Neonatology

Question 1

APGAR scoring

Answer 1

Appearance: pink(2); blue extremities(1); centrally blue, pale (0)
Pulse: >100 (2); <100 (1); absent (0)
Grimace: Cries (2); grimaces (1); no response (0)
Activity: active (2); some flexion (1); limp (0)
Respiratory: strong cry (2); slow and irregular (1); absent (0)

Question 2

Initial steps following newborn delivery

Answer 2

Bulb suction if necessary, dry, stimulate for 30 seconds. If no response, assess respiratory rate and effort, pulse, and colour.
If newborn remains centrally cyanotic provide free flow O2 and stimulation.

Question 3

Newborn resuscitation if apneic or pulse lower than 100 after 30 seconds of blow by O2 and drying.

Answer 3

BVM newborn with 100% O2 for 30 seconds at rate of 40-60/min. If newborns pulse is less than 60 BPM after 30 seconds of PPV, begin compressions.

Question 4

O2 delivery for newborn

Answer 4

Don’t blow O2 in infants eyes. Use a mask or tubing and cup hand near infants face with O2 at 5LPM. Pulse ox on upper right arm to monitor.

Question 5

Indications for artificial ventilation in newborns

Answer 5

Apnea
Pulse less than 100
Persistent central cyanosis despite 100% O2

Question 6

Chest compressions indications in newborn

Answer 6

HR less than 60 despite positioning, clearing the airway, drying and stimulation, and 30 seconds of effective BVM.

Question 7

Indications for supplementary oxygen in the newborn

Answer 7

Newborn is breathing, HR greater than 100 but pt remains cyanotic.

Question 8

CPR compression to ventilation ratio for newborn

Answer 8

3:1 compressions to ventilations at a rate of 90 compressions and 30 ventilations per minute.
Compressions should be 1/3 the diameter of the chest.

Question 9

Respiratory depression secondary to narcotic administration in newborn

Answer 9

Provide ventilation support and transport immediately if mother used chronic narcotics during pregnancy.
Use 0.1mg/kg if mother did not chronically use narcotics during pregnancy.

Question 10

4 major types of neonate seizures

Answer 10

Subtle: bicycling, eye deviation, blinking, sucking, apnea
Tonic: usually extension, sometimes flexion of extremities. More common in premature infants.
Focal clonic: localized jerking
Myoclonic: flexion jerks of upper or lower extremities.

Question 11

Common causes of newborn seizures

Answer 11

Hypoxia ischemic encephalopathy 
Hypoglycemia 
Hypocalcemia 
Meningitis
Intracranial hemorrhage 
Developmental defects
Epilepsy

Question 12

Hypoglycemia in the newborn

Answer 12

BGL equal to or less than 2.6 considered medical emergency.

Give D10W at 2ml/kg. Can use glucagon if IV access cannot be established.

Question 13

Only reliable measurement of temperature assessment in infants younger than 2 years

Answer 13

Rectal temperature.
Oral is 0.6 degrees lower
Axillary is 1.1 degree lower.

Question 14

Normal temperature of a newborn

Answer 14

37.5 degrees

Question 15

Normal temperature for a neonate

Answer 15

36.6-37.2 degrees