Exam 4 - Preparation for Discharge Flashcards
What conditions should be included in all newborn screening programs?
- Congenital hypothyroidism
- Congenital adrenal hyperplasia
- Hemoglobinopathies
- Congenital heart disease
- Cystic fibrosis
- Galactosemia
- Hearing loss
- Severe combined immunodefiencies
- PKU
- Maple Syrup urine disease
When should metabolic screening be completed?
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
All require screening for what four conditions during the newborn screen?
- Sickle cell disease
- PKU
- Hypothyroidism
- Cystic fibrosis
When should newborn screenings be performed?
On day of discharge or around 1-2 days of life
What are the two types of hearing screen testing?
- Auditory brain response testing
- Otoacoustic emissions testing (more common)
- Measures ciliary hair movement
What are the two methods used to test for hyperbilirubinemia/jaundice?
- 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)
What examples of congenital heart diseases should be screened for in infants?
- Hypoplastic left heart disease
- Pulmonary atresia
- Tetralogy of fallot
- Total anomalous pulmonaryvenous return
- Transposition of the great arteries
- Tricuspid atresia
- Truncus arteriosus
How are congential heart diseases screened?
Pre and postductal pulse ox readings
What would be considered a positive pre and postductal pulse ox reading when screening for congenital heart diseases in newborns?
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%
How does the newborns glucose levels change after birth?
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
What should be given as treatment for newborns with hypoglycemia?
IV dextrose
Why do we give newborns vitamin K injections after birth?
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)
When are infants given vitamin K injections?
Within first hour after birth
- For infants >1.5 kg, they will get 1 mg
Why is oral supplementation with vitamin K advised against?
Oral dosing of vitamin K is not well absorbed
Have seen increased risk of late hemorrhagic disease with oral vitamin K
When should newborns receive their first hep B vaccine?
Within first 24 hours of left