Healthy Term Infants

Question 1

After what point is an infant considered term?

Answer 1

After 37 weeks of completed gestation

Question 2

When is an infant classified as being post-term?

Answer 2

After 41 weeks of completed gestation

Question 3

What is the normal weight of a term infant?

Answer 3

Between 2.5-4kg

Question 4

What would a birth weight of < 2.5kg be classed as?

Answer 4

Small for gestational age (SGA)

Question 5

What would a birth weight of > 4kg be classed as?

Answer 5

Large for gestational age (LGA)

Question 6

How much weight does a foetus gain in the third trimester?

Answer 6

Daily weight gain of 24g

About 7g of fat gained per day in the last 4 weeks

Question 7

What materials are exchanged by transplacental transfer in the third trimester?

Answer 7

Iron, vitamins, calcium, phosphate, antibodies

Question 8

How does term delivery usually take place?

Answer 8

Spontaneous or induced labour
Vaginal delivery or C-section
Cephalic (vertex) or breech position (or other)

Question 9

What is the normal labour environment like?

Answer 9

Hypoxic during contractions
Placental insufficiency
Growth restriction or excess

Question 10

What does foetal Hb help with during labour?

Answer 10

Release of oxygen

Question 11

What does prolonged labour cause?

Answer 11

It reduced foetal reserves

Question 12

What do increased cortisol and adrenaline levels during labour do?

Answer 12

Enhances adaptation of baby to new environment

Question 13

What are the steps in perinatal adaptation?

Answer 13

First breath/cry, alveolar expansion, change from foetal to newborn circulation, decreased pulmonary arterial pressure, increased Pao2

Question 14

What should be done immediately once a baby has been delivered?

Answer 14

Early/immediate skin to skin contact and suckling

Question 15

What is the Apgar score?

Answer 15

Objective measure of perinatal adaptation = score out of ten (score of 0-2 in each category)

Question 16

What are the components that make up the Apgar score?

Answer 16

Heart rate, respiratory rate, responsiveness, tone, colour

Question 17

What is considered a normal Apgar score?

Answer 17

> = 8

Question 18

What is skin to skin contact important in establishing?

Answer 18

Breast feeding

Question 19

What is the change in control of glucose homeostasis in newborns?

Answer 19

Dramatic change from continuous glucose infusion ti intermittent bolus enteral feeds

Question 20

What is the calorific intake like for well grown term infants in the first 24hrs?

Answer 20

They have very little intake

Question 21

What is attachment?

Answer 21

Hormonal and emotional response to infant

Question 22

What are some features of haemorrhagic disease of the newborn?

Answer 22

Rare

Potential mortality/morbidity (GI, lungs, CNS)

Question 23

What causes haemorrhagic disease of the newborn?

Answer 23

Lack of vitamin K = deficiency impairs production of coagulation factors

Question 24

Why is haemorrhagic disease of the newborn more common with formula feeding?

Answer 24

Vitamin K is transferred via breastmilk and can be inadequate in formulas

Question 25

What is one way haemorrhagic disease of the newborn can be diagnosed?

Answer 25

By measuring PIVKA = not usually needed

Question 26

What is infection risk of newborns based on?

Answer 26

Maternal history = mother testing positive for hep B and C, HIV, syphilis, TB or Group B strep

Question 27

What are some vaccinations given to prevent infection?

Answer 27

Maternal pertussis and influenza vaccines, routine vaccination schedule, hep B at birth, BCG in first month

Question 28

What are some screening tests done for newborns?

Answer 28

Newborn examination and universal hearing screening Hip screening = clinical and USS Cystic fibrosis and haemoglobinopathies Metabolic diseases

Question 29

What are some metabolic diseases screened for in newborns?

Answer 29

Phenylketonuria (PKU) Medium-chain acyl-CoA dehydrogenase deficiency Maple syrup urine disease Isovaleric acidaemia

Question 30

What is the newborn examination?

Answer 30

Top to toe examination is carried out by midwifery staff immediately after delivery Formal neonatal examination carried out after 24hrs

Question 31

What is being assessed in an examination of the new-born's head?

Answer 31

OFC, overlapping sutures, fontanelles, ventouse/forceps marks, moulding, cephalhaematoma, caput succedaneum

Question 32

What is being assessed when the ears are being examined?

Answer 32

Position, external auditory canal, tags/pits, folding, family history of hearing loss

Question 33

How are the eyes assessed in an examination of the newborn?

Answer 33

Size, red reflex, conjunctival haemorrhage, frequent squints, iris abnormality

Question 34

What is being looked at when the mouth is being examined?

Answer 34

Shape, philtrum, tongue tie, palate, neonatal teeth, Ebsteins pearls, sucking/rooting reflex

Question 35

What are some abnormalities looked for on examination of the face?

Answer 35

Facial palsy, dysmorphism

Question 36

How is respiratory function assessed on examination?

Answer 36

Chest shape, nasal flaring, grunting, tachypnoea, in-drawing, breath sounds

Question 37

What is assessed on examination of the cardiovascular system?

Answer 37

Colour/O2 saturation, pulses (femoral, radial), apex, heart sounds, thrills and heaves

Question 38

What is being looked for on examination of the abdomen?

Answer 38

Moves with respiration, distension, hernia, umbilicus, bile-stained vomiting, passage of meconium, anus

Question 39

What are features of the examination of the GU system?

Answer 39

Normal passage of urine, normal genitalia, undescended testes, hypospadius

Question 40

How is the MSK system assessed in an examination?

Answer 40

Movement, posture, limbs and digits, spine, hip examination

Question 41

What is being assessed on examination of the neurological function of a newborn?

Answer 41

Alert and responsive, cry, muscle tone, posture, movement, primitive reflexes

Question 42

What are the primitive reflexes of a newborn?

Answer 42

Sucking, rooting, Moro, ATNR

Question 43

What are some features of health promotion in a newborn?

Answer 43

Foetal origin of adult disease Parental habits = smoking, alcohol, drug use, diet Social interaction and vaccination Feeding and sleeping position

Question 44

How should families be dealt with when they have a newborn?

Answer 44

Advise of changing family structures Parenting = not always instinct Positive feedback and confidence = parent-child attachment Community support Recognising baby blues vs post natal depression