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*CPS Statements TD > Newborn > Flashcards

Newborn Flashcards

1
Q

Risk factors in newborns for potential issues

A
  • Maternal medical and mental health concerns, positive family history
  • Psychosocial and/or socio-economic stressors, domestic violence
  • Maternal medications, smoking, alcohol, or substance use
  • Abnormal prenatal screening and ultrasound findings
  • Birth weight
  • Maternal hepatitis B surface antigen, syphilis, HIV, or rubella status
  • Maternal blood group and antibodies
  • Risk factors for infection, including maternal Group B streptococcal colonization status or intrapartum antibiotic prophylaxis
  • Abnormal glucose homeostasis
    Developmental dysplasia of the hip
  • Birth injury
  • Apgar score, need for stabilization at birth, and/or low umbilical cord pH
  • Risk factors for early-onset neonatal jaundice
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2
Q

What are abnormalities sometimes missed on newborn exam

A

cleft palate and imperforate anus

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3
Q

Term newborn discharge - what is on check list

A

Maternal readiness

  • Mother provides routine infant care, including feeding, in a safe and confident manner
  • Mother demonstrates knowledge of how to recognize illness in her infant and when to seek help
  • Psychosocial and environmental risk-factors have been assessed, with an appropriate follow-up plan

Infant health

  • Physical examination by health care provider
  • Birth weight, length and head circumference measurements obtained
  • Normal, stable temperature, heart rate and respiratory rate
  • Passed urine
  • Passed meconium
  • Weight loss <10%; if approaching or >10%, a follow-up plan has been arranged
  • Minimum of 2 successful feeds
  • Antenatal and perinatal risk factors (e.g., sepsis) have been evaluated
  • Maternal serology reviewed
  • If circumcision performed, no excessive bleeding at site
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4
Q

What tests need to be done before discharge of healthy term infant (4)

A
  • Newborn screen at 24 h (must be repeated within 7 days if administered before 24 h)
  • Hearing assessment completed or arranged
  • Bilirubin screening – results reviewed and follow-up arranged, if required
  • Pulse oximetry screen performed
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5
Q

What parental education needs to be done before discharge of health term infant

A
  • Routine infant care
  • Infant safety and injury prevention (including car seat safety, safe sleep practices, sudden infant death syndrome risk reduction)
  • Feeding
  • When to seek medical help
  • Care of circumcision site, if infant is circumcised
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6
Q

Types of Vit K deficiency B

A 
early onset (first 24 hours): maternal meds that inhibit vitamin K activity, ex antiepileptics
classic (days 2 to 7): associated with low intake of vitamin K
late onset (2-12 w - 6 mo): breastfed babies
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7
Q

Vit K prophylaxis doses

A
  1. 5 mg (≤1,500 g)
  2. 0 mg (>1,500g)

If decline:
2 mg Vit K PO at first feed, repeat at 2 to 4 and 6 to 8 weeks of age.

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8
Q

When to image in HIE

A

DOL 3-5 or when rewarming has taken place

Repeat at DOL 10-14 if clinical uncertainty

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9
Q

HIE/Encephalopathy - areas of brain injury

A

Basal ganglia/thalamic lesions: cognitive and motor disability
High risk CP

Watershed pattern: more associated with cognitive issues

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10
Q

Why do we give IAP for GBS+

A

To decrease risk of early onset sepsis

NOT late onset

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11
Q

What to do - GBS+ no RF:

GBS+ mother w adeq IAP + no other RF
GBS+ mother w inadeq IAP + no other RF

A

GBS+ mother w adeq IAP + no other RF: No investigations or tx

GBS+ mother w inadeq IAP + no other RF: Careful P/E, Vitals q3-4h x24h, no CBC

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12
Q

GBS+ mom w or w/o adeq IAP + other RF:

A

Not clear, Observe 24-48h, consider CBC at 4 h

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13
Q

GBS unknown or negative + other RF

A

If single RF, can be managed same as GBS+ mother w/wo adeq IAP
If multiple RF, mgmt should be individualized

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14
Q

Maternal and neonatal risk factors for early onset bacterial sepsis in term infants

A
  • Maternal intrapartum GBS colonization during the current pregnancy
  • GBS bacteruria at any time during the current pregnancy
  • A previous infant with invasive GBS disease
  • Prolonged rupture of membranes ≥18 h
  • Maternal fever (temperature ≥ 38oC)
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15
Q

Car seat challenge - for who?

A

no one

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16
Q

What threshold should you use for pRBC transfusion in preterm infants

A

No resp support:
1st week of life: 100
2nd week of life: 85
3rd week and older: 75

Resp support:
1st week of life: 115
2nd week of life: 100
3rd week and older: 85

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17
Q

What volume of pRBC for transfusion in preterm infants

A

20ml/kg

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18
Q

Risks of neonatal circumcision

A 
Minor bleeding	
Local infection (minor)	
Severe infection
Death from unrecognized bleeding	
Unsatisfactory cosmetic results	 
Meatal stenosis
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19
Q

Benefits of neonatal circumcision

A 
Prevention of phimosis
Decrease in early UTI	
Decrease in UTI in males with
risk factors (anomaly or
recurrent infection)	
Decreased acquisition of HIV	
Decreased acquisition of HSV	
Decreased acquisition of HPV	
Decreased penile cancer risk	
Decreased cervical cancer risk in female partners
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20
Q

What are risks associated with rbc transfusions

A

Infection (viral, bacterial, etc) – viral risk 1/1 million
CMV: risk for premature infants; risk reduced with leukoreduction

Leukocyte adverse effects (graft-vs-host, TRALI, allo-immunization all rare in neonates)

Volume and electrolyte disturbances

Blood group incompatibility (transfusion errors)

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21
Q

Indications for RBC transfusion in newborns

A

hemorrhagic shock

anemia

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22
Q

Key competencies for discharge of preterm infant

A

Thermoregulation
Control of breathing (5-7days apnea free)
Respiratory stability
Feeding skills and weight gain

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23
Q

Sarnat scoring

A

Sarnat 1
Hyperalert, normal tone, tachycardia

Sarnat 2
Lethargic, mild hypotonia, weak moro, seizures, bradycardia

Sarnat 3
Stuporous, flaccid, no reflexes

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24
Q

Late preterm - at risk for?

A 
Hyperbilirubinemia
Feeding and growth 
Apnea 
SIDS
Sepsis
Hypoglycemia 
Temperature control
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25
Q

What to do w newborn if mom had chorio

A

individual
observe at least 24h
vitals q3-4h
consider CBC at 4h

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26
Q

when should you monitor vitals of a newborn

A

chorio
multiple RF
GBS+ and RF

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27
Q

Risk factors for hyperbilirubinemia

A 
Visible jaundice at younger than 24 hours
Visible jaundice before discharge at any age
Shorter gestation <38 weeks
Previous sibling with severe hyperbili
Visible bruising
Cephalhematoma
Male sex
Maternal age >25 years
Asian/European background
Dehydration
Exclusive/partial breastfeeding
28
Q

When does TSB peak

A

DOL 3-5

29
Q

When to check first bili

A

In 24-72h

30
Q

Side effects of phototherapy

A

temperature instability, intestinal hypermotility, diarrhea,
interference with maternal-infant interaction and,
rarely, bronze discolouration of the skin
increased anxiety and health care use in parents

31
Q

When to refer brachial plexus injury?

A

1 month

32
Q

What nerves for Brachial plexus

A

C5-T1

33
Q

What percent of neonatal brachial plexus injury will have full injury?

A

75% full recovery

34
Q

Indications for surfactant therapy

A

Intubated infants with RDS
Intubated babies with meconium aspiration syndrome and > 50% FiO2 need
Sick newborns with pneumonia and oxygenation index >15
Intubated newborns with pulmonary hemorrhage and clinical deterioration

35
Q

Xray of RDS

A

ground glass appearance,
air bronchograms,
↓ lung vol

36
Q

Who should receive prophylactic surfactant?

A

<26 WGA

26-27 WGA If no steroids

37
Q

Risks of surfactant

A 
 Short term: 
bradycardia, 
hypoxemia, block ETT, 
pulm hemorrhage,
hyperventilation secondary to spontaneously increased FRC and lung compliance
 Long term: 
antibody formation against surfactant, 
possible transmission of infection (prions)
38
Q

What systems does NAS affect?

A

CNS, respiratory and GI effects

39
Q

what % of infants of moms on opioids will require tx for NAS

A

50-75%

40
Q

When do sx of NAS present?

A

usually within 48-72 hours,

up to 5-7 days
can last up to 30 days, with mild symptoms up to 6 months

41
Q

Finnegan score

  • what are sx
  • how long/often
A

CNS: cry, sleep, exaggerated moro, tremors, tone, myoclonus, seizures.
Metabolic/Resp: sweating, fever, yawning, mottling, stuffiness, nasal flare, tachypnea
GI: excessive sucking, poor feeding, emesis, loose stools

42
Q

Non-Pharm interventions for NAS

A

Skin-to-skin, swaddling, gentle waking, quiet environment, minimal stimulation, low lighting, music and massage.
Encourage breastfeeding

43
Q

Pharm interventions for NAS

A

Morphine and Methadone

Adjuncts: phenobarbitals and clonidine

44
Q

Factors important in Communicating w Families w a Perinatal Loss

A

Should be guided by honesty and respect
Info should be provided in a clear, timely and sensitive way to enhance SDM
Both parents should be present if possible
If diff language, should have interpreter present
Should have enough time for dialogue, questions and emotional expression
More than one encounter is usually needed
Should occur in quiet, private space
Small group > large, conference style
“Baby” instead of “fetus” - use name if named

45
Q

Lesions detectable using pulse ox screening

A 
HLHS
Pulmonary atresia w intact vent septum
TOF
TGA
Tricuspid Atresia
TAPVR
Truncus arteriosus
46
Q

Pulse oximetry screening - who and when

A

WHO: all term and late preterm
For asymptomatic infants in nonacute setting
WHEN: recommended 24-36 hours after birth
Flexible - can be done during day, with other tests/events
**Should be done after 24 hours

47
Q

Pulse ox screening

  • how
  • pass/fail
A

Should test RIGHT HAND and ONE FOOT

FAIL: SaO2 < 90%
BORDERLINE: SaO2 in any limb of 90-94% or >3% difference btwn limbs

48
Q

Who to screen for ROP and when

A

Either GA <31 wga
OR BW ≤ 1250g

at 31 wga or at 4 weeks old, whichever is first

49
Q

Tx for ROP

A

Tx: retinal ablation (conventional) and intravitreal injection of antivascular endothelial growth factor (anti-VEGF)

50
Q

advantages of kangaroo care

A

helps stabilize vitals
KC increases sleep time and more organized sleep
Long term - improved neurodevelopmental outcomes
assoc w better Breastfeeding
Decreased infections, NEC and improved growth and neurodevel outcomes
Decreases incidence of nosocomial infections
Improves mother infant bonding b/c NICU separates

51
Q

How prem can you do kangaroo care

A

26wga

52
Q

complications of iNO

A

production of NO2 and methemoglobin, decreased platelet aggregation, increased risk of bleeding and surfactant dysfunction.

53
Q

Who to treat with iNO
age
indications

A

Infants >35 weeks GA (not as effective in prem)
Hypoxemic respiratory failure
Echo to rule out cyanotic heart disease, and to assess for Pulm HTN/cardiac function
OI > 20-25, or PaO2 < 100 despite ventilation with 100% oxygen

54
Q

What percent of preterm infants born at ≤32+6 weeks gestational age (GA) show an abnormal brain image (IVH or parenchymal lesions) on cranial ultrasound

A

21%

55
Q

Who should receive steroids

A

≤34+6 wga with risk of delivery in the next 7 days

56
Q

Who should receive MgSO4

A

mothers at risk for imminent delivery of an infant ≤33+6 weeks GA in the next 24 hours

57
Q

What to do if PPROM or chorio and infant <33wga

A

BCx and Abx

58
Q

What gestation to use polyethylene bag

A

<32 wga

59
Q

Preterm infants - what type of ventilation

Target pCO2

A

Volume targeted

Target PCO2 of 45-55 mmHg

60
Q

How to reduce risk of brain injury in preterm infant?

A 
Treat mother with PPROM or chorio
BCx and Abx for infant of mom w chorio
Steroids <35wga
MgSO4 <32 wga
DCC
Avoid inotropes
Consider indomethacin
Target pCO2 45-55
Volume controlled ventilation
Head neutral, midline, HOB 30 deg
At tertiary centre
61
Q

Cut offs for hypoglycaemia

A

First 72h: <2.6

>72h: <3.3

62
Q

Infants at risk for hypoglycemia

A

Weight <10th percentile (SGA)
IUGR
Weight >90th percentile (LGA)
IDM
Preterm infants <37 weeks GA
Maternal labetalol use
Late preterm exposure to antenatal steroids
Perinatal asphyxia
Metabolic conditions (e.g., CPT-1 deficiency, particularly in Inuit infants)
Syndromes associated with hypoglycemia (e.g., Beckwith-Wiedemann)

63
Q

NRP Resusc:

what FiO2 to start with

A

For the term infant, resuscitation should start with 21% oxygen.
For preterm infants <35 wga, recommended initial gas is 21%–30% oxygen

64
Q

NRP: what technique for compressions

A

two thumb

65
Q

what gestation do you do thermoregulation measures and what are they

A

maintaining room temperature at 23°C, preheating the radiant warmer, use of a hat, placing a thermal mattress under the radiant warmer and using a polyethylene wrap

66
Q

What do steroids do for neuroprotection

A

IVH

67
Q

What does MgSO4 do for neuroprotection

A

CP

*CPS Statements TD (17 decks)

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