Newborn Flashcards
What is in a Biophysical profile?
LAMB
limbs (flexion + extension), amniotic fluid volume, movements, breathing
What to assess in a Newborn exam
Measurements: head circ, chest circ, weight, length
Skin: turgor, vernix
Head: fontanelles, sutures palpable
Eyes: red reflex, PEARL
Ears: startle reflex
Nose: nostrils patent bilaterally
Mouth + throat: uvula midline, tongue moves freely, sucking reflex, rooting reflex, gag reflex
Neck: clavicles, head turns easily
Chest: nipples
Abdo: soft, 3 vessel cord, bilat femoral pulses, bowel sounds
Genitalia: palpable tests
Back + rectum: patent anus, intact spine
Extremities: equal movement + tone, full ROM in joints, negative hip click, palm + sole creases present
Down syndrome features
Rounded head
Third fontanelle
Brachycephaly
Up slanted palpebral fissures
Epicanthal folds
Large tongue in small mouth
Transverse palmar creasers
Hypotonia
Wide gap between 1st + 2nd toe
Fetal alcohol syndrome features
Smooth philtrum
Thin, smooth vermilion border of upper lip
Microcephaly
Hearing loss
DDx of high unconjugated bili
Overproduction (hemolysis)
Impaired hepatic uptake (reduced blood flow, drugs)
Impaired conjugated (Gilber or Crigler-Najjar)
What are RF for severe hyperbilirubinemia in babies?
Jaundice in first 24h of life (always pathologic)
Positive direct antiglobulin test (DAT/Coombs)
Known hemolytic disease (G6PD)
Premature
Previous sibling with severe hyperbilirubinemia/phototherapy
Bleeding/bruising (cephalohematoma)
East Asian
Exclusive breastfeeding
Managment + ix for hyperbilirubinemia
Rule out sepsis
Phototherapy as indicated
Investigations
CBC (hemoglobin)
If no anemia, rule out liver disease
Total bilirubin
If conjugated, requires different work-up
Serum bilirubin q4h until decreasing then q12h until normal
Neonatal blood type
Coombs test (r/o autoimmune hemolysis)
Smear
Consider G6PD in severe hyperbilirubinemia or high risk population/family history
Screening for hyperbilirubinemia
TcB (Transcutaneous) screen at 72h of life and prior to discharge
Add TcB to 95% confidence interval to estimate maximum probably TSB concentration
Total serum bilirubin if abnormal TcB or clinical jaundice
What is VACTERL?
Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities
What is CHARGE?
Coloboma of the eye, heart defects, choanal atresia, retraction of growth and/or development, genital and/or urinary abnormalities, and ear abnormalities and deafness
Standard management at birth
0.5% erythromycin ointment (1cm ribbon in each eye)
Vitamin K 0.5mg IM
Universal hearing screen
r/o Hyperbilirubinemia (transcutaneous screen in first 24h)
r/o Hypoglycemia (preterm, postterm, diabetic mothers, LGA)
HBV vaccination, immunoglobulin as indicated
Criteria for d/c of newborn
Normal stable vital signs x 12 hours
Urination, stooling
Two successful feedings
No physical abnormalities requiring continued care
No excessive bleeding
Discharge instructions
Return to hospital if signs of:
Infection r/o sepsis
Fever <3 months old
Decreased alertness (somnolence)
Irritability unable to console
Vomiting
Skin Changes (eg, jaundice, cyanosis)
Dehydration
Poor feeding
Weight loss or poor weight gain
<3 wet diapers per day or no urinary output x 7h
Decreased tears
Breathing problems
Rapid breathing (>60/min)
Apnea
Using neck, chest, abdo muscle to breathe
Wheezing/noise breathing
Any other concern
Counselling about baby weight
May lose up to 10% within the first few days, but return back to birthweight at 14 days
Should gain 20-30g/d for first month
Counselling re feeding newborn
Avoid juices/water until solid foods (usually 4-6 months of age)
No honey until 1yo
Feed on demand, max q3-4h
Formula
Avoid heated in microwave (burn risk)
Breastfeeding
Technique
Consult physician before taking new medication
Vitamin D 400 units daily if breastfeeding
How many wet diapers is normal
Six+ wet diapers per day
Management of umbilical cord
Umbilical cord should fall off by 2w
Regular cleaning and dry
Watch for signs of infection (red, purulence)
Prevention of SIDS
Back to sleep, same room, different bed
Smoking cessation
Signs + sx of sepsis in newborn
Respiratory distress, respitory failure
Hypotension, poor perfusion
Tachycardia
Temperature instability
Lethargy, hypotonia
Apnea
Feeding intolerance
RF for early onset sepsis + what pathogens cause this
Early-onset (Mother’s GU: GBS, Ecoli, Coag-neg Staph, H influenzae, L monocytogenes)
Intrapartum maternal fever ≥38°C
Maternal chorioamnionitis (maternal fever, leukocytosis, maternal/fetal tachycardia, uterine tenderness, foul odour of amniotic fluid)
Maternal GBS colonization
Inadequate GBS antibiotic prophylaxis (eg. <4h prior to delivery)
Prolonged ROM ≥ 18h
Premature, LBW, Congenital anomalies, low APGAR (≤6)
RF for late onset sepsis + what pathogens cause this
Late-onset 4-90d (Caregiving environment: Coag-neg Staph, S aureus, E coli, Klebsiella, Pseudomonas, Enterobacter, Candida, GBS, Serratia, Actineobacter, Anaerobes)
Poor hygiene
Low gestational age, LBW
Indwelling central venous/umbilical catheter
Ventilator treatment
Definition of hypoglycemia in babies
Gluc <3.3 mmol/L
Sx of hypoglycemia
Symptoms
Lethargy, hypotonic
Jitter/tremors
Diaphoresis
Tachypnea or apnea
Hypothermia
Seizures
Poor suck/feedings
Sleep training advice
start at 6mo, take baby to bed when drowsy, leave for 5 mins if crying, reassure then leave again, extend intervals
Neonatal resus - first things to look for
Tone, tears, term
Key points in new NRP guidelines
practice PPV, limit suction, skin to skin, use O2 judiciously
NRP PPV
RR: 20-30 breaths/ min, use rescue airway, naloxone if opioids possible
Neonatal hypoglycemia sx
jittery, lethargic, hypotonic, sweating, weak cry, tachypnea, sz
When to give sugar to neonates
<2.6
Rx for hypoglycemia
hourly D10W if cannot feed, bolus if symptomatic, recheck glucose q30mins
Sepsis bugs in newborns
LEGS (listeria, e coli, group B strep)
Jaundice over 2 weeks, what to order?
Serum conjugated bili, Hb, group + screen, coomb’s test
Direct vs indirect coombs
direct = does baby have mom’s antibodies on their RBCs, and indirect = does mom have antibodies against baby’s RBC?
Chance of recurrence of Downs in subsequent pregnancies
1%
RF for hip dysplasia
firstborn, female, fam hx, fluid (oligo), feet (breech)
