1.1 MTB Step 3 - The Newborn (Management)

Question 1

MANAGEMENT OF THE NEWBORN

At the time of Delivery, what are the (2) Management Steps in the Newborn?

Answer 1

1. Erythromycin ophthalmic ointment (0.5 percent): to protect against Neisseria gonorrhoeae ophthalmia neonatorum.
2. Vitamin K (1mg IM): to prevent Hemorrhagic Disease of Newborn

Question 2

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

What are (2) typical Clinical Presentations of Hemorrhagic Disease in Newborn (a. In the 1st 24 hours, and b. After at least 24 hours)?

Answer 2

1. Apparently Healthy Neonate (1st 24 hours at least)
2. Sudden Increased Bleeding from various sites:

• Umbilicus
• GI Tract
• IV Sites
• Circumcision
• Intracranial (due to trauma during birth process) –> Seizures
• Internal Bleeding (due to trauma during birth process)

Question 3

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

Name (6) common Sites of Sudden Increased Bleeding in a patient with Hemorrhagic Disease of Newborn?

Answer 3

Sudden Increased Bleeding from:

1. Umbilicus
2. GI Tract
3. IV Sites
4. Circumcision
5. Intracranial (due to trauma during birth process) –> Seizures
6. Internal Bleeding (due to trauma during birth process)

Question 4

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

Why is Vitamin K given to all Newborns?

Answer 4

Prevents Hemorrhagic Disease of the Newborn by:

• Producing Coagulation Factors: II, VII, IX, X
• Producing Proteins C & S

Question 5

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

What are (3) reasons why Newborns have Low Vitamin K levels?

Answer 5

1. Vitamin K does NOT cross the Placenta
2. Vitamin K is NOT abundant in Breast Milk
3. Vitamin K is NOT yet produced by the underdeveloped Neonate Gut Flora

Question 11

MANAGEMENT OF THE NEWBORN

What is the Mechanism of Action (MOA) of Erythromycin?

Answer 11

Erythromycin is a Bacteriostatic drug:

• Bacteriostatic drugs Inhibit Reproduction of the Bacteria by Blocking Ribosomal formation of Proteins.*
• Penicillins are Bactericidal - kill bacteria by cell wall inhibition.*

Question 12

MANAGEMENT

A.P.G.A.R. SCORE

What does APGAR stand for and how is the APGAR Score calculated?

Answer 12

A.Activity

P.Pulse

G.Grimace

A.Appearance/Color

R.Respirations

Most Neonates achieve a score of only 9 at 1-minute and 9 at 5-minutes because their color is usually pink with cyanosis in the extremities

Question 13

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

Before Discharge, what (4) things should you do for the Newborn?

Answer 13

1. Mother HBsAg-NEGATIVE ⇒ Administer Hepatitis B Vaccine.
2. Mother HBsAg-POSITIVE ⇒ Administer Hepatitis B Vaccine & Hepatitis IVIG.
3. Perform Hearing Test - to rule out congenital sensorineural hearing loss
4. Order Neonatal Screening Tests, as required by law.

Question 14

MANAGEMENT

HEMORRHAGIC DISEASE OF THE NEWBORN

What (7) Conditions are you Required to do Neonatal Screening Tests for prior to discharge?

Answer 14

1. Phenylketonuria (PKU)
2. Congenital Adrenal Hyperplasia (CAH)
3. Biotinidase
4. Beta-Thalassemia
5. Galactosemia
6. Hypothyroidism
7. Homocystinuria

Question 15

MANAGEMENT

A.P.G.A.R. SCORE

What (2) things does the APGAR Score measure?

Answer 15

1. NEED for Resuscitation
2. EFFECTIVENESS of Resuscitation

Question 16

MANAGEMENT

A.P.G.A.R. SCORE

What is a Persistently Low APGAR (0-3) Score associated with?

Answer 16

High Mortality

Question 17

MANAGEMENT

A.P.G.A.R. SCORE

1. What does the 1-Minute Score give an idea of?
2. What does the 5-Minute Score give an idea of?

Answer 17

1. Gives an idea of what was going on During Labor and Delivery
2. Gives an idea of Response to Therapy (resuscitation)

Question 19

MANAGEMENT OF THE NEWBORN

HEMORRHAGIC DISEASE OF THE NEWBORN

1. What are the (4) Vitamin K-dependent Clotting Factors?
2. What are the (2) Vitamin K-dependent Anticoagulants?

Answer 19

1. Clotting Factors: II, VII, IX, and X (Vitamin K adds a Carboxyl group onto the Glutamic Acid on these factors)
2. Anticoagulants: Proteins C & S (Protein C inhibits Factor V)