Term
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Definition
intense, inconsolable crying or fussiness in an otherwise healthy infant;
occurs during 1st 3 months of life for 3 hrs or more a day for 3 or more days a week; |
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Term
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Definition
abdominal pain/discomfort or gassiness;
hunger;
lactose intolerance;
GERD;
slowed developmental abilities;
immature nervous system |
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Term
| Clinical Presentation of Infantile Colic |
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Definition
CRYING;
may appear to be in pain or discomfort: lifting of head, legs drawn toward stomach, redness of face, gassiness;
Sx peak at 6 wks, gradually decreases until resolution around 3-4 months |
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Term
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Definition
| must EXCLUDE all other causes: hunger, neglect, trauma, infection, milk intolerance, failure to thrive, constipation, indigestion |
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Term
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Definition
| used for babies that seem gassy |
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Term
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Definition
anti-spasmodic that may cause apnea, coma, & death;
- unsafe & unproven therapies |
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Term
| dicyclomine, hyscyamine, diphenhydramine, phenobarbital, paregoric |
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Definition
| unsafe & unproven therapies for the treatment of infantile colic |
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Term
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Definition
opioid used to control diarrhea;
- unsafe & unproven medication for treatment of colic |
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Term
| Environmental Non-Pharm Strategies for Treatment of Infantile Colic |
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Definition
| swaddling; carry in a front sling; pacifier; car rides; walk in stroller; place child in a swing; back or tummy rubs |
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Term
| Behavioral Non-Pharm Strategies for Treatment of Infantile Colic |
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Definition
Considered ESSENTIAL!!!
intervene rapidly when crying begins;
feed on demand;
burp in upright position;
position that provides gentle pressure on the abdomen;
try feeding, pacifiers, sleep, stimulation, or holding for 5 minutes; |
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Term
| Diet Non-Pharm Strategy for treatment of Infantile Colic |
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Definition
If it appears to be related to feeding:
1) formula feeding: switch to a different formula, use soy formula if 2 standard formulas fail;
2) breast-feeding: may be related to mom's diet, cut out the following from diet (beans, onions, garlic, apricot, melons, caffeine, alcohol, spicy foods), may slowly reintroduce food items to see if any can be linked to episodes;
3) Lactose intolerance: if family history have mom remove cow's milk from diet |
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Term
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Definition
most common cause of severe diarrhea in infants & children worldwide;
infects 95% of children by 5 yrs of age; |
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Term
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Definition
wheel-shaped, nonenveloped, triple-shelled RNA virus;
outer capsid contains VP7 & VP4 structural proteins - targets for neutralizing antibodies;
Inner capsid --> VP6 - target of common diagnostic tests;
Internal core --> 11 segments of double-stranded RNA |
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Term
| Transmission of Rotavirus |
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Definition
Predominate: fecal-oral route;
Theoretical: respiratory secretions, contaminated surfaces |
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Term
| Incubation period of Rotavirus |
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Definition
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Term
| Length of time that Rotavirus can be transmitted after onset |
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Definition
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Term
| Annual Seasonality of Rotavirus infection |
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Definition
| begins in Southwest in fall and ends in Northeast in spring |
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Term
| Risk Factors for Rotavirus Infection |
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Definition
Overall:
- children > adults;
- immunocompromised;
Hospitalization:
- low birth weight (<2.5 kg)
- Medicaid recipient or no health insurance
- living with another child < 24 months
- daycare |
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Term
| Clinical Presentation of Rotavirus Infection |
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Definition
watery, non-bloody diarrhea;
low-grade fever (+/-);
vomiting (+/-) - resolves in 1st day;
1st infection --> most severe;
GI symptoms resolve in 3-7 days;
- can lead to dehydration, electrolyte imbalance, shock, death;
Physical Exam:
- hyperactive bowel sounds;
- tachycardia;
- sunken eyes;
- dry mucosa;
- rectal exam stimulates watery stools;
- decreased urine output; |
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Term
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Definition
most widely used method for diagnosing Rotavirus infections;
Specificity: 71-100%;
Sensitivity: 70-98%; |
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Term
| Goal of Treatment for Non-Hospitalized Patients |
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Definition
| Prevent dehydration; If child seesm to be clinically dehydrated, refer to an Emergency Department for management; |
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Term
| Treatment of Vomiting associated with Rotavirus Infection |
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Definition
Sx usually resolves in 8-12 hrs;
STOP:
- formula feedings & breastfeeding in infants;
- solids & liquids in children on regular diets;
GIVE:
- small amounts of clear liquids frequently --> 1 ounce per hr in small sips;
- use Oral Rehydration Solutions (ORS - Pedialyte);
- DO NOT USE: plain water (hyponatremia), soft drinks/sport drinks (hyperosmolar), soups or milk (hypernatremia);
Once it has resolved --> may slowly re-introduce diet |
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Term
| Treatment of Diarrhea in Rotavirus Infection |
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Definition
Initiate BRAT diet for 1-2 days:
- B --> bananas;
- R --> rice;
- A --> applesauce;
- T --> tea or toast;
Maintain bland diet until improvement;
Avoid spicy &/or fried foods;
Limit high-sugar foods (fruit juices, Kool-aid) |
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Term
| Medications for Treatment of Non-Hospitalized Patients with Rotavirus infection |
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Definition
NO anti-viral meds available;
DO NOT USE OTC anti-emetics or anti-diarrheals in children |
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Term
| Maintenance Fluid Calculation for Non-Dehydrated Hospitalized Patients |
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Definition
100 mL/kg for 1st 10 kg
PLUS
50 mL/kg for next 10 kg
PLUS
20 mL/kg for each extra kg;
Fluid:
<3 yrs: D5/0.2NaCl + 20 mEq KCl
>=3 yrs: D5/0.45NaCl + 20 mEq KCl
- gives 24 hr total volume, divide by 24 to get mL/hr rate |
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Term
| Maintenance Fluid Calculation for Dehydrated Hospitalized Patients |
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Definition
STEP 1: If pt is hemodynamically unstable due to fluid loss, determine pre-illness weight (from parents or chart), give bolus of 20 mL/kg (max 1000 mL) of isotonic fluid (NS or Lactated Ringers);
STEP 2:
Calculate maintenance fluid requirement - 100 mL/kg for 1st 10 kg
PLUS
50 mL/kg for next 10 kg
PLUS
20 mL/kg for each extra kg;
Fluid:
<3 yrs: D5/0.2NaCl + 20 mEq KCl
>=3 yrs: D5/0.45NaCl + 20 mEq KCl
- gives 24 hr total volume, divide by 24 to get mL/hr rate;
STEP 3:
Determine percent dehydration of pt;
% Dehydration = (pre-illness weight[kg] - illness weight [kg])/(pre-illness weight [kg]) x 100;
STEP 4:
Calculate fluid deficit --> mulitply % dehydration from STEP 3 by 10 to get mL/kg to replace;
STEP 5:
Determine 24 hr requirement;
[Maintenance fluid (step 2) + Fluid Deficit (step 4)] - bolus volume given (step 1);
STEP 6:
Determine rates
- give 50% of 24-hr fluid requirement over 1st 8 hrs (divide by 8 to determine rate);
- give remaining 50% over the next 16 hrs (divide by 16 to determine rate) |
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Term
| Prevention of Rotavirus Infection |
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Definition
hand washing;
clean surfaces used by infected children;
Vaccines: Rotashield (RRV-TV), Rotateq (RVS), Rotarix (RV1) |
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Term
| Clinical Pearls for Rotavirus Vaccines |
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Definition
CDC, AAP, & ACIP do not recommend one vaccine over the other;
Recommended to complete the series with the same product;
Do not repeat the dose if the infant spits out or regurgitates the vaccine; |
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Term
| Common Adverse Reactions of Rotavirus Vaccines |
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Definition
fever;
vomiting;
diarrhea;
irritability |
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