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RDS Test 4 > B8.067 Decision Making in the Newborn > Flashcards

B8.067 Decision Making in the Newborn Flashcards

1
Q

neonatal dilemmas by frequency

A
  1. rashes
  2. jaundice
  3. early discharge
  4. hypoglycemia
  5. tachypnea
  6. DDH
  7. sepsis (GBS)
  8. failure to stool/ urinate
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2
Q

what is a late preterm infant

A

birth between 34 and 36w6d gestation

often the size and weight of term infants

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3
Q

the “problem” with late, preterm infants

A

treatment by caregivers and parents as if they are developmentally mature
evidence indicates higher risk of mortality and morbidity and hospital readmissions

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4
Q

what types of issues are late preterm infants more at risk for?

A 
airway instability
apnea and bradycardia
excessive sleepiness
excessive weight loss
feeding intolerance
hyperbilirubinemia
hypoglycemia
hypothermia
immature self regulation
respiratory distress
sepsis
weak suck
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5
Q

what should be the first step if a neonate appears jaundiced?

A

order a serum bilirubin

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6
Q

function of phototherapy

A

converts bilirubin into a soluble form for excretion

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7
Q

at what serum bili level is jaundice appreciated visually

A

around 5 mg/dl

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8
Q

at what stage of life is jaundice ALWAYS pathologic

A

<24 hours old

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9
Q

how is risk of kernicterus assessed

A

age in hours compared to serum bili level
options:
-phototherapy
-exchange transfusion

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10
Q

root causes of kernicterus

A

early discharge (<48 hr) with no early follow up, esp in late pre term infants
failure to check bili in infants noted to be jaundiced in first day of life
failure to recognize risk factors for jaundice
underestimating severity of jaundice by visual assessment
lack of concern
delay in measurement of bili or initiation of phototherapy
failure to respond to parental concern

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11
Q

obstetrical risk factors for nonhemolytic hyperbilirubinemia

A 
previously jaundiced sibling
east asian race
infant of a diabetic mother
bruising, cephalohematoma, vacuum extraction (due to breakdown of Hgb)
<37 weeks gestation
maternal age > 24
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12
Q

neonatal risk factors for nonhemolytic hyperbilirubinemia

A 
breast feeding
male
caloric deprivation- weight loss > 25%
jaundice before discharge
increased hemolysis
crigler-najjar
hospital stay <72 hrs
bilirubin >75% for age
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13
Q

what is the bhutani nomogram

A

plots age vs serum bilirubin to stratify risk of significant hyperbilirubinemia requiring intervention

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14
Q

what can WE do to prevent kernicterus

A

dont ignore visible jaundice on first day
check curves for risk
check levels
follow babies discharged in <72 hrs in 24-48 hrs
dont ignore phone calls
don’t delay treatments

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15
Q

maternal risk factors of GBS

A

positive maternal GBS culture of vagina or rectum
previous infant who had invasive GBS disease
GBS bacteriuria during this pregnancy
delivery at <37 wks
intrapartum fever (>38)
rupture of membranes >18 hrs

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16
Q

full GBS evaluation

A 
CBC w diff
blood culture
chest Xray
lumbar puncture
treat
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17
Q

limited GBS evaluation

A

CBC w diff
blood culture
observe >48 hr

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18
Q

when do you do a full GBS eval

A

signs of neonatal sepsis!!!

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19
Q

when do you do a limited GBS eval

A

maternal chorioamionitis
OR
if mother should have received GBS prophylaxis and didnt + neonate is <37 wks and membrane rupture was > 18 hrs

20
Q

when do you observe for >48 hrs due to GBS risk

A

if GBS prophylaxis is indicated for the mother AND it was received properly
OR it wasn’t received but the baby is >37 weeks and membrane rupture was < 18 hrs

21
Q

what is GBS prophylaxis for a mother

A

IV penicillin, ampicillin, or cefazolin for >4 hrs before delivery

22
Q

goals of treatment of hypoglycemia in newborn

A

normalize blood glucose rapidly

maintain blood glucose until normal homeostasis is established

23
Q

normal treatment of newborn hypoglycemia

A

enteral feedings
-if baby is term, asymptomatic, and has a good suck
use formula or breast milk (D20)
if next glucose level is <40, enteral feeding should be considered unsuccessful > go to IV

24
Q

IV treatment of newborn hypoglycemia

A 
bolus 2cc/kg D10W (highest level IV can go)
continuous infusion
baseline: 4-8 mg/kg/min
100 cc/kg/day of D5W
check glucose at 30, 60, and 120 min
25
Q

follow up on treatment of hypoglycemia

A

if preprandial glucose > 50 for 12-24 hrs, start to wean
decrease infusion rate by 10-20%
if weaning not possible, look for persistent problem

26
Q

groups of risk factors for hypoglycemia

A
  1. limited glycogen
  2. hyperinsulinism
  3. unknown
    - large for gestational age
    - sepsis
    - polycythemia
27
Q

reasons for limited glycogen in newborn

A

small for gestational age
prematurity
birth stress
glycogen storage diseases

28
Q

reasons for hyperinsulinism in newborn

A 
infant of a diabetic mother
beckwith-wiedemann
nesidoblastosis
pancreatic adenoma
Rh disease
exchange transfusion
drugs
urinary catheters
29
Q

what is neonatal abstinence syndrome

A

a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb

30
Q

classic triad of NAS

A

high pitched cry
tremor
tachypnea

31
Q

screening for NAS

A

maternal history
maternal urine drug screen
infant drug screen - can have false negative as it requires recent exposure to be accurate
meconium testing - often not available and not practical as it delays diagnosis

32
Q

neuro symptoms of NAS

A 
excessive irritiability
hyper reflexive
decreased sleep
increased muscle tone
tremors
myoclonic jerks
seizures
33
Q

GI symptoms of NAS

A

diarrhea
regurgitation
poor suckling

34
Q

autonomic symptoms of NAS

A

diaphoresis
temp instability
sneezing
mottling

35
Q

nonpharmacologic treatments for NAS

A

soothing techniques: swaddling, pacifier, rocking
environment modification (quiet, dark rooms)
maternal education and reassurance
-babies cry for numerous reasons
-maternal guilt
-psych and rehab services for mother
60-80% of infants won’t respond to non-pharma and will need pharma therapy

36
Q

goal of pharmacotherapy in NAS

A

relief of signs, such as seizures, weight loss, sufficient to allow parental care of infant
no national standardized guidelines
treatment options vary depending on maternal drug exposure

37
Q

pharmacotherapy options on NAS

A

typically, opiates used for opioid exposed infants
may use 2nd line agents as needed
may consider other treatment options if polysubstance use

38
Q

what is developmental dysplasia of the hip

A

spectrum of disorders affecting the acetabulum and the proximal femur
dynamic condition, can occur
-prenatally
-postnatally

39
Q

continuum of pathology/outcomes of developmental dysplasia of the hip

A

stabilize and become normal
stabilize and remain dysplastic
progress to dislocation

40
Q

DDH statistics

A 
subluxable hips (14/1000)
dislocatable hips (2.5/1000)
dislocated hips (1.3/1000)
41
Q

incidence of DDH

A 
varies by race
M:F = 1:6
left =60%, right =20%, bilateral =20%
multifactorial
breech has up to 23% incidence
42
Q

impact on fam history on DDH

A

6% with affected sib
12% with affected parent
36% with affected parent and sib

43
Q

most reliable screening for DDH

A

physical exam

44
Q

physical exam for DDH

A

child should be warm and relaxed
barlow test and ortolani sign good in first 2 months
-barlow attempts to dislocate an unstable hip (applies adduction and posterior pressure)
-ortolani sign attempts to relocate (applies abduction and anterior pressure on knee)
click = innocent soft tissue sign
clunk = bad

45
Q

presentation of DDT after 2 months of age

A 
barlow and ortolani are of limited value at this stage
limitation of abduction
asymmetric skin folds
uneven knee heights
bilateral dislocations can be misleading
46
Q

when should you use an US for DDT eval?

A

after 2 months

better than xray until 6 months

RDS Test 4 (17 decks)

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