4500 Class 10 Complicated Newborn Flashcards
Assessment and management of newborn feeding practices
How often to feed baby
Every 2-3 hours
How often do we give vit d to newborn? How much
Vit d
400IU
What is a colustrum
It is more concentrated than mature milk
A clear yellowish fluid
More concentrated than mature milk
Extremely ruch in immune globulins
High concentration of protein, fat-coluble vit. And minerals
Has less fat than transitional or mature milk
Has less immunoglobilins and less protein
Higher fat, higher cals
Transitional milk
How much void in mecomium expected in day 1?
1 each
In day 2, how much mecomium and voids expected?
2 voids, 1-2 stools
Ave duration of feed
20 mins
Acronym lach assessment stand for
L latch characteristics — infants mouth positioned over nipple, areola and breast so that it makes a seal between the mouth and breast which will allow for suction and facilitate milk removal
A AUDIBLE swallowing
T TYPE — flat, inverted or everted
C CONFORT — maternal comfort
H HOLDING skills
What is not normal in breast when feeding
Erythema, cracks
What % of weight loss if acceptable in newborn
5-7% weight loss in the first 3 days
Weight gain in day 4??? And onward
Newborn should be gaining 20-35 g/kg
When should newborn be back at birth weight???!
10-14 DAYS
How much % is not normal loosing from birth weight
8%!!!!
What is a late sign of hunger
Crying
Feeding cues
Hand to mouth
Sucking motions
Rooting reflex
Mouthing
Flexed arms and legs with clenched fists
Void and stool in newbown
Day 2-3
2-3 voids. Clear pale yellow
1 or more meconium or greenish brown transition stools
Void and stool day 3-5
3-5 void
3-4 stools changing to loose yellow
Void stool in day 3-7 of newborn
4-6 voids
3-6 yellow. Golden generally loose
Day 7-8 void and stool of newborn
Frequent and pale yellow void
5-10 +yellow stools
What to do with feeding on a sleftlip/palate newborn
Alter positioning
Occurs on days 2-5, lasts ~24 hours; girm, tender, swollen, hot, aerolae can become firm and nipple flattens
ENGLRGEMENT
Breat]st feed vit req?
Vit D of 400IU per day!
When is complementary feeding prompted
After 6 montha
Hemolytic disease of the newborn (HDN)
Jaundice
Hoe does jaundice presents
Yellow colorimg in sclera, skin and mucosal membranes
Can either be physiologic versus pathologic
60% of fullteerm newborns and 80% of preterm newborns will experience physiologic jaundice
Jaundice
Increased rbc at birth
Decreased lifespan of newborn rbs (60-90 days, N is 120)
Decreased ability of newborn liver to conjugate bilirubin in the 1st few days of life
Decreased vol of serum albumin to bind bilirubin]increased enterohepatic circ
WHAT IS THE BEST METHOD TO LREVENT JAUNDICE
EARLY AND FREQUENT BREASTFEEDING
Weight loss / weight expectations in first 3 days bersus day 10-14
5-7T weight loss over the 1st 3 days is normal!
Newborn should regain this weight within 10-14 days!Q!!
How do you calculate % weight gain or loss
Net weight gain or loss DIVE BY previous weight MULTIPLY BY 100 = % weight gain or loss
what are risks for jaundice
Prematurity: GA 35-38 weeks
Excessive weight loss
Sibling who had neonatal jaundice
Visible bruising
CEPHALOHEMATOMA
DAT + other hemolytic disease (G6 PD)
Ethnic backgrounf (East Adian)
Asphyxia (Apgar 0-3 beyond 5 min & cord pH <u)
Acodosis (pH of blood less than 7)
Albumin < 30g/L
Deosis
Temp instability
Lethargy/poor feeding
It is a sign of neurotoxicity.
It is where there is a loss of startle reflex, poor feeding/sucking, lethargic, poor muscle tones (may be subtle), high pitched cry, irritability, seizures, coma death
ACUTE BILIRUBIN ENCEPALOPATHY
What is KERNICTERUS
What is it characterized by(name 3!!)
Hearing loss, cerebral palsy, gaze abnormalities
It is an irreversible brain damange from CHRONIC BILIRUBIN ENCEPGALOPATHY
What PATHOLOGIC JAUNDICE??
- Jaundice that presents in the first 24 hours after birth. IT IS ALWAYS CONSIDERED ABNORMAL (pathologic) and needs to be investigated
- If TSB increases more than 100mcmol/L in 24 hours
- Is TSB > 256 mcmol/L at any time
- If caused by pathological condition (e.g. HDN)
Characteristics of a PHYSIOLOGIC JAUNDICE
Jaundice that does not reach concerning levels based on the gestational age of the infant
Presents after 24 hours of age
It os not due to underlying condition
USUALLY RESOLVE WITHOUT TREATMENT
*Jaundice related to breat/chest feeding
When should serum bilirubin measured?
If jaundice still rpesent at 203 weeks of age
What would be required at ANY TIME serum bilirubin falls in higher than acceptable range?
PHOTOTHERAPY
This usually occurs due to isoimmunic\zation or ABO incompatibility.
Can cause anemia.
A condition where rbc are broken down or destroyed
How to we treat this?
HDN/ aka erythroblastosis
Tx is PHOTOTHERAPY. Exchange transfusion on rose case
How do we visually assess for jaundice?
Apply gentle pressure over a bony prominencefor 2-3 secs then assess for yellow color in the blanced area
What is orimary site for tcb reading
Forehead unless bruised and discoloored, then use intang’s sternum if equired
What is a high TSB
Greater than256
What to do is baby appears jaundiced < 24 hours of age
- Screen using TcB
- Plot TcB on nomogra
- Notify pcp
- Obtain order for TSB and DAt
When do we assess newborn with jaundice?
Weight loss of more than 7%
Decreased milk intakr
Decrease in stools (less than 3stools in day 4)
Decrease in urine output (less than 4-6 by day 4)
What do we expect with Infants of Diabetic Mothers/Birthers
Hypocalcemia and hypomagnesemia
Cardiomyopathy
Hyperbilirubinemia and polycythemia
RDS
Cardiac anomalies; VSD
Congenital hyperinsulinemia
When to check the glucose of IDM when they are >= 35 weeks gestation at birth
2 hours after birth, after first feed
What is the goal serum blood glucose of IDM????
> = 2.6 mmol/L
Diagnostics may include in neo infections
CBC, blood and urine cultures, lumbar puncture, CRP, ciral cultures, CXR, liver func and enzymes, fungal culture,
What will chlamydia do to the infant
Conjuctivitis
Pneumonia
Intervention to newborn when mom have gonorrhea
Eye prophylaxis
What is tx for thrush, it is common in breast feed infants
Nystatin
What too to measure adverse exposure affecting newborns
When
Finnegan neonatal abstinence scale
2 years of age
What does these suggest
Crynf/comsoable in 5 min and % of time spent crying
Time spent sleeping after a feed
Muscle tone (increased)
Tremors
RR > 60/min, with or withiut retractions
Sweating
Excessive sucking
What substances can cause neuro symptoms but not withdrawal
Caffeine, cocoaine, meth, marijuana, hashish, nitrous oxide, vicotine
What drugs can cause NAS when taken 72 hours prior birth
Narcs (methadone. Morphome. Heroin, fentanyl)
Alcohol
Barbituates\
Benzos
Inhalants
SSRI’sm
SSRI’sm
