Immediate Care of Newborn

Question 1

Mothers with diabetes have infants with risk for what?

Answer 1

Hypoglycemia and hyperinsulinemia (small babies more common with type 1 than type 2)
Hyperbilirubinemia
Respiratory distress
Polycythemia and hyperviscosity
Hypocalcemia

Question 2

How does a septic infant appear?

Answer 2

Pale, lethargic, high temperature

Question 3

Complications of twin-twin transfusion syndrome

Answer 3

Plethoric twin: Polycythemia, volume overload and polyhydramnios can lead to heart failure and hydrops

Anemic twin: Fetal growth restriction and oligohydramnios

Question 4

Order of operations for labored breathing and persistent cyanosis in newborn

Answer 4

1. Warm infant, optimize position, clear airway, supplemental “blow-by” oxygen
2. Positive pressure ventilation
3. Intubation

Question 5

When should naloxone not be provided to an infant?

Answer 5

When the mother had history of opioid dependence - infant may have severe and potentially fatal withdrawal reaction

Question 5

What opioid has lower side effect profile for mom and infant and may be used in labor?

Answer 5

Nalbuphine - partial opioid agonist

Question 6

What components make up the Apgar score? Each is 2 points

Answer 6

Heart rate
Respiratory effort (crying)
Reflex response
Spontaneous activity
Color

Question 7

Order of steps after delivery

Answer 7

1. Skin-to-skin contact
2. Bulb suction of mouth and nose
3. Additional stimulation unnecessary if good respiratory effort
4. Cord clamping (may be delayed for 60s or until cord stops pulsing)