Medical Issues of the Newborn Flashcards
At what times are infants APGAR scores assessed?
1 and 5 minutes
What is assessed as part of APGARs?
A - activity (muscle tone)
P - pulse
G - grimace (reflex irritability)
A - appearance (skin color)
R - respiration
An APGAR score < 4 indicates what?
Resuscitation
What is a normal pulse rate in a full term neonate?
110-160 (term neonates when asleep can be 85-90)
What is a normal BP in a neonate?
65-85 / 35-55
What is a normal respiratory rate in a neonate?
30 - 40
What are the benefits of immediate skin to skin for baby?
- Thermoregulation
- Glucose regulation
- Lower/more stable HR
- Increase oxygenation and decrease apnea
- Neurobehavioral organization
What interventions are included in “Eyes and Thighs” and should be given by 1 hour of life?
- Erythromycin ophthalmic ointment to prevent neonatal GC conjunctivitis
- 1 mg IM Vitamin K to prevent vitamin K deficient bleeding
- Hepatitis B vacine
Is the HBV vaccine effective in preventing perinatal transmission when given within 24 hours of birth?
Yes
Who should have glucose screening?
Infants at high risk:
- GA < 37 or > 42 weeks
- LGA or SGA
- Infants of diabetic mothers
- Family history of hypoglycemia
- Mothers treated with beta adrenergic or oral hypogycemic agents
Are babies born to diabetic mothers more likely to be hypoglycemic or hyperglycemic?
Hypoglycemic
How many hours do newborns sleep per day?
16-18 hours/day until 3 months
A newborn typically loses 8-10% of their body weight but should be back to birth weight by when?
2 weeks
When should NBS be performed?
24-48 hours of life (36 hours ideal)
Can parents refuse NBS?
Yes, but must sign refusal form
Hearing implement services should be initiated by what age in those who fail newborn hearing screens?
6 months of age is the goal
The goal of newborn hearing screening is to diagnose any hearing abnormality by what age?
< 3 months
What is the newborn recommendation for oximetry screening for congenital heart disease?
Perform pre-ductal (RIGHT hand) and post-ductal (either foot) saturations between 24-48hrs
Where is the oximeter probe placed to screen pre-ductal saturations?
Right hand
What criteria are included in a positive oximetry screen?
- O2 sat < 90% at anytime
- O2 sat 90-94% in both extremities on 3 seperate measurements
- O2 sat with >/= absolute difference between right hand and either foot on 3 separate measurements
*each measurement should be separated by one hour
What are the risk factors for neonatal sepsis?
- Maternal intrapartum temp >/= 38 C (100.4 F)
- Membrane rupture of 18 hours
- Delivery before 37 weeks
- Chorioamnionitis
- Maternal GBS colonization
The newborn head exam reveals a firm and fluctuant mass, what are you concerned for?
Subgaleal hemorrhage
Where is the PMI felt in a newborn?
Lower left sternal border (RV is dominant)
What is the Moro Reflex?
Sudden, slight dropping of head from slightly raised supine position: open hands, extension and abduction of arms (and legs), then flexion of arms (and legs) and crying
What is the last primitive reflex to disappear in babies?
Babinski, usually lasts until about 2 years while all others typically disappear around 6 months
What tool is used to predict bilirubin levels in a newborn?
Bhutani nomogram
What are some hepatocellular diseases that can cause direct (conjugated) hyperbili?
- Hepatitis
- TPN (cholestasis)
- Hepatic ischemia
- Erythroblastosis fetalis
- Metabolic disorders
What is the treatment for hyperbili?
Phototherapy
Infants with severe hyperbili should receive what treatment?
Exchange transfusion
What are some causes of peripheral cyanosis?
- Cold exposure
- Acrocyanosis
- Shock
- Sepsis
- Neonatal polycythemia
What are signs of respiratory distress?
- Retractions
- Grunting
- Nasal flaring
- Stridor (laryngeal)
What is the initial management for cyanosis?
- IV, O2, Monitor
What is the initial work-up for cyanosis in the newborn?
- ABG
- CBC with diff (low WBC may indicate sepsis)
- Glucose
- Blood cultures
- CXR
- Echo
What are common pulmonary causes of respiratory distress in full-term infants?
- TTN
- Meconium aspiration
- PPPHN
What is transient tachypnea of the newborn (TTN)?
Inadequate clearance of fluid in lungs at birth
What are the CXR findings of TTN?
- Increased lung volumes, flat diaphragms, prominant central vascular markings, fluid in the fissures, and possible pleural effusion
What is the treatment for TTN?
Management is supportive, and typically resolves in 24-72 hours
- O2
- Neutral thermal environment
- Nutrition
What is the diagnosis and work-up for Meconium aspiration?
- CXR
- ABG
- CBC
- Blood culture
- ECHO
What are the typical CXR findings of meconium aspiration?
- Initially: streaky densities
- Progressive changes: hyperinflation and patchy densities
What is the management of MAS?
- Maintain oxygenation and ventilation (surfactant, NO, or ECMO maybe needed)
- Broad spectrum abx
How can you definitively diagnose PPHN?
ECHO
What is the treatment for PPHN?
- Treat underlying condition
- 100% O2 to reverse vasoconstriction, titrate to pre-ductal sats of 90-95%
- NO?
- Consider ECMO
True or False: all neonates with fever require a full evaluation for sepsis
True
How is early onset sepsis defined?
First 7 DOL (often beings in-utero)
What is the evaluation of early onset sepsis?
- Blood culture
- LP
- CBC with Diff, glucose, VBG (lactate)
- CXR
What is the evaluation for late onset sepsis?
Same as early onset plus: U/A
How is failure to thrive defined?
- Weight that falls or remains below 3rd %ile
- Weight that decreased 2 major percentile lines on growth chart
- Weight that is < 80% of the median weight for height
What ages is SIDS more common?
2-4 months of age
A full-term male newborn is brought to the emergency department with signs of respiratory distress shortly after birth. On examination, he appears cyanotic, has nasal flaring, grunting, and subcostal retractions. His mother had an uneventful pregnancy, and prenatal ultrasounds showed no anomalies. What is the most likely diagnosis?
What should be the first line treatment?
TTN
Self-limited, Oxygen therapy support with 30-40% FIO2
