CCS

Question 1

APGAR score system

Answer 1

0-1-2-

Appearance : blue - acrocyanosis ( pink body, blue extremities)- blue

Pulse: none- < 100 - >100

Grimace : no response - Facial movement - try to pull away

Activity: limp - flexion of extremities- active movement

RR: none- slow, irregular- active crying

Question 2

normal HR and RR in newborns

Answer 2

HR: 120-160 bpm

RR: 30-50 breaths/min

Question 3

Once the baby is born, apgar good, whats next?

Answer 3

Erythromycin ointment

Question 4

Why do you give eythromycin ointment? MOA ?

Answer 4

Erythromycin mechanism: binds to the Ribosomal 50S unit, blocking protein synthesis and translation of RNA.

Is to prevent “ ophtalmia neonatorum” due to gonorrhea which can lead to blindness.

Gonorrhea: Gram negative diplococcus, pili, chocolate apgar

Pharmacokinetics of erythromycin?

Demethylation in the liver, Cytochrome P450 system, excretion through bile.

Question 5

MOA of Vitamin K , factors?

Answer 5

II, VII,IX,X, C,S

Vitamin K act as a cofactor, so the inactive factors + Vit K in presence of gamma glutamyl transferase are converted into active factors

Neonates lack enteric bacteria, which produces vit K and breast mil not a good source.

Mechanism of vit K: gamma carboxylation, adds carboxyl group to glutamate.

Question 6

Before discharging newborn, what is the checklist that have to be done?

Answer 6

• Erythromicin ointment and Vit K at birth
• Hearing test ( able to diagnose deafness at 2-3 months)
• Screening Newborn
• Hep B Ig and Hep B vaccine

Question 7

Contraindications of breastfeeding

Answer 7

Classic Galactosemia

Mom:

HIV

untreated TB

herpetic lesion in breast

Varicella < 5 days prior to or within 2 days of delivery

Specific maternal meds

Chemotherapy ongoing, radiation therapy

Active use of illicit drugs and alcohol

Question 8

Benefits of breastfeeding infant

Answer 8

Improved immunity

Improved GI function

Prevent Otitis media, gastroenteritis, respiratory illness, UTI

Decrease risk of childhood Ca, DM type I and necrotizing enterocolitis.

Question 9

Newborns usually lose weight in the first week of life but SHOULD NEVER BE MORE TAN 10%. T/F

Answer 9

True

Question 10

Timing of physiologic jaundice and mechanisms

Answer 10

2-4 days of life

1. At birth, RBC conc. Is ↑ (Hct 50-60%), short RBC life span (~90 days)à↑ Hb turnover and ↑ bilirubin
2. Bilirubin clearance is slow as hepatic UDP glucuronosyltransferase (UGT) does not reach adult level until 14 wks of age—Asian newborns have ↓ UGT activity as compared to other ethnicities
3. Sterile newborn gut cannot breakdown bilirubin into urobilinogen to be excreted in stoolà↑ enterohepatic recycling of bilirubin -> more bilirubin resorbed in gut until gut is colonized and produces more bacterial enzymes for reduction into urobilinogen
   - Usually benign and resolves in 1-2 wks

Question 11

When do you use phototherapy for newborn jaundice?

Answer 11

unconjugated bilirubin >20mg/dl

Question 12

When do you use plasma exchange for newborn jaundice?

Answer 12

total bilirubin levels >25 mg/dl or there are signs of neurological impairment

Question 13

Pathway of bilirrubin

Answer 13

Question 14

Genetic disorders of bilirrubin metabolism

Answer 14

Question 15

Difference between Breastfeeding failure jaundice and breast milk jaundice

Answer 15

Question 16

yellowish or green stool in a 4 day old

Answer 16

NORMAL.

Normal infants: pass dark, sticky meconium during 1st 2 days of life after which they should transition to yellowish or green stool of ingesting adequate milk

If inadequate stooling-> ↓ bilirubin excretion and ↑ enterohepatic circulation of bilirubin

Question 17

Normal # of wet diapers in newborn?

Answer 17

Normal infant: during 1st week of life, normal no. of wet diapers=infants age in days eg. 4 days old child=>/= 4 wet diapers

Question 18

Treatment of breastfeeding failure jaundice?

Answer 18

Check if its technique, or any mom factor that is limiting adequate breastfeeding. Improve latch.

↑ frequency and duration of feeds to stimulate milk production, maintain adequate hydration, and promote bilirubin excretion in feces.

Neonates should breastfeed ~8-12 times a day (every 2-3 hours) for >10-20 minutes per breast during the first month of life.

• Closely monitor to ensure baby is fed adequately (remonitor in 2 days) and that his bilirubin level is decreasing.

Question 19

Definition of Hyperbilirubinemia in infants ≥35 weeks gestational age (GA)

Answer 19

total serum or plasma bilirubin (TB) level >95th percentile on the hour-specific Bhutani nomogram

Question 20

Deifnition of Severe neonatal hyperbilirubinemia

Answer 20

TB >25 mg/dL (428 micromol/L). It is associated with an increased risk for developing bilirubin-induced neurologic dysfunction (BIND),

Question 21

Causes of pathologic hyperbilirrubinemia

Answer 21

Question 22

Cephalohematoma what is it? mechanism to produce jaundice?

Answer 22

hemorrhage collection on the outside of skull

complication of vaccum assisted deliveries

blood needs to be reabsorbed by the body -> increased bilirrubin causing jaundice.

Question 23

Risk factors for Hyperbilirrubinemia

Answer 23

Jaundice in first 24 hours of life

ABO incompatibility

Cepahlohematoma

Previous sibbling needing phototherapy

Exclusive breastfeeding.