CLIPP 1 Flashcards
maternal heroin use associated with increased risk of what in fetus
fetal growth restriction, placental abruption, fetal death preterm labor intrauterine passage of meconium.
neonatal abstinence syndrome symptoms
uncoordinated sucking reflexes leading to poor feeding, irritability,
high-pitched cry
cocaine during pregnancy
vasoconstriction leading to placental insufficiency and low birth weight.
deficits in cognitive performance, information processing, and attention
maternal etiologies of SGA at birth
Both young and advanced maternal age
Maternal prepregnancy short stature and thinness
Poor maternal weight gain during the latter third of pregnancy
Nulliparity
Failure to obtain normal medical care during pregnancy
Cigarette smoking, cocaine use, other substance abuse
Lower socioeconomic status
African-American ethnicity (in the U.S.)
Uterine and placental abnormalities (see below)
Polyhydramnios
fetal etiologies of SGA at birth
Chromosomal abnormalities (e.g., trisomies) and syndromes Metabolic disorders Congenital infections (e.g., "TORCH" infections, zika)
measuring what is an estimate of gestational age.
measuring fundal height (done by palpating the superior aspect of the enlarged uterus).
intrapartum antimicrobial prophylaxis against Group B streptococcal disease (GBS) should be administered if one of the following is present and the mother is in labor with ruptured membranes:
Previous infant with invasive GBS disease
GBS bacteriuria during any trimester of the current pregnancy
Positive GBS vaginal-rectal screening culture in late gestation during current pregnancy
Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and any of the following:
Delivery at < 37 weeks’ gestation
Amniotic membrane rupture ≥ 18 hours
Intrapartum temperature ≥ 38°C (100.4°F)
Intrapartum NAAT positive for GBS
what pregnant of women have vaginal or rectal colonization of GBS.
30%
what happens if nontreated GBS in newborn?
sepsis
newborn rescusitation
Warm and dry the infant and remove any wet linens immediately. Infants have a large surface area relative to their body weight and can thus experience significant hypothermia from evaporation.
Stimulate the infant to elicit a vigorous cry. This helps clear the lungs and mobilize secretions.
Suction amniotic fluid from the infant’s nose and mouth. This helps clear the upper airway.
Initiate further resuscitation if required. This may include using blow-by oxygen, positive pressure (bag-valve mask) ventilation with oxygen, chest compressions, and medications.
APGAR stands for
Appearance (skin color) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiration
when is apgar done
he score is reported at 1 minute and 5 minutes after birth for all infants.
if score <7 at 5 minutes –> resuscitation, with re-assessment every 5 minutes, up to 20 minutes, until a score of 7 is achieved.
Ballard Gestational Age Assessment Tool
uses signs of physical and neuromuscular maturity to estimate gestational age.
useful when gestational age unknown
Symmetric vs Asymmetric IUGR
symmetric includes small head
asymmentric normocephalic
risks for SGA newborns
hypoglycemic
hypothermia
polycthemic
causes of absent red reflex
A cataract An opacified cornea (such as in mucopolysaccharidosis) Inflammation of the anterior chamber Developmental anomalies of the eye Retinoblastoma,
Which medications are routinely given to newborns
vit K
hep B vaccine
erythromycin
early VKDB
0-24 hrs
Severe
Mainly found in infants whose mothers used medications (e.g antiepileptic drugs or isoniazid) that interfere with how the body uses vitamin K
classical VKDB
1-7 days
Bruising
Bleeding from the umbilical cord
late VKDB
2-12 weeks after birth is typical, but can occur up to 6 months
30-60% of infants have bleeding within the brain
Tends to occur in breastfed only babies who have not received the vitamin K shot
Warning bleeds are rare
ophthalmia neonatorum
caused by neisseria gonnorrhea –> blindness
treated by erythromycin at birth
Chlamydia trachomatis conjunctivitis
more common than gonorrhea
but occurs at 7-14 days after birth, and neonatal prophylaxis does little to prevent it
Discharge teaching should include the following:
Reasons to seek immediate medical care, including fever, signs of poor feeding, worsening jaundice
Expectations for normal feeding, stooling, urine output
Safety issues (including placing the newborn on his back to sleep, proper infant auto restraint, avoiding cigarette smoke exposure.)
Plan for physician outpatient followup in 48-72 hours
Social Services follow up plan
24 hour emergency contact information
anticolvulsants effect on fetus
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.
