CLIPP 01: Newborn evaluation

Question 1

How can smoking during pregnancy affect the fetus?

Answer 1

Maternal tobacco use during pregnancy increases the risk for low birth weight in the fetus.

Question 2

How does cocaine and other stimulant use affect pregnancy?

Answer 2

These cause vasoconstriction leading to placental insufficiency and low birth weight.

Question 3

How can heroin and other opiates affect pregnancy?

Answer 3

Maternal heroin use is associated with increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor and intrauterine passage of meconium.

Question 4

How to treat healthy vs ill appearing infants born to GBS positive mothers not prophylaxed with amp

Answer 4

Healthy: CBC and blood culture

Ill-appearing: CBC, blood culture, chest xray and lumbar puncture

Question 5

What does APGAR stand for?

Answer 5

A- appearance
P- pulse
G- grimace (reflex ability)
A- activity (muscle tone)
R- respirations

Question 6

How to we follow APGAR scores?

Answer 6

a score below 7 at 5 minutes should prompt continued resuscitation, with re-assessment every 5 minutes, up to 20 minutes, until a score of 7 is achieved

Question 7

How do apgar scores predict mortality?

Answer 7

The Apgar score does not identify birth asphyxia and does not predict individual neurologic outcome or mortality

Question 8

What defines an SGA neonate?

Answer 8

Small for gestational age (SGA) = Weight below the 10th percentile for gestational age

Question 9

What determines a term baby?

Answer 9

Term = Born at > 37 weeks’ gestation

Question 10

Describe asymmetric intrauterine growth restriction

Answer 10

Asymmetric IUGR refers to a greater decrease in the size of the length and/or weight without affecting head circumference (“head-sparing phenomenon”). Poor delivery of nutrition to the fetus (example maternal smoking) often results in asymmetric IUGR

Question 11

List three additional risks associated with SGA babies

Answer 11

Polycythemia- due to chronic hypoxia

Hypothermia- due to cold stress, hypoxia, hypoglycemia, increased surface area and decreased subq insulation

Question 12

Causes of an absent red reflex?

Answer 12

A cataract
An opacified cornea (such as in mucopolysaccharidosis)
Inflammation of the anterior chamber
Developmental anomalies of the eye
Retinoblastoma

Question 13

Three meds administered at birth?

Answer 13

Erythromycin
Hep B vaccine
Vitamin K

Question 14

infants born to mothers who are positive for HepB surface antigen should be treated how? How effective are these interventions?

Answer 14

Should receive the hepatitis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery

Vertical transmission can be prevented in 85-95% of cases using these interventions

Question 15

What is the weight cut off for administering hepB vaccine?

Answer 15

2kg

Question 16

What interventions should be administered to neonates to mothers with unknown HepBAg status?

Answer 16

Administration of HBIG can be delayed until the maternal HBsAg is known, and is effective if given within 7 days following delivery if the patient is greater than 2 kg at birth

Question 17

What does erythromycin in the eyes prevent?

Answer 17

gonococcal conjunctivitis

Chlamydia trachomatis conjunctivitis in newborns is more common than gonococcal, but chlamydia typically occurs at 7-14 days after birth, and neonatal prophylaxis does little to prevent chlamydia conjunctivitis

Question 18

What are some of the risks of taking anticonvulsants during pregnancy?

Answer 18

Taking anticonvulsants during pregnancy may lead to cardiac defects, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, IUGR, and microcephaly. Mental retardation may be seen. A rare neonatal side effect is methemoglobinuria

Question 19

List a few causes of congenital heptosplenomegaly

Answer 19

Hepatosplenomegaly in newborns is seen in metabolic diseases, storage diseases, HIV vertical transmission, intrinsic liver disease, and in congenital infections