High Risk Child: SGA Overview

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Questions and Answers

Which of the following complications is most commonly associated with Spina Bifida?

Hydrocephalus (correct)

Hearing loss

Congenital heart defects

Vision impairment

What is the primary treatment goal for a child with Meningocele or Encephalocele?

Observation and monitoring for signs of complications

Physical therapy to strengthen muscles and improve mobility

Administering antibiotics to prevent infection

Immediate surgical intervention to close the gap in the skin and replace the meninges (correct)

What is the purpose of observing spontaneous movement in the lower extremities of an infant born with a neural tube defect?

To assess the severity of the spinal deformity

To evaluate the presence of lower motor function (correct)

To monitor for signs of infection

To determine the need for immediate surgical intervention

Which of the following prenatal tests can detect neural tube disorders?

All of the above Signup and view all the answers

Why is a Cesarean birth often recommended for infants with neural tube defects?

To prevent pressure and injury to the spinal cord Signup and view all the answers

What is the clinical significance of observing a newborn with Spina Bifida Occulta displaying spontaneous movement of the lower extremities?

The defect is typically mild and does not require further monitoring Signup and view all the answers

Which of the following statements accurately describes the clinical presentation of Spina Bifida Occulta?

The defect is often asymptomatic and may only be discovered during routine physical exams Signup and view all the answers

What is the potential consequence of a large portion of meninges being removed during surgery for Meningocele or Encephalocele?

Hydrocephalus Signup and view all the answers

What is the primary treatment for patients with a patent ductus arteriosus if they are between 6 months to 1 year of age?

Surgical intervention Signup and view all the answers

Which of the following is a common sign of coarctation of the aorta?

Absent femoral pulse Signup and view all the answers

Which structural defect allows for blood to shunt from the left atrium to the right atrium?

Atrial septal defect Signup and view all the answers

What typically results from a substantial ventricular septal defect?

Increased right ventricular hypertrophy Signup and view all the answers

What is the common initial symptom of coarctation of the aorta in young children?

Exceptional irritability Signup and view all the answers

How does a patent ductus arteriosus affect pulmonary circulation?

It increases pressure in the pulmonary circulation Signup and view all the answers

What is the mainstay of treatment for smaller ventricular septal defects?

Observation, as they often close spontaneously Signup and view all the answers

Which medication is typically used as the drug of choice for maintaining patent ductus arteriosus in infants?

Ibuprofen Signup and view all the answers

What is an important care step to take immediately after the birth of an infant with Omphalocele?

Insert a nasogastric tube to prevent intestinal distention. Signup and view all the answers

How should the sac of an infant with Omphalocele be covered until surgery?

With sterile saline-soaked gauze or a sterile plastic bowel bag Signup and view all the answers

Which of the following is NOT a characteristic feature of Tetralogy of Fallot?

Atrial Septal Defect Signup and view all the answers

What is a potential complication of Gastroschisis during pregnancy?

Volvulus due to displacement of intestinal contents Signup and view all the answers

Which of the following statements about Spina Bifida is true?

Incidence can be reduced through prenatal Folic Acid supplementation. Signup and view all the answers

What is the primary reason behind the bluish tint of the skin in a newborn with Tetralogy of Fallot as they become more active?

Decreased oxygen saturation in the blood Signup and view all the answers

What is a critical observation to watch for in infants after they begin oral feedings post-surgery for Omphalocele or Gastroschisis?

Signs of obstruction such as abdominal distention Signup and view all the answers

What physiological change does squatting provide to a person with Tetralogy of Fallot?

Increases blood flow to the lungs Signup and view all the answers

Which condition is characterized by the absence of cerebral hemispheres?

Anencephaly Signup and view all the answers

What is the primary medical intervention used to correct the narrowing of the pulmonary valve in Tetralogy of Fallot?

Interventional cardiac catheterization Signup and view all the answers

What is a common outcome for children with Gastroschisis after surgical correction?

Persistent difficulty with absorption of nutrients Signup and view all the answers

Which of the following is a common symptom associated with Tetralogy of Fallot?

Syncope (fainting) Signup and view all the answers

Which of the following processes fails to occur during intrauterine life leading to the development of cleft lip?

Fusion of the maxillary and median nasal processes Signup and view all the answers

Which laboratory finding may indicate a case of Anencephaly during pregnancy?

Elevated levels of MAFP Signup and view all the answers

What is the primary reason for the flattened appearance of the nose in infants with cleft lip?

Incomplete fusion of the upper lip Signup and view all the answers

Which of the following statements regarding cleft lip is TRUE?

Cleft lip can occur as a familial tendency. Signup and view all the answers

What is a possible cause of microcephaly?

Severe malnutrition Signup and view all the answers

What distinctive feature may indicate the presence of Spina Bifida Occulta?

Dimpling or abnormal skin markings on the back Signup and view all the answers

What is a characteristic of Meningocele?

The protrusion is usually covered by skin Signup and view all the answers

Which of the following best describes Meningomyelocele?

A defect where the spinal cord is located at the protrusion site Signup and view all the answers

How is the incidence of Spina Bifida Occulta described?

It is a common congenital defect with a high frequency Signup and view all the answers

What challenges do infants with little or no cerebral function face after birth?

They may survive for several days but struggle with basic functions Signup and view all the answers

The protrusion in Meningocele occurs primarily in which anatomical region?

Lumbar region Signup and view all the answers

What aspect of the spinal cord is affected in Meningomyelocele?

It is protruded through unformed vertebrae Signup and view all the answers

What is the typical timeframe for palatal process closure during intrauterine life?

Weeks 9 to 12 Signup and view all the answers

What is a potential contributing factor to the development of cleft palate, according to the provided information?

Viral infection Signup and view all the answers

What is the recommended age range for surgery to repair a cleft palate?

12 to 18 months Signup and view all the answers

Which of the following methods is NOT recommended for feeding an infant with cleft lip?

Standard baby bottle nipple Signup and view all the answers

Why is it important for an infant with a cleft lip to be bubbled well after feeding?

To prevent aspiration Signup and view all the answers

What specific challenge do infants with cleft palate face during breastfeeding?

Risk of aspiration Signup and view all the answers

What is the recommended action for a dry mouth and lips in an infant with a cleft lip?

Give the infant small sips of fluid between feedings Signup and view all the answers

Study Notes

High Risk Child

Small for Gestational Age (SGA): Infants with birth weight below the 10th percentile on an intrauterine growth chart for their gestational age.
- Etiology: Intrauterine growth restriction (IUGR), failure to grow at the expected rate in utero. Maternal nutrition during pregnancy is a key contributor. Adolescents are at higher risk due to their own nutritional needs taking priority over fetal development. Placental anomaly (inadequate nutrient supply or transport) is another common cause.
- Assessment: Fundal height during pregnancy may be less than expected. May have poor skin turgor, large head relative to body size, widely separated skull sutures, dull hair, small liver, sunken abdomen, and dry/yellow stained umbilical cord.
- Laboratory Findings: High hematocrit, increased RBC count (polycythemia), prolonged acrocyanosis (blueness of hands and feet), and decreased glycogen stores leading to hypoglycemia.
Large for Gestational Age (LGA): Infants with birth weight above the 90th percentile for gestational age.
- Etiology: Overproduction of nutrients and growth hormones in utero. Obese or diabetic mothers are more likely to have LGA babies. Multiparous women (having more than one pregnancy) may also have larger subsequent babies.
- Assessment: Immature reflexes, potentially low scores on gestational age examinations. Bruising or birth injuries (e.g., fractured clavicle) are a possibility. Potential for large head, exposing it to more pressure during birth. Caput succedaneum or cephalhematoma may be apparent.
- Appearance: Immature reflexes, potential for birth injuries.

Caput Succedaneum and Cephalhematoma

Caput succedaneum: Bruising and edema (swelling) of presenting part that extends beyond the margin of the skull bone. Often resolves within a few days. Usually caused by pressure during vaginal delivery, forceps/vacuum use. Associated with prolonged delivery.
Cephalhematoma: Collection of blood between the cranial bone and periosteum. Does not cross suture lines. Usually resolves within several weeks. More likely to be present if forceps or vacuum birth is used. Occurs more commonly in infants who are born with a forceps delivery or vacuum extraction.

Extracranial Hemorrhage

Bleeding outside the brain.

Respiratory Distress Syndrome

Occurs in preterm infants, infants of diabetic mothers, and those with reduced blood perfusion to the lungs.
Characterized by a hyaline membrane lining the terminal bronchioles and alveoli, impairing gas exchange.
Often presents with difficulty initiating respirations and respiratory distress symptoms (tachypnea, retractions, cyanosis).

The Post-Term Infant

Delivered after 41 weeks of gestation.
Placental function may be compromised, potentially leading to weight loss for the fetus.
Potential features include wrinkled, patchy, peeling skin, long thin body, open eyes, alert appearance, long nails. Oligohydramnios (low amniotic fluid) increases the likelihood of post-maturity.

Other Congenital Heart Disorders

Patent Ductus Arteriosus (PDA): Failure of the ductus arteriosus to close. Signs include wide pulse pressure, continuous machine-like murmur, present in the upper left sternal border or under the left clavicle. Often closes spontaneously.
Ventricular Septal Defect (VSD): An opening in the septum between the ventricles. A systolic murmur, often described as a pansystolic murmur, is a hallmark of VSD.
Atrial Septal Defect (ASD): An opening in the septum between the atria. Blood flows from the left atria to the right atria, leading to increased volume and hypertrophy in the right side of the heart.
Coarctation of the Aorta: Narrowing of the aorta, the main artery carrying blood away from the heart. High blood pressure in the upper extremities and low blood pressure in the lower extremities can occur with this condition.
Tetralogy of Fallot: A combination of four structural defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. Associated with cyanosis and squatting.
Truncus Arteriosus: A single great artery arises from both ventricles, rather than separate arteries. Usually presents with cyanosis & heart murmurs in newborns.
Transposition of the Great Vessels (TGA): The aorta connects to the right ventricle, and the pulmonary artery connects to the left ventricle. This requires immediate intervention for survival of the newborn.

Other conditions associated with high-risk infants

Hypoplastic left heart syndrome (HLHS): The left side of the heart is underdeveloped, making it difficult to circulate blood.

Hemolytic Disease of the Newborn (HDN)

Characterized by excessive destruction of red blood cells, resulting in increased bilirubin, a yellow pigment.
Bilirubin levels higher than 12 mg/dl in term infants and as low as 10 mg/dl in preterm infants can be dangerous to the brain.
Hyperbilirubinemia is a potential complication of HDN.
Phototherapy is used to treat elevated bilirubin levels.

Other High-Risk Conditions

Cleft Lip and Cleft Palate: Incomplete fusion of the lip or palate.
Gastroschisis: The abdominal wall fails to close properly, allowing intestines to protrude outside the abdomen through the abdominal wall.
Omphalocele: Intestines and other abdominal organs herniate through a defect in the abdominal wall, often covering the defect with a membrane.
Tracheoesophageal Atresia (TEA): The esophagus is closed or obstructed, often connecting to the trachea (windpipe).
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF): The esophagus doesn't connect properly to the stomach, often connected to the trachea, causing secretions to enter the lung and requiring immediate surgery.
Diaphragmatic Hernia (Diaphragmatic Diastasis): A hole, or weakness, in the diaphragm permits the stomach (and likely the intestines) to enter the thoracic cavity, disrupting lung development.
Congenital Diaphragmatic Hernia (CDH): The diaphragm doesn't properly separate the chest cavity from the abdominal cavity and permits abdominal contents to enter the thoracic cavity, resulting in respiratory distress or failure in newborns.
Spina Bifida: A neural tube defect resulting in incomplete closure of the spinal cord. Multiple types exist, ranging from mild (Spina Bifida Occulta) to severe (Myelomeningocele).
Anencephaly: Absence of a major portion of the fetal brain, which occurs when the neural tube fails to close properly.

Post-Partum Hemorrhage

Uterine Atony: Uterus fails to contract effectively following delivery, resulting in excessive bleeding.
Retained Placenta: Portions of the placenta remain in the uterus, preventing effective uterine contraction and contributing to bleeding.
Lacerations: Tears in the cervix, vagina, or perineum during delivery.
Subinvolution: Incomplete return of the uterus to its pre-pregnancy size and tone. Can happen if the uterus is not contracting adequately.
Perineal Hematoma: Collection of excessive blood in the tissues of the perineum. Can result from lacerations or excessive pressure during delivery.

Conditions of Pregnancy, Labor, and Delivery

Dysfunctional Labor: Inefficient or prolonged uterine contractions.
CPD (Cephalopelvic Disproportion): The fetus's head or size is too large compared to the mother's pelvis.
Prolonged Latent Phase: The latent phase of labor (early labor) lasts longer than expected.
Secondary Arrest of Dilation: Cervical dilation stops progressing.
Prolonged Descent: The baby is not descending in labor at the expected pace.
Arrest of Descent: Fetal descent has stopped entirely.
Retained Placental Fragments: Placental fragments are not delivered after birth.

Other High-Risk Issues

Intussusception : One part of the intestine slides into another part, obstructing blood flow.
Volvulus: Twisting of the intestines, causing obstruction and/or decreased blood supply.
Celiac Disease (Malabsorption Syndrome): A condition causing problems with nutrient absorption due to intolerance of gluten.
Hirschsprung's Disease: Absence of certain nerves in part of the bowels; causes constipation.
Diaphragmatic Hernia: An opening in the diaphragm permits abdominal contents to enter the chest cavity.
Inguinal Hernia: A segment of the intestine protrudes into the inguinal canal.
Umbilical Hernia: A segment of the intestine protrudes through the umbilical opening.
Inversion of the Uterus: The uterus turns inside out after delivery.

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Description

This quiz covers the critical aspects of Small for Gestational Age (SGA) infants. It discusses the etiology, assessment criteria, and laboratory findings associated with SGA. Understanding these factors is vital for monitoring and managing high-risk children effectively.