Neonatal History Flashcards
What is the standard of perinatal care for a comprehensive physical exam?
to be completed within 18h post birth by MD, NP or PA
What should precede the physical exam?
a thorough review of the history of the current pregnancy, post OB hx, intrapartum hx, maternal medical, family medical and social hx, as well as immediate neonatal adaptation
What is included in the assessment of the neonatal history?
1) reviewing the hx
2) reviewing results of physical exam
3) review lab data
4) formulating a differential
How is identifying data defined?
the patient’s name, DOB and referral source
How is the chief complaint defined?
age, sex, birth, current weight, GA by dates and exam and any presenting clinical signs
What should be included in an infant’s interim hx?
chronological record of the neonate’s hx to present and includes: temp stability, feeding, voiding, stooling, behavioral adaptation, sequence of problems, lab/xray findings, interventions, response to tx, age of MOB, type of del, BW, current wt and apgars
What is the antepartum history?
includes more specific historical data on the pregnancy; maternal age, gravidity and parity, LMP and EDD
What should be reviewed as it applies to prenatal visits?
the date and GA at which prenatal care began and # of visits, complications, high-risk factors, treatments, exposure to radiation, all medications, use of drugs/ETOH/tobacco
What is included in the typical prenatal screening lab work?
maternal blood type and Rh, antibody screen, serology, VDRL, rubella immunity, cx for Gonococcus, chlamydia, GBS, hep B, alpha fetoprotein, HIV, trip/quad screen and US
Who should be screened for TB?
women with specific high risk factors
What should be reviewed as it pertains to OB hx?
of pregnancies, abortions, still births, living children, type of deliveries, dates of births/abortions, BW, GA at birth; serial US findings, BPP and nonstress tests/ctx tests
What should be reviewed as it pertains to intrapartum hx?
duration of labor, spont/induced, meds/anesthetics during L&D, length of stages of labor, type of del, forcep/vacuum assistance, time/duration of ROM, amniotic fluid vol, presence/absence of mec, maternal fever, bleeding, HTN, neonate presentation at del, APGAR, resusc interventions and response to interventions
What are high-risk pregnancy factors a/w SES?
inadequate finances, poor housing, severe social problems, unwed (especially adolescent), minority status, nutritional deprivation and parental occupation
What are high-risk pregnancy factors a/w demographic factors?
maternal age 35, overweight/underweight prior to pregnancy, ht <11yr and family h/o severe inherited disorders
What are high-risk pregnancy factors a/w OB history?
infertility, ectopic pregnancy or spontaneous abortion, grand multiparity, stillborn/neonatal death, uterine/cervical abnormality, multiple gestation, PTL/PTB, PROM, CSX, LBW, macrosomic, midforceps, baby with neurologic deficit, birth injury or malformation and hydatidiform mole or choriocarcinoma
What are high-risk pregnancy factors a/w maternal medical history/status?
cardiac dz, pulmonary dz, metabolic dz (particularly DM and thyroid), chronic renal dz, repeated uti, repeated bacteriuria, GI dz, endocrine disorders (pituitary and adrenal), chronic HTNm hemoglobinopathies, sz disorder, venereal and other infectious dz, wt loss >5lbs, malignancy, surgery during pregnancy, major congenital anomalies of the reproductive tract and maternal retardation, emotional disorders
What are high-risk pregnancy factors a/w current maternal OB status?
late or prenatal care, Rh sensitization, LGA/SGA, PTL, PIHTN, multiple gestation, polyhydramnios, PROM, antepartum bleeding (placenta previa or abruptio placentae), abnormal presentation, post maturity, abnormality in fetal well being test, anemia
What are high-risk pregnancy factors a/w maternal habits?
smoking during pregnancy, regular alcohol intake and drug use/abuse
What are the possible effects of aspirin on the fetus/newborn?
hemorrhage, premature closure of the DA, pulmonary artery HTN
What are the possible effects of codeine on the fetus/newborn?
neonatal drug withdrawal
What are the possible effects of ibuprofen on the fetus/newborn?
reduced amniotic fluid volume when used in tocolysis, theoretic risk of premature PDA closure
What are the possible effects of indomethacin on the fetus/newborn?
premature closure of the DA, pulmonary artery HTN
What are the possible effects of meperidine on the fetus/newborn?
respiratory depression peaks 2-3h after maternal dose
What are the possible effects of propoxyphene on the fetus/newborn?
neonatal drug withdrawal; possible risk of increased anomalies
What are the possible effects of general anesthesia on the fetus/newborn?
respiratory depression of infant at delivery if anesthesia is prolonged before delivery
What are the possible effects of lidocaine on the fetus/newborn?
high fetal serum levels cause CNS depression, accidental direct injection into the fetal head causes seizures
What are the possible effects of aminoglycosides on the fetus/newborn?
ototoxicity reported after first trimester use of kanamycin and streptomycin
What are the possible effects of streptomycin on the fetus/newborn?
damage to the 8th cranial nerve, hearing loss
What are the possible effects of vancomycin on the fetus/newborn?
potential for ototoxicity
What are the possible effects of cephalosporins on the fetus/newborn?
some drugs in this group displace bilirubin from albumin
What are the possible effects of Isoniazid on the fetus/newborn?
risk for folate deficiency
What are the possible effects of metronidazole on the fetus/newborn?
potential teratogen
What are the possible effects of sulfonamides on the fetus/newborn?
some drugs in this group displace bilirubin from albumin
What are the possible effects of tetracycline on the fetus/newborn?
yellow-brown stining and caries of teeth
What are the possible effects of trimethoprim on the fetus/newborn?
folate antagonism
What are the possible effects of warfarin on the fetus/newborn?
warfarin embryopathy
What are the possible effects of carbamepine on the fetus/newborn?
neural tube defects, midface hypoplasia
What are the possible effects of phenobarbital on the fetus/newborn?
withdrawal symtpoms, hemorrhagic dz
What are the possible effects of phenytoin on the fetus/newborn?
hemorrhagic dz, fetal hydantoin syndrome
What are the possible effects of trimethadione on the fetus/newborn?
fetal trimethadione syndrome, cleft lip and palate, cardiac and genital anomalies
What are the possible effects of valproic acid on the fetus/newborn?
myelomeningocele, facial and cardiac anomalies
What are the possible effects of aminopterin on the fetus/newborn?
cleft palate, hydrocephalus, myelomeningocele, growth restriction
What are the possible effects of cyclophosphamide on the fetus/newborn?
growth restriction, cardiovascular and digital anomalies
What are the possible effects of methotrexate on the fetus/newborn?
absent digits
What are the possible effects of Iodide-containing drugs on the fetus/newborn?
hypothyroidism
What are the possible effects of methimazole on the fetus/newborn?
hypothyroidism, cutis aplasia
What are the possible effects of propylthiouracil on the fetus/newborn?
hypothyroidism
What are the possible effects of acyclovir on the fetus/newborn?
no known adverse effects reported
What are the possible effects of ribavirin on the fetus/newborn?
teratogenic and embryolethal in animals
What are the possible effects of zidovudine on the fetus/newborn?
potential fetal bone marrow suppression, reduces perinatal HIV transmission
What are the possible effects of angiotensin-converting enzyme inhibitors on the fetus/newborn?
neonatal bradycardia, hypoglycemia
What are the possible effects of Beta-blockers (propranolol) on the fetus/newborn?
neonatal bradycardia and hypoglycemia
What are the possible effects of Calcium channel blockers on the fetus/newborn?
if maternal hypotension occurs, could affect placental blood flow
What are the possible effects of diazoxide on the fetus/newborn?
hyperglycemia
What are the possible effects of digoxin on the fetus/newborn?
fetal toxicity with maternal overdose
What are the possible effects of hydralazine on the fetus/newborn?
maternal hypotensive risk with possible effect on placental blood flow
What are the possible effects of methyldopa on the fetus/newborn?
mild, clinically insignificant decrease in neonatal blood pressure
What are the possible effects of furosemide on the fetus/newborn?
increases fetal urinary sodium and potassium
What are the possible effects of thiazides on the fetus/newborn?
thrombocytopenia
What are the possible effects of androgenics on the fetus/newborn?
masculinization of the female fetus
What are the possible effects of corticosteroids on the fetus/newborn?
cleft palate reported in animals
What are the possible effects of diethylstilbesterol on the fetus/newborn?
DES daughters: genital tract anomalies, increased rate of PTB; DES sons: possible increase in GU anomalies
What are the possible effects of estrogens/progestins on the fetus/newborn?
uncertain teratogenic potential, virilization of female fetuses reported with progestins
What are the possible effects of tamoxifen on the fetus/newborn?
DES like effect in some animal studies
What are the possible effects of barbiturates (short acting) on the fetus/newborn?
theoretic risk for hemorrhage and drug withdrawal
What are the possible effects of benzodiazepines on the fetus/newborn?
hypotonia, impaired thermoregulation
What are the possible effects of lithium on the fetus/newborn?
cardiac anomalies (ebstein’s), diabetes insipidus, thyroid depression, CV dysfunction
What are the possible effects of thalidomide on the fetus/newborn?
limb reduction and other anomalies
What are the possible effects of tricyclic antidepressants on the fetus/newborn?
association with limb reduction defects (causation unproven)
What are the possible effects of vitamin A on the fetus/newborn?
excessive doses are teratogenic
What are the possible effects of vitamin D on the fetus/newborn?
megadoses may cause hypercalcemia
What are the possible effects of isotretinoin on the fetus/newborn?
ear, cardiac, CNS and thymic anomalies
