IBCLC EXAM Infant Pathology Questions With Verified Answers

Failure to thrive - Answer -infant continues to lose weight after 10 days of life -does not regain birth weight by 3 weeks of age -below 10th percentile beyond 1 month of age signs: lethargic, sleep excessively, hypertonic, irritable, difficult to soothe, <6 wet diapers with concentrated urine, infrequent scant stools, <8 short duration feedings/day late signs: content to starve, sleep a lot, whine quietly/weakly can be caused by maternal milk production, maternal or infant illness, management of breastfeeding, and/or psychosocial issues. Usually a combination of factors to plan catch up growth, use infant's ideal or birth weight to calculate volume required (wt in lbs x 2.5/ feedings in a 24 hour period) plan: frequent feedings, supplements with or after feedings until infant gaining well, assess latch and suck technique Dehydration - Answer rare, sodium levels >150, few to no stooling, little urine output, sleepy, high weight loss, lethargy, weak cry, dry mucus membranes, lack of tears, poor skin turgor, sunken fontanels -causes: jaundice, poor suck, cardiac condition, downs syndrome, c/s, bfeed difficulty, diabetes in mother, obesity in mother, breast reduction -treat: review hx, observe feed, check labs, IV hydration, monitor milk sodium levels, maintain lactation, resume breastfeeding once milk sodium levels normal and IV fluids tapered Jaundice - Answer yellow skin and sclera d/t high levels of bile pigment bilirubin -Pathologic/direct/conjugated: hepatocellular disorders: levels rise quickly, requires recognition and treatment -Physiologic/indirect/unconjugated: elevated bilirubin levels secondary to either increased production or decreased excretion physiologic: normal jaundice, first days of life, monitor to ensure effective feeding, phototherapy possible breastfeeding associated: starvation jaundice, first days of life, increase caloric intake, establish effective feeding, phototherapy possible breastmilk: unknown cause, usually days 5-10 of life, monitor, may require brief interruption of feedings -higher risk in preterms, excessive bruising, ABO incompatibility, infection, diabetes, asian descent, family hx, delayed meconium passage, male -sx: lethargy, refused feedings, excessive weight loss, vomiting, inadequate output -tx with effective feedings to help infant stool, phototherapy possible, may require supplementation (if wt loss >10%). risk is that infant could eventually develop kernicterus (brain damage) Hypoglycemia - Answer likely in first 24 hours postpartum d/t lag in cessation of maternal glucose supply and development of infant's capacity for glucose synthesis -breastfed infants can tolerate a lower plasma glucose without significant clinical manifestations -if infant asymptomatic, no evidence that treatment is necessary -if levels are between 36-45 may require intervention -risk factors: preterm, gestational diabetes, small or large for gestational age, or those with sx, separation, cold room, infant crying, delayed feedings, acute brain injury, inborn errors of metabolism -sx: irritability, tremors, jitteriness, exaggerated moro reflex, high pitched cry, seizures, lethargy, coma, cyanosis, apnea, tachypnea, hypothermia, poor suck, instability