Assessment and Care of the Newborn

Question 1

when is the transition period after birth?

Answer 1

first 4-6 hours of life

Question 2

what happens during the transition period?

Answer 2

• closure of the ductus arteriosus
• lung expansion with clearance of alveolar fluid
• increased blood flow to lungs
• decreased pulmonary vascular resistance

Question 3

how do we prevent heat loss in the newborn?

Answer 3

• hats
• skin contact with mother
• swaddling
• dry and remove wet linens

Question 4

what is a normal core temperature in a neonate?

Answer 4

36.5-37.5 (97.7-99.5)

Question 5

what is a normal neonate response to cold stress?

Answer 5

vasoconstriction

increased muscle flexion

metabolism of glucose, brown fat

Question 6

when does glycogen storage increase in a fetus?

Answer 6

during the 3rd trimester

Question 7

what affects post-birth blood glucose levels?

Answer 7

• hyperinsulinemia (diabetic mother)
• inadequate glycogen stores (pre-term)
• increased glucose utilization (stress, other congenital anomalies)

Question 8

what do hypoglycemic neonates present with?

Answer 8

• lethargy
• poor feeding
• tachypnea
• jitteriness
• hypothermia

Question 9

when screening for glucose, when do you want to do the first glucose level?

Answer 9

• first 30 minutes -1 hour of life (after the first feeding)
• measure pre-feeding glucose every 3-6 hours for 24-48 hours

Question 10

what is normal heart rate in a neonate?

Answer 10

120-160 bpm

85-90 may be normal in a sleeping infant

Question 11

what is the normal rr in a neonate?

Answer 11

40-60 breaths/min

tachypnea can be a sign of respiratory/cardiac disease

apnea - due to maternal meds, neuro impairment, sepsis

Question 12

what color is normal in a newborn?

Answer 12

central cyanosis is abnormal

acrocyanosis (peripheral) - normal in 1st 48 hours

Question 13

when are apgar scores done?

Answer 13

1 minute and 5 minutes

Question 14

what are the components of the Apgar?

Answer 14

• heart rate
• breathing
• grimace
• activity
• appearnance

Question 15

what vitamin do you typically receive in the first few hours of life?

Answer 15

IM Vitamin K

Question 16

why do newborns have low Vitamin K at birth?

Answer 16

• can’t synthesize it
• low placental transfer from mother
• can’t store it

Question 17

what is Vitamin K bleeding in the early days called?

Answer 17

hemorrhagic disease of the newborn

Question 18

what are the signs of hemorrhagic disease of the newborn

Answer 18

bruising, mucosal bleeding

bleeding at umbilicus or circumcision site

intracranial hemorrhage

Question 19

what is put in the eyes in the neonate and what is used to prevent?

Answer 19

erythromycin 0.5% ophthalmic oinment

prevents gonococcal and chlamydia opthalmia neonatorum

Question 20

when is an infant considered extremely premature?

very premature?

late pre-term?

early term?

Answer 20

28 weeks or less

28 weeks to 31 6/7 weeks

32 weeks to 36 6/7 weeks

37 weeks and 38 6/7 weeks

Question 21

what are the birth weight criteria?

Answer 21

low birth weight <2500 gm

very low birth weight < 1500 gm

extremely low birth weight < 1000 gm

small for gestational age <10th percentile for GA

large for gestational age >90th percentile GA

Question 22

what is the incidence of birth injuries?

Answer 22

1-2% (maybe lower for C-section)

Question 23

what are the different extracranial birth injuries?

Answer 23

Question 24

how can you tell a caput succedaneum from a cephalohematoma?

Answer 24

in caput, there is burring on the skin of the scalp

Question 25

what are the signs of a subgaleal bleed?

Answer 25

* increase of head circumference in the first 24 hours * anemia * (poss. problems with coag factors)

Question 26

shoulder dystocia is what?

Answer 26

anterior shoulder cannot pass below the pubic symphysis in birth canal

Question 27

what is a key sign of clavicular fracture in the newborn?

Answer 27

crepitus at the shoulder with a lump

Question 28

what are the discharge criteria?

Answer 28

* stable vitals for at least 12 hours * regular urine output, at least one spontaneous stool * at least 2 successful feedings * no excessive cricumcision bleeding for greater than or equal to 2 hours * appropriate screening for hyperbilirubinemia * appropriate evaluation and monitoring of sepsis risk * Hep B baccine, review of maternal vaccinations * newborn screening (blood spot, hearing, CCHD)

Question 29

is vaginal discharge from a female infant normal?

Answer 29

Yes, around day 3 of life, transfer of materal hormones can cause some transient bleeding

Question 30

what are the rules of thumb for weight loss in infants?

Answer 30

no more than 10-12% of bw feeding well return to bw by 2 weeks of age if not, monitor closely

Question 31

jaundice in the first _____ hours of life is considered pathologic

Answer 31

24 hours

Question 32

what are the three components of newborn screening?

Answer 32

heel stick blood sample pulse oximetry hearing screen

Question 33

what is the CCHD screening algorhithm?

Answer 33

Question 34

what can you use for neonatal resuscitation?

Answer 34

the umbilicus

Question 35

what is a prolonged umbilical stump healing a sign of?

Answer 35

immunodeficiency

Question 36

AAP currently recommends breastfeeding for how long?

Answer 36

at least 4-6 months

Question 37

excessive tiredness or sweating during feeding is a sign of what?

Answer 37

anemia or CHD

Question 38

how much sleep does the average infant require?

Answer 38

16-20 hours

Question 39

What newborns are at risk for neonatal hypoglycemia?

Answer 39

late pre-term small for GA large for GA birth asphyxia or other stressor

Question 40

who should be screened for hypoglycemia at birth?

Answer 40

* symptomatic infants * asymptomatic infants at risk

Question 41

Apgar Chart

Answer 41

Question 42

Pulse Oximeter Screening for Cyanotic Heart Disease in the Newborn

Answer 42

Question 43

what are the risk factors for birth injuries?

Answer 43

macrosomia \>4000 gm maternal obesity? abnormal presentation operative vaginal delivery with forceps or vacuum small maternal stature/maternal pelvic anomalies precipitous delivery

Question 44

what should you consider with delayed passage of meconium?

Answer 44

Hirschprung disease imperforate anus or other obstruction meconium ileus = cystic fibrosis until proven otherwise

Question 45

what are breast feeding and breast milk jaundice

Answer 45

Breast Feeding Jaundice * onset DOL 2-4 * related to poor feeding and intake * self-limiting and improves as supply and feeding increases Breast Milk Jaundice * onset DOL 4-7, peaks at week 1-2 * 10-30% breastfed infants * exaggerated physiologic response to substances in breastmilk that inhibit GTA

Question 46

what are the three components of newborn screening?

Answer 46

heel stick pulse oximetry hearing screen

Question 47

what are the most common disorders detected by newborn screening?

Answer 47

* hearing loss * congenital hypothyroidism * hemoglobinopathies * cystic fibrosis * medium chain acyl-CoA dehydrogenase deficiency

Question 48

when do you obtainn the heel stick blood spot screening?

Answer 48

24-48 hours after birth (after 1st feeding)

Question 49

if a neonate with high-risk for hearing loss passes newborn screening, do they need to have further audiological evaluation?

Answer 49

Yes, between 24-30 months (varies by state)

Question 50

what should you do (and the parents do for the umbilical stump)

Answer 50

clamp and cut with sterile scissors and gloves keep stump dry allow to fall off naturally (average 10-14 days)

Question 51

what do the parents need to have/receive before discharge?

Answer 51

appropriate car seat follow-up care (pediatric) identified maternal and family education provided risk factors for safe home environment assessed

Question 52

infants can cry up to how many hours a day and it is considered "normal"?

Answer 52

5-6 hours (generally peaks at 2 months)

Question 53

what is the current AAP recommendation on duration of breastfeeding

Answer 53

4-6 months | (on demand every 2-3 hours)

Question 54

how much infant formula should be given to the newborn?

Answer 54

2 ounces every 2-3 hours wake to feed at 4 hour mark

Question 55

what is a normal finding in a neonate diaper?

Answer 55

urate crystals (orange color) in females, vaginal discharge

Question 56

when is weight loss considered concerning in the newborn?

Answer 56

when the newborn is not feeding well or \>10-12% of birth weight in the first post-natal week (most infants return to birth weight by 2 weeks)

Question 57

when is newborn jaundice considered pathologic?

Answer 57

in the first 24 hours of life

Question 58

what's the treatment for newborn jaundice?

Answer 58

phototherapy hydration IVIG exchange transfusion

Question 59

what is physiologic jaundice in the newborn?

Answer 59

jaundice where not other cause can be found that occurs in the first days of life generally peaks at days 3-4 of life, resolves by 1-2 weeks

Question 60

what's the concern with neonatal jaundice?

Answer 60

BIND - bilirubin-induced neurologic dysfunction acute bilirubin encephalopathy, kernicterus occurs when bilirubin levels are markedly elevated

Question 61

what are the major and minor risk factors for hyperbilirubinemia?

Answer 61

* major * early jaundice * positive ab screen * GA 35-36 weeks * sibling needing phototherapy * bruising * exclusive breastfeeding * East Asian descent * minor - GA 37-38 weeks, jaundice prior to hospital discharge, sibing with jaundice, macrosomia/IDM mother, maternal age \> 25, male gender

Question 62

how do you do an assessement for hyperbilirubinemia risk?

Answer 62

* pre-discharge measurement of bili in ALL infants * assessment of risk factors * follow-up within three days, depending upon timing/risk