4500 Class 10 Complicated Newborn Flashcards by M. B.

Assessment and management of newborn feeding practices

How well did you know this?

Not at all

Perfectly

How often to feed baby

Every 2-3 hours

How well did you know this?

Not at all

Perfectly

How often do we give vit d to newborn? How much

Vit d

400IU

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Has less immunoglobilins and less protein
Higher fat, higher cals

Transitional milk

How well did you know this?

Not at all

Perfectly

How much void in mecomium expected in day 1?

1 each

How well did you know this?

Not at all

Perfectly

In day 2, how much mecomium and voids expected?

2 voids, 1-2 stools

How well did you know this?

Not at all

Perfectly

Ave duration of feed

20 mins

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is not normal in breast when feeding

Erythema, cracks

How well did you know this?

Not at all

Perfectly

What % of weight loss if acceptable in newborn

5-7% weight loss in the first 3 days

How well did you know this?

Not at all

Perfectly

Weight gain in day 4??? And onward

Newborn should be gaining 20-35 g/kg

How well did you know this?

Not at all

Perfectly

When should newborn be back at birth weight???!

10-14 DAYS

How well did you know this?

Not at all

Perfectly

How much % is not normal loosing from birth weight

8%!!!!

How well did you know this?

Not at all

Perfectly

What is a late sign of hunger

Crying

How well did you know this?

Not at all

Perfectly

Feeding cues

Hand to mouth

Sucking motions

Rooting reflex

Mouthing

Flexed arms and legs with clenched fists

How well did you know this?

Not at all

Perfectly

Void and stool in newbown

Day 2-3

2-3 voids. Clear pale yellow

1 or more meconium or greenish brown transition stools

How well did you know this?

Not at all

Perfectly

Void and stool day 3-5

3-5 void

3-4 stools changing to loose yellow

How well did you know this?

Not at all

Perfectly

Void stool in day 3-7 of newborn

4-6 voids

3-6 yellow. Golden generally loose

How well did you know this?

Not at all

Perfectly

Day 7-8 void and stool of newborn

Frequent and pale yellow void

5-10 +yellow stools

How well did you know this?

Not at all

Perfectly

What to do with feeding on a sleftlip/palate newborn

Alter positioning

How well did you know this?

Not at all

Perfectly

Occurs on days 2-5, lasts ~24 hours; girm, tender, swollen, hot, aerolae can become firm and nipple flattens

ENGLRGEMENT

How well did you know this?

Not at all

Perfectly

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

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??

1. Jaundice that presents in the first 24 hours after birth. IT IS ALWAYS CONSIDERED ABNORMAL (pathologic) and needs to be investigated 2. If TSB increases more than 100mcmol/L in 24 hours 3. Is TSB > 256 mcmol/L at any time 4. 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

1. Screen using TcB 2. Plot TcB on nomogra 3. Notify pcp 4. 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