Miscellaneous Flashcards
Developmental dysplasia of the hip
unilateral in 80%, L>R
more common in first born infants
more common in females
white>black infants
Craniosynostosis
Sagittal synostosis is most common
Coronal synostosis
Bicoronal synostosis can be associated with increased ICP. Surgical correction is required.
Lambdoidal synostosis
Metopic synostosis
Surgical correction is cosmetic
Brachycephaly
Shortening of the extremities
A. Caput
B. Cephalohematoma
C. Subgaleal
D. Epidural
passive flexion tested on Ballard
popliteal angle
passive extension tested on Ballard
heel to ear
nonshivering thermogenesis
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
Why is a neonate more prone to heat loss?
neonatal heat loss ~4X greater than adult heat loss
preterm > term
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
heat gain: neonate vs adult
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
Name the types of neonatal heat loss
describe conductive heat loss
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
describe convective heat loss
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
describe evaporative heat loss
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
describe radiant heat loss
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
how to convective incubators help prevent heat loss?
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
radiant warmers and infant heat loss
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
definition of thermoneutral zone in a newborn
environmental temperature in which the newborn has minimal metabolic demands in the form of oxygen consumption and maintains temperature in the normal range
Born-Alive Infants Protection Act of 2002
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
characteristics of effective feedback
descriptive (not judgmental)
specific
focus on issues learner can control and change
emphasis on consequences
timely
based on first-hand data
Infant vs neonatal vs perinatal mortality
infant = death within first year
neonatal = death within first 28 days
perinatal = death from 22 wks to 7 days old
Total Infant Mortality Rate
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
brachial plexus injury
