CLIPP 7

Question 1

What are the effects of uncontrolled maternal hyperglycemia on fetal birth weight?

Answer 1

Large for gestational age (LGA)

Question 2

Define LGA

Answer 2

Newborns with birth weight >90th percentile

Question 3

Name three potential problems with LGA (how they are delivered, what can happen during delivery, and after birth complications)

Answer 3

1) Large infants must be delivered via c-section, by forceps, or vacuum (all of which have associated complications)
2) Birth injuries (fractured clavicle, brachial plexus injury, facial nerve palsy)
3) hypoglycemia

Question 4

Define appropriate for gestational age (AGA)

Answer 4

newborns with birth weight between the 10th and 90th percentiles

Question 5

define small for gestational age (SGA)

Answer 5

Newborns with birth weights below the 10th percentile

Question 6

is SGA the same thing as IUGR?

Answer 6

no

A growth-restricted fetus is one that has not reached its growth potential at a given gestational age due to one or more causative factors.

A fetus is noted to be IUGR during the pregnancy.

Question 7

name 3 potential complications of SGA

Answer 7

hypothermia –> temperature instability

hypoglycemia –> inadequate glycogen stores

polycythemia and hyperviscosity

Question 8

Name 3 classic signs of respiratory distress

Answer 8

tachypnea

retractions (intercostal and subcostal)

grunting

Question 9

when does tachypnea in an infant preclude oral feeding (when do providers use NG feeding/IV support)?

Answer 9

no evidence from controlled studies that show it is contraindicated.

Some providers use NG feeding when respiration rates are between 60-80

above 80, infant often require IV fluid support

Question 10

name some common problems in ate preterm infants (34-36 weeks gestation) (6 problems). When can these babies go home from the hospital?

Answer 10

hypothermia

hypoglycemia

respiratory distress

apnea

hyperbilirubinemia

feeding difficulty

all of these problems, if present, must be resolved

Question 11

Define hypoglycemia in an infant

Answer 11

< 45 mg/dL glucose

Question 12

how do hypoglycemic infants often present?

Answer 12

NORMAL

thats why its important to screen these bitches

Question 13

Explain why infants from diabetic mothers are at high risk for hypogycemia

Answer 13

• mom transfers a shit ton of glucose across the placenta\
• baby senses glucose and secretes a shit ton of insulin (hyperinsulinemia)
• at birth, baby’s source of glucose (from mom) is cut off but baby is still in a state of hyperinsulinemia
• baby becomes hypoglycemic

Question 14

how do you treat astumptomatic hypoglycemic infants? symptomatic?

Answer 14

asymptomatic - breast milk or formula

symptomatic - IV dextrose

Question 15

define developmental dysplasia of the hip

Answer 15

malformation of the hip joint

Question 16

what factors are important in planning the discharge of newborns from the hospital?

Answer 16

follow up with a provider

feeding (Q2-4 10-15 minutes each breast)

jaundice (total bili should be measured)

vitamin D (daily supplementation is needed)

car seat safety

Sleeping and co-sleeping (sleeping in same room decreases risk for SIDS, sleeping with baby increases risk for death)

Question 17

What is the differential of tachypnea in the newborn? (9)

Answer 17

respiratory distress syndrome (NRDS)

Transient tachypnea of the newborn (TTN)

Pneumothorax

Meconium aspiration

Hypoglycemia

Hypothermia

cardiac abnormalities

neonatal sepsis

congenital diaphragmatic hernia