HIGH RISK MATERNAL

• Asthma - Chronic inflammatory disorder of the respiratory tract and the most common chronic illness in children.
• allergens, pollen, dust, moulds, animal dander - Inflammatory mediators
• wheezing, coughing, chest tightness, shortness of breath - Signs and Symptoms of Asthma
• Hypoxemia, Respiratory alkalosis - Complication of Asthma
• Spirometry and Expiratory flow rate monitor - Diagnostic test for asthma
• Pneumonia


  Infection and inflammation of the lung parenchyma associated with alveolar edema and congestion that impaired gas exchange. Spread to droplets or by contact.
• Tetralogy of Fallot

  A syndrome of four defects: ventricular septal defect (VSD), pulmonary artery stenosis, overriding aorta that straddles the VSD, and right ventricular hypertrophy. The right ventricular hypertrophy is not an isolated problem but occurs secondary to the pulmonary stenosis.
• Sickle Cell Anemia


  An autosomal recessive inherited disorder carried on the beta chain of hemoglobin; the amino acid valine takes the place of the normally appearing glutamic acid. The erythrocytes appear elongated and crescent-shaped (sickled) when they are submitted to low oxygen tension (less than 60% to 70%), low blood pH (acidosis), or increased blood viscosity. When RBCs sickle, they cannot move freely through the vessels.
• Propranolol


  A beta blocker medication
• Propranolol


  • Route: Oral/IV
  • Indication: To prevent tet spells; increase venous circulation
  • Action: Competes with sympathomimetic neurotransmitters for binding to receptors, which inhibits sympathetic stimulation of the heart
  • Dosage: 0.6 mg/kg (Oral)
• Sickle Cell Anemia


  An autosomal recessive inherited disorder carried on the beta chain of hemoglobin; the amino acid valine takes the place of the normally appearing glutamic acid
• Sickle Cell Anemia Symptoms

  • Tachycardia, cardiomegaly, chronic fatigue, unexplained dyspnea, hepatomegaly, joint swelling, aching bones, or chest pain
  • Severe pain in the abdomen, thorax, muscle, or bones
  • Jaundice, dark urine, and low-grade fever due to blood vessel obstruction by rigid, tangled, sickle cells leading to tissue anoxia and possibly necrosis
• Sickle Cell Anemia Complications

  • Retinopathy, nephropathy,and cerebral vessel occlusion due to organ infarction; hypovolemic shock and death due to massive entrapment of cells; necrosis; infection; and gangrene
• Sickle Cell Anemia Diagnostic Tests

  • Positive family history and typical clinical features confirm diagnosis
  • Hb electrophoresis shows Hb S
  • Electrophoresis of umbilical cord blood provides screening for all neonates at risk
  • Stained blood smear shows sickle cells
  • Blood studies reveal low RBC counts, elevated WBC and platelet counts, decreased erythrocyte sedimentation rate, increased serum iron levels, decreased RBC survival, and reticulocytosis (Hb levels may be low or normal)
  • Lateral chest X-ray shows "Lincoln log" deformity
  • Neonatal screening for Hb abnormalities
• Sickle Cell Anemia Treatment

  • Packed RBC transfusion to correct hypovolemia (if Hb levels decrease)
  • Sedation and analgesics, such as morphine, for pain
  • Oxygen administration to correct hypoxia
  • Large amounts of oral or IV fluids to correct hypovolemia and prevent dehydration and vessel occlusion
  • Prophylactic penicillin before age 4 months to prevent infection
  • Hydroxyurea to reduce painful episodes by increasing production of fetal Hb
  • Iron and folic acid supplements to prevent anemia
• Morphine Sulfate


  An opioid analgesic medication
• Morphine Sulfate


  • Route: Oral solution
  • Indication: For management of chronic, moderate to severe pain
  • Action: Binds with opioid receptors within CNS, inhibiting ascending pain pathways
  • Dosage: 0.08-0.1 mg/kg
• Hirschsprung's Disease


  An absence of ganglion innervation to the muscle of a section of the bowel–in most instances, the lower portion of the sigmoid colon just above the anus
• Hirschsprung's Disease Symptoms

  • Mild to severe chronic constipation
  • Diarrhea (liquid can only pass through the aganglionic section)
  • Thin, undernourished appearance
  • Distended abdomen
  • History of not having a bowel movement more than once a week of ribbonlike or watery stools
• Hirschsprung's Disease Complications

  • Enterocolitis, tissue destruction (due to the severe edema of the colon, obstructing blood and lymphatic flow)
  • Gram-negative sepsis (bacteria infiltration in the bowel wall from the lumen)
• Hirschsprung's Disease Diagnostic Tests

  • Rectal biopsy that demonstrates the aganglionic bowel; a more definitive diagnosis
  • Anorectal manometry - tests the strength of the internal rectal sphincter by inserting a balloon catheter into the rectum and measuring the pressure
  • Rectal Exam - in true constipation, the examining finger will touch hard, caked stool. In HD, the rectum is empty because fecal material cannot pass through the rectum
  • Barium enema (X-ray) or UTZ - outline the narrow, nerveless portion and large proximal distended portion of the bowel
• Hirschsprung's Disease Treatment


  • Resection and removal of the aganglionic segment with anastomosis of the intestine (pull-through operation)
  • Constant attention to bowel hygiene
• Gentamicin


  • Route: IV
  • Indication: For treatment of enterocolitis
  • Action: Passes through the gram-negative membrane in an oxygen-dependent active transport
  • Dosage: 2.5 mg/kg
• Acute Gastroenteritis


  Inflammation of the lining of the stomach and small and large intestines
• Acute Gastroenteritis Symptoms

  • Diarrhea (loose, watery stools)
  • Dehydration
  • Vomiting
  • Dysuria
  • Abdominal pain
  • Infection (fever, chills, myalgias, rash, rhinorrhea, sore throat, cough)
  • Poor skin turgor
  • Dry lips and oral mucosa
• Acute Gastroenteritis Diagnostic Tests

  • Stool exam - stool specimens are collected for culture and sensitivity testing to determine the causative infectious organism
• Acute Gastroenteritis Treatment


  • Oral rehydration solution (ORS) - for mild-to-moderate gastroenteritis
  • NG Feeding - for patients who do not tolerate ORS
  • IV rehydration - for severe dehydration
  • Diet - normal diet ASAP through small, frequent meals
• Metronidazole


  A nitroimidazole antibiotic medication
• Metronidazole


  • Route: IV/Oral
  • Indication: Used to treat gastrointestinal infections; in H. pylori infections; taken with Amoxicillin
  • Action: Diffuses into the organism, inhibits protein synthesis by interacting with DNA, and causes a loss of helical DNA structure and strand breakage
  • Dosage: 15-20 mg/kg
• Patent Ductus Arteriosus


  Failure of the ductus arteriosus to close within the first weeks of life
• Patent Ductus Arteriosus Symptoms

  • Machinery murmur (Gibson murmur) in early life OR Continuous murmur as the child ages
  • Rales, congestion, increased breathing effort, difficulty feeding, failure to thrive
  • Dilated heart (over time)
  • Respiratory distress, with signs of heart failure
  • Thrill palpated at the left sternal border caused by the shunting of blood from the aorta to the pulmonary artery
  • Prominent left ventricular impulse due to left ventricular hypertrophy
  • Bounding peripheral pulses (Corrigan's pulse) due to the high-flow state
  • Widened pulse pressure because of an elevated systolic blood pressure and, primarily, a drop in diastolic blood pressure as blood is shunted through the PDA, thus reducing peripheral resistance
  • Slow motor development
• Patent Ductus Arteriosus Complications

  • Left ventricular hypertrophy, heart failure (due to the increased workload and pressure in the left side of the heart)
• Patent Ductus Arteriosus Diagnostic Tests

  • Echocardiogram - detects and estimates the size of PDA; reveals an enlarged left atrium and left ventricle, or right ventricular hypertrophy
  • Chest X-ray - increased pulmonary vascular markings, prominent pulmonary arteries, and enlargement of the left ventricle and aorta
  • Electrocardiography - may normal or may indicate left atrial or ventricular hypertrophy and, in pulmonary vascular disease, biventricular hypertrophy
  • Cardiac catheterization - shows higher pulmonary arterial oxygen content than right ventricular content because of the influx of aortic blood
• Patent Ductus Arteriosus Treatment

  • Surgery - ligate the ductus if medical management can't control heart failure
  • Indomethacin - prostaglandin inhibitor
• Indomethacin


  A nonsteroidal anti-inflammatory drug (NSAID) medication
• Medications that may lower seizure threshold

  • Antibiotics
  • Anti-asthmatics
  • Anti-depressants
  • Hormones
• Bulging fontanelle


  Increased ICP
• Diagnostic Tests


  • Health history
  • Physical assessment
  • Clinical signs
  • Electroencephalogram
  • Skull x-ray
  • CT scan
  • MRI
  • Lumbar puncture
  • Blood glucose
  • Serum electrolytes
• Anti-seizure drugs


  • Phenobarbital
  • Phenytoin
  • Valproic acid
  • Diazepam
• Phenobarbital

  Nonselective CNS depressant/Barbiturate