B8-080 CBCL Care of the Infant Flashcards
APGAR is assigned at […] and […] min of life
1 and 5
(if less than 7, continue every 5 min until improvement)
medications administered to infant in the first few hours of life [3]
vitamin K
erythromycin eye ointment
hepatitis B vax
what does APGAR evaluate?
Appearance
Pulse
Grimace
Activity
Respiration
(each category given score from 0-2)
Note: she says HR, RR, muscle tone, reflex irritability, color in her lecture
if the cord has […] vessels, that could indicate genetic anomalies
two
(3 normal)
if you are unsure of baby’s GA, you can use the […] method to evaluate them
ballard
“hang on for life” reflex
baby extends/abducts arms when startled and then draws together
moro reflex (startle reflex)
required newborn screening tests [3]
hearing
newborn screen: CF, PKU, thyroid, etc.
CHD
high pitched crying
uncontrolled tremors
fragmented sleep
diarrhea/vomiting
frequent sneezing
sweating
in a newborn can be signs of
NOWS
the highest risk of congenital anomalies due to teratogens occurs in the […] period
embryonic (weeks 3-8)
causes of congenital anomalies are […] in 55% of cases
multifactorial
intrinsic developmental defect that occurs during the embryonic period
malformation
secondary breakdown of tissue with normal developmental potential
disruption
(ex. amniotic band)
extrinsic mechanical distortion occurs during fetal period
deformation
(ex. club foot from low amniotic fliud)
birth defects associated with smoking and pregnancy [4]
cleft lip/palate
club foot
gastroschisis
heart defects
placental problems associated with tobacco exposure [2]
abruption (painful)
previa (painless)
following delivery, babies born to mothers who smoked tobacco are at an increased risk of […]
SIDS
congenital anomalies associated with opioids [4]
CVD anomalies (tet. and HLHS)
neural tube defects
gastroschisis
clubfoot
failure of closure of the […] results in anencephaly
anterior neuropore
[…] use in pregnancy is associated with prune belly syndrome and cryptorchidism
cocaine
inhibits the transport of biotin and vitamin B6 across the placenta
ethanol
blood entering the fetus through the umbilical vein is conducted through the […] to the IVC
ductus venousus
in the fetus, the highly oxygenated blood reaching the heart via the IVC is direct through the […] into the left atrium
foramen ovale
in the fetus, deoxygenated blood from the SVC passes through the RA -> RV -> main pulmonary artery -> […] –> descending aorta
ductus arteriosus
describe the changes that occur in the heart when an infant takes a breath after birth
decreased resistance in pulmonary vasculature –>
increased left atrial pressure vs RA –>
foramen ovale closes
the increase in O2 and decrease in prostaglandins allows for closure of ductus arteriosus
erythromycin is administered to newborns for […] prophylaxis
gonorrhea
vitamin K is administered to newborns for […] prophylaxis
bleeding
below the […]% is considered SGA
above the […]% is considered LGA
below the [10]% is considered SGA
above the [90]% is considered LGA
the first stool produced by baby is called […]
meconium
failure of the […] to close results in gastroschisis
ventral body wall
gastroschisis is most commonly linked to maternal use of […] [2]
opioid
tobacco smoke
pregnant women exposed to […] are at an increased risk of having a baby with low birth weight
secondhand smoke
the umbilical vein drains into the […] via the ductus venosus
IVC
[…] vessel cord is associated with congenital and chromosomal anomalies
two vessel
(single umbilical artery)
benign neonatal hyperbilirubinemia is caused by [3]
increased fetal RBC turnover
immature newborn liver (less UDP activity)
increased enterohepatic circulation
how can failure of breastfeeding cause jaundice?
insufficient breastmilk intake leads to decreased bilirubin elimination in stool
how can breast milk cause jaundice?
increased B-glucoronidase in milk causes deconjugation
severe cases of benign neonatal hyperbilirubinemia can lead to
kernicterus
(deposits in basal ganglia)
gastrulation occurs in the […] period
embryonic (3-8)
(formation of trilaminar disc)
the majority of the contributing factors to birth defects are […]
multifactorial
morphological alterations to already formed structures
disruption
result from mechanical forces that mold structures over a prolonged period of time
deformations
affect the formation of structures
malformations
external factors that cause birth defects
teratogens
(genetics are not teratogens)
categories of teratogens [4]
chemical
hormones
infectious
physical
examples of male mediates teratogenesis [3]
male germ cell mutations
paternal exposure to secondhand smoke/hazards (mercury)
transmission of teratogens in seminal fluid
a sacral dimple [with/without] a base is a normal finding
with
(without raises concern for spina bifida)
a hip clunk raises suspicion for […]
developmental dysplasia of the hip
circumcision decreases the risk of […] [3]
HIV, HPV
UTI in first year of life
(important to consider geographical prevalence of HIV, HPV in risk/benefit ratio)
decreases the risk of UTI in the first year of life
circumcision
[milestones]
cooing/gurgling
2 months
[milestones]
stringing vowels together
4 months
[milestones]
responds to simple requests, waves
12 months
[milestones]
puts together sentences
2 yrs
[milestones]
acts bored
2 months
[milestones]
passes objects from hand to hand
4 months
[milestones]
uses objects properly
12 months
[milestones]
builds a tower of 4 blocks
2 yrs
condition that causes breathing problems in newborn babies
transient tachypnea of the newborn
risk factors for transient tachypnea of the newborn
C-section
precipitous delivery
(not enough time for fluid to be squeezed from lungs)
what is an appropriate amount of stool and wet diapers for a newborn?
1 stool and 1 wet per day of life
normal, blue-grey marking of the skin in newborns
dermal melanocytosis
exams that check for developmental dysplasia of the hip
Barlow and Ortolani
babies hands/feet are blue but is otherwise pink
acrocyanosis
if mom is Hep B+, what treatment should baby receive to prevent vertical transmission?
Hep B vaccine
hep B IVIg
babies need to pass their first stool by […] hours of life
24-48
delayed passage of meconium could be a sign of
CF
(colonic dysmotility)
risk factors for hyperbilirubinemia
jaundice in first 24 hrs of life
ABO/Rh incompatibility
GA 35-36 weeks
TSB/TcB in high risk zone (greater than 10)
risk factor for developmental dysplasia of the hip
Breech presentation
(diagnosis confirmed via US in infants less than 4 mo)
gestation diabetes is a risk factor for [3]
hypoglycemia
large for GA infants
shoulder dystocia
in breastfeeding […] milk supply is associated with jaundice
low
a prior sibling with jaundice increases the risk for
jaundice
reduces risk of anemia by allowing the newborn to receive all blood in the placenta
delayed cord clamping
helps the infant create clotting factors that decrease the risk of intracranial bleeding
vitamin K
given to all infants at birth to prevent gonococcal ophthalmia of of the newborn
erythromycin
leading preventable cause of blindness worldwide
gonococcal ophthalmia of of the newborn
[…] is used to treat chlamydia in pregnancy
azithromycin
(doxy normally)
why are tetracyclines contraindicated in pregnancy?
binds to calcium –> inhibits bone growth
looks for different elements of neuromuscular and physical maturity to help determine gestational age
Ballard exam
the […] reflex is caused by an abrupt position change or loud noise
moro/startle
neural tube defects are associated with […] deficiency
folic acid
(anticonvulsants interfere with folate metabolsim)
white keratin inclusions on the nose
millia
a benign, self-limiting rash that appears within the first week of life
Small, red macules and papules that progress to pustules with surrounding erythema
erythema toxicum
normal newborn exam findings of the head [2]
moulding
puffy eyes
When the infant is lying supine, turning the head to one side elicits extension of the ipsilateral extremities and flexion of the contralateral extremities
(fencing posture).
tonic neck reflex
Holding the infant upright in a standing position elicits a walking motion, with alternating flexion and extension of the legs
step reflex
Pressing or placing something into the infant’s palm causes the fingers to flex towards the palm
grasp reflex
jaundice appearing after first 24 hours of life
resolves without intervention
benign neonatal hyperbilirubinemia
breastmilk jaundice is caused by increased […] in breastmilk
beta glucoronidase
breastfeeding jaundice is caused by
suboptimal intake
what is the result of untreated Rh incompatibility?
hemolytic disease of the newborn
if a mother is HIV+, what treatment should the baby receive after birth?
start zidovudine within 6-12 hours
bathe baby immediately, breastfeeding not recommended
test at 24 hours of life and again at regular intervals after discharge
most common genetic mutation causing CF
F508
live attenuated vaccines [3]
varicella
rotavirus
MMR
