mod 9. Neonate Flashcards
Is it true that circumcision can decrease the risk of acquiring and transmitting an STI
yes, but other preventative measures, including abstinence, use of condoms and other safe sex practices, must continue to be taught and practiced.
As an NP would you advise all patients to be circumsized?
The CPS does not recommend the routine circumcision of every newborn male.
it is not medically indicated
What are some of the potential benefits of circumsicon ?
- reduces uti in young boys
- reduces the need for medical circumcision in later childhood to treat a severe phimosis
- lowers risk of devloping penile cancer
- lower risk of obtaining STI
That being said the CPS still advises against routine circumsicion in otherwise healthy infants
Why is it important to ween a baby from the breast at arround 6 months
- they need to learn how to develop motor skills eat, if they only suck milk for a long time they can become poor eaters
- ## they need iron and micronutrients that they cant get from breastmilk
should infant ween from the breast abruptly or gradually?
An abrupt wean is traumatic for the infant, uncomfortable for the mother and may result in blocked ducts, mastitis or breast abscesses.[7]
true or false?
As an NP you can encourage continued breastfeeding for up to two years and beyond while providing appropriate nutritional guidance.
this is true, the mother may breastfeed as long as she likes, most babys will start to ween at 6 months
What are some risk factors to neonatal jaundice
- Male baby
- Asian or European background
- Visible bruising
- Dehydration/exclusivley breastfed
- shorter gestational age
- previous sibling with jaundice
in terms of ABO incompatibility what infants are at higher risk for neonatal jaundice?
an infant born with ABO-incompatibility with a positive coombs (DAT) test is at higher risk for requiring phototherapy
BUT
you should not universally screen babies for incompatability unless they have clinical signs of jaundice
true or false>
A car seat or carrier is not a safe place for a baby to sleep.
true its not safe
when is the peak periof where babies cry more?
3-12 weeks of age
usually it ends by 3-4 months
When does the posterior fontanelle and anterior fontanelle close?
Fontanelles: The posterior fontanelle is usually closed by 2 months and the anterior by 18 months. The Abnormal fontanel (AAFP)
What does it mean if a neonate is HBsAg-positive on the neonatal screening?
It means the baby was born to a mother with acute or chronic hepatitis B , the first dose of Hep B vaccine should be given at birth (with Hepatitis B immune globulin) and repeat doses of vaccine at 1 and 6 months of age.
What is Plagiocephaly?
its a type of craniosynostosis, where the scalp is twisted, its diagnosed on physical exam
and if it is not treated it can lead to increased ICP and will require surgery at 2-3 months of age
What is the moro reflex and when does it disappear?
it occurs when the baby is startled by something loud or abrupt–they will extend his arms and legs and neck and then rapidly bring his arms together. He may even cry loudly.
it disappears by 2 months
What is the tonic neck reflex? and when would you expect that to disappear?
When a baby turns their head to one direction the arm in that direction will straighten, and the ipsilateral arm will bend
What is the palmar grasp and plantar grasp?
place your hand in the baby hand and they hold on
Place your thumb on their foot and their toes curl
what is the rooting reflex and when does it go away?
its the baby trying to find the nipple to feed
the baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking
It last till about 4 months
List all the primitive reflexes for baby
- Palmar/plantar grasp
- Rooting
- Moro
- Tonic neck (fencing reflex)
What is Positional plagiocephaly ?
deformation of the skull produced by extrinsic forces acting on an intrinsically normal skull.
The greatest amount of deformation usually occurs in the first 3 months of life when the skull is most malleable and when an infant spends the majority of time lying on his or her back.
What causes Positional plagiocephaly?
When infants spend too much day time on their back or they have a positional preference
How do you diagnose a baby with positional plagiocephaly?
To make the diagnosis, stand behind the
infant as they are supported in the caregiver’s lap and look down from above
identify the flattened side
place your fingers in their ear cannals and see which ear is more anterior
What are is another differential diagnosis for plagiocephaly?
Congenital Torticollis can actually cause positional plagiocephaly so if a patient presents with head flattening you want to assess their range of motion to see if the cause is due to torticollis, if so they will also need a physio referral
What is the difference between physiological and pathological reflux?
Physiologic reflux episodes typically occur postprandially, are short-lived, asymptomatic, and rarely occur during sleep. Pathologic reflux is associated with symptoms or mucosal injury and often occurs nocturnally.
up to what percentage of weight loss is normal in the first week?
less thn 10%
Is it normal for a baby to continue to lose weight after day 3?
no, after day 3 they should be starting to gain weight
how many oz should a baby gain per week in the first month?
4-7 Oz/week in the first month
Roughly how much should a baby gain per month till 6 months?
1-2 pounds/month till 6 months
by how many months would you expect a baby to double their birth weight?
By 6 months a baby should double their birth weight
By how many months should a baby triple their birth weight?
by 12 months a baby will triple their birth weight
True or false?
Breast fed infants by 4-6 weeks of age may only have a bowel movement once every 7-21 days?
apparently this is true
How much Vitamin D should breastfed infants have per day?
400 IU
If a neonate presents with “constipation” as per the caregiver, what are some red flags to rule out?
*Delayed passage of meconium (first meconium passed after 48 hours of life
- fever
- abdominal distension
- rectal bleeding/ melena
- Weight loss or poor weight gain
*WHAT DO THE BOWEL MOVEMENTS LOOK LIKE
it is not normal for an infant less than 9 months of age to have hard stool, it should be soft, if its hard stool the baby might have
What is infant dyschezia?
This is what most parents think constipation is. It occurs in infants less than 9 months of age.
ineffective defecation, manifested as straining in the absence of constipation.
Infant dyschezia is a functional disorder, defined as at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stool in an otherwise healthy infant younger
failure to relax the pelvic floor during the defecation effort.
What are differential diagnosis for infant constipation (even though its extremely rare)
cow’s milk protein allergy,
gastroesophageal reflux,
Colic
Most likely Infant Dyschezia
As per the Rourke guidelines what is Room sharing compared to bed sharing?
During first 6 months of life baby should sleep in an approved crib in the parents room with no bumpers blankets or stuffed animals
BUT NO BED SHARING, baby should never sleep in parents bed
What considerations do we need to make regarding pacifier use?
You want to make sure that breastfeeding is well established before initiating a pacifier
Pacifiers may decrease risk of SIDS and should not be discouraged in the 1st year of life
but should be restricted in children with chronic/recurrent otitis media.
Is it true that having a fan in the babies room reduces the risk of SIDs by 72%?
yes
what is the difference between physiologic and pathologic neonatal jaundice?
physiologic jaundice occurs from RBC lysis first 7 days
Pathological is where there is an anatomical blockage or cause leading to jaundice like biliary atresia
Colic is often defined by the “rule of three”: crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy
