumoniae and viruses are the most common causes in infants three weeks to three months of age. Viruses are the most frequent cause of pneumonia in preschool-aged children; Streptococcus pneumoniae is the most common bacterial pathogen. Mycoplasma pneumoniae and Chlamydia pneumoniae often are the etiologic agents in children older than five years and in adolescents. In very young children who appear toxic, hospitalization and intravenous antibiotics are needed. The symptoms in outpatients who present with community-acquired pneumonia can help determine the treatment. Knowing the age-specific causes of bacterial pneumonia will help guide antibiotic therapy. Childhood immunization has helped decrease the incidence of invasive Haemophilus influenzae type B infection, and the newly introduced heptavalent pneumococcal vaccine may do the same for Streptococcus pneumoniae infections.
A Practical Guide to Infant Oral Health - Article
ABSTRACT: Early childhood caries is the most common chronic disease in young children and may develop as soon as teeth erupt. Bacteria, predominately mutans streptococci, metabolize simple sugars to produce acid that demineralizes teeth, resulting in cavities. Physicians should examine children's teeth for defects and cavities at every well-child visit. Any child with significant risk factors for caries (e.g., inadequate home dental care and poor oral hygiene, a mother with a high number of cavities, a high sugar intake, enamel defects, premature birth, special health care needs, low socioeconomic status) should be referred to a dentist by 12 months of age. Promoting appropriate use of topical and systemic fluoride and providing early oral hygiene instruction can help reduce caries in young patients, as can regularly counseling parents to limit their child's consumption of sugar.