01: Newborn male infant evaluation and care Flashcards
Which substance exposure causes low birth weight but no facial abnormalities?
Tobacco exposure
Which substance exposure causes cognitive and learning problems, facial abnormalities, and CNS dysfunction?
Alcohol exposure
What effects does marijuana have on the fetus?
Hasn’t been studied yet
Which substance exposure causes growth restriction, placental abruption, preterm passage of meconium, and irritability, poor feeding, high pitched cry?
Heroin and opiates
Which substance exposure causes low birth weight, placental insufficiency, and later cognitive effects?
Cocaine
What strep is a cause of neonatal bacterial sepsis?
GBS
20% of pregnant women have vaginal or rectal colonization of what?
GBS
Without antibacterial prophylaxis, what percent of infants born to colonized women develop invasive disease?
1-2%
Any ill-appearing neonate should received which 4 diagnostic items?
- CBC
- Blood culture
- CXR
- Lumbar puncture
What does the “A” in APGAR stand for?
Appearance (skin color)
What does the “P” in APGAR stand for?
Pulse
What does the “G” in APGAR stand for?
Grimace (reflex irritability)
What does the second “A” in APGAR stand for?
Activity (muscle tone)
What does the “R” in APGAR stand for?
Respiration
What’s the scoring for each letter in APGAR?
0, 1, or 2
An APGAR score below __ at 5 minutes should prompt continued resuscitation, with re-assessment every 5 min?
Below 7
Does the APGAR score predict neurologic outcome or mortality?
No
What assessment tool uses signs of physical and neuromuscular activity to estimate gestational age?
The Ballard Assessment Tool
What’s the definition of SGA?
Weight below 10th percentile at gestational age
What is symmetric vs asymmetric IUGR?
Symmetric: head, length, and weight are decreased proportionately
Asymmetric: greater decrease in length or weight without affecting head
What may decreased glycogen stores, heat loss, possible hypoxia, and decreased gluconeogenesis cause in SGA newborns?
Hypoglycemia
What may cold stress, hypoxia, hypoglycemia, increased surface area, or decreased subcutaneous insulation cause in SGA infants?
Hypothermia
What may chronic hypoxia, or maternal-fetal transfusion cause in SGA newborns?
Polycythemia
Which reflex involves the newborn turning his head toward your finger when you touch his cheek?
Rooting
Which reflex involves the newborn sucking on your finger when you touch the roof of his mouth?
Sucking
Which reflex involves dropping the infant’s head 10cm and catching it, which causes the newborn to flex his thighs and knees, and fan and clench his fingers, with arms first thrown outward and then brought together as though embracing something?
Startle (Moro)
Which reflex involves the newborn grasping your finger when you stroke it against the palm of his hand or plantar surface of his foot?
Palmar and plantar reflexes
Which arm flexes in the asymmetrical tonic neck response (fencer reflex)?
The contralateral
Which reflex involves the newborn’s legs making a stepping motion when you hold him vertically above the table and stroke the foot against the table?
Stepping response
What are 5 causes of an absent red reflex in an infant?
- Cataract
- Opacified cornea
- Inflammation of anterior chamber
- Developmental anomalies of eye
- Retinoblastoma
Early VKDB occurs in what fraction of newborns?
1/60-1/250 of newborns
Infants who do not receive a Vitamin K shot are ____ x more likely to develop hemorrhage than those who do?
81x
When does early VKDB occur?
0-24 hours after birth
What drugs did the mother likely take if the neonate has early VKDB (2)?
- Antiepileptics
2. Isoniazid
When does classical VKDB occur?
1-7 days after birth
Which type of VKDB causes bruising and bleeding from the umbilical cord?
Classical
When does late VKDB occur?
2-12 weeks after birth
In what infants does late VKDB tend to occur?
Breastfed only babies who haven’t gotten the Vitamin K shot
When should neonates weighing more than 2000 grams born to mothers positive to Hep B surface antigen get the Hep B vaccine and Hep B immune globulin?
Within 12 hours of delivery and then routine vaccine again at age 1 month
When should infants born to mothers not tested for Hep B get the Hep B vaccine and Hep B immune globulin?
Within 12 hours of delivery, and then can wait on the immune globulin until mother has been tested (still effective within 7 days of birth)
What are the 3 routine newborn medications?
- Vitamin K
- Hep B vaccine
- Erythromycin
What lab tests should you look for in the maternal record?
Blood type Rh and Ab screen Rubella Hep B surface Ag HIV Ab RPR or VDRL NAAT for chlamydia or gonococcus GBS Hep C Ab Tb test
