Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > Newborn at Risk > Flashcards

Newborn at Risk Flashcards

1
Q

7 Common Complications of Newborns

A

§ Prematurity
§ Thermoregulation
§ Respiratory Distress
§ Hyperbilirubinemia
§ Care of Newborn Exposed to Substances (NAS)
§ Hypoglycemia
§ Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Survival rates on newborns doubles with:

A

Every week gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Having one PTB increases your risk for:

A

Another EARLIER PTB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does surfactant development begin in gestation?

A

24-26 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory issues in the premature are due to

A

Lack of surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What respiratory problems arise in premature newborn?

A
  1. RDS (r/t poor gas exchange)
  2. Apnea (r/t poor neurological development)
  3. Bronchopulmonary Dysplasia (secondary to intubation/ventilation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What cardiovascular problems arise in premature newborn?

A
  1. Patent Ductus Arteriosis
  2. Increased respiratory effort
  3. CO2 retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What thermoregulatory problems arise in the premature infant?

A
  1. decreased brown/SC fat
  2. poor muscular development to maintain flexed tone
  3. inability to shiver
  4. thin skin
  5. increased BSA
  6. increased exposure during resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What GI problems arise in the premature infant?

A
  1. small stomach
  2. immature feeding reflexes
  3. NEC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What renal problems arise in the premature infant?

A
  1. decreased ability to concentrate urine
  2. decreased ability to excrete drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What hepatic/hematologic problems arise in the premature infant?

A
  1. immature liver - decreased conjugate bilirubin - jaundice
  2. risk for hypoglycemia
  3. anemia - limited iron stores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What neurological problems arise in the premature infant?

A
  1. Peri/Intraventricular Hemorrhage
  2. hydrocephalus
  3. hearing loss
  4. retinopathy of prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who and how long is delayed cord clamping for?

A

Preterm ( <37) and extremely preterm (<28) for 60-120 seconds

If cannot be deferred for that long, at least 30 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

6 Reasons Preterm are at risk for decreased thermoregulation

A
  1. higher BSA
  2. lack of brown fat
  3. thin skin
  4. lack of flexion
  5. increased exposure during resuscitation efforts
  6. ambient temperature of delivery room
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 Guidelines for Preterm Temperature Control

A
  1. Delivery room temperature 25-26
  2. <28 weeks should be placed wet up to their neck in a food grade polyethylene bag

(can’t rub/stimulate babe r/t thin skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gestation of Late Preterm Infant

A

34-38 weeks
Still immature at birth though appear normal size
Have missed 4-6 weeks of 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Brain size of 34-35 week gestation

A

60% of that of infant at termThe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The largest proportion of preterm births are

A

Late preterm (34-36 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

5 Criteria for DC of Preterm Infant

A
  1. 24 hours successful feesing
  2. First time mothers require rooming in experience
  3. Take into account health, parenting/feeding skills, support at home
  4. Post DC assessment in community
  5. Developmental follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

8 Signs of Respiratory Distress

A

§ Tachypnea ( > 60)
§ Apnea ( > 15 seconds)
§ Cyanosis (circumoral)
§ Grunting/cooing
§ Nasal flaring
§ Retractions/indrawing
§ Poor feeding
§ Accessory muscle use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 common causes of neonatal respiratory distress

A
  1. Respiratory Distress Syndrome (RDS)
  2. Meconium Aspiration (MSAF, MAS)
  3. Transient Tachypnea of the Newborn (TTN – wet lung syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

RDS accounts for _____ of neonatal deaths in ________

A

20%

First month of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common cause of respiratory distress

A

RDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is respiratory distress syndrome caused by?

A

Lack of surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When is the onset of RDS

A

At birth or within a few hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a protective factor against RDS

A

Intrauterine Stress - triggers increased maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

7 Rx Factors for RDS

A

Ø Prematurity/immaturity of lung – lack of surfactant
Ø C/S without labour
Ø Males
Ø Previous birth with RDS
Ø Cold stress
Ø Maternal Diabetes
Ø Perinatal asphyxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

5 Protective Factors for RDS

A

Ø Prolonged ROM
Ø GHTN
Ø Donor twin (r/t stress)
Ø Any physiological stress experienced by the fetus in utero accelerates surfactant development
Ø Use of corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of RDS

A
  1. antenatal steroids
  2. synthetic surfactant
  3. CPAP
  4. PEEP
  5. supportive care
  6. vitals, BGM, s+s assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

MSAF occurs in ______ of live births

A

12% (8-20)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

2 Primary Causes of MSAF

A
  1. Physiologic (breech/post-term)
  2. Fetal Compromise (stress, cord compression, hypoxia)`
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When amniotic fluid is stained, what is first ruled out?

A

Physiologic reason before suspecting fetal compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does fetal compromise cause MSAF?

A

hypoxia leads to vagal reflex and vasoconstriction, inducing in turn hyperperistalsis and meconium emission

also relaxes anal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If the meconium is above vocal cords when aspirated:

A

Very little chance it is in the lung - risk for impaired gas exchange decreases

35
Q

What % of MFAS develops into MAS?

A

5%

36
Q

The primary concern with MFAS/MAS is:

A

Inactivation of surfactant decreasing lung compliance

Secondary: pneumonitis

36
Q

Care for Meconium Aspiration

A
  1. prevention (avoid post maturity, suctions as indicated)
  2. ventilation
  3. synthetic surfactant and steroids
  4. observation for RD, crackles, rhonchi
36
Q

Define Transient Tachypnea of Newborn

A

Excess fluid in the lungs or delayed re-absorption of fetal lung fluid (sometimes called “wet lung syndrome”)

37
Q

Transient Tachypnea is _______ @ birth-develops respiratory distress symptoms in ______

A

Normal

4-6 hours

38
Q

What is TTN related to:

A
  1. aspiration of amniotic fluid
  2. excess secretions/tracheal fluid
  3. C/S or preterm
39
Q

When does TTN normally resolve?

A

12-72 hours PP

40
Q

Periventricular Hemorrhage occurs in ____ of neonates < _______ and/or ____ weeks

A

50%

1500g

35

41
Q

Why does periventricular hemorrhage occur?

A

Immature cerebral vascular development and weak ventricular capillaries easily rupture

42
Q

When do most periventricular hemorrhages occur?

A

Within 72 hours

43
Q

NEC occurs in ____ of neonates

A

10%

44
Q

Mortality rates of NEC

A

50%

45
Q

What 4 things are thought to cause NEC

A
  1. ischemic/necrotic injury
  2. immature intestinal barrer
  3. abnormal colonization
  4. formula feedings
46
Q

When does NEC typically present?

A

3-12 days of life

47
Q

Hyperbilirubinemia

A

excessive concentration of bilirubin in the blood

causes jaundice

48
Q

Jaundice

A

bile pigment deposited in the skin, mucous membranes and sclera

49
Q

Kernicterus

A

bilirubin levels rise > accepted levels at a given age or rate of rise is high enough  deposited in brain  encephalopathy

Levels rise so high that effects brain – irreversible

50
Q

When bilirubin is broken down, RBCs are broken into:

A

Heme and Globin

51
Q

What happens to heme in RBC breakdown

A

Becomes unconjugated bilirubin: metabolized and bound to circulating albumin

Can be seen in skin, sclera, and mucous membranes

If increased levels can enter brain

52
Q

What happens to the globin in RBC breakdown

A

Goes to liver and binds with gluconaride and becomes conjugated bilirubin and enters gut

Can be excreted or if unable/excess can become unconjugated

53
Q

Conjugated Bilirubin

A

a water-soluble form of bilirubin that has been processed by the liver, making it easier for the body to excrete in urine and giving it a yellow color

54
Q

Unconjugated Bilirubin

A

insoluble form of bilirubin that originates from the breakdown of red blood cells and becomes soluble only after being processed by the liver; it can accumulate in tissues, causing a yellowing of the skin and eyes if levels are elevated.

55
Q

What is the most common cause of jaundice?

A

Physiological Jaundice (50-60% of newborns)

56
Q

4 Mechanisms Leading to Physiological Jaundice

A
  1. Newborns increased RBC volume + decreased life span … RBC hemolysis increases after birth leading to increased bilirubin load
  2. Decreased clearance of bilirubin from plasma
  3. Immature livers’s decreased ability to excrete conjugated bilirubin
  4. immaturity of conjugation at birth
57
Q

When is physiological jaundice seen?

A

peaks at 3 - 5 days; typically resolved by day 8

58
Q

What causes pathological jaundice?

A
  1. excessive RBC destruction
  2. increased extravascular blood
  3. polycythemia
  4. hereditary conditions
59
Q

Why is jaundice seen in the first 24 hours of life pathological?

A

Mechanisms that cause physiological jaundice take time to occur and should not be present in 24 hours

60
Q

Describe full assessment of baby with jaundice

A
  1. visual inspection
  2. assessment of associated findings
  3. TcB
  4. TsB
  5. Coombs/DAT
61
Q

Describe expected visual inspection of infant with jaundice

A

o Yellowing of skin and sclera
o Cephalocaudal (head  toe) progression
o Well lit area, preferably natural daylight
o Gentle pressure to blanch skin to reveal underlying color of skin

62
Q

only 50% of babies with a TSB concentration greater than _________ appear jaundiced

A

128 μmol/L

63
Q

TSB Value Severe Hyperbilirubinemia

A

> 340 at any time in first 28 days

64
Q

TSB value Critical Hyperbilirubinemia

A

> 425 any time in first 28 days

65
Q

What is Coomb/s/DAT test?

A

Tests for blood type (ABO) incompatibility to assess reason for excess RBC breakdown

DAT + = hemolytic disease of the newborn

mother is -, + attacks newborn’s RBC

66
Q

Either TSB or transcutaneous bilirubin (TcB) concentration should be measured in ___ infants between ____________ hours of life, the results plotted on the __________ to determine the __________ to severe hyperbilirubinemia

A

all

24 and 72

predictive nomogram

risk of progression

67
Q

Bilirubin Encephalopathy

A

Kernicterus

Neurological effects of unconjugated bilirubin in the brain may be reversible or permanent

68
Q

How does phototherapy help breakdown bilirubin?

A

Turns unconjugated (fat soluble) to conjugated (water soluble) bilirubin so it can be excreted in the stool

69
Q

What treatment other than phototherapy is there for jaundice newborns?

A
  1. frequent feedings
  2. prevention of dehydration
  3. exchange transfusion
70
Q

Why are frequent feedings used for treatment of jaundice?

A

increase intestinal transit time to assist excretion/removal of conjugated bilirubin through feces & urine

71
Q

Newborns with NAS general present with:

A
  1. neurological irritability (high pitched cry, tremors, hyperactive reflex, increased tone, seizures)
  2. increased fluids out of everywhere (vomiting, diarrhea, sweating, tachypnea, stuffiness)
72
Q

Cocaine increases risk of:

A
  • Increased risk of placental problems
  • Increased Risk of miscarriage
  • Increased Risk of preterm labor
  • Increased Risk of SIDS
73
Q

Compared to other substances, cocaine decreases incidence and severity of:

A

Withdrawal symptoms

74
Q

Considerations of Anti-Depressants in Pregnancy

A

Benefits may outweigh the risks of use during pregnancy

SSRIs are most commonly used

Newborns may manifest S & S after exposure in utero

75
Q

How does symptoms of utero exposure to antidepressants present in newborn

A
  • Mild symptoms (neuro-behavioral, respiratory, feeding issues, unstable temp)
  • May be seen within hours but resolves within 2 weeks
76
Q

Are anti-depressants contraindicated in breast feeding

A

No

77
Q

What drugs are used to treat withdrawal in NAS?

A
  • Opium
  • Morphine – primarily given
  • Methadone
  • Phenobarbital – seizure prevention
    o Given as newborn and weaned slowly
78
Q

Why is naloxone contraindicated for NAS withdrawal treatment?

A

can cause rapid withdrawal and seizures

o Given to newborns if mother’s had opioids during labour to prevent fetal respiratory depression NOT for infants who may have NAS

79
Q

3 Points of therapeutic handling/developmental positioning for infant with NAS

A
  1. reduce stimulation
  2. swaddling to control tremors
  3. C - position
80
Q

Describe the C - position used for NAS

A

to feed and cuddle – differs from rocking
* Hold baby and move up & down carefully with baby held away from person (to reduce stimulation) swaddled in c position

81
Q

Newborn Sepsis Symptoms

A
  1. Subtle behaviour changes “not doing well”
  2. Temperature instability
  3. tachycardia
  4. seizures - hypotonia
  5. Poor peripheral circulation
  6. respiratory distress
  7. hyperbilirubinemia
82
Q

DAT positive meaning

A

ABO incompatibility

reaction between the mother’s and baby’s blood groups. If your baby’s DAT is positive, there is a risk that he/she could develop anaemia (low number of red blood cells) and/or jaundice (yellow colour to the skin).

Obstetrics (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions