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PEDIATRICS 1 > Essential Intrapartum and Newborn Care > Flashcards

Essential Intrapartum and Newborn Care Flashcards

1
Q

This is the campaign for all practitioners and health facilities to adopt and embrace the safe and quality care of Essential Intrapartum and Neonatal Care (EINC)

A

Unang Yakap Campaign

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2
Q

This pertains to the series of time-bound chronologically ordered, standard procedures that a baby receives from birth.

A

Essential Intrapartum and Newborn Care

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3
Q

The globally accepted evidence-based protocol to essential newborn care (EINC) focuses on the _____ week of life

A

first

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4
Q

What are the four basic steps included in the Immediate Essential Newborn Care for the first 90 minutes?

A

DSCoN:

Immediate and thorough drying
Early skin-to-skin contact with mother
Properly timed cord clamping
Non-separation of mother and baby for the first breastfeeding

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5
Q

What is the cue for the 2nd stage of labor?

A

perineal bulging, with presenting part visible

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6
Q

What are the actions included in the preparation for delivery during the 2nd stage of labor?

A

“Area, Hands and Gloves”
-Ensure that the delivery area is draft-free and room temperature between 25-28 deg C
-Wash hands with clean water and soap
-Double glove just before delivery

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7
Q

Give the list of equipment needed to be prepared for delivery

A

Two set of sterile gloves
Two clean and warm towels or cloth
Self-inflating bag and mask
Suction device
Sterile cord clamp or ties
Sterile forceps and scissors
Rolled up piece of cloth
Bonnet
Clean dry warm surface

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8
Q

This is the single most important method of controlling infection

A

Hand Hygiene

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9
Q

How long is the recommended duration for handwashing?

A

40-60 seconds

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10
Q

How long is the recommended duration for hand rubbing?

A

20-30 seconds

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11
Q

What are the 5 moments of hand hygiene?

A

Before touching the patient
Before clean or aseptic procedure
After body fluid exposure risk
After touching the patient
After touching the patient’s surroundings

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12
Q

How many antenatal visits is recommended during pregnancy?

A

at least 4

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13
Q

What are the required supplements for pregnant women?

A

Iron and folate

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14
Q

What are the EINC protocol upon Mother’s arrival at the facility?

A

Identify women in or at risk of preterm labor or delivery (inject 1st dose of antenatal steroids if so)

Take Hx, PE, VS, Birth plan, Companion, then stabilize if with complications

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15
Q

What is the EINC protocol at Perineal Bulging?

A

Perform proper handwashing and put on 2 pairs of gloves

No routine episiotomy and NO fundal pressure

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16
Q

EINC protocol during delivery

A
  • Deliver the baby in prone position on the mother’s abdomen, face turned to side
  • Call out time of birth and sex of baby
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17
Q

EINC protocol within the first 30 seconds

A

Dry and provide warmth
Check for Breathing

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18
Q

EINC protocol after 30 seconds with breathing/crying newborn

A

Skin-to-skin contact

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19
Q

When should the cord be clampled after birth in term and preterm newborns?

A

When the cord pulsation stops
Between 1 to 3 minutes
Between 30 seconds to 1 minute in preterms

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20
Q

What is the EINC intervention if after 30 seconds, newborn is not breathing or is gasping?

A

Re-position, suction, ventilate

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21
Q

What are the EINC protocol for action in newborns who are not breathing or who are gasping after 30 seconds?

A

Clamp or cut cord immediately
Call for help
Transfer to warm firm surface
Inform the mother
Start resuscitation protocol

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22
Q

What is the EINC intervention at 1-3 minutes?

A

Delayed or non-immediate cord clamping

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23
Q

What is the action immediately prior to cord clamping at time band 1-3 minutes?

A

Remove first set of gloves

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24
Q

Where should the cord be tied tightly during initial cord care?

A

at 2 cm to 5 cm from the newborn’s abdomen

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25
Q

What is the evidence-based reason for the properly timed clamping of the cord?

A

Reduces the risk of anemia for both term and preterm babies

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26
Q

True or False:

Properly timed clamping of the cord has no significant impact on incidence of post-partum hemorrhage

A

True

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27
Q

Washing should be delayed until after ____ hours?

A

6 hours

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28
Q

This is a newborn’s protective barrier to bacteria such as E.coli and Group B Strep of microorganisms; hence, should not be removed upon delivery of the baby

A

vernix

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29
Q

What pediatric reflex was found to be removed by washing?

A

crawling reflex

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30
Q

What is the first intervention in EINC time band 90 minutes of age

A

Provide breasttfeeding support for initation of breastfeeding

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31
Q

How often should the monitoring of the baby be within 90 minutes of age?

A

every 15 minutes

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32
Q

What is the maintaining temperature of the baby within 90 min of age time band?

A

36.5-37.5 Celsius

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33
Q

Which of the following is not a feeding cue of the newborn for the initiation of breastfeeding?
A. Opening of mouth
B. Nudging
C. Tonguing
D. Licking
E. Rooting

A

B. Nudging

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34
Q

What is the guiding mnemonics for finding alternatives for breastfeed?

A

A - acceptable
F - feasible
A - affordable
S - sustainable
S - safe

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35
Q

What is the second intervention within the first 90 minutes time band?

A

Eye care

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36
Q

This is the antibiotic of choice for eye care of the newborn

A

Erythromycin

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37
Q

What is the third intervention within the 90 minute time-band?

A

Examining the baby, check for birth injuries, malformations, or defects

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38
Q

What is the normal weight of Filipino babies?

A

2.5 to 4 kg

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39
Q

This intervention provides similar benefits of incubator care

A

Kangaroo Mother Care (KMC)

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40
Q

What is the intervetion for the newborn with 90 min to 6 hours time-band?

A

Vitamin K prophylaxis, Hepatitis B and BCG vaccinations

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41
Q

Dosage of Vitamin K and specific ROA for newborns

A

1 mg IM at anterolateral Left thigh

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42
Q

Dosage of Hepatitis B vaccine and specific ROA for newborn

A

0.5 mL IM anterolateral Right thigh

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43
Q

Dosage of BCG vaccination and specific ROA for newborns

A

0.05 mL ID at right upper deltoid or upper lateral buttocks (for keloid formers)

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44
Q

What is the range of coverage of perinatal period?

A

28 weeks Age of Gestation to 7 days of life

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45
Q

What is asked for the History taking as to the First trimester?

A

When and how was the pregnancy recognized?

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46
Q

What is asked for the History taking as to the Second trimester?

A

First quickening (of moving of the baby)

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47
Q

What is asked for the History taking as to the Third trimester?

A

Onset of abdominal pain

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48
Q

Which of the following is not included in the history taking as for the first, second and third trimester information?
A. Excercise routine
B. Prenatal check-up
C. Illnesses
D. Intake of vitamins
E. Exposure to teratogens

A

A. exercise is not part of the essentials

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49
Q

What information is asked for the description of the labor during history taking?

A

Duration of labor
Fetal presentation
Fetal distress
Fever

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50
Q

What information is asked for the description of the delivery during history taking?

A

CS, anesthesia or sedation, use of forceps, APGAR score, need for resuscitation

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51
Q

This is a practical method of systematically assessing newborn infants immediately after birth to help identify those requiring resuscutation and to predict survival in the neonatal period

A

APGAR

This is the scoring system that doctors and nurses ise to assess newborns at one minute and five minutes after they are born

52
Q

What is the meaning of the mnemonics of APGAR

A

Activity, Pulse, Grimace, Appearance, Respiration

53
Q

What is the aimed score for APGAR to stop resuscitation?

A

7

54
Q

The APGAR score for 1 minute will indicate:

A

Need for further resuscitation

55
Q

The APGAR score for 5-minutes indicate:

A

Neurologic sequelae of the newborn

56
Q

Low APGAR score predicts neonatal death in both term and preterm infants based on ____-minutes with score of ____

A

5 minute score of 0-3

57
Q

True or False

Low APGAR score + umbilical artery blood pH less than or equal to 7.0 indicate increased risk of neonatal mortality

A

True

Note, however, that low score or extremely depressed score is a better predictor if used alone

58
Q

What is the APGAR score range for Moderatekly depressed newborn?

A

4-6

59
Q

Only about ___ percent of newborns are expected to require some assistance (drying, tactile stimulation, suctioning)

A

10%

60
Q

Only __ percent of newborn need major resuscitative measures (intubation, chest compressions, and/or medications) to survive

A

1%

61
Q

The transition from fetal to neonatal physiology occurs at:

A

birth

62
Q

True or False:

Fetal oxygenated blood has a lower PaO2 compared to adults and infants

A

True

63
Q

True or False:

Fetal blood has much less concentration of Hemoglobin that has a higher affinity for oxygen due to Fetal 2α and 2γ chains

A

False.

Fetal blood has much HIGHER concentration of fetal hemoglobin that has higher affinity for oxygen

64
Q

Fetal circulation:

What is the fraction of the blood from the ductus venosus entering the IVC then travelling to the RA will be received by the LA via the foramen ovale?

A

1/3

2/3 will mix with the venous return thru the SVC (where deoxygenated blood from the upper body enter)

65
Q

Fetal circulation:

What is the percentage of blood reaching the pulmonary artery that goes to the pulmonary circuit?

A

8-10%

66
Q

Fetal circulation:

What is the percentage of blood reaching the pulmonary artery bypasses the lungs through the ductus arteriosus?

A

90-92%

67
Q

The amount of blood flowing to the pulmonary system is low due to:

A
  • pulmonary vasoconstriction (since there is medial muscle hypertrophy of the pulmonary arterioles)
  • fluid in the fetal lung (increases the resistance to blood flow)
68
Q

What normal physiological change increase the systemic blood pressure in the newborn seconds after birth for the transition from fetal to neonatal circulation?

A

Constriction of the umbilical arteries and veins

69
Q

Which intervention eliminates the low-pressure system of the placenta?

A

clamping of the umbilical cord

70
Q

What causes the closure of the foramen ovale?

A

Increase in LA pressure in excess to the RA pressure

71
Q

What causes closure of the ductus arteriosus?

A

Increase in the PaO2 tension after pulmonary blood flow increases

72
Q

The ductus arteriosus is expected to close how many days after birth of a term infant?

A

1 day

73
Q

Which circulating lipid compound elevates in premature infants causing Patent Ductus Arteriosus?

A

Prostaglandins (vasodilator)

74
Q

What intervention within the 1-3 minute time band causes the closure of the Ductus Venosus?

A

Clamping of the umbilical cord (decreases prostaglandins coming for the placenta)

75
Q

What is the cause of Pulmonary Hypertension of the Newborn?

A

Hypercarbia (also by acidosis, hypoxia, hypercapnia, hypothermia, polycythemia, asphyxia, shunting of blood from the lungs or pulmonary parenchymal hypoplasia)

76
Q

This condition occurs when there is persistence or aggravation of pulmonary vasoconstriction after birth?

A

Pulmonary Hypertension in the newborn or Persistent Fetal Circulation

77
Q

According to the Philippine Essential Newborn Care Resuscitation Program, newborn shall be pronounced dead after failure to revive a newborn after ____ minutes

A

10 minutes

78
Q

This occurs when there is a failure to replace pulmonary alveolar fluid completely with air

A

Respiratory distress
- transient tachypnea of the newborn

79
Q

What is the first step in Newborn Resuscitation once baby is recognized as apneic/ gasping or limp at first 30-second time band?

A

Clamp and cut cord

NRPh+ is call for help

80
Q

At 60 seconds, what is the intervention if baby is still apneic or limp after Newborn Resuscitation?

A

Positive Pressure Ventilation and SPO2 monitoring

81
Q

At 60 seconds, what is the intervention if the newborn is no longer apneic/gasping or HR <100bpm but presents with labored breathing after PPV provision?

A

Position head and clear airway
SPO2 monitoring
Supplemental O2 as needed or when persistently cyanotic (and Continuous Positive Airway Pressure)

82
Q

At 60 seconds, what is the intervention if the newborn is still longer apneic/gasping or HR <100bpm after PPV provision?

A

Ventilation corrective steps
Intubate if needed

83
Q

30 seconds after provision of ventilation corrective steps or intubation, what is the intervention if the HR <60 bpm?

A

Coordinated PPV and chest compression
100% O2
Consider umbilical vein catheter (UVC) insertion

84
Q

30 seconds after provision of Coordinated PPV and chest compression with 100% O2, what is the intervention in HR is still <60 bpm?

A

Give IV epinephrine
-consider hypovolemia
Give volume expanders or plain NSS
-consider pulmonary leaks like pneumothorax if still not improved

85
Q

What are the 2 accepted methods of tactile stimulation of newborn?

A

Gentle drying/rubbing of the back
Slapping of the sole of the foot or flicking of the heel

86
Q

What is the frequency of ambu-bagging when doing Positive Pressure Ventilation?

A

40-60 breaths per minute
Cadence recited as breath… two… three… breath… two… three…

87
Q

What are the 2 techniques for newborn chest compressions?

A

Thumb technique
Two-finger technique

88
Q

What is the cadence recited for coordinated PPV and chest compressions?

A

One and Two and Three and Breathe and One and Two and Three and Breathe

89
Q

This is the scoring tool used to know the age of gestation

A

Ballard Scoring (based on physical and neuromuscular maturity of the newborn)

90
Q

How many months should an infant be exclusively breastfed or given breast milk?

A

6 months

91
Q

This is the law that ensures safe and adequate nutrition for infants through the promotion of breastfeeding and the regulation of promotion, distribution, selling, advertising, product public relations and information services of artificial milk formulas and other covered products.

A

EO 51 or The Milk Code

92
Q

This is an act of providing incentives to all government and private health institutions with rooming-in and breastfeeding practices and for other purposes.

A

Republic Act No. 7600 (Rooming-in and Breastdfeeding Act of 1992)

93
Q

A law requiring private enterprises as well as government agencies including government owned and controlled corporation to put up lactation stations.

A

Republic Act No. 10028 (The Expanded Breastfeeding Promotion Act: Support of Breastfeeding in the Workplace)

94
Q

In this breastfeeding position, the baby’s lower arm is tucked around the mother’s side

A

Cradle position

95
Q

This breastfeeding position is comfortabe after a cesarean section

A

Side-lying position

96
Q

This breastfeeding position help drain all areas of the breast and is useful for twins

A

Underarm position

97
Q

In this breastfeeding position, the mother has good control of baby’s head and body so may be useful when learning to breastfeed

A

Crossarm position

98
Q

This is pertains to baby feeding from other mothers

A

Wet nursing

99
Q

What are the most practical method’s of feeding a baby?

A

Direct expression into the baby’s mouth
Cup feeding

100
Q

If breastfeeding is not possible, what alternative method of feeding would you recommend that is considered practical?
a. Cup feeding
b. Dropper feeding
c. Tube feeding
d. Spoon feeding

A

A. Cup feeding

101
Q

If breastfeeding is not possible, what alternative method of feeding is good for babies who are able to swallow but cannot yet suckle well (30-32 weeks of gestation)?
a. Cup feeding
b. Dropper feeding
c. Tube feeding
d. Spoon feeding

A

a. cup feeding

102
Q

If breastfeeding is not possible, what alternative method of feeding make use of OGT tube or dropper for babies who are unable to suckle?
a. Cup feeding
b. Dropper feeding
c. Breastfeeding supplementer
d. Spoon feeding

A

C. Breastfeeding supplementer

103
Q

Coordinated sucking, swallowing, and breathing normally develops at ___ weeks of age of gestation

A

36 weeks of gestation

104
Q

What hormone is increased by breast pumping?

A

prolactin

105
Q

How often should a mother express her milk?

A

8 times in 24 hours or every 3 hours

106
Q

What is the age of gestation of a “small baby”?

A

32-36 weeks of gestation

107
Q

Birthweight of a small baby

A

1500g to 2500g

108
Q

What is the age of gestation for very small babies?

A

less than 32 weeks of gestation

109
Q

Birthweight of a very small baby

A

less than 1500g

110
Q

How often should one feed a small baby?

A

every 2-3 hours

(direct expression every 1-2 hours for very small)

111
Q

True or False:

A preterm baby can be cared for in a primary health facility

A

True

112
Q

This is the Newborn Screening Act of 2004

A

RA 9288

113
Q

The newborn screening act of 2004 screen for which conditions:

A

G6PD
Congenital Adrenal Hyperplasia
Congenital Hypothyroidism
Phenylketonuria
Galactosemia
Maple Syrup Urine Disease

114
Q

The expanded newborn screening act of May 2019 screens for how many disorders?

A

28 disorders

115
Q

The first collection of sample for NBS is done upon:

A

upon admission at the NICU regardless of age and ideally before any treatment is administered

116
Q

The second collection of sample for NBS must be done at:

A

28th day of life or before discharge

117
Q

Low birth weight infants are those weighing:

A

<2000 grams at birth

118
Q

This is an act providing for the early detection, diagnosis, and intervention for congenital hearing loss aming children in the Philippines and for other purposes

A

Hearing Loss Screening Act of 2007 (Senate Bill No. 1372)

119
Q

Follow up for hearing screening is done for newborns with APGAR Score of _____ or less at _____ minutes.

A

6 or less at 5 minutes

120
Q

Infants with abnormal Auditory Brainstem Responses (ABR) in both ears should have follow-up testing within _______ after initial test

A

2 weeks

121
Q

Infants with unilateral abnormal results in Auditory Brainstem Responses (ABR) should have follow-up testing within:

A

3 months

122
Q

Postnatal visit is usually scheduled within:

A

1st week (preferably 2-3 days)

123
Q

When is the immunization visit conducted if BCG and HB-1 was given in the 1st week of life?

A

6 weeks

124
Q

A newborn presented with red umbilicus prior to discharge, when should you schedule the follow up check up?

A

in 2 days

125
Q

A mother is asking when should she bring her baby back for consultation. If the baby was treated for eye infection and presented with feeding difficulty, your best response is:
a. 2 days
b. 5 days
c. 2 weeks
d. 1 month

A

a. 2 days

7 days - orphan baby
14 days - INH prophylaxis, congenital syphillis/HIV positive mother

126
Q

True or False:

The ability to coordinate sucking and swallowing is essential before KMC

A

False

PEDIATRICS 1 (3 decks)

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