Take a picture it'll last longer
What is the window for imaging with CT in HIE
72hrs +/- 12h after the insult
A 62 day old male presented with fever and a positive UA. He was clinically well and you decided he could be managed at home. How soon do you need to follow him up?
24-48h
Name the most common sign of stroke in neonates
seizures
An 11 day old presents with fever of 39.2, poor feeding, and irritability. What investigations are warranted?
CBC with differential, inflammatory markers (CRP or PCT), blood culture/sensitivity, urinalysis, and urine culture/sensitivity, and LP (CSF for cell count, protein, glucose, gram stain, bacterial culture)
"It's the most beautiful time of the year, lights fill the streets, spreading so much cheer, I should be playin in the winter snow..."
"But I'ma be under the mistletoe"
Basal ganglia/thalamic
A 22 day old well appearing infant presented with fever and was admitted after having an LP and starting antibiotics. All investigations were reassuring and cultures are negative at 24h hours. Is he appropriate for discharge?
Negative cultures at 24-36h - appropriate to stop antibiotics and discharge home with anticipatory guidance
Name 4 treatable causes of NE
HIE, inborn error of metabolism, hyperbilirubinemia, infection, metabolic disturbance
An 15 day old infant presents with a temp of 39.0 and lethargy. On exam, they have a bulging fontanelle. What empiric treatment would you start?
Ampicillin 75mg/kg q6h AND cefotaxime 50mg/kg q6h AND Acyclovir 20mg/kg q8h
próspero año y felicidad
Name two areas with T1 hyperintensity on MRI in bilirubin encephalopathy
globus pallidus and subthalamic nuclei
Name 3 risk factors that exclude infants from the "Well appearing febrile infant" guideline
History of prematurity; Prior hospitalization or prolonged newborn nursery course; Chronic medical conditions/ chromosomal abnormality; Known or suspected immunodeficiency; Recent antibiotic exposure; Any focal bacterial infection (e.g., cellulitis, omphalitis, osteoarticular infection)
This type pattern of injury in HIE is most associated with motor disability
basalganglia/thalamic
A 32 day old female presents to the ED with a fever of 38.6. A UA is done which is positive for leukocyte esterase. She looks very well on clinical exam. What are the next steps in her management?
Admit to hospital, Start antibiotics for UTI, LP not required, await results of urine culture and blood culture
""Merry Christmas", I wrapped it up and sent it..."
"With a note saying "I love you", I meant it"
An infant is born following placenta abruption and difficult extraction. What U/S findings might be seen the following day?
Rebound increases in flow may be seen with doppler of the anterior cerebral artery
You are working in a rural hospital with no access to PCT testing. What scoring system will you use to determine the risk of infants presenting with fever and what are its components?
Aronson Rule (low risk if </= 1) -
Age <21days = 1pt; Fever measured in ED (38-38.4 = 2pts, >38.5 = 4 pts); ANC >5.1 = 2pts; UA + = 3pts
What does PLIC stand for
posterior limb of the internal capsule
Option 1 - No LP, admit without antibiotics, and observe until culture negative
Option 2 - LP, admit w/ or w/o antibiotics, and observe pending cultures
"It was christmas eve babe... In the drunk tank"
an old man said to me, won't see another one
Name BOTH metabolic markers used in MSRI
N-acetylaspartate and lactate
A 15 day old female was admitted after a temp of 38.2 was measured in ED. They are clinically well, UA was negative, CRP was 40, PCT was 3, and their NPS was positive for rhinovirus. Parents are eager to go home because cultures are negative at 24 hours. Is she appropriate for discharge?
No - she would be classified as a high-risk infant and should be observed for at least 36 hours. The positive rhino result is also the exception for when a positive viral result can support a discharge at 24 hours.
Name 3 types of bleeds poorly seen on cranial U/S
subdural, subarachnoid and posterior fossa.
Repeat blood culture, LP, empiric antibiotics (Ceftriaxone 100mg/kg q24h +/- Vancomycin 15mg/kg q6h, if CSF WBC count >9).
"You nauseate me, Mr. Grinch. With a nauseous super "naus". You're a crooked jerky jockey and you drive a crooked horse, Mr. Grinch..."
"You're a three-decker sauerkraut and toadstool sandwich, With arsenic sauce"