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Clinical Specialties - Pediatrics > Assessment and Care of the Newborn > Flashcards

Assessment and Care of the Newborn Flashcards

1
Q

when is the transition period after birth?

A

first 4-6 hours of life

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2
Q

what happens during the transition period?

A
  • closure of the ductus arteriosus
  • lung expansion with clearance of alveolar fluid
  • increased blood flow to lungs
  • decreased pulmonary vascular resistance
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3
Q

how do we prevent heat loss in the newborn?

A
  • hats
  • skin contact with mother
  • swaddling
  • dry and remove wet linens
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4
Q

what is a normal core temperature in a neonate?

A

36.5-37.5 (97.7-99.5)

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5
Q

what is a normal neonate response to cold stress?

A

vasoconstriction

increased muscle flexion

metabolism of glucose, brown fat

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6
Q

when does glycogen storage increase in a fetus?

A

during the 3rd trimester

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7
Q

what affects post-birth blood glucose levels?

A
  • hyperinsulinemia (diabetic mother)
  • inadequate glycogen stores (pre-term)
  • increased glucose utilization (stress, other congenital anomalies)
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8
Q

what do hypoglycemic neonates present with?

A
  • lethargy
  • poor feeding
  • tachypnea
  • jitteriness
  • hypothermia
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9
Q

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

A
  • first 30 minutes -1 hour of life (after the first feeding)
  • measure pre-feeding glucose every 3-6 hours for 24-48 hours
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10
Q

what is normal heart rate in a neonate?

A

120-160 bpm

85-90 may be normal in a sleeping infant

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11
Q

what is the normal rr in a neonate?

A

40-60 breaths/min

tachypnea can be a sign of respiratory/cardiac disease

apnea - due to maternal meds, neuro impairment, sepsis

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12
Q

what color is normal in a newborn?

A

central cyanosis is abnormal

acrocyanosis (peripheral) - normal in 1st 48 hours

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13
Q

when are apgar scores done?

A

1 minute and 5 minutes

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14
Q

what are the components of the Apgar?

A
  • heart rate
  • breathing
  • grimace
  • activity
  • appearnance
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15
Q

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

A

IM Vitamin K

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16
Q

why do newborns have low Vitamin K at birth?

A
  • can’t synthesize it
  • low placental transfer from mother
  • can’t store it
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17
Q

what is Vitamin K bleeding in the early days called?

A

hemorrhagic disease of the newborn

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18
Q

what are the signs of hemorrhagic disease of the newborn

A

bruising, mucosal bleeding

bleeding at umbilicus or circumcision site

intracranial hemorrhage

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19
Q

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

A

erythromycin 0.5% ophthalmic oinment

prevents gonococcal and chlamydia opthalmia neonatorum

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20
Q

when is an infant considered extremely premature?

very premature?

late pre-term?

early term?

A

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

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21
Q

what are the birth weight criteria?

A

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

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22
Q

what is the incidence of birth injuries?

A

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

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23
Q

what are the different extracranial birth injuries?

A
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24
Q

how can you tell a caput succedaneum from a cephalohematoma?

A

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

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25
Q

what are the signs of a subgaleal bleed?

A
  • increase of head circumference in the first 24 hours
  • anemia
  • (poss. problems with coag factors)
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26
Q

shoulder dystocia is what?

A

anterior shoulder cannot pass below the pubic symphysis in birth canal

27
Q

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

A

crepitus at the shoulder with a lump

28
Q

what are the discharge criteria?

A
  • 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)
29
Q

is vaginal discharge from a female infant normal?

A

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

30
Q

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

A

no more than 10-12% of bw

feeding well

return to bw by 2 weeks of age

if not, monitor closely

31
Q

jaundice in the first _____ hours of life is considered pathologic

A

24 hours

32
Q

what are the three components of newborn screening?

A

heel stick blood sample

pulse oximetry

hearing screen

33
Q

what is the CCHD screening algorhithm?

A
34
Q

what can you use for neonatal resuscitation?

A

the umbilicus

35
Q

what is a prolonged umbilical stump healing a sign of?

A

immunodeficiency

36
Q

AAP currently recommends breastfeeding for how long?

A

at least 4-6 months

37
Q

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

A

anemia or CHD

38
Q

how much sleep does the average infant require?

A

16-20 hours

39
Q

What newborns are at risk for neonatal hypoglycemia?

A

late pre-term

small for GA

large for GA

birth asphyxia or other stressor

40
Q

who should be screened for hypoglycemia at birth?

A
  • symptomatic infants
  • asymptomatic infants at risk
41
Q

Apgar Chart

A
42
Q

Pulse Oximeter Screening for Cyanotic Heart Disease in the Newborn

A
43
Q

what are the risk factors for birth injuries?

A

macrosomia >4000 gm

maternal obesity?

abnormal presentation

operative vaginal delivery with forceps or vacuum

small maternal stature/maternal pelvic anomalies

precipitous delivery

44
Q

what should you consider with delayed passage of meconium?

A

Hirschprung disease

imperforate anus or other obstruction

meconium ileus = cystic fibrosis until proven otherwise

45
Q

what are breast feeding and breast milk jaundice

A

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
46
Q

what are the three components of newborn screening?

A

heel stick

pulse oximetry

hearing screen

47
Q

what are the most common disorders detected by newborn screening?

A
  • hearing loss
  • congenital hypothyroidism
  • hemoglobinopathies
  • cystic fibrosis
  • medium chain acyl-CoA dehydrogenase deficiency
48
Q

when do you obtainn the heel stick blood spot screening?

A

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

49
Q

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

A

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

50
Q

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

A

clamp and cut with sterile scissors and gloves

keep stump dry

allow to fall off naturally (average 10-14 days)

51
Q

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

A

appropriate car seat

follow-up care (pediatric) identified

maternal and family education provided

risk factors for safe home environment assessed

52
Q

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

A

5-6 hours (generally peaks at 2 months)

53
Q

what is the current AAP recommendation on duration of breastfeeding

A

4-6 months

(on demand every 2-3 hours)

54
Q

how much infant formula should be given to the newborn?

A

2 ounces every 2-3 hours

wake to feed at 4 hour mark

55
Q

what is a normal finding in a neonate diaper?

A

urate crystals (orange color)

in females, vaginal discharge

56
Q

when is weight loss considered concerning in the newborn?

A

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)

57
Q

when is newborn jaundice considered pathologic?

A

in the first 24 hours of life

58
Q

what’s the treatment for newborn jaundice?

A

phototherapy

hydration

IVIG

exchange transfusion

59
Q

what is physiologic jaundice in the newborn?

A

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

60
Q

what’s the concern with neonatal jaundice?

A

BIND - bilirubin-induced neurologic dysfunction

acute bilirubin encephalopathy, kernicterus

occurs when bilirubin levels are markedly elevated

61
Q

what are the major and minor risk factors for hyperbilirubinemia?

A
  • 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
62
Q

how do you do an assessement for hyperbilirubinemia risk?

A
  • pre-discharge measurement of bili in ALL infants
  • assessment of risk factors
  • follow-up within three days, depending upon timing/risk
63
Q
A

Clinical Specialties - Pediatrics (18 decks)

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