Neonatal labs Flashcards by Erin bryar

Blood glucose

>35 mg/dL 0-24 hours
>45 mg/dL >24 hours
Many now use 50 mg/dL as cutoff value
hyperglycemia is >150
Treatment for hypoglycemia:
D10W at 2mg/kg slow IV push
Maybe glucagon (converts glycogen to sugar)

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total white blood cell count

generally, 5,000-30,000
preterm 6,000-19,000
term 10,000-26,000
Limited value in diagnosing infection

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Granulocytes versus agranulocytes

Granulocytes: neutrophils, basophils, eosinophils
Agranulocytes: lymphocytes, monocytes, macrophages

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Neutrophils

70% for first few weeks
Often seen during acute bacterial infection (go to inflamed area and phagocytose the organism)
“Left shift” refers to enhanced production of new neutrophils (It takes 13-15d to make a mature neutrophil)

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I:T ratio

<0.2 is normal. >0.8 carries higher risk of death.
(Immature neutrophils)/(All neutrophils)
=(bands+metamyelocytes+myelocytes)/(segs+bands+metas+myelos)

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Absolute neutrophil count

>2,000, 0-24 hours
>7,000, after 24 hours
<1,500 is suggestive of infection
Multiply WBCs by all neutrophil percentages
=WBC * (% segs+ % bands+ %metas)

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Eosinophils

1-3%

Elevated ina allergic response, parasitic infections

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Basophils

<1%

Seen in allergic response, during healing phase of inflammation

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Monocytes

4-8%

Elevated in response to viral and chronic bacterial infections (2nd line of defense against bacterial infections)

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Lymphocytes

30% initially, 60% in first few weeks
Elevated in viral infections
Provide B and T cell immunity

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Types of antibodies

IgG: crosses placenta, protects babies in 1st months (75%)
IgM: early antibody, produced by fetus in response to intrauterine infection (10%)
IgA: predominately in mucous/saliva, passed in human milk
IgD: Unknown function (<1%)
IgE: unknown function (trace)

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Platelets

150,000-450,000
>80,000 on days 3-5
Can be nonspecific late sign of infection, may be decreased with fungal infections

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C-reactive protein

Signals acute inflammation, one of the first serum acute-phase reactants to rise in response to sepsis
Generally returns to normal within 2-7d of successful treatment. Persistent rise indicates persistent infection/meningitis

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Gram positive cocci

In pairs: strep or staph
In chains: strep
In clusters: staph

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Gram negative bugs

rods: e.coli
diploid: neisseria

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Indirect coombs test

Used to screen pregnant women for antibodies that may cause hemolytic disease of newborn (as in ABO or Rh incompatibility)

Direct coombs test

looks for autoimmune hemolytic anemia

categories of hypoxia

Hypoxemic hypoxia
anemic hypoxia
circulatory hypoxia
histologic hypoxia

PaO2

50-80 (term)

45-65 (preterm)

base deficit/excess

-2 to +2
base excess indicates too much buffer (metabolic alkalosis)
base deficit indicates too little buffer (metabolic acidosis)

causes of metabolic acidosis

Diarrhea
 Small bowel drainage
 Hyperalimentation
 Ingestion of Chloridecontaining compounds
 Renal Tubular Acidosis
 Renal Failure
 Carbonic Anhydrase 
Deficiency
 Lactic Acidosis
 Tissue Hypoxia
 Sepsis
 Neonatal Cold Stress
 Ketoacidosis
 Diabetes Mellitus
 Starvation
 Ingestion of Toxins
 Inborn Errors of Metabolism

causes of metabolic alkalosis

Vomiting
 Nasogastric Suctioning
 Congenital Chloride-Wasting 
Diarrhea
 Dehydration
 Diuretic Therapy
 Steroid Therapy
 Cushing’s Syndrome
 Bartter’s Syndrome
 Sodium Bicarbonate Use
 Hypokalemia
 Hypochloremia
 Chewing Tobacco
 Massive Blood Transfusion
 Cystic Fibrosis Infants Fed 
Regular Formula or BM

causes of respiratory acidosis

Lung Disease
 Upper Airway Obstruction
 Small Airway Obstruction
 Chronic Obstructive Disease
 Pneumonia
 Pulmonary Edema
 RDS, ARDS
 Aspiration
 Pulmonary Hypoplasia
 Impaired Lung Motion
 Pleural Effusion
 Pneumothorax
 Thoracic Cage Abnormalities
 Apnea
 Neurologic or Neuromuscular 
Disorders Affecting 
Respiration

causes of respiratory alkalosis

 Anxiety
 Fever
 Sepsis
 Hypoxemia
 Pneumonia
 Atelectasis
 Pulmonary Emboli
 Congestive Heart Failure
 Asthma
 Central Nervous Syndrome 
Disorders
 Liver Failure
 Reye’s Syndrome
 Hyperthyroidism
 Salicylate Poisoning
 Mechanical Ventilation

bilirubin

produced from catabolism of hem-containing proteins Unconjugated (indirect): lipid soluble, bound to albumin. Conjugated (direct): water soluble and able to be eliminated. Unconjugated is converted to conjugated by liver or by phototherapy. Albumin is needed to transport bilirubin to the liver.

sodium

135-145 | helps conduct neuromuscular impulses, maintain intravasular osmolarity, and acid-base balance

Potassium

3.5-5.5 responsible for cardiac and skeletal muscle contraction abnormal can cause weakness an arrhythmias

chloride

96-111 Works with Na+ to maintain acid/base balance, transmit nerve impulses, and regulate fluid in and out of cells

Calcium

Term: iCa >1.1, serum Ca 8.0-10.8 Preterm: iCa>1, serum Ca 7-10.8 Needed for bone mineralization. Because dietary intake is decreased in the first few days, serum concentration decreases in the first day of life. ~30% will develop hypocalcemi in first 2 days, usually improves in 1-3 days with feedings, renal phosphorus excretion, and improved parathyroid function

Phosphorus

5-7.8 Needed for bone mineralization, erythrocyte function, cell metabolism and the generation and storage of energy

Magnesium

1.6-2.8 Needed for energy production, cell membrane function, and protein synthesis. HpoMg is often seen with hypoCa; need to correct hypoMg to correct hypoCa