Newborn Flashcards
Harlequin color change
dramatic confluent red color change of dependent part of body, the other half is pale. Lasts for 30s-to 20minutes and resolves with increased activity. Up to 10% of infants undergo this color change that occurs between day 2-5 of life. 2/2 autonomic dysregulation. Seen more commonly in LBW infants
What is considered the neonatal period?
1st month of life
When does myelination of the cortex begin?
starts at 8 months gestation, complete by 2 years.
What should rate of growth be during first month?
30g/day. This is the period of fastest postnatal growth
By when does birthweight double?
4 months
What should 2-4 mo old sleep pattern be?
Needs 14-16 hours of sleep per day, with 9-10 concntrated at night and 2 naps through day.
When do babies start to “sleep through night”
70% sleep for 6-8 hours straight by 6 months
By when does birthweight triple?
1 year
At what age are they expected to sleep through night
Add 2 hours to age in month - expected amount of hours sleep through night.
When can start using OTC cold meds
at earliest age 6
How much should newborns be eating in the first week
1-2 oz q1-2 hours
How much should newborns be eating in first month
3-4oz q2-3 hours
Signs of a successful latch
Audible swallowing noises without clicking noises from the infant’s mouth (may not be audible in the very early days, but should be visible)
Infant nose aligned to nipple with head tilted backwards
Full rounded cheeks, no dimpling cheeks
Rhythmic jaw movements
Treatment of sore nipples?
An over-the-counter product, lanolin, can also be applied to the affected area and does not need to removed before nursing. This product is 100% natural and comes from the raw wool grease of sheep’s wool.
How much should babies gain in first 2-3mos of life
she/he should gain somewhere between 4 to 7 ounces a week
When do newborn stooling patterns change?
At around 6 weeks of life, the stools may become less frequent, even as infrequent as every 3 days for breastfed infants.
Signs of adequate milk intake?
Bowel movements: 3-4 or more every 24 hrs.
Urination: 6 or more times every 24 hrs.
Baby is content between feedings
Average weight gain: 5-7 ounces/week (100 -
200 gms per week
When should nipple shields be used
temporarily if woman has inverted nipple or very sore nipples
up to what age is thrush ok in normal baby?
6 months after 6-12 months , raised concern for immunodeficiency. Ask if mom has rash, contaminated vitamin dropper, etc?
Similac special care
Premature infant formula (<34 weeks)
Enfamil Premature
Premature infant formula (<34 weeks)
Good Start Premature
Premature infant formula (<34 weeks) partially hydrolyzed whey
Neosure
Transition NICU Discharge; intact proteins
Enfacare
Transition NICU Discharge; intact proteins
Good Start Nourish
Transitional NICU Discharge formula; partially hydrolyzed whey.
Similac Advance
Standard formula whey 18: casein 82
Enfamil Premium
Healthy Term Infant whey 100: casein 0
Enfamil Gentlease
For mild GI discomfort; partially hydrolyzed proteins
Good start Protect
partially hydrolyzed proteins for mild GI discomfort. Has probiotics
Good start Gentle
partially hydrolyzed proteins for mild GI discomfort. Has Prebiotics
Good Start soothe
partially hydrolyzed proteins for mild GI discomfort. Has probiotics and less lactose.
Complete elemental formulas
Neocate Infant, Elecare Infant, Nutramigen AA
Nutramigen Enflora
Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.
Pregestimil
Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.
Alimentum Advance
Entensive hydrolyzed proteins (casein), lactose free. For family history of food allergies or sensitive to casein and soy.
What is included in the biophysical profile?
Non-stress test, fetal movement, reactive HR, Breathing, Tone, AFI - get either 0 or 2 for each. total score of 8-10 is normal.
What can cause false negative in newborn screen?
Drawn
What can cause false positives in newborn screen?
TPN, antibiotics, hemoglobinopathies
Placental Accreta
the uterus lacks normal decidua because of previous trauma ( curettage, myomectomy, or c section
Placental percreta
develops when the placenta penetras the scars in placental accreta, resulting in serious hemorrhage
Placental abruption
develops when a firm blood clot forms after a retroplacental hemorrhage
What is the difference between primary and secondary apnea?
Primary apnea can be reversed with tactile stim, for secondary apnea, oxygen and stim will not work. PPV is needed. Both types can occur in utero and it is difficult to tell the difference, thus when a baby is born and is apneic, you are quick to start PPV in case this is secondary apnea.
Causes of increased AFP
Renal (renal agenesis, nephrosis, polycystic kidney disease), abd wall defects, NTD, incorrect dates, multiple gestation
When is the quad screen done?
15-20 weeks
Causes of decreased AFP
TRisomy 13, 18, 21, incorrect fetal age, IUGR, fetal demise
Increased AFP, normal hcg, uE3
NTD
Low AFP, increased hcg, low uE3
trisomy 21
Low AFP, low hcg, low uE3
trisomy 18
What is a non stress test
done in 3rd trimester, 20 minutes of continuous monitoring for fetal HR and movement. Measures autonomic system integrity
Contraction stress test
Done at >34 weeks. Mom given oxytocin to cause contractions. Look for decels. Measures uteroplacental insufficiency and tolerance of labor
What test is used to test lung maturity?
lecithin:sphingomyelin ratio. If greater that 2, low risk for RDS. This helps decide about giving antenatal steroids. MAternal diabetes can mess up this ratio
How does hypermagnesemia present in the newborn?
respiratory depression, failure to pass meconium, lethargy, flaccidity, hyporeflexive, poor feeding. IV Ca and mag will reduce levels
How can you remember blood pressure parameters in preemies?
MAP should equal GA
What is unique about preemie formula
24kcal/oz, higher ca and phos, more MCT, whey:casein 60:40
aplasia cutis
ulcerated, noninflammatory, well demarcated congenital absence of skin that is usually limited to a small area. Associated with Trisomy 13. Self resolves with epithilization and atrophic, hairless scar over a few weeks
What are congenital cataracts associated with?
rubella, toxo, CMV congenital infections
What percent of hemoglobin is fetal at birth?
50%
When do you trewat plycythemia in a newborn
when >70%. Partial exchange transfusion
When is the nadir of Hgb in full term vs preemie infants?
Full tern 2-3 months, preemie 1-2 months. Also preemies start with a low hgb
What is the Apt test?
tests newborns gastric secretions to determine if it in actual swallowed maternal blood
What is a neoanatal side effect of turbutaline?
leads to hyperinsulinism and hypoglycemia
Widely spaced nipples with shield chest - associated with which conditions
Turners and noonan
Why do infants of diabetic mothers have higher risk of RDS?
bc insulin seems to block the development of enzymes necessary for the synthesis of lecithin, a precursor of surfactant
Which heart abnormalities occurs in infants of diabetic mothers (type 1)
hypertrophic CM (however this serlf resolves by 3-6 months. Septal defects, TOGA, Truncus arteriosus, coarctation
Who gets prophylactic surfactant at birth
infants 50% FiO@ for PaO2>50mmHg
Describe lithium in pregnancy and breastfeeding
Lithium use in pregnancy poses some risks but is not completely contraindicated during pregnancy. It is associated with an increased risk for a few birth defects as well as other problems that may develop in the second trimester, and may also cause transient feeding and respiratory problems at birth. Mothers who require lithium to address a serious psychiatric disorder should not breastfeed while taking this medication
Which signs and symptoms suggest persistent pulmonary hypertension of the newborn
tachypnea with cyanosis, hypoxia more severe than imaging suggests, greater O2 sats in upper body (due to R to L ductus shunting), prominant precordial pulse, tricuspid regurg murmur, loud, narrowly split P2
What is Wilson-Mikity Syndrome?
Interstitial pulmonary fibrosis syndrome. Seen in infants
What workup does a well appearing infant, of any GA who mother had chorio need?
limited eval (CBC and blood cultlure with diff) and need empiric antibiotics until cultures are 48 hours neg
Management of a GBS positive mother, well appearing infant, adequate GBS prophy
> 48 hours of observation (or 24 if there is experienced observer or prompt access to medical care)
If well appearing, > or =37 weeks, inadequate prophy and ROM
needs 48hours obs
If infant is well appearing, inadequate prophy, 18 hours,
should undergo limited eval and observe for 48 hours
What is postive end pressure ventilation helpful in infants with PDA?
it helps to decrease the amoutn of left to right shunting through the PDA, leading to increased systemic blood flow
What are contraindications to indomethacin therapy for closing PDA
Nec, serum Cr>1.6, UOP
Whats the highest APGAR a VLBW infant can get
6 (2 for HR, 1 breathing, 1 color, 1 flexion, 1 grimace)
How do you define direct hyperbilirubinemia?
direct hyperbilirubinemia, which is defined by a serum direct bilirubin concentration of more than 1.0 mg/dL (17.1 µmol/L) with total bilirubin values of less than 5.0 mg/dL (85.5 µmol/L) or greater than 20% of the total bilirubin for values greater than 5.0 mg/dL (85.5 µmol/L).
What is the abnormal enzyme in galactosemia?
galactose-1-phosphate uridyltransferase level
What do intraabdominal calcifications suggest
meconium peritonitis
which parts of the bowel are most often affected by NEC
distal ileum and proximal colon
What are reasonable antibiotic regimens for treating NEC
vancomycin, gentamicin and clinda OR metronidazole OR zosyn
What score on a biophysical profile suggests need for urgent delivery
4 or less
What conditions is hirschsprungs associated with?
Waardenbergs, Downs, Bardet-Biedl syndrome, multiple endocrine neoplasia type 2, Smith-Lemli-Opitz
What is used as the CF newborn screening test?
immunoreactive trypsinogen levels
how is hemoglobin nadir different in preterm than term infants?
Preterm start with lower hct, reach nadir sooner and recover slower
What is molded baby syndrome?
When have too little amniotic fluid and results in torticollis, metatarsus adductus, and DDH. may include head molding, postural torticollis, congenital scoliosis, pelvic obliquity with altered hip movement, and malposition of the knees and feet.
Below what age do most cases of IVH occur?
