Management of the newborn Flashcards
is there a correlation between DM severity and perinatal outcome?
yes
what are the effects of DM on the fetus?
- macrosomia
- small for gestational age
macrosomia is defined by what parameter? what can it lead to? what is the cause?
- defined by gestational age
- can lead to birth trauma
- caused by insulin which is a growth factor in utero
what is the cause for small size for gestational age? what is the prevalence?
- maternal renovascular insufficiency
- occurs in 20% of pregnancies
what are the signs of a fetus born to a mother with DM?
- sacral agenesis
- femoral hypoplasia
- heart defects
- cleft palate
what are the effects on the newborn born to a diabetic mother?
- hypoglycemia (MOST COMMON)
- hypocalcemia
- hypomagnesemia
- polycythemia
- hyperbilirubinemia
- RDS
- hypertrophic cardiomyopathy
what is the cause of hypoglycemia in a baby born to a diabetic mother? what are the symptoms?
- hyperinsulinism secondary to maternal glucose
- poor feeding
- poor tone
- jittery
what is the prevention for hypoglycemia in a baby born to a diabetic mother?
early and frequent feeding
what is the treatment for a hypoglycemia in a baby born to a diabetic mother?
feeding and D10 IV
prolonged rupture of membrane is rupture lasting for longer than what time period? what is the greatest risk?
- 18 hours
- greater risk for infection
women with prolonged rupture of membrane are at risk for infection from what pathogen?
group B strep
screening for ROM occurs at what time?
35-37 weeks
what are the symptoms of a baby with group B strep?
- poor temperature control
- respiratory distress / apnea / hypoxemia
- poor color
- poor feeding
- excessive jaundice
- decreased tone
early onset disease occurs in what timeframe?
within first week
meningitis is associated more with early or late onset disease?
late onset
late onset disease occurs in what timeframe?
from 1 week to 3 months
late onset disease has an increased risk of what infection?
meningitis
mothers who are group B strep positive receive what? what is the mother’s status is not known?
- IV PCN or ampicillin at least 4 hours prior to delivery
- IF group B strep status is not known then abx for the mother are recommended from PROM or maternal fever
if a baby is symptomatic following group B strep exposure, what is the workup?
begin lab and X ray work up including cultures and begin abx
if a baby is asymptomatic following group B strep exposure, what is the workup?
- observe in the hospital for signs or symptoms of illness
- if maternal abx administered under 4 hours prior to delivery observe for 48 hours
what is the workup for a fever WITHOUT SOURCE in the neonate under 28 days old after discharge from the nursery?
- CBC, BC
- UA, UC
- LP and CSF culture
- HSV PCR of CSF
- CXR if cough is present
- fecal WBC if diarrhea is present
what are the pathogens responsible for fever in the neonate less than 28 days old?
- late onset group B strep
- e. coli
- listeria monocytogenes
- HSV
what is the treatment for a fever in a neonate under 28 days of age?
- hospitalize until cultures are positive or negative at 48 hours
- begin abx as soon as cultures are collected
- cover for group B strep, e. coli, listeria, HSV
- ampicillin, gentamicin / cefoxamine, acyclovir
what are two of the most common features of down syndrome?
- endocardial cushion defect
- mental retardation
polyhydramnios is defined as AFI greater than what value? what is AFI?
25
amniotic fluid index
what is the main association with polyhydramnios?
GI abnormalities
what is the presentation for GI abnormalities secondary to polyhydramnios?
tracheoesophageal fistula:
- poor feeding
- excessive secretions
- respiratory distress
what is the most common type of tracheoesophageal fistula?
blind esophageal pouch
what disorder should you think about with a TE fistula?
VACTERL
oligohydramnios is defined by what AFI value?
AFI under 5
what is the potter sequence?
fetal compression leading to:
- fetal growth retardation
- fetal GU abnormalities
- pulmonary hypoplasia
- positional deformities of the fetus
- flat face, beaked nose, low set ears
what is the standard of care for a baby that received late prenatal screening?
drug screen
what are the consequences of smoking for a fetus?
- IUGR
- heart defects
- limb deficiencies
when is it appropriate to discharge (in general)?
- drug screen results are in
- seen social services
- stable vital signs for over 12 hours
- urine and stool output one or more times
- feeding well
- arranged follow up
