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
