Neonates

Question 1

Jaundice

Answer 1

Yellowing of skin and whites of eyes (sclera) as a result of bilirubin build up

Normally RBCs breakdown in liver and are released into intestines as bile; in jaundice the bilirubin is absorbed back into the body from the intestines

Question 2

Diaphragmatic tear

Answer 2

Abnormal opening in the diaphragm that allows abdominal contents to enter the chest cavity

S/S: decreased breath sounds, scaphoid (sunken) abdomen, cyanotic
Requires ET tube and OG tube to intermittently suction; BMV causes intestinal distension

Question 3

Spina Bifida Occulta

Answer 3

Malformation of the vertebrae that creates a small gap, but no protruding contents (“closed” spina bifida)

Question 4

Menginocele

Answer 4

A sac containing spinal fluid protrudes through a gap in the vertebrae

Question 5

Myemenginocele

Answer 5

The spinal canal and backbone do not close and the spinal cord and meninges protrude

Question 6

Types of neonatal seizures

Answer 6

Subtle seizure - sucking, blinking, pedalling legs, eye deviation

Tonic seizure - extension of limbs

Focal clonic seizure - localized jerking

Myoclonic seizure - repetitive flexion jerking

Question 7

Causes of neonatal seizures

Answer 7

Hypoxic ischemic encephalopathy (secondary to perinatal asphyxia) - usually within first 24 hours, and can lead to severe developmental and cognitive delays, or motor impairment

Hypoglycemia - jitteriness, stupor, hypotonia (floppy), poor feeding, seizures

Question 8

Average temperature of a newborn and neonate

Answer 8

Newborn = 37.5

Neonate = 36.6 - 37.2

Most heat loss is caused by evaporation

Question 9

Nonshivering thermogenesis

Answer 9

Production of heat by metabolism and the primary source of heat in a neonate (brown fat)

Brown adipocytes contain numerous smaller droplets and a higher number of iron-containing mitochondria
Contains more capillaries than white fat since it requires more oxygen than most tissue
Stored around the scapula, kidney, adrenal glands, neck, and axilla

Question 10

Risk factors for hypothermia

Answer 10

< 36 degrees

• All neonates in first 8-12 hours
• Home delivery
• Prolonged resuscitation
• Small gestational age
• CNS problems
• Prematurity
• Sepsis
• Not keeping infant warm during transport

Question 11

Effects of heat loss on a neonate

Answer 11

Increased metabolic function to overcome heat loss, resulting in hypoglycemia, metabolic acidosis, and hypoxemia

Question 12

Signs and symptoms of hypothermia

Answer 12

• Pale
• Skin cool to touch
• Acrocyanosis or central cyanosis
• Respiratory distress or apnea
• Bradycardia
• Irritability changing to lethargy

Question 13

Risk factors for hypoglycemia

Answer 13

Disorders of fetal growth and maturity (SGA, LGA, twins)
Premature (<37 weeks)
Disorders of maternal glucose regulation
Neonatal conditions (distress, hypoxemia, shock)
Severe anemia
Congenital anomalies/genetic disorders

Neonates are only age group to develop hypoglycemia without having diabetes

Question 14

Signs and symptoms of hypoglycemia

Answer 14

Cyanosis, apnea, irritability, poor feeding, hypothermia
Lethargy, tremors, seizures, coma
Tachycardia, tachypnea, vomiting

Question 15

Signs and symptoms of severe diarrhea

Answer 15

Ill appearance, poor vital signs, cap refill > 2 seconds, dry mucous membranes, absent tears, weight loss, low urine output

Question 16

Causes of delayed transition

Answer 16

Hypoxia
Hypothermia
Acidosis
Meconium aspiration or pneumonia
Delayed resorption of lung fluid
Maternal narcotics or anesthesia

Question 17

Foramen ovale

Answer 17

Hole between the right and left atrium that allows oxygenated O2 to mix with blood in the left ventricle bound for the aorta

Shunts most of the oxygenated blood from the right atrium to the left atrium rather than through the pulmonary system

Question 18

Ductus arteriosus

Answer 18

Connects the pulmonary artery to the aorta, bypassing uninflated lungs

Question 19

Fetal circulation after birth

Answer 19

Pressure on the chest from the birth canal squeezes fluid from the lungs - the first breath inflates the lungs - ductus arteriosus, ductus venosus, and foramen ovale constrict/collapse after birth

Infants hands and feet remain bluish until the process is complete

Question 20

Transition of bypasses (before vs after)

Answer 20

Umbilical vein - ligamentum teres
Ductus venosus - ligamentum venosum
Foramen ovale - fossa ovals
Ductus arteriosus - ligamentum arteriosum
Umbilical arteries - medial umbilical ligaments

Question 21

Positive pressure ventilation criteria

Answer 21

Heart rate less than 100
Apnea
Persistent central cyanosis

Ventilate with room air if born to term; ventilate with 100% oxygen if born < 32 weeks
Re-evaluate heart rate, and begin compressions if <60