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4.3 Neonatal and Pediatric labs
By Dr. McGoey
56
Pathology
Professional
04/03/2012

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Cards

Term
What is the typical blood draw for an adult versus a pediatric versus a neonatal patient?
Definition
adult= 10 mL; pediatric 5-7 mL; neonatal <1 mL
Term
What is the total blood volume in a neonate?
Definition
approximately 300 mL
Term
Why are there more identification errors when dealing with newborn blood test results?
Definition
barcode labels don't fit or cannot be read by barcode readers
Term
Common pediatrictests are often performed as ______ tests.
Definition
point of care
Term
Esoteric pediatric tests are performed by...
Definition
outsourcing to a send-out-lab
Term
Why is there a lot of variation between labs for pediatric values?
Definition
analytes and their normal ranges may change over life due to physiologic processes and developmental changes; little data regarding normal ranges, esp in kinds <3 yoa
Term
T/F Electrolytes are different for pediatric patients than for adults.
Definition
true; esp ionized calcium is increased
Term
What common lab markers are decreased in the pediatric patient?
Definition
albumin and total protein; pretty muchn all other lab values are increased
Term
What is the average Hb/Hct of a newborn?
Definition
19/53
Term
What is the average WBC in a term newborn?
Definition
19
Term
What is the definition of neonatal anemia?
Definition
Hct <45
Term
What is a normal RR for an infant?
Definition
30-60 breaths per minute
Term
What is a normal pulse rate for an infant?
Definition
100-160
Term
What is a noraml systolic BP for an infant?
Definition
>60
Term
What measurements are taken on a baby as soon as they are born?
Definition
APGAR, BL, BW, OFC
Term
What type of prophylactic and diagnostic care is given to a newborn before they leave the hospital?
Definition
opthalmic antibiotic ointment (prophylaxis for gonorrhea and chlamydia), vitamin K, hepatitis B vaccine, CBC, type and screen, newborn screen, hearing screen
Term
What are 2 common causes of neonatal anemia?
Definition
physiologic anemia and immune mediated (HDN)
Term
What lab should you definately get to work up neonatal anemia?
Definition
DAT (direct coomb's test)
Term
How do you manage neonatal anemia?
Definition
limit blood draws, EPO, PRBC transfusion
Term
What causes physiologic neonatal anemia?
Definition
excessive blood draw, prematurity with inadequate EPO production, blood loss at delivery
Term
Why does it matter if your DAT is strongly positive or weakly positive?
Definition
strong positive indicates HDN with Rh incompatibility (Duffy or Kell), weakly positive indicates ABO HBD which is common but mild)
Term
How common is ABO HBN?
Definition
1/5 newborns
Term
How common is neonatal jaundice?
Definition
60% of term neonates; 80% of preterm neonates
Term
In HDN, at what day does the baby present with jaundice?
Definition
day 1-2
Term
In physiologic jaundice, what day does the baby present with HDN?
Definition
after day 3
Term
How can you measure serum bilirubin in a newborn?
Definition
SBR quantitation as a blood test or SBR estimation with either Kramer's rule or transcutaneous bilirubinometry
Term
How should you measure bilirubin levels in premature infants?
Definition
SBR quantitation
Term
What is the gold standard for measuring bilirubin in infants?
Definition
SBR quantitation with blood draw
Term
What is Kramer's rule?
Definition
jaundice progresses caudally: face= 10; trunk= 15; pelvis/thighs=20; arms/fore-arms/legs= 25; hands and feet= > 25
Term
What are the symptoms of kernicterus?
Definition
lethargy, fever, seizures, permanent neurologic disability
Term
At what level are bilirubin levels unsafe in the neonate?
Definition
ther are no safe or unsafe levels that have been established but generally around 30 -45 is when kernicterus happens
Term
Of the four million US babies who are screened annually, how many test positive for the newborn screening test?
Definition
3000
Term
All states test their newborns for what diseases?
Definition
PKU and hypothyroidism
Term
Almost all (47) states test for what on the newborn screening test?
Definition
CAH
Term
When should the heel stick be drawn for newborn screening tests?
Definition
48-96 hrs of life (if less than 36 hours need a re-screen by day 14)
Term
What is the cost of newborn screening?
Definition
$30.00
Term
The vast majority of diseases tested for on the LA Newborn screen are what types of diseases?
Definition
inborn errors of metabolism
Term
Most visitis with the pediatrician are during what time period for a child?
Definition
1st two years of life
Term
After 2, when do children need to come back for immunizations?
Definition
4-6 years and 11-12 years
Term
What kinds of lab testing is performed on healthy kids?
Definition
CBC maybe after 12 yoa, lead screening and cholesterol at least once
Term
What percent of hospital admissions are pediatric?
Definition
20%
Term
What percent of peds admission are neonates?
Definition
2/3
Term
What is a neonate?
Definition
child less than 30 days old
Term
Pediatric patients are most often admitted to the hospital through the...
Definition
ED
Term
How do you test for respiratory viruses in pediatric patients?
Definition
nasopharyngeal aspirate against a respiratory viral panel
Term
What viruses are tested for on a respiratory viral panel?
Definition
adenovirus, flu A and B, parainfluenza, RSV, metapneumovirus
Term
What is the methodology behind a respiratory viral panel?
Definition
antigen testing by EIA, IF, or RT-PCR
Term
When is sensitivity highest for a respiratory viral panel?
Definition
within 1st two days of symptoms
Term
What is the advantage of using a respiratory viral panel over say a culture or serology?
Definition
the panel is faster (takes 30 minutes versus 10 days) and requires only 1 specimen (serology requires at least 2)
Term
Why might you order cultures if you have already have a respiratory viral panel?
Definition
for epidemiologic data
Term
Name the acute phase reactants?
Definition
increased platelet count, increased erythrocyte sedimentation rate, and increased C-reative protein
Term
At what platelet count is an acute phase reaction?
Definition
>400,000
Term
How is an ESR performed?
Definition
2mL of blood set in a vertical tube and analyzed for cellular and plasma separation rate at 1 hr
Term
Whatis the most sensitive acute phase reactanat?
Definition
CRP
Term
What acute phase reactant will rise and fall to parallel course of disease?
Definition
CRP
Term
What are the features of Kawasaki's disease?
Definition
fever x > 5 days; erythema on extremities; buccal erythema, rash, injection sclerae, LAD aneurysm, ESR
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