Which one of the following is associated with a reduction in risk for sudden infant death syndrome?
Correct Answer A:
Sleeping with a pacifier has been associated with a reduced risk for sudden infant death syndrome (SIDS), which occurs most frequently between 2 and 4 months of age. Avoid excessively soft or padded sleep surfaces, including pillows, comforters, and waterbeds. Keep soft objects and loose bedding out of the crib.
→ Putting a baby to sleep in a prone position or on his or her side increases the risk of SIDS.
→ Sleeping on soft bedding, or with comforters, quilts, or stuffed toys also increases the risk, as does sleeping with parents or siblings. Bed-sharing may lead to compromise of the infants' airway. Sleeping in a separate bed or crib in the same room with the parents may be a safer alternative.
A 2-month-old baby girl is brought to your office for a routine visit. The baby is growing and developing well, and there are no medical problems. There were no problems with the pregnancy. Her mother tells you that her friend had a baby who recently died of sudden infant death syndrome (SIDS). Although there is no history of SIDS in her family, the mother is worried about her own child.
You advise her to:
Correct Answer C:
Since 1992, when the American Academy of Pediatrics recommended babies be put to sleep on their backs, there has been a dramatic decrease in the incidence of SIDS.
A. Apnea monitors are usually used after a severe life-threatening event or when a baby is having apneic episodes or periodic breathing. Some experts believe in using an apnea monitor for siblings of a SIDS victim. In this child’s case, there is no reason to use a home apnea monitor.
B. Only babies with certain problems, such as severe gastroesophageal reflux or craniofacial abnormalities, should be placed to sleep in a prone position.
D. A sleep study is not indicated for this asymptomatic baby with no family history of apnea.
E. It is important to pay attention to the mother’s concerns. In this case, placing the baby to sleep on her back will reduce the risk of SIDS significantly.
A baby born prematurely develops tachypnea, tachycardia, bounding peripheral pulses, and a machine like murmur.
What is the most likely cause of this?
Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth, resulting in a left-to-right shunt. Symptoms may include failure to thrive, poor feeding, tachycardia, and tachypnea.
A continuous machine-like murmur in the upper left sternal border is common. Diagnosis is by echocardiography.
Small PDAs may not require treatment or may close without treatment. In premature babies, indomethacin is often given. Indomethacin has been shown to be very effective in causing the PDA to close.
If a PDA does not respond to medication, or is due to causes other than prematurity, surgery may be needed. This surgery is called ligation and involves placing a suture around the ductus to close it.
A newborn is diagnosed with a patent ductus arteriosus (PDA).
What type of murmur will you hear in such a patient?
Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth, resulting in a left-to-right shunt. Symptoms may include failure to thrive, poor feeding, tachycardia, and tachypnea. A continuous machine-like murmur in the upper left sternal border is common.
Diagnosis is by echocardiography. Administration of indomethacin with or without fluid restriction may be tried in premature infants with a significant shunt but not in term infants with PDA. If the connection persists, surgical or catheter-based correction is indicated. Endocarditis prophylaxis is recommended before and for 6 to 12 months after correction.
On physical examination of a 3-month-old child you detect a thrill and a machinery-type murmur at the left upper sternal border. A widened systemic pulse pressure and bounding peripheral pulses are also noted.
Based on these findings, which one of the following is the most likely diagnosis?
Correct Answer B:
Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth, resulting in a left-to-right shunt. Symptoms may include failure to thrive, poor feeding, tachycardia, and tachypnea. A continuous machine-like murmur in the upper left sternal border is common. Diagnosis is by echocardiography.
Administration of indomethacin with or without fluid restriction may be tried in premature infants with a significant shunt but not in term infants with PDA. If the connection persists, surgical or catheter-based correction is indicated. Endocarditis prophylaxis is recommended before and for 6 to 12 months after correction.
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