Exam 4 - Preparation for Discharge

Question 1

What conditions should be included in all newborn screening programs?

Answer 1

• Congenital hypothyroidism
• Congenital adrenal hyperplasia
• Hemoglobinopathies
• Congenital heart disease
• Cystic fibrosis
• Galactosemia
• Hearing loss
• Severe combined immunodefiencies
• PKU
• Maple Syrup urine disease

Question 2

When should metabolic screening be completed?

Answer 2

As close to hospital discharge as possible (some states require rescreening at 2 weeks of age)

• If infant born at home, should be done in primary care setting within 24-48 hours

Question 3

All require screening for what four conditions during the newborn screen?

Answer 3

• Sickle cell disease
• PKU
• Hypothyroidism
• Cystic fibrosis

Question 4

When should newborn screenings be performed?

Answer 4

On day of discharge or around 1-2 days of life

Question 5

What are the two types of hearing screen testing?

Answer 5

• Auditory brain response testing
• Otoacoustic emissions testing (more common)
  
  • Measures ciliary hair movement

Question 6

What are the two methods used to test for hyperbilirubinemia/jaundice?

Answer 6

• Transcutaneous hyperbilirubinemia/jaundice monitor
  
  • Measured through the skin, non-invasive
  • Takes the average of five measurements
• Serum testing
  
  • Done on all infants where jaundice is visible (most concerned if jaundice is visible within 24 hours of life)

Question 7

What examples of congenital heart diseases should be screened for in infants?

Answer 7

• Hypoplastic left heart disease
• Pulmonary atresia
• Tetralogy of fallot
• Total anomalous pulmonaryvenous return
• Transposition of the great arteries
• Tricuspid atresia
• Truncus arteriosus

Question 8

How are congential heart diseases screened?

Answer 8

Pre and postductal pulse ox readings

Question 9

What would be considered a positive pre and postductal pulse ox reading when screening for congenital heart diseases in newborns?

Answer 9

O2 measurement <90%

O2 measurements <95% in both upper and lower extremeties on three measurements separated by 1 hour

Differences in O2 from the hands to the foot of more than 3%

Question 10

How does the newborns glucose levels change after birth?

Answer 10

Within first hour after birth glucose levels drop as low as 25 mg/dL

At four hours, threshold is 25-35 mg/dL

After four hours, should be greater than 45 mg/dL

Question 11

What should be given as treatment for newborns with hypoglycemia?

Answer 11

IV dextrose

Question 12

Why do we give newborns vitamin K injections after birth?

Answer 12

Newborns have immature hepatic systems and are unable to make coagulation factors

• Synthesis of coagulation factors occur in their gut (which is sterile until their first feed)

Question 13

When are infants given vitamin K injections?

Answer 13

Within first hour after birth

• For infants >1.5 kg, they will get 1 mg

Question 14

Why is oral supplementation with vitamin K advised against?

Answer 14

Oral dosing of vitamin K is not well absorbed

Have seen increased risk of late hemorrhagic disease with oral vitamin K

Question 15

When should newborns receive their first hep B vaccine?

Answer 15

Within first 24 hours of left

Question 16

For infants born to hepatitis B negative mothers, when should they receive their first vaccine?

Answer 16

If they weigh more than 2000 mg, within first 24 hours

If they weigh less than 2000 mg, at one month or at time of discharge (whatever comes first)

Question 17

For infants born to hepatitis B positive mothers, when should infants receive their first vaccine?

Answer 17

Give first dose of hep B vaccine AND hep B immunoglobulin at birth (regardless of weight or other comordities)