A 4-month-old girl is brought to the office for a well-child evaluation. The girl has been growing and developing normally and her parents have no concerns. When questioned about the home environment, the parents say that they both smoke cigarettes but "try to smoke outside the house." The patient's mother smoked a pack of cigarettes a day until her second trimester, when she found out she was pregnant. However, she resumed smoking shortly after delivery and says that the stress of sleep deprivation and difficulty with postpartum weight loss have made it difficult for her to quit. The parents are counseled on the risks of secondhand smoke exposure. Which of the following conditions is the infant at highest risk for developing from exposure to cigarette smoke?

Question

A 4-month-old girl is brought to the office for a well-child evaluation.  The girl has been growing and developing normally and her parents have no concerns.  When questioned about the home environment, the parents say that they both smoke cigarettes but "try to smoke outside the house."  The patient's mother smoked a pack of cigarettes a day until her second trimester, when she found out she was pregnant.  However, she resumed smoking shortly after delivery and says that the stress of sleep deprivation and difficulty with postpartum weight loss have made it difficult for her to quit.  The parents are counseled on the risks of secondhand smoke exposure.  Which of the following conditions is the infant at highest risk for developing from exposure to cigarette smoke?

Quizplus · Accepted Answer

11ec160b_3a1f_6549_9249_c75e1fb72ba6_MD0001_00 Secondhand smoke (SHS) has numerous adverse effects on nearly every organ system. The level of tobacco in the fetus of a mother who smokes is the same as that of an active smoker. Maternal tobacco use impairs fetal oxygenation, alters fetal development and response, and exposes the fetus to multiple toxins (eg, nicotine, carbon monoxide, ammonia). As a result, detrimental outcomes include abnormal placentation (eg, previa, abruption), prematurity, perinatal mortality, and significantly reduced birth weight. One of the most dangerous effects of SHS exposure (pre- and postnatal) is the increased risk of sudden infant death syndrome (SIDS). SIDS refers to the unexpected death of a seemingly healthy infant during sleep. Up to half of all SIDS cases are due to SHS exposure, likely due to impaired arousal and abnormal cardiovascular responses to stimuli. SHS also increases the risk of recurrent otitis media, asthma, and other respiratory tract illnesses (eg, pneumonia) in children. Parents who smoke outside the home should be counseled on cessation as chemicals from cigarette smoke are adsorbed and retained by clothing, skin, and hair and therefore pose a risk to children. (Choices A and B) Although the risk of asthma increases with secondhand smoke exposure, there appears to be no increased risk of other atopic diseases, such as eczema or food allergies. The major risk factor for atopic disease is a family history of atopy. (Choice C) Although prenatal smoke exposure is associated with low birth weight and poor fetal growth, it does not increase the risk of obesity. The primary risk factors for childhood obesity are parental obesity and excessive television viewing. (Choice E) SHS exposure has been shown to reduce renal function (decreased glomerular filtration rate) in adolescents but does not increase the risk of urinary tract infections. Risk factors for recurrent urinary tract infections in children include anatomic anomalies (eg, posterior urethral valve, vesicoureteral reflux). Educational objective: The adverse effects of secondhand smoke exposure include an increased risk of low birth weight, asthma, middle ear disease, and sudden infant death syndrome (SIDS). Up to half of all SIDS cases are due to tobacco exposure, likely from impaired arousal and abnormal cardiovascular responses to stimuli. __________ References: Parental smoking and the risk of middle ear disease in children: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/21893640) Maternal smoking and increased risk of sudden infant death syndrome: a meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/23219585) Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/22430451)

A 4-Month-Old Girl Is Brought to the Office for a Well-Child