Exam 4 - Preparation for Discharge Flashcards

1
Q

What conditions should be included in all newborn screening programs?

A
  • Congenital hypothyroidism
  • Congenital adrenal hyperplasia
  • Hemoglobinopathies
  • Congenital heart disease
  • Cystic fibrosis
  • Galactosemia
  • Hearing loss
  • Severe combined immunodefiencies
  • PKU
  • Maple Syrup urine disease
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2
Q

When should metabolic screening be completed?

A

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
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3
Q

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

A
  • Sickle cell disease
  • PKU
  • Hypothyroidism
  • Cystic fibrosis
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4
Q

When should newborn screenings be performed?

A

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

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5
Q

What are the two types of hearing screen testing?

A
  • Auditory brain response testing
  • Otoacoustic emissions testing (more common)
    • Measures ciliary hair movement
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6
Q

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

A
  • 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)
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7
Q

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

A
  • Hypoplastic left heart disease
  • Pulmonary atresia
  • Tetralogy of fallot
  • Total anomalous pulmonaryvenous return
  • Transposition of the great arteries
  • Tricuspid atresia
  • Truncus arteriosus
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8
Q

How are congential heart diseases screened?

A

Pre and postductal pulse ox readings

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9
Q

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

A

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%

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10
Q

How does the newborns glucose levels change after birth?

A

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

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11
Q

What should be given as treatment for newborns with hypoglycemia?

A

IV dextrose

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12
Q

Why do we give newborns vitamin K injections after birth?

A

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)
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13
Q

When are infants given vitamin K injections?

A

Within first hour after birth

  • For infants >1.5 kg, they will get 1 mg
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14
Q

Why is oral supplementation with vitamin K advised against?

A

Oral dosing of vitamin K is not well absorbed

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

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15
Q

When should newborns receive their first hep B vaccine?

A

Within first 24 hours of left

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16
Q

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

A

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)

17
Q

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

A

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