APAR Flashcards
What are 4 pre-birth questions to ask?
- What is expected gestational age
- Is the amniotic fluid clear
- How many babies are expected
- Are there any additional risk factors
What are 3 questions to ask with baby birth?
- Does the baby appear term
- Is the baby breathing or crying
- Is there good muscle tone
If yes to birth questions what’s next?
initial steps can be performed on mother’s chest
If no to birth questions what’s next?
initial steps, ventilation, chest compressions, admin of epi/volume expanders
Who created the APGAR score?
Dr. Virginia Apagar in 1952
What does the APGAR score access?
newborn transition from the womb to the outside
What does APGAR stand for?
A- Activity (muscle tone) P- Pulse G- Grimace (reflex irritability) A- Appearance R- Respiratory
What is the assessment for activity 0-2
absent, flexed arms and legs, active
What is the assessment for pulse 0-2
absent, <100rpm, >100rpm
What is the assessment for grimace 0-2
floppy, minimal response to stimulation, prompt response
What is the assessment for appearance 0-2
blue;pale, pink body blue extremities, pink
What is the assessment for respiratory 0-2
absent, slow and irregular, vigorous cry
What is the scoring for APGAR?
0-3 extremely depressed, 4-6 moderately depressed, 7-10 excellent condition
What age is border of viability?
22 to <25wks
What age is considered pre-mature?
born before <37 wks gestation alive
What is considered term?
37-41 wks
WHO says a induction or cesarean birth shouldn’t be done when?
<39 wks
What is the leading cause of death?
premature birth complications
IVH is treated how?
antenatal steroIds prophylaxis
What is the most severe IVH?
Grade III, IV
Where does the bleeding occur in IVH?
germinal matrix
What can ROP lead to?
retinal detachment and blindness
Leading cause of blindness in developing countries?
ROP
What babies are at high risk for ROP?
<30 wks or <1500g
What is the txt for ROP?
laser, vitreal anti-VEGF injection, cryotherapy
What two hearing screenings is done in TEJAS?
ABR or OAE
NICU babies are required to get hearing screens when?
rescreening at 9 mo - 1yr
Why is the AABR used?
due to increased risk for neural dysfunction
What does AABR stand for?
Automated Auditory Brainstem Response
What is the txt for PDA?
Indomethacin/ Ibuprofen/ Tylenol
Formerly known as Hyaline Membrane Dx?
RDS
What is deficient in RDS and what produces it?
surfactant, type II pneumocytes
What is txt for RDS?
antenatal steroids for women at risk before 34wks
What is the long term sequelae for RDS?
BPD
What is the major factor contributing to BPD?
larger and fewer alveoli w/ reduced pulmonary capillar leading to PHTN
What is BPD/CLD?
persistent oxygen required beyond 28 days of life
What is the most common acquired acute gastro-intestinal illness?
Necrotizing Enterocolitis
What are premature infants at a higher risk for in feeding difficulties?
oral aversion
What is the txt for feeding difficulties?
feeding therapy, restricted milk flow, G tubes
Why is the weight gain in the NICU lagging?
low BW and GA, severity of illness, and postnatal steriods
Energy and protein deficits leads to?
less lean tissue growth
Mineral deficiency leads to?
low bone mineral content
Zinc deficiency leads to?
less lean mass accretion
Iron deficiency leads to?
anemia and poor growth
What are the goals of growth failure?
promote human milk feeding
avoid over nourishing
minimize nutritional deficits
Growth chart used for 22wks-50wks?
Fenton Preterm growth chart
Growth chart used for 50wks- 24 months?
WHO-CBC growth chart
How much calcium should be consumed?
150-220 mg/kg
How much phosphorus should be consumed?
75-140 mg/kg
How much Vitamin D should be consumed?
400 IU/day
How much Iron should be consumed?
2-4 mg/kg day
How should gastro-reflex be treated in a premature?
non-med, feed in reclined position, left lateral or prone position
Should breastfed pt receive multi-nutrient fortifier?
human milk is preferred, individualized approach
When is milk fortification recommend?
subnormal weight for gestational age infants
Should preterm infants receive enriched or standard formula?
enriched (continue until 40wks)
When should preterm babies be weighed?
biweekly to weekly for 1st 4-6wks, then q 2mo
When should nutrient fortified breast milk or formula ben used?
when infant falls below 10th percentile
Which infants receive RSV vaccination?
born <29 wks GA, CLD of prematurity, and hemodynamically significant heart disease
What is the RSV vaccine?
Palivizumab (Synagis)
What is the dose for RSV vaccine
max of 5 monthly doses during RSV season
What age should preterm babies be screened for iron?
4 mo, 9 mo, 12mo
Who should receive iron supplementation?
breastfed infants
What is the risk for developmental delays in preterms?
12-50% risk
What subjects do preterms preform worser in?
math, reading, spelling
What screening recommendation for neurodevelopment in preterms?
9, 18, 24, 30 mo W/ standardized tool
