Fetus and the Newborn Flashcards
Components of the APGAR score
1 - HR 2 - RR 3 - muscle tone 4 - reflex irritability 5 - color
most objective measurement of intrapartum hypoxia-ischemia
presence of metabolic acidosis in umbilical arterial blood at time of birth (pH < 7.0 or BE > -12 is increased risk of neonatal neurological morbidity)
appropriate eye prophylaxis for a newborn infant
erythromycin –> MC used to prevent opthalmia neonatorum from GC/Chlam; applies immediately after birth
- alternatives: silver nitrate (less effective, causes chemical conjunctivitis), povodone iodine (developing nations)
RF for vitamin K deficient bleeding in infant
- maternal drugs: antiepileptics, anti-TB, warfarin
- exclusively breast fed
- lack of prophylaxis at birth
lab value most likely to be affected in vit K deficiency in newborn
prothrombin time
types of vitamin K deficiency bleeding
- early - first 24 hours; mother taking drugs during pregnancy
- classic - 2 to 7 days; no vit K prophylaxis
- late - 2 to 12 weeks; exclusively breast fed infants w/o prophylaxis, CF or celiac dz pts w/ inadequate vit K absorption
presenting CF in classic vit K deficiency in newborn
bleeding from umbilicus, nares, venipuncture or circumcision site and/or GI tract; infant will appear ill or feed poorly
- CNS bleeding uncommon with classic form (but occurs in 50% of late onset disease)
what studies do you do in any infant who presents with abnormal bleeding
PT, PTT, INR, fibrinogen, d-dimer and platelet count
diagnosis: vit K deficiency
abnormal PTT
- confirm by administering vit K and documenting normalization of PTT and cessation of bleeding
appropriate admin of vit K following birth
single parenteral dose
- oral may be substituted but must be given multiple times over first 2 months (preferred by some bc of study showing link between vit K shot and cancer)
physiologic anemia of infancy
Hb prod decreased 10-fold by end of first week of life (increase in tissue oxygenation leads to decreased EPO prod) - leads to a nadir of Hb by 6-8 weeks of life in a full term infant; in healthy preterm infants, this nadir can be exagerrated
physiologic anemia of prematurity
nadir in Hb is exagerated
- preterm infants weighing < 1500 g have an avg Hb of 8 g/dL at 4-8 weeks of life
folate deficiency in a newborn - causes
- severe maternal deficiency
- congenital defects in metabolism, absorption or transport of folate
- results in a macrocytic anemia
iron deficiency in a preterm infant
normally, infants accumulate iron stores in third trimester of pregnancy; preterm infants are at risk of iron deficiency when they deplete their iron stores around 3-4 months of age
differences in hyperbilirubinemia in a full term vs. late preterm infant
late preterm infants are at increased risk of severe hyperbili and kernicterus 2/2 decreased ability to process UCB due to decreased hepatic maturity reflected in ability to uptake bilirubin and conjugate it within the liver
– as a result, infants between 35 and 36+6 have lower bilirubin thresholds
Major RF for Hyperbilirubinemia
- Late preterm
- isoimmune hemolytic disease
- G6PD deficiency
- sepsis
- asphyxia
- lethargy
- temperature instability
- acidosis
- albumin < 3.0 mg/dL
- exclusively breast fed infants w/ sig weight loss
blood glucose goal level in a newborn infant
> 45 mg/dL before feedings in an asymptomatic infant
tx. hypoglycemia in a newborn
if symptomatic and < 40 mg/dL –> IV glucose
definition: polycythemia in a newborn
Htc > 65%
Complications of polycythemia
- Cardioresp: tachypnea, CHF, apnea, cyanosis
- CNS: lethargy, tremors, seizures, stroke
- GI: poor feeding, NEC
- GU: renal failure, renal vein thrombosis, priapism
- Heme: plethora, thrombocytopenia, DIC
- Metabolic: hypoglycemia, hypocalcemia
Tx. polycythemia
- asymptomatic and Htc 60-70%: aggressive hydration and observation 24-48 hrs
- symptomatic: partial volume exchange transfusion (replace calculated blood volume with normal saline) –> puts infant at risk of NEC (must consider in decision making)
what should the mean blood pressure be in a newborn?
should be equal to or greater to gestational age in weeks
tx. of hypotension in neonate 2/2 septic shock
dopamine - improves myocardial contractility and peripheral SVR
preferred agents for volume resuscitation in hypovolemic shock
normal saline
PRBCs
lactated ringers solution
