Assessment and Care of the Newborn Flashcards
when is the transition period after birth?
first 4-6 hours of life
what happens during the transition period?
- closure of the ductus arteriosus
- lung expansion with clearance of alveolar fluid
- increased blood flow to lungs
- decreased pulmonary vascular resistance
how do we prevent heat loss in the newborn?
- hats
- skin contact with mother
- swaddling
- dry and remove wet linens
what is a normal core temperature in a neonate?
36.5-37.5 (97.7-99.5)
what is a normal neonate response to cold stress?
vasoconstriction
increased muscle flexion
metabolism of glucose, brown fat
when does glycogen storage increase in a fetus?
during the 3rd trimester
what affects post-birth blood glucose levels?
- hyperinsulinemia (diabetic mother)
- inadequate glycogen stores (pre-term)
- increased glucose utilization (stress, other congenital anomalies)
what do hypoglycemic neonates present with?
- lethargy
- poor feeding
- tachypnea
- jitteriness
- hypothermia
when screening for glucose, when do you want to do the first glucose level?
- first 30 minutes -1 hour of life (after the first feeding)
- measure pre-feeding glucose every 3-6 hours for 24-48 hours
what is normal heart rate in a neonate?
120-160 bpm
85-90 may be normal in a sleeping infant
what is the normal rr in a neonate?
40-60 breaths/min
tachypnea can be a sign of respiratory/cardiac disease
apnea - due to maternal meds, neuro impairment, sepsis
what color is normal in a newborn?
central cyanosis is abnormal
acrocyanosis (peripheral) - normal in 1st 48 hours
when are apgar scores done?
1 minute and 5 minutes
what are the components of the Apgar?
- heart rate
- breathing
- grimace
- activity
- appearnance
what vitamin do you typically receive in the first few hours of life?
IM Vitamin K
why do newborns have low Vitamin K at birth?
- can’t synthesize it
- low placental transfer from mother
- can’t store it
what is Vitamin K bleeding in the early days called?
hemorrhagic disease of the newborn
what are the signs of hemorrhagic disease of the newborn
bruising, mucosal bleeding
bleeding at umbilicus or circumcision site
intracranial hemorrhage
what is put in the eyes in the neonate and what is used to prevent?
erythromycin 0.5% ophthalmic oinment
prevents gonococcal and chlamydia opthalmia neonatorum
when is an infant considered extremely premature?
very premature?
late pre-term?
early term?
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
what are the birth weight criteria?
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
what is the incidence of birth injuries?
1-2% (maybe lower for C-section)
what are the different extracranial birth injuries?
how can you tell a caput succedaneum from a cephalohematoma?
in caput, there is burring on the skin of the scalp
what are the signs of a subgaleal bleed?
- increase of head circumference in the first 24 hours
- anemia
- (poss. problems with coag factors)
shoulder dystocia is what?
anterior shoulder cannot pass below the pubic symphysis in birth canal
what is a key sign of clavicular fracture in the newborn?
crepitus at the shoulder with a lump
what are the discharge criteria?
- 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)
is vaginal discharge from a female infant normal?
Yes, around day 3 of life, transfer of materal hormones can cause some transient bleeding
what are the rules of thumb for weight loss in infants?
no more than 10-12% of bw
feeding well
return to bw by 2 weeks of age
if not, monitor closely
jaundice in the first _____ hours of life is considered pathologic
24 hours
what are the three components of newborn screening?
heel stick blood sample
pulse oximetry
hearing screen
what is the CCHD screening algorhithm?
what can you use for neonatal resuscitation?
the umbilicus
what is a prolonged umbilical stump healing a sign of?
immunodeficiency
AAP currently recommends breastfeeding for how long?
at least 4-6 months
excessive tiredness or sweating during feeding is a sign of what?
anemia or CHD
how much sleep does the average infant require?
16-20 hours
What newborns are at risk for neonatal hypoglycemia?
late pre-term
small for GA
large for GA
birth asphyxia or other stressor
who should be screened for hypoglycemia at birth?
- symptomatic infants
- asymptomatic infants at risk
Apgar Chart
Pulse Oximeter Screening for Cyanotic Heart Disease in the Newborn
what are the risk factors for birth injuries?
macrosomia >4000 gm
maternal obesity?
abnormal presentation
operative vaginal delivery with forceps or vacuum
small maternal stature/maternal pelvic anomalies
precipitous delivery
what should you consider with delayed passage of meconium?
Hirschprung disease
imperforate anus or other obstruction
meconium ileus = cystic fibrosis until proven otherwise
what are breast feeding and breast milk jaundice
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
what are the three components of newborn screening?
heel stick
pulse oximetry
hearing screen
what are the most common disorders detected by newborn screening?
- hearing loss
- congenital hypothyroidism
- hemoglobinopathies
- cystic fibrosis
- medium chain acyl-CoA dehydrogenase deficiency
when do you obtainn the heel stick blood spot screening?
24-48 hours after birth (after 1st feeding)
if a neonate with high-risk for hearing loss passes newborn screening, do they need to have further audiological evaluation?
Yes, between 24-30 months (varies by state)
what should you do (and the parents do for the umbilical stump)
clamp and cut with sterile scissors and gloves
keep stump dry
allow to fall off naturally (average 10-14 days)
what do the parents need to have/receive before discharge?
appropriate car seat
follow-up care (pediatric) identified
maternal and family education provided
risk factors for safe home environment assessed
infants can cry up to how many hours a day and it is considered “normal”?
5-6 hours (generally peaks at 2 months)
what is the current AAP recommendation on duration of breastfeeding
4-6 months
(on demand every 2-3 hours)
how much infant formula should be given to the newborn?
2 ounces every 2-3 hours
wake to feed at 4 hour mark
what is a normal finding in a neonate diaper?
urate crystals (orange color)
in females, vaginal discharge
when is weight loss considered concerning in the newborn?
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)
when is newborn jaundice considered pathologic?
in the first 24 hours of life
what’s the treatment for newborn jaundice?
phototherapy
hydration
IVIG
exchange transfusion
what is physiologic jaundice in the newborn?
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
what’s the concern with neonatal jaundice?
BIND - bilirubin-induced neurologic dysfunction
acute bilirubin encephalopathy, kernicterus
occurs when bilirubin levels are markedly elevated
what are the major and minor risk factors for hyperbilirubinemia?
- 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
how do you do an assessement for hyperbilirubinemia risk?
- pre-discharge measurement of bili in ALL infants
- assessment of risk factors
- follow-up within three days, depending upon timing/risk
