MIH Chapter 35 Flashcards by Cynthia Carrillo

What are acquired problems of the newborn?

conditions resulting from environmental rather than genetic factors.

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Birth trauma definition

physical injury sustained by a neonate during labor and birth

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risk factors for birth trauma

Maternal age <16 or >35
Primigravida
Uterine dysfunction - not contracting enough or too much
Preterm or postterm labor
Cephalopelvic disproportion
Oligohydramnios
Macrosomia
Multifetal gestation
Abnormal or difficult presentation
Obstetric birth techniques

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Types of soft tissue injuries

Erythema and ecchymosis
Petechiae
Abrasions and lacerations
Edema
Forceps injury
Accidental lacerations
subconjunctival or retinal hemorrhage
caput succedeneum
cephalhematoma
subgaleal hemorrhage

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erythema definition

superficial reddening of skin, in patches, results of injury or irritation, inflammation of capillaries and blood vessels

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what is petechiae

pinpoint round spots. Appear on skin as result of bleeding, appear in clusters and look like rash, not blanchable

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What are important considerations for petechiae in newborns ?

as long as they go away within 48 hrs and don’t reoccur they are benign
Have to document to ensure it wasn’t an abuse situation, be specific in documentation, important to relay info in report

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what can cause petechiae and bruising?

fast labors and pushing

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what causes abrasions and lacerations

forceps, scalpel, vacuum

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what is a subconjunctival hemorrhage

bright red patch on sclera of eye, should not cause change in vision, no discharge or pain

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Describe a retinal hemorrhage

may result in partial or Total loss of vision, typically heals itself

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what is caput succedaneum

swelling of the head, involving serosanguineous, subcutaneous extreperiosteal fluid collection, poorly defined margins, can extend across suture lines, looks like pitting edema

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what causes caput succedaneum

caused by a tourniquet effect from head being up against cervix

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what is a Cephalohematoma

a collection of blood in between baby scalp and skull, damaged blood vessels release blood and the blood pools between scalp and skull
Does not cross sutures, distinct margins, initially firm, more fluctuant in 48 hrs, rarely severe, jaundice is likely

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what is a subgaleal hemorrhage

rare but potentially lethal condition caused by rupture of emissary veins, blood pools outside of the baby’s skull extracranially,

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what are potential newborn complications for subgaleal hemorrhage

potential to drain significant amount of blood from newborn, puts baby at risk for neonatal encephalopathy, seizures, or death

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what is the most common bone fractured during birth?

clavicle

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types of peripheral nervous system injuries

Brachial plexus injury
Upper plexus injury
Erb-Duchenne palsy
Lower plexus injury
Klumpke’s palsy
Phrenic nerve injury
Component of brachial plexus injury
Facial paralysis (palsy)

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what is a brachial plexus injury

nerves between neck and shoulder are stretched, compressed, or torn during birth

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what is an upper plexus injury

injury to the upper trunk C5/C6 nerves, occurs from shoulder dystocia

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What is Klumpke’s palsy

rare type of injury to nerves around shoulder, affects movement of lower arm and hand

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what is a phrenic nerve injury

primary motor support to diaphragm, won’t be able to breathe appropriately

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types of central nervous system injuries

Intracranial hemorrahage:
subdural hemorrhage
subarachnoid hemorrhage
spinal cord injuries

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what is subdural hemorrhage

usually present with apnea, unequal pupils, tense fontanel, ands even coma

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what is a subarachnoid hemorrhage

Occurs in term infants as a result of trauma and in preterm infants as a result of hypoxia

what is the most common type of brain bleed in newborns

subdural

what is hyperinsulinemia

Increased amounts of glucose cross the placenta and stimulate the fetal pancreas to release insulin

most common anomalies related to diabetic mothers

cardiac, renal, musculoskeletal, and CNS

does fetus have increased or decreased insulin production

increased

does insulin or glucose cross the placenta

glucose does, insulin does not

what occurs more often in infants of diabetic mothers

birth trauma and perinatal hypoxia

what is a complication related to macrosomia

Excessive shoulder size in these infants often leads to dystocia.

what causes respiratory distress syndrome in newborns

Maternal hyperglycemia can affect fetal lung maturity.

what is the reason for late term amniocentesis

to check for fetal lung maturity in infants of diabetic mothers

What is hypoglycemia in newborns

Blood glucose levels less than 40 mg/dl in term infants

what are symptoms of hypoglycemia in a newborn

jitteriness, apnea, tachypnea, and cyanosis

when do hypocalcemia and hypomagnesemia show up in newborns

not present until 48-72 hrs after birth

what is cardiomyopathy and what types

Disease affecting the structure and function of the heart hypertrophic and nonhypertrophic

what is the cause of hyperbilirubinemia in infants

Increased number of red blood cells to be hemolyzed increases the potential bilirubin load that the neonate must clear

Presence of microorganisms or their toxins in blood or other tissues

sepsis

why is the infant susceptible to infection

because of the immature immune system

interventions for sepsis in newborn

breastfeeding med administration (antibiotics)

types of infections related to fetus and labor

choreoamnionitis , GBS, maternal infection, PROM is the most common cause

what should you frequently assess with PROM

check temp frequently

Signs of infection in newborn

tachycardia (even in utero), decreased variability in utero, low Apgar scores, pale, tachypnea

ways to prevent infection in newborns

handwashing standard precautions erythromycin ointment in eyes

an acronym that is often used to describe maternal infections during early pregnancy associated with various congenital malformations and disorders

torch infections

What does torch stand for

T - toxoplasmosis O - other agents R - rubella C - CMV H - herpes

types of transplacental infections

Toxoplasmosis Gonorrhea Syphilis Varicella-zoster Hepatitis B virus (HBV) CMV enterovirus parvovirus B19 Hepres simplex HIV/AIDS

syphilis symptoms

copper colored, macular rash on palms, around mouth, and anus

what education is important with rubella injection

do not get pregnant for 4 weeks after injection

what infection is a leading cause of neonatal morbidity and mortality in US

GBS

when is the GBS test performed

around 36 wks

Type of bacterial infections

Group B strep Escherichia coli Staphylococcus aureus Listeriosis Chlamydia infection

type of fungal infections

candidiasis (Candida albicans)

what is the treatment for candidiasis

anti fungal ointment like nystatin or miconazole , applied 3 times a day for 7-10 days

How does the use of tobacco during pregnancy affect the fetus

Results in deficits in intellectual ability, emotional development, and behavior

which substance is the most common cause of cognitive impairment

alcohol

what are characteristics of an infant with Fetal alcohol syndrome

small for gestational age, thin upper lip, microcephaly

What are the complications associated with heroin use during pregnancy

Many of the medical complications attributed to heroin result from prematurity

how is heroin addiction treated

Methadone, a synthetic opiate, has been the therapy of choice for heroin addiction since 1965

complications related to marijuana use during pregnancy

Shortened gestation and a higher incidence of IUGR

complication related to cocaine use during pregnancy

Recognized cause of placental abruption Neonates do not experience withdrawal but rather show neurotoxic effects of the drug, increase HR and BP

what are complications related to methamphetamines use during pregnancy

higher incidence of placental abruption, preterm birth, and intrauterine growth restriction (IUGR)

what is the recommended amount of caffeine a pregnant woman can have per day

200 mg/day

can SSRIs be taken during pregnancy

Use should be determined by a risk-benefit analysis of the risks to the fetus or neonate with use of the medication weighed against risks of not treating the mother’s psychiatric condition. Baby can have withdrawals and symptoms can occur until 72 hrs after birth