Archive for April, 2010

Persistent Pulmonary Hypertension

Posted by on Wednesday, 28 April, 2010

Persistent pulmonary hypertension (PPHN) is the presence of blood flow through the lungs and heart seen in fetuses. While growing inside the womb, the mother did the breathing for him/her. Oxygenated blood went from the mother’s lungs, through her body , across the placenta, and into the baby. Therefore, the baby did not need to use it’s lungs. However, after the bay is born it cries, and takes breaths, the pressure in the pulmonary (lung) vessels should decrease; therefore blood can travel to the lungs to get oxygen. when a baby has PPHN, the pressure in the pulmonary vessels does not decrease causing blood to shunt the wrong way (away from the lungs), as the baby was still inside the womb. Therefore, the baby receives unoxygenated blood to their body.

persistent pulmonary hypertension

This condition is usually seen in near term, term, or post term infants. Symptoms are usually seen with in the first twelve hours of life. Several factors that cause PPHN, are stressful birthing process, swallowing the meconuim (the first few stools which are thick, sticky and pasty) by gasping for a breath in the birthing canal. The meconium can get into the baby’s lungs and cause the baby to have difficult breathing after birth. Other causes of PPHN may be cold stress, low blood sugar, low calcium, thickening of the blood, or infection.

Symptoms that are first noticed will be that the baby may begin to breathe faster, known as (tachypnea) and the baby’s chest may suck in (retractions) as if their having a difficult time breathing. The baby will probably need to be placed on a breathing machine(ventilator). A nurse will need to give some medication(sedation) to help the baby rest. You may see a bluish discoloration of the skin (cyanosis) because of decreased oxygen, resulting in the baby’s blood pressure being low. The main goal is to get oxygenated blood to the rest of the baby’s body. This is done by using a ventilator and medications. The baby may also need to be on a special medication to increase their blood pressure (vasopressor). The baby will have several lines and intravenous access to measure and monitor their condition. PPHN is a very Serious Condition. Some babies show long-term developmental problems, therefore, the baby’s development should be closely evaluated.


Pyloric Stenosis

Posted by on Saturday, 24 April, 2010

Pyloric Stenosis

What is pyloric stenosis?

Pyloric stenosis is a problem that affects babies between 2 and 8 weeks of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem requiring surgery in newborns.

The lower portion of the stomach that connects to the small intestine is known as the pylorus.
pyloric stenosis
In pyloric stenosis, the muscles in this part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stomach to the intestine.

What causes pyloric stenosis?

Pyloric stenosis (PS) is considered a “multifactorial trait.” Multifactorial inheritance means that “many factors” (multifactorial) are involved in causing a birth defect. The factors are usually both genetic and environmental. Often one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different “threshold of expression,” which means that one gender is more likely to show the problem, over the other gender. For example, pyloric stenosis is four times more common in males than females. Once a child has been born with pyloric stenosis, the chance for it to happen again depends upon the gender of the child already born with the condition, as well as the gender of the next child.

Which babies are at higher risk for pyloric stenosis?

  • Two to three out of 1,000 infants are affected by pyloric stenosis (PS).
  • Babies 2 to 8 weeks old are at the highest risk.
  • Caucasians seem to develop pyloric stenosis more frequently than babies of other races.
  • Boys develop pyloric stenosis four to five times more often than girls.
  • Pyloric stenosis may be inherited; several members of a family may have had this problem in infancy.

Why is pyloric stenosis of concern?

Because the stomach opening becomes blocked and babies start vomiting, several problems can happen. The most serious problem is dehydration. When a baby vomits regularly, he/she will not get enough fluids to meet his/her nutritional needs. Babies have smaller bodies than adults and cannot tolerate losing fluid as easily as adults can. Minerals that the body needs to stay healthy, such as potassium and sodium, are also lost as the baby vomits. Babies who lack the right amount of water and minerals in their bodies can become very sick very quickly.

Another problem that occurs is weight loss. A baby who vomits most of (or all of) his/her feedings will not have adequate nutrition to gain weight and stay healthy.

What are the symptoms of pyloric stenosis?

The most common symptoms noted in a baby with pyloric stenosis is forceful, projectile vomiting. This kind of vomiting is different from a “wet burp” that a baby may have at the end of a feeding. Large amounts of breast milk or formula are vomited, and may go several feet across a room. The baby is usually quite hungry and eats or nurses eagerly. The milk is sometimes curdled in appearance, because as the milk remains in the stomach and does not move forward to the small intestine, the stomach acid “curdles” it.

Other symptoms may include:

  • weight loss
  • lack of energy
  • fewer bowel movements
  • constipation
  • frequent, mucous stools

The symptoms of pyloric stenosis may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

How is pyloric stenosis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pyloric stenosis may include:

  • blood tests – to evaluate dehydration and mineral imbalances.
  • abdominal x-rays – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • abdominal ultrasound – a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • barium swallow / upper GI series – a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
  • Treatment for pyloric stenosis:

    Specific treatment for pyloric stenosis will be determined by your baby’s physician based on:
    your baby’s gestational age, overall health, and medical history the extent of the problem
    your baby’s tolerance for specific medications, procedures, or therapies expectation for the course of the problem your opinion and preference Pyloric stenosis must be repaired with an operation.

    However, physicians may need to treat your baby’s dehydration and mineral imbalances first. Water and minerals can be replaced through intravenous (IV) fluid. Once your baby is no longer dehydrated, surgery can be performed. Under anesthesia, a small incision is made above the navel and the tight pyloric muscle is repaired.

    Babies can often begin drinking small amounts of clear liquids in the first 24 hours. Generally, clear liquids such as an electrolyte drink will be given to your baby first. However, babies may still vomit for several days after surgery due to swelling of the surgical site of the pyloric muscle. The swelling goes away within a few days.

    Most babies will be taking their normal feedings by the time they go home. Babies are usually able to go home within two to three days after the operation.

    What is the long-term prognosis for pyloric stenosis?

    This problem is unlikely to reoccur. Babies who have undergone the surgery should have no long-term effects from it.


Respiratory Syncytial Virus

Posted by on Tuesday, 20 April, 2010

RSV stands for Respiratory Syncytial Virus, the most frequent cause of serious respiratory tract infections in infants and children under 4 years of age. This is such a common virus that RSV has infected virtually all children by the age of three. In most young children, it results in a mild respiratory infection that is not distinguishable from a common cold. RSV occurs throughout the year and is most prevalent in winter months.

respiratory-syncytial-virus

RSV causes nasal stuffiness and discharge, cough and sometimes ear infections. It is usually self-limiting and does not require hospitalization or specific treatment, even in the majority of those who also have lower respiratory tract involvement. These children may have a low-grade fever for several days, respiratory symptoms that may last for 1 to 2 weeks, and a cough that sometimes persists beyond 2 weeks.

Sometimes an infant or a young child who is experience his or her first RSV infection may develop a severe infection in the lower respiratory tract that is best managed in the hospital. Approximately 90,000 children are hospitalized with these infections each year. Most commonly, the ones requiring hospitalization are newborns and infants and those with complicating or underlying conditions, such congenital heart, lung disease or prematurity.

A child who develops signs of more stressful breathing, deeper and more frequent coughing, and who generally acts sicker by appearing tired, less playful, and less interested in food may have developed a more serious RSV infection an need to be hospitalized. In the great majority of cases RSV infection is self-limiting and requires no specific therapy. For the more serious cases, that are hospitalized, the doctor may order an antiviral treatment that is administered in a mist form This will depend on the severity of the illness, any associated diseases or conditions, and several other factors.

Children and adults of all ages can become infected. The infection in older children and may be very mild, usually causing cold- like symptoms. A person becomes infected by coming in close contact with another infected person or by the secretions from an infected person. An infant usually acquires the infection from close contact with an older family member who may have only a mild, cold-like symptoms. As noted earlier, RSV occurs throughout the year, but because it occurs in a wide-scale, sudden outbreaks, and is so prevalent in the winter months, it is not feasible or advisable to attempt to prevent the normal child’s exposure to RSV infection. When a family member is infected, extra precautions may be taken by washing of hands often, and preventing spreading of infectious secretions on tissues and other objects.

Although a child can get a second RSV infection, it’s very unlikely that the symptoms will be much milder than the first time. Most children recover completely and will handle their next respiratory infection with no more than the average child. A few children, however, appear to be more susceptible to subsequent respiratory problems. Susceptibility may relate, however, to some other underlying medical condition or allergy found in medically fragile children.


Failure to Thrive

Posted by on Saturday, 17 April, 2010

In the first few years of life is a time when most children begin to gain weight and grow much more rapidly than later on in childhood. Sometimes, however, children and infants don’t meet expected standards of growth. Although most of these children follow growth patterns that vary from the norm standards, others are considered to have “failure to thrive.” This is a general diagnosis, with many possible causes. Common to all cases however, is the failure to gain sufficient weight as expected, which is often accompanied by poor height growth. Diagnosing and treating a child who fails to thrive focuses on identifying any underlying problem. From there, doctors and the family work together to get the child back into a healthy growth pattern.

neonate

Although it’s been recognized for more than a century, failure to thrive lacks a precise definition, in part because it describes a condition rather than a specific disease. Children who fail to thrive don’t receive or are unable to take in, retain, or utilize the calories needed to gain weight and grow as expected.

Most diagnoses of failure to thrive are made in infants and toddlers in the first few years of life, a crucial period for physical and mental development. After birth, a child’s brain grows as much in the first year as it will grow during the rest of the child’s life. poor nutrition during this period can have permanent effects on a child’s mental development. Typically the average term baby will double his or her birth weight by 4-months old and triples it at the 1-year mark, children with failure to thrive often don’t meet those milestones. Sometimes, a child who starts out “plump” and who shows signs of growing well can begin to fall off in weight plan. After a while, linear (height) growth may slow as well.

If the conditions progresses, the undernourished child may:

  • Become disinterested in his or her surroundings
  • Tend to avoid eye contact
  • Become irritable
  • Don’t reach developmental milestones such as sitting up, crawling, walking and talking at the usual age.

Failure to thrive can result from a wide variety of underlying causes, to find out more about failure to thrive, I recommend purchasing my training manual, where I have a in depth chapter on the causes and treatment for this medical condition, along with many other interesting topics regarding medically fragile children.


Panhypopituitarism

Posted by on Friday, 16 April, 2010

What is panhypopituitarism?


Hypopituitarism refers to a deficiency of one or more of the hormones secreted by the anterior pituitary gland. Panhypopituitarism refers to an absence of all hormones released by the pituitary gland.

Pituitary insufficiency in the adult is most commonly caused by a nonfunctioning tumor, surgical removal or irradiation of the pituitary gland.
What are the symptoms? 
The lack of pituitary hormones results in a reduction in the hormones released by the target glands (i.e. thyroid, adrenals and gonads). When hypo- or pan- hypopituitarism results from inherent disease or irradiation, symptoms develop gradually. After surgery, symptoms of adrenal sufficiency can develop within days, and hypothyroidism after only a month.

In panhypopituitarism facial and body hair decrease and reproductive organs and muscle tissue shrivel. There can be loss of libido, impotency, amennorhea, and infertility. Hypoglycemia may occur due to a deficiency of growth hormone. There is also a loss of normal skin pigmentation, which can become pale and waxy in appearance. Wrinkles may develop around the eyes and mouth making the person appear older than normal. When pituitary deficiency is severe there is extreme weight loss, emaciation, with eventual coma, and if untreated, death.

How is it treated? 
Because pituitary hormones are destroyed in the gastrointestinal tract, treatment of hypopituitarism involves replacement of the deficient hormones of the target organs. Additionally, within the last five years the FDA approved growth hormone for treatment in those with panhypopituitarism. Growth hormone is self-administered by injection, subcutaneously, on a daily basis.


Shaken Baby Syndrome

Posted by on Thursday, 15 April, 2010

Shaken baby syndrome: Is an extreme form of child abuse caused by the violent shaken of an infant or child.

Shaken baby syndrome can occur in as little as five seconds of shaking. Injuries usually occur in children younger than 2 years of age but have be seen in children up to the age of 5. When a child is shaken their brains can bounce back and forth inside their skulls causing bruising to the brain, also known as a cerebral contusion, this causes swelling, pressure and bleeding inside the brain. If the larger blood vessels on the outer region of the brain tear, this can cause additional swelling, bleeding and pressure sometimes causing permanent brain damage and even death. Other areas of the body can also be affected such as the neck, eyes, and spine.

In some cases, it’s an angry parent or caregiver that shakes the baby to punish or quiet them. Such shaking usually takes place when the baby is crying inconsolably and the frustrated caregiver finally loses control. Research has shown that a crying baby is the number one trigger leading caregivers to shaking an infant. Statistics show an estimated at 1,200 to 1,400 children annually are injured or killed by shaking in the U.S. This is one of the most unrealized forms of child abuse, as many times the caregiver didn’t intend on harming the baby. It is estimated that over 300 babies a year will die from being shaken in this country. This means that roughly 20% of the victims die and the other remaining 80% suffer permanent disability.

Injury to the brain is most likely to happen when a baby is shaken and then the baby’s head hits something even hitting a soft object, such as a pillow or mattress is enough to injure newborns and small infants. Newborn infant brains are much softer and their neck muscles and ligaments are weak. Since their heads are large and heavy in proportion to their bodies. The result of being shaken is a type of whiplash, similarly occurring in some auto accidents. It is important to note that shaken baby syndrome doesn’t occur from playful swinging or gentle bouncing. It rarely occurs from accidents such as small falls, those injuries often cause smaller head injuries.

Signs & Symptoms that you should look for if you suspect Shaken baby Syndrome
  • Decreased alertness
  • Seizures (convulsions)
  • Vomiting
  • Extreme irritability
  • Sleepiness, lethargy
  • Loss of vision
  • Loss of consciousness
  • Pale or blueish skin tone
  • Even lack of appetite

In some cases their may not be any visible signs of trauma such as bleeding, bruising or swelling and may difficult to diagnose in a routine office visit. where broken ribs or bone fractures are easily spotted on x-rays.

If your child suffers a head injury and begins vomiting first turn the child’s head to one side to prevent aspiration of the vomit and if you suspect any spinal injury carefully roll the child’s entire body over on it’s side so they don’t aspirate and seek medical attention as soon as possible.

Do not ignore the signs if you suspect child abuse in your home or in the home of someone you know, report it to the local police or county social services

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What Defines a child that is Medically Fragile?

Posted by on Tuesday, 13 April, 2010

“Medically Fragile or Special Health Care Needs Dependent”

To be defined as a special needs child, children must have special health care needs meaning the child must have a the need for specialized in-home health care based upon one or more of the following criteria:

  • Enteral Feeding Tube (nutrition fed through a tube placed in the nose, the stomach, or the small intestine.)
  • (TPN Dendent) Total Parenteral Feeding (supplies all the nutritional needs of the body by bypassing the digestive system, dripping nutrient solution directly into a vein.)
  • Cardiorespiratory Monitoring
  • Intravenous Therapy
  • Ventilator dependent
  • Oxygen Support
  • Urinary Catherization
  • Renal Dialysis
  • Ministrations imposed by tracheotomy, colostomy, Ileostomey, or other medical, surgical procedures.

Also, any condition that can rapidly deteriorate resulting in permanent injury or death. These children are commonly referred to as “medically fragile.” Typically, medically fragile children are infants under 3 years of age who are prone to hospitalization.

The following are a few examples of conditions that often, but certainly not always, qualify a child as medically fragile.

  • Prenatal exposure to drugs and/or alcohol
  • Congenital or hereditary defects such as spina bifida, sickle cell, anemia, cystic fibrosis, netherton syndrome, heart , lung defects.
  • Burns
  • Cerebral Palsy
  • Muscular Dystrophy
  • Epilepsy
  • BPD – Bronchopulmonary dysplasia
  • Failure to thrive
  • HIV positive and symptomatic
  • Permaturity

With the on going advances in medicine, the quality of life and longevity has vastly improved for medically fragile children. Many medically fragile children are able to be cared for in “specialized licensed foster care homes” with mandated individualized care plans outlining the child’s medical care needs as opposed to having to stay in hospital ward. This home setting has proven to to facilitate improvements in the child’s condition and well being.