mod 9. Neonate

Question 1

Is it true that circumcision can decrease the risk of acquiring and transmitting an STI

Answer 1

yes, but other preventative measures, including abstinence, use of condoms and other safe sex practices, must continue to be taught and practiced.

Question 2

As an NP would you advise all patients to be circumsized?

Answer 2

The CPS does not recommend the routine circumcision of every newborn male.
it is not medically indicated

Question 3

What are some of the potential benefits of circumsicon ?

Answer 3

• 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

Question 4

Why is it important to ween a baby from the breast at arround 6 months

Answer 4

• 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

Question 5

should infant ween from the breast abruptly or gradually?

Answer 5

An abrupt wean is traumatic for the infant, uncomfortable for the mother and may result in blocked ducts, mastitis or breast abscesses.[7]

Question 6

true or false?

As an NP you can encourage continued breastfeeding for up to two years and beyond while providing appropriate nutritional guidance.

Answer 6

this is true, the mother may breastfeed as long as she likes, most babys will start to ween at 6 months

Question 7

What are some risk factors to neonatal jaundice

Answer 7

• Male baby
• Asian or European background
• Visible bruising
• Dehydration/exclusivley breastfed
• shorter gestational age
• previous sibling with jaundice

Question 8

in terms of ABO incompatibility what infants are at higher risk for neonatal jaundice?

Answer 8

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

Question 9

true or false>

A car seat or carrier is not a safe place for a baby to sleep.

Answer 9

true its not safe

Question 10

when is the peak periof where babies cry more?

Answer 10

3-12 weeks of age

usually it ends by 3-4 months

Question 11

When does the posterior fontanelle and anterior fontanelle close?

Answer 11

Fontanelles: The posterior fontanelle is usually closed by 2 months and the anterior by 18 months. The Abnormal fontanel (AAFP)

Question 12

What does it mean if a neonate is HBsAg-positive on the neonatal screening?

Answer 12

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.

Question 13

What is Plagiocephaly?

Answer 13

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

Question 14

What is the moro reflex and when does it disappear?

Answer 14

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

Question 15

What is the tonic neck reflex? and when would you expect that to disappear?

Answer 15

When a baby turns their head to one direction the arm in that direction will straighten, and the ipsilateral arm will bend

Question 16

What is the palmar grasp and plantar grasp?

Answer 16

place your hand in the baby hand and they hold on

Place your thumb on their foot and their toes curl

Question 17

what is the rooting reflex and when does it go away?

Answer 17

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

Question 18

List all the primitive reflexes for baby

Answer 18

1. Palmar/plantar grasp
2. Rooting
3. Moro
4. Tonic neck (fencing reflex)

Question 19

What is Positional plagiocephaly ?

Answer 19

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.

Question 20

What causes Positional plagiocephaly?

Answer 20

When infants spend too much day time on their back or they have a positional preference

Question 21

How do you diagnose a baby with positional plagiocephaly?

Answer 21

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

Question 22

What are is another differential diagnosis for plagiocephaly?

Answer 22

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

Question 23

What is the difference between physiological and pathological reflux?

Answer 23

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.

Question 24

up to what percentage of weight loss is normal in the first week?

Answer 24

less thn 10%

Question 25

Is it normal for a baby to continue to lose weight after day 3?

Answer 25

no, after day 3 they should be starting to gain weight

Question 26

how many oz should a baby gain per week in the first month?

Answer 26

4-7 Oz/week in the first month

Question 27

Roughly how much should a baby gain per month till 6 months?

Answer 27

1-2 pounds/month till 6 months

Question 28

by how many months would you expect a baby to double their birth weight?

Answer 28

By 6 months a baby should double their birth weight

Question 29

By how many months should a baby triple their birth weight?

Answer 29

by 12 months a baby will triple their birth weight

Question 30

True or false?

Breast fed infants by 4-6 weeks of age may only have a bowel movement once every 7-21 days?

Answer 30

apparently this is true

Question 31

How much Vitamin D should breastfed infants have per day?

Answer 31

400 IU

Question 32

If a neonate presents with “constipation” as per the caregiver, what are some red flags to rule out?

Answer 32

*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

Question 33

What is infant dyschezia?

Answer 33

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.

Question 34

What are differential diagnosis for infant constipation (even though its extremely rare)

Answer 34

cow’s milk protein allergy,
gastroesophageal reflux,
Colic
Most likely Infant Dyschezia

Question 35

As per the Rourke guidelines what is Room sharing compared to bed sharing?

Answer 35

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

Question 36

What considerations do we need to make regarding pacifier use?

Answer 36

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.

Question 37

Is it true that having a fan in the babies room reduces the risk of SIDs by 72%?

Answer 37

yes

Question 38

what is the difference between physiologic and pathologic neonatal jaundice?

Answer 38

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

Question 39

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