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Neonate > Newborn > Flashcards

Newborn Flashcards

1
Q

Normal newborn respirations

A

30-60 breaths per minute

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2
Q

Normal newborn heart rate

A

120-160 beats per minute

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3
Q

What is the purpose of APGAR scoring?

A

Apgar scoring is used to assess neonatal need for resuscitation

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4
Q

When would a neonates pulse oximeter reading normalize?

A

1 day of life

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5
Q

How should the neonates temperature be taken?

A

Rectally is most accurate

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6
Q

Why would the clinician put their finger in a new borns mouth

A

To assess the :

  1. Sucking reflex and cleft palate
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7
Q

What does tachypnea in the infant reveal?

A
  1. Transient tachypnea of the new born.
  2. Meconium aspiration
  3. Pulmonary HTN
  4. Pulmonary hypoplasia
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8
Q

What are the 5 T’s of congenital cardiac abnormalities?

A
  1. Truncus arteriosus
  2. Transposition of the great vessels
  3. Tricuspid valve atresia
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
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9
Q

What is the diameter of the anterior fontanelle?

A

3-6 cm in diameter

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10
Q

When does the posterior fontanelle close

A

by age 2 months

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11
Q

What is the diameter of the posterior fontanelle?

A

1-1.5 cm

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12
Q

What should a neonates fontanelles look like a birth?

A

soft and flat

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13
Q

What does a sunken fontanelle indicate?

A

Dehydration

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14
Q

Hyperbilirubinemia in the infant is always benign but can be what?

A
  1. Physiologic

2. Pathologic

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15
Q

Newborn red blood cells have a half life of how many days?

A
  1. 70
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16
Q

Are newborns born with a higher hemoglobin concentration?

A
  1. Yes
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17
Q

Newborns have less hepatic conjunction, which means what occurs with the break down of RBC?

A

Less bilirubin excretion into the intentional tract

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18
Q

Unconjugated bilirubin that crosses the blood brain barrier, can cause what?

A
  1. Kernicterus
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19
Q

Hyperbilirubinemia can be a sign of what other problems in the newbord?

A
  1. Hemolytic anemia
  2. Infection
  3. Metabolic disease
  4. Liver disease
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20
Q

Unconjugated bilirubin that crosses the blood brain barrier affects with area of the brain particularily?

A
  1. Basal ganglia
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21
Q

What are the reasons a baby has a conjugated hyperbilirubinemia?

A
  1. Bile duct obstruction
  2. choledochal cyst
  3. alagille syndrome
  4. galactosemia
  5. alpha 1 antitrypsin def
  6. protein metabolism defect
  7. cystic fibrosis
  8. neonatal hepatitis
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22
Q

When is Rho-gam given

A
  1. 28 weeks gestation
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23
Q

Causes of unconjugated hyperbilirubinemia?

A
  1. Rh incompatibility
  2. Red cell membrane defect
  3. G6PD deficiency
    Pyruvate kinase defic
  4. Hemoglobinopathy
  5. Metabolic problems
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24
Q

In the newborn what is the first organ to showcase jaundice?

A

Head

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25
Q

Midline abdominal wall defect in the newborn is called where the viscera is still in the peritoneal sac

A
  1. omphalocele
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26
Q

What is a gastroschisis?

A

A full thickness defect in the abdominal wall, evisceration of bowel without covering or membrane.

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27
Q

What are associated defects in newborns with gastroschisis?

A
  1. intestinal atresia

2. undescended testes

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28
Q

Triad of an infant born after exposure to rubella

A
  1. Cataract
  2. Deafness
  3. Cardiac defects
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29
Q

Infants born with blueberry muffin spots will often have what congenital disease

A
  1. Congenital rubella
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30
Q

A drop in HGB or HCT by more than 2 standard deviations is the term for?

A
  1. Anemia
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31
Q

Which vaccines are live attenuated vaccines?

A

MMR
Varicella
Rotavirus

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32
Q

Why are live vaccines contraindicated in pregnant women and immunocompromised children?

A

They can still cause infection

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33
Q

If a patient is moderately ill which vaccine may they not respond to?

A

MMR

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34
Q

What is a side effect of the pneumococcal vaccine?

A

Fever

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35
Q

The yellow boxes CDC vaccine schedule is for what?

A

Vaccines to be given at the time of well visit

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36
Q

The CDC’s green box vaccine schedule are for what type of immunization?

A
  1. Make up vaccine
37
Q

CDC purple box vaccine schedule is for what?

A

Specific vaccines to be given at certain times

38
Q

When is the Hep B vaccine first given?

A

Immediately after birth

39
Q

When is the 2nd dose of Hep B given to the newborn

A

1 month

40
Q

When is the Rotavirus vaccine given

A

2
4
6 months of age oral vaccine

41
Q

How many versions of the Rotavirus vaccine are there?

A

There are two versions of the Rotavirus vaccine. 1 requires 2 does and one requires 3 doses.

42
Q

When is DTaP vaccine given?

A 
2 mos 1st dose
4 mos 2nd dose
3 mos 3rd dose
14 mos 4th dose
4-6 years 5th dose
43
Q

DTaP is given for children under what age?

A

<7 y/o

44
Q

After 7 years of age what version of DTaP are children given?

A

TdaP booster 7 >

45
Q

What does the A stand for in DTaP?

A

acellular

46
Q

When is HIB vaccine administered?

A
  1. mos
  2. mos
  3. mos
    12 mos
    15 mos
47
Q

When is PCV 13 administer

A

2 mos 1st
4 mos 2nd
6 mos 3rd
12 to 15 mos 4th dose

48
Q

PCV 13 vaccine is also used to prevent what infections?

A

Ear infections

49
Q

When is the polio vaccine administered?

A

2 mos 1st dose
4 mos 2nd dose
6-18 mos 3rd dose
4-6 years 4th dose

50
Q

When is the MMR vaccine given?

A

12-15 mos 1st dose

4-6 years 2 nd dose

51
Q

When is the varicella vaccine given?

A

112 to 15 mos 1 dose

4-6 years 2nd dose

52
Q

When is the Hep A vaccine administered

A

6-18 months apart

53
Q

When is the HPV vaccine given?

A

given as 2 doses at 0 and 6-12 months indicated in all adolescents 11 or 12
given as 3 doses at -, 1-2 and 6 months and all adolescents after age 15

54
Q

When is the meningitis vaccine given?

A

given at 11-12 and booster at 16 years

55
Q

What is defined as a fever in an infant?

A
  1. A Tempt of 38 Celsius/100.4 F
56
Q

What can cause fever in an infant?

A

Meningitis
Bacteria
UTI

57
Q

Babies 4-8 weeks with a fever will be treated in what way?

A
  1. Admitted to the hospital
58
Q

How does HSV present in the neonate?

A

Skin eye mouth disease
Meningitis
Disseminated HSV

59
Q

How does HSV in the neonate present?

A

Hypothermia
Seizure
Meningitis
Irritable

60
Q

When to worry about HSV in a new born

A

Age 7-28 days
irritable or seizure
Hypothermia
History of new disease in mom during pregnancy

61
Q

What test are done for newborn with HSV?

A

HSV PCR blood
HSV culture eyes, nose, mouth, rectum
HSV PCR of CSF
LFT’s disseminated HSV

62
Q

When should Acyclovir be started when HSV is suspected in a newborn?

A

After cultures are drawn

63
Q

How long should a newborn with HSV be treated with IV Acyclovir

A

2 weeks

64
Q

A newborn with meningitis disseminated HSV should be treated with IV acyclovir for how long?

A

3 weeks

and oral acyclovir for 6 months

65
Q

Bacterial infections in newborns

A 
E. Coli
Group B Strep
Strep pneumoniae
Neisseria meningitis
Enterococcus
Klebsiella
Staph Aureus
66
Q

Most common bacterial infection, newborn?

A

UTI

67
Q

How should a urine specimen be obtained in a child

A

Bag more sensitive
Cath more specific
Supra pubic tap needle in bladder

68
Q

Nitrite 98% specific most like means a child has a?

A

UTI

69
Q

Untreated sepsis in the newborn can lead to what?

A

Shock and death

70
Q

In the newborn in the WBC is above what number and below what number what do clinicians worry about? What are the quick test for bacteremia

A

15,000 or below 5 worry about bacteremia
Procalcitonin
CRP
CBC

71
Q

When should a LP be done in children under 4 weeks of age?

A 
Cell count > 21 under 1 month
>11 over 1 month
Glucose <2/3 of blood glucose
Protein >90
Gram Stain not always positive
Culture Gold standard
Enterovirus PCR if positive discontinue ABT
72
Q

How do Staph infections appear in the newborn?

A

Osteomyelitis

73
Q

What should be done for an infant under 28 days, well appearing and febrile?

A
  1. U/A and culture
    CBC/CRP/Procalcitonin
    Blood culture
    LP (almost all)
74
Q

If labs are abnormal what is the next step of action for a febrile infant under 28 days?

A
  1. admit
    AMP/Gent-AMP Strep and Listeria
    Amp/Cefotax
75
Q

How long are febrile infants monitored in the hospital?

A

24-36 hours

76
Q

What is the management protocol in a febrile infant 29-60 days?

A

UA/culture
CBC/CRP/Procalcitonin
Blood culture-labs normal discharge home
labs abnormal LP admit but only if +UA

77
Q

How is a febrile infant 61-90 days managed?

A

U/A and culture

if abnormal labs discharge home on oral ABT and close follow-up

78
Q

Why is Ceftriaxone contraindicated in infants before 28 days?

A

It can cause Kernicterus

79
Q

Which immunoglobulin is present in great amounts in breast milk?

A

IgA

80
Q

The description given to the appearance of the heart on plain film in some cases of Tetralogy of Fallot. It describes the appearances of an upturned cardiac apex due to right ventricular hypertrophy and a concave pulmonary arterial segment.

A

Boot shaped heart

81
Q

The cyanosis associated in babies with Tetralogy of Fallot results from?

A

Mixing of deoxygenated and oxygenated blood, the right heart must be under higher pressure then the left heart as a result of a septal defect

82
Q

Is the pressure in the right heart low or high

A

low

83
Q

Cyanotic congenital heart diseases involve what?

A

Left to right shunts in which deoxygenated blood does not pass through the lungs but mixes with oxygenated blood

84
Q

Besides cyanosis what are other symptoms of Tetralogy of Fallot

A
  1. Nail clubbing
  2. tachycardia
  3. tachypnea
  4. inadequate feeding
  5. delay of reaching development mild stones
85
Q

What are the 4 features with cyanotic congenital heart disease?

A
  1. Pulmonary stenosis
  2. right ventricular hypertrophy
  3. overriding aorta
  4. ventricular septal defect
86
Q

What is a tet spell?

A
  1. Babies turning blue when feeding
87
Q

How is tetralogy of fallot diagnosed

A

transthoracic echocardiogram
heart ultrasound
doppler flow
x-ray may reveal boot shaped heart due to right ventricular hypertrophy

88
Q

How is tetralogy of fallot treated

A

with surgery generally in the first year of life

Neonate (6 decks)

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