Neonates Flashcards
Define:
extremely preterm preterm late preterm early term term post-term
extremely preterm: ≤28 weeks
preterm: 28 weeks to 34 weeks
late preterm: 34 weeks to ≤36 weeks and 6 days
early term: ≥37 weeks to ≤38 weeks and 6 days
term: ≥39 weeks to <42 weeks
post-term: ≥42 weeks
Define
extremely low birth weight (ELBW):
very low birth weight (VLBW):
low birth weight (LBW):
extremely low birth weight (ELBW): ≤1000 grams
very low birth weight (VLBW): ≤1500 grams at birth
low birth weight (LBW): ≤2500 grams
Define
small for gestational age (SGA):
appropriate for gestational age (AGA):
large for gestational age (LGA):
small for gestational age (SGA): ≤10th percentile for gestational age
appropriate for gestational age (AGA): 10th to 90th percentile for gestational age
large for gestational age (LGA): ≥90th percentile for gestational age
Preterms have the highest percentage of total fluid water relative to the body weight.
True, the percentage of total body water decreases with increasing gestational age and into adulthood.
Infants have high ratio of surface area to body weight which results in….
high evaporative losses
Insensible water losses increases with gestational age T/F
True.
In extreme preterm placing baby in bag is useful because
decreases insensible water loss.
Why preterm babies can develop hypernatremia and what do we do?
there is increase insensible water losses, leading to hypernatremia.
Can require up to 200mL/kg/day of maintenace fluids to maintain fluid losses and normal sodium levels.
Causes of hypoNa in neonates
excessive fluid resuscitation
donor human milk intake in very low weight
SIADH
HyperK is common in preterm and term infants T/F
True, some causes:
acidosis
Congenital adrenal hyperplasia
HEMOLYZED sample- so recheck
Why preterm formulas ave higher concentrations of Ca and phosphorus
They are supplied 2:1 ratio
most preterm do not obtain adequate calcium and phosphorus stores during third trimester and have a greater need to maintain bone growth than term babies
Definition of hypoglycemia
< 40 in first 48 hours of life, and PES defines it by hypoglycemia < 60 mg/dL by 48 hours of life.
Risk factors for neonatal hypoglycemia
Prematurity LGA or SGA infant of diabetic mother stress sepsis congenital disorders ( Beckwith Wiedemann Syndrome, inborn errors of metabolism) Polycythemia Materna medication exposure ( beta blockers, insulin)
Screen for glucose in neonates
within the first hour of life AFTER receiving an initial feed(formula or milk)
Infants of diabetic mother are at increased risk for
hypoglycemia shoulder dystocia hypoCa and hypoMg respiratory distress ( RDS vs transient tachypnea of the newborn) polycythemia hyperbilirubinemia congenital defects ( interventricular septal hypertrophy, Fallot, TGA) small left colon syndrome caudal regression syndrome
Fluid administration on the first day of life to <1.0 kg/<28 weeks
120 cc/kd/day
Fluid administration on the first day of life to
1 - 1.5 kg/28-32 weeks
100 cc/kg/day
Fluid administration on the first day of life to\
1.5-2.0 kg/32-36 weeks
80 cc/kg/day
Term ( >36w)
60cc/kg/d
Goals of enteric feeding ( should be introduced as fast as possible)
- promote bacterial growth and achieve adequate nutrition
In which patients do you consider NG tube.
Most preterms < 34 cannot feed by mouth, and NG can be placed until the baby develops cues and mature.
Breastmilk reduces the risk of NEC in most premature infants
TRUE.
In whom should Vit D supplementation be given
breastmilk babies.
Classification of types of formulas
Preterm formula (prot,vit, minerals, calories) Postdischarge/ transitional formulas (calcium, pO4,calories for additional growth) Hypoallergenic and elemental formulas ( ie. short gut syndrome, milk protein allergy, metabolic conditions) Term formulas
Why preterm babies have anemia
absence of iron transfer during third trimester and from iatrogenic blood loss.
ALL INFANTS SHOULD RECEIVE VIT D AND IRON supplementation once thye reach full volume feeds.
kcal of MBM and DBM ?
which carbohydrate?
19 kcal/30 mL, lactose
1 oz in ml
30 ml
Preterm formula kcal/oz
20-30
lactose and glucose
term formula kcal/oz
20
Postdischarge preterm formula
22, lactose
Contraindications of enteral feeding
hemodynamic instability
NEC
GI obstruction
When giving TPN what should be monitored
Glucose levels when increasing or decreasing volume,
Electrolytes: mg, ca, phosphorus, aa
Na and K.
How much weight loss is expected in preterms and terms in the first week of life, and when do they regain it?
10-15% in the first week.
regain this by day 10 -14%
What is the rate for weight gain after gaining back their birth weight in :
<2 kg
>2 kg
< 2 kg: 15-20 g/kg/day
> 2 kg: 20-30g/kg/day
How many cm do infants typically grow per week in lenght and head circumference
1 cm/week lenght
and 1cm/week in HC
Fenton growth chart
combines info from the WHO and IU growth charts to estimate growth at varying gestational ages
Olsen growth chart
for preterm infants combines multicenter data to reflect actual growth in the NICU rather than expected intrauterine growth.
persistent hypoglycemia most often results from
congenital or genetic defect in regulating secretion of insulin, deficiency of
cortisol and/or growth hormone, or defects in the metabolism of glucose, glycogen, and fatty acids.
Whipple’s triad
for confirming hypoglycemia
Whipple’s triad
for confirming hypoglycemia: symptoms and/or signs consistent with hypoglycemia, a documented low PG concentration, and relief of signs/symptoms when PG concentration
is restored to normal.
Which moms receive intrapartum antibiotic prophylaxis for GBS
- Women who delivered a previous infant with GBS disease, whether currently colonized or not
- Women with GBS bacteriuria during any trimester of the current pregnancy
- Women with GBS positive screening result as 35-37 weeks of gestation in the current pregnancy
- Women at onset of labor with GBS unknown who have one of the following:
a. Delivery < 37 weeks
b. Intrapartum temperture >= 38
c. ROM >18 hrs
d. Intrapartum NAAT positive for GBS
Meds for GBS in mom
Penicillin
if allergic, and low risk of anaphylaxis: cefazolin
if allergic and high risk of anaphylaxis: clindamycin
Hypermagnesemia presentation in newborns, in the setting of mom with preclampsia
respiratory depression failure to pass meconium flaccidity lethargy hyporeflexia poor feeding
- generally supportive tto
- if severe mechanical ventilation, IV calcium and diuresis
Potter sequence
characteristics due to oligohydramnios in the setting of renal disease
MC renal agenesis
lung hypoplasia, growth retardation , flattened facias ( flattened nose, low set ears, micrognathia) and limb deformities.
Definition of reactive nonstress test
2 accelerations in 20 minutes
if nonstress test is non reactive, next step?
BPP
What does a biophysical profile assess?
1.Fetal movement ( by NST) By US: 2. Fetal tone 3. Fetal reactivity 4. Fetal breathing 5. Amniotic fluid volume
points 0-2 are given to each factor
if total=<4 emergent delivery
Definition of oligohydramnios/polyhydramnios
Amniotic fluid index < 5.1 - oligo
>=24 -polyhydramnios
