Neonatal Prophylaxis and Screening

Question 1

What is the recommended eye prophylaxis for newborns?

Answer 1

Newborns should receive eye prophylaxis with 0.5% erythromycin ophthalmic ointment within one hour of birth.

Question 2

What disease is neonatal eye prophylaxis meant to prevent?

Answer 2

Gonococcal conjunctivitis.

Question 3

What is the effect of ocular prophylaxis with erythromycin opthlalmic ointment on neonatal ocular infections caused by Chlamydia?

Answer 3

Erythromycin prophylaxis prevents gonococcal conjunctivitis but is not effective in preventing chlamydial conjunctivitis.

Question 4

If a newborn does not receive Vitamin K prophylaxis, what bleeding disorder is the infant at risk for?

Answer 4

Vitamin K deficiency bleeding (formerly hemorrhagic disease of the newborn).

Question 5

What is the dose for prophylactic neonatal vitamin K?

Answer 5

Infants should receive 1 mg IM Vitamin K during the first few hours after birth to prevent Vitamin K deficiency bleeding.

Question 6

How does Vitamin K deficiency bleeding present in infants?

Answer 6

VKDB typically presents within the 1st month of life and is characterized by bleeding from mucus membranes, the GI tract, the circumcision site, and/or intracranial hemorrhage.

Question 7

List three maternal risk factors for the development of neonatal vitamin K deficiency bleeding.

Answer 7

Liver disease, anticonvulsants, and strict veganism.

Question 8

Vitamin K is an essential cofactor for which 6 molecules in the clotting cascade?

Answer 8

Factors 2, 7, 9, and 10, and proteins C and S.

Question 9

What lab findings (PT, PTT, plt) would you expect to find in an infant with vitamin K deficiency bleeding?

Answer 9

Normal platelet count and PTT. Prolonged PT.

Question 10

What should an infant born to a mother who is positive for Hepatitis B surface antigen receive soon after delivery?

Answer 10

Infants born to Hep B positive mothers must receive Hepatitis B immunoglobulin in addition to the Hep B vaccine within the first 12 hours of life.

Question 11

What should an infant born to a mother with unknown Hepatitis B status receive for prophylaxis?

Answer 11

The infant should receive the Hep B vaccine within the first 12 hours of life, but the Hep B immunoglobulin can be deferred until the mother’s results come back.

Question 12

When should infants born to Hep B positive mothers be tested for Hepatitis B infection?

Answer 12

Infants should be tested at 9-12 months of age, or 1-2 months after the most recent vaccine dose if vaccination is delayed.

Question 13

If a mother is Hepatitis B positive and her infant receives Hepatitis B vaccine and immunoglobulin at birth, what recommendation should you give the mother regarding breastfeeding?

Answer 13

It is safe to breastfeed in this scenario.

Question 14

What is the official AAP stance on neonatal circumcision?

Answer 14

In 2012, the AAP concluded that the preventive health benefits of elective circumcision outweigh the risks of the procedure.

Question 15

What are the benefits of neonatal circumcision?

Answer 15

The benefits include significant reduction in the risk of UTI in the 1st year of life and in the risk of heterosexual acquisition of HIV and transmission of other STIs later in life.

Question 16

What (11) conditions place neonates at an increased risk of hypoglycemia?

Answer 16

Infants of diabetic mothers, infants of toxemic mothers, LGA, SGA, prematurity, Low birth weight (< 2,500 g), polycythemia (Hct > 70%), hypothermia, birth depression (Apgar < 5 at 1 minute), acute illness, and a discordant twin.

Question 17

Which newborns should be screened for hypoglycemia?

Answer 17

Infants with one of the (11) risk factors for hypoglycemia, or if any of the following clinical signs are noted: tremors, jitteriness, irritability; high-pitched or weak cry; lethargy, hypotonia, poor suck; cyanosis, apnea, tachypnea; and seizures.

Question 18

What are the current intervention levels for hypoglycemia in a neonate?

Answer 18

Intervention is recommended in all neonates with a plasma glucose < 40 mg/dL during the first 24 hours of life and < 50 mg/dL after 24 hours of life.

Question 19

What is the recommended treatment for neonates with hypoglycemia?

Answer 19

Infants should receive a bolus of 200 mg/kg (2 mL/kg) of a 10% glucose solution. If hypoglycemic seizures are present, increase the dose to 400 mg/kg (4 mL/kg).

Question 20

What is the average capillary hemoglobin/hematocrit for a term newborn?

Answer 20

The average capillary Hgb is 19.3 +/- 1.2 (g/dL), and the average Hct is 61 +/- 7.4 (g/dL).

Question 21

What maternal blood type/Rh status would require testing of the infant? What testing would be most appropriate?

Answer 21

If the mother’s blood type is O or Rh negative, or if the mother has a positive antibody titer, the infant’s blood type should be determined and a direct Coombs test performed.

Question 22

What three situations might lead to erroneous results on a neonatal screen?

Answer 22

Testing before the infant is 24 hours old, testing after the infant has received a transfusion (hemoglobinopathies), and testing prior to protein feeding initiation (PKU).

Question 23

When does the AAP recommend neonates have a hearing screen?

Answer 23

The AAP recommends hearing screening for all neonates prior to hospital discharge after birth.

Question 24

What is the auditory brainstem response system?

Answer 24

ABR is a physiological measure of the brainstem’s response to sound and tests the integrity of the hearing system from the ear to the brainstem.

Question 25

What is the otoacoustic emissions test?

Answer 25

One of the two methods of hearing screening. It measures an acoustic response produced by the cochlea.

Question 26

How is cyanotic congenital heart disease screening performed?

Answer 26

Preductal (RUE) and postductal (lower extremities) pulse oximetry is assessed between 24 and 48 hours of age.

Question 27

What is considered to be a passing result for the cyanotic congenital heart disease screen?

Answer 27

Those with preductal and postductal saturations ≥95% and a pre/post difference of ≤3% are considered to have passed.

Question 28

What is considered to be a failing result for the cyanotic congenital heart disease screen?

Answer 28

Those with preductal and postductal saturations < 90% are considered to have failed the CCHD screen.

Question 29

What is considered to be an indeterminate result for the cyanotic congenital heart disease screen?

Answer 29

Those with saturations >90% but <95% or with >3% difference between pre- and post-ductal values are considered to be indeterminate.

Question 30

What is the recommended management of infants with an indeterminate cyanotic congenital heart disease screen?

Answer 30

Repeat the screen in 1 hour.

Question 31

What is the recommended management of infants with a failed cyanotic congenital heart disease screen?

Answer 31

Those who fail their screen should have an ECHO performed if other causes of low saturations have been ruled out.