Exam 4 - Neonatal Assessment and Hospital Discharge (sync) Flashcards
Why do we give eye prophylaxis to newborns? Within how many hours are drops given?
Tetracycline or erythromycin drops given to prevent chlamydia or gonorrhea conjunctivitis that can be transmitted via birth canal
Given within first hour of life
Does vitamin K cross the placenta?
No, not readily available in breastmilk/formula
How long is one shot of vitamin K good for?
Single injection provides enough vitamin K to last until the newborn gets sufficient amounts from solid foods (around 6 months of age)
When should a newborn receive their first shot of hep B?
Within first 24 hours
What are the guidelines for hep B vaccine if the infant is born to a hep B NEG mother? What if the infant is <2000 g?
Administer to infants weighing >2000 g in first 24 hours
If <2000 g, administer at 1 month or at hospital discharge
What are the guidelines for hep B vaccine if the infant is born to a hep B POS mother?
Administer hep B vaccine within first 24 hours regardless of weight AND give hep B immunoglobulin
What five screenings should be done before the newborn can be discharged?
- Glucose screen
- Jaundice screen
- Hearing screen
- Newborn metabolic screen
- Congenital heart disease screen
How would the provider perform a newborn metabolic disorder screening?
Simple heel stick between 24-48 hours after birth
Air dry for 4 hours then sent to states lab
- Takes 10-14 days for results
What factors can influence newborn metabolic disorder results?
- Samples obtained too early
- On antibiotics
- Blood transfusion
- Stress or sick infant (CAH)
- Failure to wipe away first drop of blood
- Not enough feeding
- Inadequate sample
Under what conditions will the provider institute immediate treatment for based on newborn metabolid disorder screening results?
- Galactosemia
- Maple syrup urine disease (MSUD)
No treatment for any other positive results until further testing confirms diagnosis
Do glucose levels increase or decrease withint the first hour after birth? What are currently guidelines for intervention based on glucose levels?
Levels DROP within first hour
What maternal situations would cause the provider to monitor glucose levels closely?
- Gestational diabetes –> increased insulin levels at birth
- Preeclampsia/HTN
- Previous macrosomic infant
- Substance abuse
- Exposure to medications (tocolytics, glucose)
What neonate situations would cause the provider to monitor glucose levels closely?
- Prematurity/IUGR
- HIE event
- Sepsis
- Congenital cardiac, endocrine, inborn errors of metabolism disorders
Signs and symptoms of hypoglycemia in neonate
- Irritability
- Tremors
- Lethargy
- Changes in LOC
- Seizures
- Hypotonia
- Feeding difficulty
- Respiratory distress
- High pitched cry
At what point are newborns screened for hyperbilirubinemia?
Prior to hospital discharge
- If discharged sooner than 72 hours, done in primary care
Hearing screening: otoacoustic emission test (OAE)
Measures sound waves produced in inner ear
- Soft probe placed in ear canal
- Series of soft “clicking” sounds sent via computer and probe
- Measures echo of sound back
Hearing screening: automated auditory brainstem response (AABR)
Measures how the acoustic nerve and brain respond to sound
- Tones played through headphones
- Electrodes measure brains response to sound
What is the goal of a newborn hearing screening?
Screen by 1 month
Identify deficit by 3 months
Be receiving services and/or treatment by 6 months of age
What is the pattern of bloodflow in the fetus prior to birth?
- From the placenta, oxygenated blood travels through umbilical vein to IVC
- Bypasses the liver (ductus venosus)
- From IVC, oxygenated blood enters R atrium + mixes with deoxygenated blood
- Passes through foramen ovale to L atrium
- L atrium to L ventricle –> goes to aorta and upper body
- Upper body to SVC –> returns to R atrium + mixes with oxygenated blood
- R atrium to R ventricle
- Blood goes to lower body via ductus arteriosus
How does blood flow change at birth for the neonate?
First breath and air entering the alveoli triggers a drop in SVR –> rapid increase in perfusion of lungs d/t increased pressure of L ventricle
- At same time, cord clamping occurs –> vasoconstriction and rise in SVR
What three events must occur to cause increased systemic vascular resistance and decreased pulmonary vascular resistance?
- Increased pressure in L atrium
- Increased PO2
- Decreasing levels of prostaglandins
Although the three major fetal shunts close with the newborns first breath, what causes the ductus arteriosus to open?
Can remain open
- Most commonly in premature neonates or neonates with other cardiac anomalies
Can the foramen ovale reopen at any time?
Yes, until 6 months of age before cells seal shunt closed
Are murmurs common in newborns?
Yes, newborn is still transitioning while at hospital
However, some cardiac anomalies won’t become evident until transition is complete and the newborn is home
