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NURS 501 > Exam 4 - Newborn Nutrition and Hyperbilirubinemia (sync) > Flashcards

Exam 4 - Newborn Nutrition and Hyperbilirubinemia (sync) Flashcards

1
Q

What percentage of body weight will newborns lose in their first few days of life? What is the nadir period?

A

Async says 5-8%, sync 7-10%

Nadir: 3-4 days after birth

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2
Q

What complications are associated with excessive weight loss of the newborn?

A
  • Hypoglycemia
  • Hyperbilirubinemia
  • Dehydration
  • Electrolyte imbalances

All affect brain development

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3
Q

What weight and height changes are seen in newborns by the end of the first year?

A

Weight tripled and height increased by 50% by the end of the first year

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4
Q

Most common factors causing poor weight gain in the newborn

A
  • Infrequent or inadequate feedings
  • Inadequate milk production in breastfed infants
  • Error in formula reciple in bottle fed infants
  • Genetic predisposition or organic diseases in infant
    • Hypermetabolic
    • Poor absorption of nutrients
  • Infection
  • Physical anomaly that prevents good suck/swallow
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5
Q

Method used to calculate weight loss in newborns (steps taken)

A
  1. Take birth weight (or last weight) in kg
  2. Take current weight in kg
  3. Subtract difference
  4. Divide by birth weight
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6
Q

What should the provider do if an infant is unable to feed with vigor?

A

Requires immediate referral to acute care for evaluation and potential rehydration

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7
Q

Infant hunger cues

A
  • Wriggling or restless movements
  • Rooting when face is stimulated
  • Bringing hands to mouth
  • Mouth movements/sucking
  • Tongue protrusion

Late cues - crying, agitated body movements, color turning red

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8
Q

AAP recommendations for breastfeeding

A

Exclusive breastfeeding through 6 months of life and continuing when solids are introduced until at least 1 year (or when mom/baby decides to stop)

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9
Q

What are the benefits of breastfeeding for the infant and mother?

A
  • Antibodies - IgA, first milk
  • Reduces disease risk
    • Respiratory, bowel, allergies, diabetes
  • Promotes healthy weight, prevents obesity
    • Leptin - regulates appetite and fat storage
  • Positive effects on brain development
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10
Q

Stages of breastmilk - colostrum

  • When does it first present?
  • What nutrients does it provide?
A

Superfood pre-milk (“liquid gold”), teaspoons

  • First 1-5 days after delivery
  • Considered first immunization
    • Rich in IgA antibodies, proteins, mineral, vitamins
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11
Q

Stages of breastmilk - transitional milk

  • When does it first present?
A
  • Comes in 5-10 days after delivery
  • Breast milk that is mixed with some colostrum
  • Thin, blue-grey in color
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12
Q

Stages of breastmilk - mature milk

  • When does it present?
  • What nutrients does it provide?
  • Foremilk versus hindmilk
A
  • Presents 10+ days (about 2 weeks after delivery)
  • 90% water, 10% carbs, protein and fat
  • Foremilk - beginning of feed, quenches thirst, lactose and protein but little fat or calories

Hindmilk - end of feed, higher in fat and calories

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13
Q

What two supplements can be given to breastfed infants?

A
  • Vitamin D
  • Iron
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14
Q

What are the benefits of vitamin D supplementation for breastfed infants?

A

Supports healthy bone development and prevents Rickets

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15
Q

What is the recommended vitamin D dosage for breastfed infants? When can supplementation stop?

A
  • 400 IU liquid drops daily beginning first few days after birth
  • Can stop supplementation once baby is taking equivalent of 1 L of formula per day, getting enough in solid foods, or drinking 4 cups whole milk per day
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16
Q

At what age will breastfed infants require iron supplementation? At what dosage?

A
  • Iron stores are good for first 3-4 months due to maternal iron
  • Starting at 4 months, need 1 mg/kg/day of supplementation
  • At 6 months, iron needs to be met through iron fortified foods/cereals
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17
Q

Common issues of breastfeeding: nipple breakdown

  • Cause? Treatment?
A

Inappropriate latch or candidal infection

Treatment

  • Mupirocin
  • Betamethasone
  • Miconazole
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18
Q

Common issues with breastfeeding: thrush (candidal infection)

  • When does it typically present?
  • What systems does it affect?
  • Risk factors
A

Usually occurs in the first 1-2 weeks after breastfeeding begins

  • Affects the nipples and ductal systems
  • Recent antibiotic therapy is a risk factor
    • GBS (+) women can take probiotics for 3 weeks to rebalance their flora
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19
Q

Mastitis: treatment and management

A
  • Heat
  • Massage
  • Frequent feeding/pumping
  • Rest
  • Fluids
  • Pain relievers
  • Antibiotics
20
Q

Thrush (candida): infant symptoms

A
  • White plaques on mucus membranes in mouth and tongue that does not wipe off
  • Mouth pain
  • Feeding refusal
  • Monilial diaper rash with satellite lesions
21
Q

Thrush (candida): mother symptoms

A
  • Dry cracked, itchy or shiny nipples and areolas
  • Shooting or burning pain during nursing
    • Especially during letdown
  • Vaginal yeast infection
22
Q

Thrush (candida): treatment

A

Both mother and baby need to be treated otherwise reinfection is likely

  • Topical nystatin for infant and nipples
  • Consider systemic fluconazole for mother
23
Q

Common issues with breastfeeding: mastitis

  • When does it typically present?
  • Symptoms
A

Most common 6-7 weeks after birth

  • Sudden unilateral red hot swollen area on breast
  • Warm to touch
  • Flu like symptoms
  • Fever over 101 F
24
Q

Common issues with breastfeeding: mastitis

  • Causes
A

Bacterial infection in breast tissue

  • Due to milk stasis, nipple trauma, engorgement, maternal fatigue/stress
25
Q

Formula fed infants should start with how much formula? On average, how much formula should infants take per pound of body weight?

A

Formula fed infants should start by being offered 1-2 oz every 2-3 hours in the first days of life

  • Will feed at least 8 times/day
  • Infants should take 2.5 oz of formula for every pound of body weight
26
Q

Common issues: reflux

  • Treatment and management
A
  • Supportive care - upright position after feeding, small, frequent feeds
  • Trial of AR (acid reflux) formula
    • Recommended over thickened agents
    • Decreases volume of regurgitation, reduces crying, improve sleep and weight gain
  • Consider anti-reflux medication
    • Famotidine (PPI)
27
Q

Breastmilk versus formula stools

A

Breastmilk stools

  • Seedy, yellow, thin
  • Can range from 7+ times/day to once a week

Formula stools

  • Tan, brown, green, soft consistency
  • Can range from 1-4 times/day to once every 3-4 days
28
Q

What would be considered abnormal stool findings in the newborn?

A
  • Hard or formed stools (“logs” or “balls”)
  • Blood or mucous in stool
29
Q

Constipation in the newborn: treatment and management

A
  • Consider formula change
  • Supportive care with prune juice, +/- rectal stimulation
  • Consider glycerin suppository
  • Medications
    • Lactulose if under 6 months
    • Miralax if over 6 months
30
Q

What is colic? At what age range does it normally present?

A

Develops suddenly from 1-3 months of age (most common in first 6 weeks)

Period of extended LOUD crying and difficult to soothe - rule of 3’s

  • 3 or more hours/day
  • 3 or more days/week
  • 3 week period
31
Q

Colic: treatment and management

A

Normally resolves by 3-6 months of age

  • Provide support and reassurance to parents
  • Provide coping strategies
  • Teach strategies for soothing fussy baby
  • Consider formula change/elimination diet
32
Q

Causes of hyperbilirubinemia

A
  • Immature liver function
  • Decreased ability to conjugate bilirubin
  • Decreased ability/rate to excretion
  • Poor feeding causing mild dehydration
  • Prematurity (less than 38 weeks gestation)
33
Q

Hyperbilirubinemia: symptoms

A
  • Yellow skin or sclerae (more severe cases)
  • Drowsiness/lethargy
  • Itchy skin
  • Pale stools
  • Poor sucking/feeding
  • Dark urine
34
Q

Physiologic jaundice

  • Is it more common in breastfed or formula fed infants?
  • When does it first present?
  • Treatment and management
A

Presents when TSB levels peak (6mg/dL) between days 3-4 of life

  • Most commonly resolves within 2 weeks (TSB <1 mg/dL)
  • More common in breastfed infants
  • Self-limiting
    • Monitoring
    • Further workup can be needed to rule out organic causes
35
Q

Breastmilk jaundice: cause

A

Thought to be due to infant’s immature liver and intestines –> may be due to how substances in breastmilk affect the breakdown of bilirubin in the liver

36
Q

Breastmilk jaundice: when does it present? peak? treatment?

A

Appears after day 7 of life; peaks during weeks 2 and 3

Not reason to stop breastfeeding as long as infant is feeding well and gaining weight

  • Rarely needs treatment
37
Q

Pathologic jaundice: causes

A
  • Erythrocyte defects
  • Structural abnormalities in liver (biliary atresia most common)
  • Infection
  • Sequestered blood
38
Q

Pathologic jaundice: definition (including lab values)

A

Signs of jaundice within first 24 hours

TSB rise of 5 mg/dL or greater per day or TSB greater than 15 mg/dL

Requires prompt diagnosis and management

39
Q

Screening for hyperbilirubinemia

A
  • Clinical risk assessment/checklists
  • Comprehensive history
  • Visual inspection - can see when level is 5 mg/dL, press on bony areas
  • Bilirubin measurement either via serum or transcutaneous
    • Not as accurate over 15 mg/dL
  • Use of tools to interpret results (nomogram)
40
Q

How is screening for hyperbilirubinemia done?

A

All newborns should be screening prior to discharge and again 3-5 days after birth

  • Screen earlier if signs of jaundice develop in first 24 hours

Use transcutaneous bilirubinometer device (TcB)

41
Q

Complications of hyperbilirubinemia: acute bilirubin encephalopathy

A

If blood bilirubin levels rise too high bilirubin may get into the brain and cause reversible damage - requires immediate treatment

  • Fever
  • Lethargy
  • High pitched cry
  • Arching of body or neck
  • Poor feeding
42
Q

Complications of hyperbilirubinemia: kernicterus (nuclear jaundice)

A

Permanent damage

  • Sight/hearing deficits
  • Athetoid cerebral palsy
  • Cognitive delays
  • Death
43
Q

How does phototherapy help with hyperbilirubinemia?

A

Exposes the skin to blue LEDs which helps break bilirubin down into parts that are easier to eliminate in urine and stool

  • Can be done at home using biliblankets if health and low risk of complications
  • Therapy should be continuous, breaks for feeding only
44
Q

True/false: bilirubin levels can rebound after phototherapy

A

True - may rebound 18-24 hours after stopping phototherapy

45
Q

Potential side effects of phototherapy

A
  • Skin rash
  • Loose stools
  • Overheating/dehydration
    • Hydration is very important
    • May require supplementation
  • “Bronze baby” syndrome - skin and urine
46
Q

Management of hyperbilirubinemia: high risk

  • Exchange transfusion
A

Procedure that is done urgently to prevent/minimize bilirubin related brain damage

  • Replaces infants blood with donated blood to lower bilirubin levels
  • Done in infants who have not responded to other treatments or have signs of neurologic risk (toxicity)
47
Q

Management of hyperbilirubinemia: high risk

  • Intravenous immunoglobin (IVIG)
A

If there is a Rh incompatability, the infant can get IVIG

  • Protein in blood that can lower levels of any remaining antibodies from the mother which may be attacking the infants RBCs

NURS 501 (66 decks)

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