Neonatology Flashcards
acrocyanosis
cyanosis of the extremities
antepartum
before the onset of labor
APGAR score
a numerical system of rating the condition of a newborn. It evaluates the newborn’s Appearance (skin color), Pulse (0,100), Grimace (reflex irritability: 0, grimace, cry), Activity (muscle tone: 0, some, active), and Respiratory Effort (0, slow, strong cry).
birth injury
avoidable and unavoidable mechanical and anoxic trauma incurred by the newborn during L&D.
choanal atresia
congenital closure of the passage between the nose and pharynx by a bony or membranous structure
cleft lip
congenital vertical fissure in the upper lip
cleft palate
congenital fissure in the roof of the mouth, forming a passageway between oral and nasal cavities.
DeLee suction trap
a suction device that contains a suction trap connected to a suction catheter. The negative pressure that powers it can come either from the mouth of the operator, or, preferably an external vacuum force.
diaphragmatic hernia
protrusion of abdominal contents into the thoracic cavity through an opening in the diaphragm
ductus arteriosus
channel between the main pulmonary artery and the aorta of the fetus
extrauterine
outside the uterus
glottic function
opening and closing of the glottic space
herniation
protrusion or projection of an organ or part of an organ through the wall of the cavity that normally contains it.
hyperbilirubinemia
an excessive amount of bilirubin – the orange-colored pigment associated with bile – in the blood. In newborns, the condition appears as jaundice. Precipitating factors include maternal Rh or ABO incompatibility; neonatal sepsis, anoxia, hypoglycemia, and congenital liver or gastrointestinal defects.
intrapartum
occurring during childbirth
isolette
also known as an incubator; a clear plastic enclosed bassinet used to keep prematurely born infants warm. The temperature of an isolette can be adjusted regardless of the room temperature. Some isolettes also provide humidity control.
meconium
dark green material found in the intestine of the full-term newborn. It can be expelled from the intestine into the amniotic fluid during periods of fetal distress.
meningomyelocele
herniation of the spinal cord and membranes through a defect in the spinal column.
nasogastric tube / orogastric tube
a tube that runs through the nose or mouth and esophagus into the stomach; used for administering liquid nutrients or medications or for removing air or liquids from the stomach.
neonatal abstinence syndrome
A generalized disorder presenting a clinical picture of CNS hyperirritibility, gastrointestinal dysfunctions, respiratory distress, and vague authonomic symptoms. It may be due to intrauterine exposure to heroin, methadone, or other less potent opiates. Nonopiate CNS depressants may also cause NAS.
neonate
an infant from the time of birth to one month of age.
newborn
a baby in the first few hours of life; also called a newly born infant
omphalocele
congenital hernia of the umbilicus.
PEEP
positive end-expiratory pressure
persistant fetal circulation
condition in which blood continues to bypass the fetal respiratory system, resulting in ongoing hypoxia
phototherapy
exposure to sunlight or artificial light for therapeutic purposes. In newborns, light is used to treat hyperbilirubinemia or jaundice
Pierre Robin syndrome
unusually small jaw, combined with a cleft palate, downward displacement of the tongue, and an absent gag reflex.
polycythemia
an excess of red blood cells. In a newborn, the condition may reflect hypovolemia or prolonged intrauterine hypoxia.
thyrotoxicosis
toxic condition characterized by tachycardia, nervous symptoms, and rapid metabolism due to hyperactivity of the thyroid gland.
vagal stimulation
stimulation of the vagus nerve, which in turn slows the heart rate.
Antepartum factors indicating possible complications in newborns:
multiple gestation; inadequate prenatal care; mother’s age -16 or +35; Hx of perinatal M and M; post-term gestation; drugs/meds; toxemia, HTN, DIA
Intrapartum factors indicating possible complications in newborns:
premature labor; meconium stained amniotic fluid; early rupture of membranes (>24h); narcs w/in 4h of delivery; abnormal presentation; prolonged labor or precipitous delivery; prolapsed cord or bleeding
Factors that stimulate baby’s first breath include:
mild acidosis, initiation of stretch reflexes in lungs, hypoxia, hypothermia
Newborn normal vital signs
40-60RR; 150-180HR at birth, 130-140 after
APGAR
Appearance; Pulse Rate; Grimace; Activity; Respiratory Effort
Appearance 0-2
0: blue, pale;
1: acrocyanotic;
2: pink
Pulse Rate 0-2
0: absent;
1: 100
Grimace 0-2
0: no response;
1: Grimace;
2: Cries
Activity 0-2
0: Limp;
1: flexion of extremities;
2: active motion
Respiratory Effort 0-2
0: absent;
1: slow and irreg;
2: strong cry
Inverted pyramid of neonatal resuscitation, 6 steps
1: drying, warming, positioning, suction, tactile stimulation
2: O2
3: BVM
4: Cx Compressions
5: Intubation
6: Meds
When to ventilate newborn?
HR less than 60 or
60-80 that does not improve
When to intubate newborn?
CPR can't ventilate with mask tracheal suctioning prolonged ventilation diaphragmatic hernia inadequate respiratory effort
Newborn intubation considerations
Use size 2.5 for tiny, 3.5 for small, 4.0 for big.
Use PEEP, 2-4 cmH2O
Use NG or OG tube if allowed
When to give chest compressions to newborn?
HR
Hypovolemia in infants, treatment
Start w/ 10mL/kg crystalloid (NO Dextrose!) over 5-10m
May need 40-60 mL/kg
Diaphragmatic Hernia assessment findings
little to severe distress dyspnea and cyanosis unresponsive to ventilations small, flat (scaphoid) abdomen bowel sounds in chest heart sounds displaced to right
Diaphragmatic Hernia treatment
position with head and thorax higher than abd and feet
NG or OG tube with low, intermittent suctioning
DO NOT USE bag valve mask ventilation
If necessary, ventilate cautiously through ETT
Epinephrine for neonatal resuscitation:
0.01 mg/kg IV/IO
Most common cause of bradycardia in newborn…
hypoxia
caput succedaneum
a large scalp hematoma, developed during birth process and usually resolved over the first week of life.
Newborn hypothermia findings
pale, cool skin acrocyanosis respiratory distress to apnea bradycardia irritability to lethargy
Newborn hypoglycemia findings
twitching or SZ limpness lethargy eye rolling high-pitched cry apnea or irregular respirations, cyanosis
Causes of neonatal diarrhea:
infection gastroenteritis lactose intolerance phototherapy neonatal abstinence syndrome thyrotoxicosis cystic fibrosis
newborn hypovolemia findings:
pale, cool skin diminished peripheral pulses delayed capillary refill when warm AMS oliguria: dark urine or dry diaper
Most of fetal development that could lead to congenital problems occurs during:
first trimester
neonatal SZ causes:
sepsis, fever, hypoglycemia, hypoxic-ischemic encephalopathy, metabolic disturbances, meningitis, developmental abnormalities, or drug withdrawal
The most common cause of cardiac arrest in a newborn is
hypoxia
The most common form of congenital heart disease
Ventricular Septal Defect
Vomiting in the neonate is usually caused by
an anatomical abnormality; or a symptom of ICP or infection
Neonatal Apnea causes:
Narcotic or CNS Depressants Respiratory muscle weakness Sepsis Metabolic Disorders CNS disorders
Patent Ductus Arteriosus
ductus arteriosus fails to close
Atrial Septal Defect
a hole between the atria allows commixing of blood
Ventricular Septal Defect
a hole between the two ventricles
Tetralogy of Fallot
- overriding aorta
- VSD
- right ventricular hypertrophy
- pulmonary outflow tract stenosis
Transposition of the great vessels
normal outflow tracts of the right and left ventricles are switched
coarctation of the aorta
narrowing in the arch of the aorta that obstructs blood flow
pulmonary stenosis
problem with the pulmonary valve that obstructs flow
aortic stenosis
problem with the aortic valve that obstructs flow
