Miscellaneous

Question 1

Developmental dysplasia of the hip

Answer 1

unilateral in 80%, L>R
more common in first born infants
more common in females
white>black infants

Question 2

Craniosynostosis

Answer 2

Sagittal synostosis is most common

Question 3

Coronal synostosis

Answer 3

Bicoronal synostosis can be associated with increased ICP. Surgical correction is required.

Question 4

Lambdoidal synostosis

Answer 4

Question 5

Metopic synostosis

Answer 5

Surgical correction is cosmetic

Question 6

Brachycephaly

Answer 6

Question 7

Shortening of the extremities

Answer 7

Question 8

Answer 8

A. Caput
B. Cephalohematoma
C. Subgaleal
D. Epidural

Question 9

passive flexion tested on Ballard

Answer 9

popliteal angle

Question 10

passive extension tested on Ballard

Answer 10

heel to ear

Question 11

nonshivering thermogenesis

Answer 11

leads to heat production through oxidation of brown fat

mediated by catecholamines
leads to increased metabolic rate and increased oxygen consumption
impaired by hypoxemia and hypoglycemia

Question 12

Why is a neonate more prone to heat loss?

neonatal heat loss ~4X greater than adult heat loss
preterm > term

Answer 12

decrease epidermal and dermal thickness–> increased radiant and conductive heat loss

minimal subcutaneous brown fat–> decreased response to cooling

immature nervous system–> decreased response to cooling

increased surface area to body weight ratio

Question 13

heat gain: neonate vs adult

Answer 13

Neonate with heat gain has more difficulty returning to normal body temperature because:

additional thermal stresses (insulated clothing, phototherapy)

sweat glands not completely functional until several weeks of age

Question 14

Name the types of neonatal heat loss

Answer 14

Question 15

describe conductive heat loss

Answer 15

transfer of heat from neonatal to a contacting solid object

causes: infant placed on cold blanket or mattress

prevention: place infant on warm blanket or mattress
use of chemical mattress

Question 16

describe convective heat loss

Answer 16

transfer of heat from neonate to surrounding gas
heated air expands and then travels upwards
~40-50% of nonevaporative neonatal heat loss

causes: cool air, air currents

prevention: limit air currents, plastic cover

may require environmental temperature to be greater than skin temperature to maintain a normal core temperature

Question 17

describe evaporative heat loss

Answer 17

transfer of heat from skin and respiratory tract to a drier environment

causes: newborn covered in amniotic fluid in DR, prematurity leading to immature stratum corneum and poor epidermal barrier function, younger postnatal age, high velocity of surrounding air, low humidity environment

prevention: dry newborn in DR, plastic cover, increase incubator humidity

Question 18

describe radiant heat loss

Answer 18

transfer of heat between neonatal and codl surface that is nearby but NOT in contact with neonate
heat loss is in the form of electromagnetic waves

causes: presence of incubator walls, widows, chairs, light bulbs, other people

prevention: protect incubator walls from excess cooling, double walled isolette, plastic cover

Question 19

how to convective incubators help prevent heat loss?

Answer 19

infant still has a lot of radiant/evaporative heat loss

increase humidity/dress infant: decrease evaporative heat loss

double walled incubator: decrease radiant heat loss

add plastic heat shields: decrease radiant heat loss

utilized portholes: decrease convective heat loss

rubber foam mattress: decrease conductive heat loss

Question 20

radiant warmers and infant heat loss

Answer 20

use infrared radiant warming
leads to large difference in sin temp between exposed and unexposed areas
still with convective and evaporative heat losses

higher evaporative heat loss compared with incubators–> insensible water loss, greater skin-air temp differences, lower relative humidity

if cover infant with plastic film, decrease convective/evaporative heat losses

Question 21

definition of thermoneutral zone in a newborn

Answer 21

environmental temperature in which the newborn has minimal metabolic demands in the form of oxygen consumption and maintains temperature in the normal range

Question 22

Born-Alive Infants Protection Act of 2002

Answer 22

affirms the legal rights of all infants born alive, regardless of gestational age at the time of delivery or the circumstances of the birth

as a results, the medical condition of every infant must be assessed at birth in order to determine the most appropriate plan of care

AAP NRP steering committee has ensured that the law does not mandate the provision of care to those infants born at the limits of viability

Question 23

characteristics of effective feedback

Answer 23

descriptive (not judgmental)
specific
focus on issues learner can control and change
emphasis on consequences
timely
based on first-hand data

Question 24

Infant vs neonatal vs perinatal mortality

Answer 24

infant = death within first year

neonatal = death within first 28 days

perinatal = death from 22 wks to 7 days old

Question 25

Total Infant Mortality Rate

Answer 25

infants weighing < 500g account fof 20%

1983-2005 there has been no significant change in overall IMR due to increase in rate of preterm deliveries and increase in low birth weight infants births

Question 26

brachial plexus injury

Answer 26