Newborn Flashcards
1
Q
Normal newborn respirations
A
30-60 breaths per minute
2
Q
Normal newborn heart rate
A
120-160 beats per minute
3
Q
What is the purpose of APGAR scoring?
A
Apgar scoring is used to assess neonatal need for resuscitation
4
Q
When would a neonates pulse oximeter reading normalize?
A
1 day of life
5
Q
How should the neonates temperature be taken?
A
Rectally is most accurate
6
Q
Why would the clinician put their finger in a new borns mouth
A
To assess the :
- Sucking reflex and cleft palate
7
Q
What does tachypnea in the infant reveal?
A
- Transient tachypnea of the new born.
- Meconium aspiration
- Pulmonary HTN
- Pulmonary hypoplasia
8
Q
What are the 5 T’s of congenital cardiac abnormalities?
A
- Truncus arteriosus
- Transposition of the great vessels
- Tricuspid valve atresia
- Tetralogy of Fallot
- Total anomalous pulmonary venous return
9
Q
What is the diameter of the anterior fontanelle?
A
3-6 cm in diameter
10
Q
When does the posterior fontanelle close
A
by age 2 months
11
Q
What is the diameter of the posterior fontanelle?
A
1-1.5 cm
12
Q
What should a neonates fontanelles look like a birth?
A
soft and flat
13
Q
What does a sunken fontanelle indicate?
A
Dehydration
14
Q
Hyperbilirubinemia in the infant is always benign but can be what?
A
- Physiologic
2. Pathologic
15
Q
Newborn red blood cells have a half life of how many days?
A
- 70
16
Q
Are newborns born with a higher hemoglobin concentration?
A
- Yes
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
18
Q
Unconjugated bilirubin that crosses the blood brain barrier, can cause what?
A
- Kernicterus
19
Q
Hyperbilirubinemia can be a sign of what other problems in the newbord?
A
- Hemolytic anemia
- Infection
- Metabolic disease
- Liver disease
20
Q
Unconjugated bilirubin that crosses the blood brain barrier affects with area of the brain particularily?
A
- Basal ganglia
21
Q
What are the reasons a baby has a conjugated hyperbilirubinemia?
A
- Bile duct obstruction
- choledochal cyst
- alagille syndrome
- galactosemia
- alpha 1 antitrypsin def
- protein metabolism defect
- cystic fibrosis
- neonatal hepatitis
22
Q
When is Rho-gam given
A
- 28 weeks gestation
23
Q
Causes of unconjugated hyperbilirubinemia?
A
- Rh incompatibility
- Red cell membrane defect
- G6PD deficiency
Pyruvate kinase defic - Hemoglobinopathy
- Metabolic problems
24
Q
In the newborn what is the first organ to showcase jaundice?
A
Head
25
Midline abdominal wall defect in the newborn is called where the viscera is still in the peritoneal sac
1. omphalocele
26
What is a gastroschisis?
A full thickness defect in the abdominal wall, evisceration of bowel without covering or membrane.
27
What are associated defects in newborns with gastroschisis?
1. intestinal atresia
| 2. undescended testes
28
Triad of an infant born after exposure to rubella
1. Cataract
2. Deafness
3. Cardiac defects
29
Infants born with blueberry muffin spots will often have what congenital disease
1. Congenital rubella
30
A drop in HGB or HCT by more than 2 standard deviations is the term for?
1. Anemia
31
Which vaccines are live attenuated vaccines?
MMR
Varicella
Rotavirus
32
Why are live vaccines contraindicated in pregnant women and immunocompromised children?
They can still cause infection
33
If a patient is moderately ill which vaccine may they not respond to?
MMR
34
What is a side effect of the pneumococcal vaccine?
Fever
35
The yellow boxes CDC vaccine schedule is for what?
Vaccines to be given at the time of well visit
36
The CDC's green box vaccine schedule are for what type of immunization?
1. Make up vaccine
37
CDC purple box vaccine schedule is for what?
Specific vaccines to be given at certain times
38
When is the Hep B vaccine first given?
Immediately after birth
39
When is the 2nd dose of Hep B given to the newborn
1 month
40
When is the Rotavirus vaccine given
2
4
6 months of age oral vaccine
41
How many versions of the Rotavirus vaccine are there?
There are two versions of the Rotavirus vaccine. 1 requires 2 does and one requires 3 doses.
42
When is DTaP vaccine given?
```
2 mos 1st dose
4 mos 2nd dose
3 mos 3rd dose
14 mos 4th dose
4-6 years 5th dose
```
43
DTaP is given for children under what age?
<7 y/o
44
After 7 years of age what version of DTaP are children given?
TdaP booster 7 >
45
What does the A stand for in DTaP?
acellular
46
When is HIB vaccine administered?
2. mos
4. mos
6. mos
12 mos
15 mos
47
When is PCV 13 administer
2 mos 1st
4 mos 2nd
6 mos 3rd
12 to 15 mos 4th dose
48
PCV 13 vaccine is also used to prevent what infections?
Ear infections
49
When is the polio vaccine administered?
2 mos 1st dose
4 mos 2nd dose
6-18 mos 3rd dose
4-6 years 4th dose
50
When is the MMR vaccine given?
12-15 mos 1st dose
| 4-6 years 2 nd dose
51
When is the varicella vaccine given?
112 to 15 mos 1 dose
| 4-6 years 2nd dose
52
When is the Hep A vaccine administered
6-18 months apart
53
When is the HPV vaccine given?
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
When is the meningitis vaccine given?
given at 11-12 and booster at 16 years
55
What is defined as a fever in an infant?
1. A Tempt of 38 Celsius/100.4 F
56
What can cause fever in an infant?
Meningitis
Bacteria
UTI
57
Babies 4-8 weeks with a fever will be treated in what way?
1. Admitted to the hospital
58
How does HSV present in the neonate?
Skin eye mouth disease
Meningitis
Disseminated HSV
59
How does HSV in the neonate present?
Hypothermia
Seizure
Meningitis
Irritable
60
When to worry about HSV in a new born
Age 7-28 days
irritable or seizure
Hypothermia
History of new disease in mom during pregnancy
61
What test are done for newborn with HSV?
HSV PCR blood
HSV culture eyes, nose, mouth, rectum
HSV PCR of CSF
LFT's disseminated HSV
62
When should Acyclovir be started when HSV is suspected in a newborn?
After cultures are drawn
63
How long should a newborn with HSV be treated with IV Acyclovir
2 weeks
64
A newborn with meningitis disseminated HSV should be treated with IV acyclovir for how long?
3 weeks
| and oral acyclovir for 6 months
65
Bacterial infections in newborns
```
E. Coli
Group B Strep
Strep pneumoniae
Neisseria meningitis
Enterococcus
Klebsiella
Staph Aureus
```
66
Most common bacterial infection, newborn?
UTI
67
How should a urine specimen be obtained in a child
Bag more sensitive
Cath more specific
Supra pubic tap needle in bladder
68
Nitrite 98% specific most like means a child has a?
UTI
69
Untreated sepsis in the newborn can lead to what?
Shock and death
70
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
15,000 or below 5 worry about bacteremia
Procalcitonin
CRP
CBC
71
When should a LP be done in children under 4 weeks of age?
```
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
How do Staph infections appear in the newborn?
Osteomyelitis
73
What should be done for an infant under 28 days, well appearing and febrile?
1. U/A and culture
CBC/CRP/Procalcitonin
Blood culture
LP (almost all)
74
If labs are abnormal what is the next step of action for a febrile infant under 28 days?
1. admit
AMP/Gent-AMP Strep and Listeria
Amp/Cefotax
75
How long are febrile infants monitored in the hospital?
24-36 hours
76
What is the management protocol in a febrile infant 29-60 days?
UA/culture
CBC/CRP/Procalcitonin
Blood culture-labs normal discharge home
labs abnormal LP admit but only if +UA
77
How is a febrile infant 61-90 days managed?
U/A and culture
| if abnormal labs discharge home on oral ABT and close follow-up
78
Why is Ceftriaxone contraindicated in infants before 28 days?
It can cause Kernicterus
79
Which immunoglobulin is present in great amounts in breast milk?
IgA
80
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.
Boot shaped heart
81
The cyanosis associated in babies with Tetralogy of Fallot results from?
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
Is the pressure in the right heart low or high
low
83
Cyanotic congenital heart diseases involve what?
Left to right shunts in which deoxygenated blood does not pass through the lungs but mixes with oxygenated blood
84
Besides cyanosis what are other symptoms of Tetralogy of Fallot
1. Nail clubbing
2. tachycardia
3. tachypnea
4. inadequate feeding
5. delay of reaching development mild stones
85
What are the 4 features with cyanotic congenital heart disease?
1. Pulmonary stenosis
2. right ventricular hypertrophy
3. overriding aorta
4. ventricular septal defect
86
What is a tet spell?
1. Babies turning blue when feeding
87
How is tetralogy of fallot diagnosed
transthoracic echocardiogram
heart ultrasound
doppler flow
x-ray may reveal boot shaped heart due to right ventricular hypertrophy
88
How is tetralogy of fallot treated
with surgery generally in the first year of life
