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Peds/Geriatrics > Newborn Care and Concerns > Flashcards

Newborn Care and Concerns Flashcards

1
Q

prophylactic care in delivery room

A

1 cm ribbon of erythromycin or tetracycline ointment to eyes to prevent neonatal gonococcal opthalmia, and single IM dose of Vitamin K1 to prevent Vitamin K deficient bleeding

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2
Q

Transitional period

A

first 4-6 hours of newborn life

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3
Q

how often should newborns be checked in transitional period?

A

every 30-60 minutes - temp, HR, RR, color, and tone

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4
Q

most newborns don’t need lab tests in transitional period. what are indications to get them?

A

Glucose testing for infants at risk for hypoglycemia (if <45 mg/dL) and hematocrit testing for infants at risk for or symptoms of polycythemia or anemia (if skin very reddenned or pale)

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5
Q

volume of feedings on day 1-3

A

0.5-1 oz per feed on day 1. Increase to 1.5-2 oz. by day 3

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6
Q

prophylactic procedures for newborns

A

umbilical cord care, hep B first vaccination, newborn circumcision if wanted, monitor for hyperbilirubinemia, and routine screening for hearing loss, metabolic and genetic disorders, and congenitally acquired infectious disorders

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7
Q

gestational age best determined by

A

LMP

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8
Q

If growth of baby symmetric vs. asymmetric-

A

if asymmetric, problem happened later in pregnancy, like placental problem or pregnancy induced HTN. If growth is symmetric, then implies event happened earlier in pregnancy like mom using alcohol or drugs early

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9
Q

5 educational points to focus on to caregiver:

A
  1. importance and benefits of breastfeeding, in first 3-5 days of life, expect 4-8 wet diapers and 3 soiled diapers. In 5-7 days of life, 6 or more wet diapers and 3 soiled diapers. 3. talk to them about cord, skin, and genital care
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10
Q

complications of preterm neonate

A

prone to pulm complications, renal complications, patent ductus arteriosus, inc risk of hypoglycemia, hypocalcemia, and infection, and difficulty w/feeding and maintenance of body temperature

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11
Q

aspiration of meconium most commonly occurs in..

A

utero

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12
Q

normal heart rate

A

90-180 bpm

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13
Q

Normal resp rate for neonates

A

30-60. more than 60 is tachypnea, less than 60 is bradypnea/apnea

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14
Q

fever in neonate

A

over 100 deg F

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15
Q

baby presents with irregular irregular rhythm on 1st day. is this serious?

A

no, usually caused by PAC and resolves within the first dya of life

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16
Q

early onset neonatal sepsis

A

birth to 7 days

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17
Q

neonatal sepsis cause

A

group B beta-hemolytic strep

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18
Q

risk factors for sepsis

A

temp more than or equal to 38 deg c, membrane rupture at 18 or more hours, delivery at less than 37 wks gestation, and chorioamnionitis

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19
Q

neutropenia in newborn often caused by either…

A

preeclampsia in mom or sepsis

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20
Q

characteristics of physiological jaundice

A

onset more than 24 hours of age, peak rise at 3-5 days, total bilirubin rise less than 5 mg/dL/day, total bilirubin less than 15 mg/dL, and visible jaundice should resolve by 1 week in full time infant (2 weeks in preterm infant)

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21
Q

if neonates have risk factors for sepsis,

A

they should be observed for at least 48 hours- do not discharge till resolved!

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22
Q

diagnostic evaluation of hyperbilirubinemia

A

serum bilirubin levels or transcutaneous bilirubin measurement

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23
Q

tx hyperbilirubinemai in neonate

A

phototherapy- conjugates bilirubin and allows more to be excreted

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24
Q

how should extreme indirect hyperbilirubinemia be treated?

A

it’s a medical emergency- treat with exchange transfusion

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25
Q

Hypoglycemia in neonate

A

blood glucose less than 40 mg/dL at birth to 4 hours or less than 45 mg/dL at 4-24 hrs of life

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26
Q

risk factors for hypoglycemia

A

LGA, SGA, preterm, or stressed infants

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27
Q

tx of hypoglycemia

A

feeding of IV dextrose depending on severity

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28
Q

normal derm findings in newborn

A

vernix caseosa, lanugo, superficial desquamation

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29
Q

what is lanugo

A

fine hair that covers the entire body and is shed within the first weeks - normal dermatologic findings

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30
Q

superficial desquamation

A

normal derm finding often noticeable 24-36 hours postpartum

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31
Q

vernix caseosa

A

cheesy white material - normal derm finding in newborn

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32
Q

bruising or petechiae in newborn infant can indicate

A

birth trauma

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33
Q

pallor in newborn can indicate

A

anemia

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34
Q

ruddy or plethoric infant can indicate

A

polycythemia

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35
Q

when is jaundice unusual?

A

in first 24 hrs of life- almost always pathologic

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36
Q

greenish discoloration of skin in newborn can indicate

A

meconium staining

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37
Q

name some common dermatologic concerns in newborns

A

milia, miliaria crystallina, miliaria rubra, transient pustular melanosis, erythema toxicum, mongolian spots, nevus flammeus, nevus simplex, and cafe au lait spot

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38
Q

distinguish presentaion and tx of miliaria crystallina vs. rubra

A

miliaria crystallina- superficial obstruction of eccrine sweat glands while rubra is a deeper obstruction and erythematous. they rarely progress to pustules. are tiny, grouped vesicles. treated by removal to a cooler environment

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39
Q

benign idiopathic generalized eruption of vesicles, superficial pustules, and pigmented macules

A

transient pustular melanosis

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40
Q

prognosis of transient pustular melanosis

A

vesicles and pustules rupture easily and resolve within 48 hours. pigmented macules may persist for several months

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41
Q

prognosis of erythema toxicum

A

usually resolve in 5-7 days

42
Q

this dermatolic skin reaction in newborns may develop within a few hours of life and persist upto 2 weeks of life

A

erythema toxicum

43
Q

small, yellow white colored papules surrounded by red skin in newborn that may be present upto 2 weeks of age. NOT on palms or soles, mostly on body not face

A

erythema toxicum

44
Q

nevus flammeus vs. nevus simplex

A

pink or red patches, mostly unilateral that enlarge and as child grows, often persists. nevus simplex does not enlarge and does not persist- often disappear by 1 year of age

45
Q

if nevus simplex occurs on lumbosacral region,

A

check if a/w another lumbosacral abnormality- then consider further evaluation for underlying spinal dysraphism

46
Q

is nevus flammeus a/w developmental defects?

A

rarely

47
Q

when are cafe au lait spots concerning?

A

6 or more lesions that are greater than 1.5 cm = major diagnostic criteria for neurofibromatosis type I

48
Q

port wine stain aka

A

nevus flammeus

49
Q

congenital blue/grey or brown macule , often over buttocks- prognosis

A

benign, usually fade during 1-2 year of life. mongolian spots

50
Q

tense, bulging fontanelle in a sitting infant NOT cryiing may indicate

A

increased ICP

51
Q

affect of dehydration on fontanelle

A

may cause depressed fontanelle

52
Q

effect of congenital hypothyroidism on fontanelle

A

a/w enlarged posterior fontanelle

53
Q

widely split sutures with full fontanelles may indicate

A

increased ICP

54
Q

what does asymmetric skull indicate

A

in first 1-2 days, may have just been from passage through birth canal. if persists longer than 2-3 days, may suggest craniosynostosis (premature fusion of sutures)

55
Q

soft of thinned area of skull, common in newborns

A

craniotabes

56
Q

may see this abnormality upon HEENT exam in child with rickets or syphilis, or other dz affecting bone growth

A

craniotabes

57
Q

commonly d/t prolonged engagement of head in birth canal or use of vacuum extraction. benign and resolves in a few days

A

caput succedaneum- area of edema over presenting part of head

58
Q

commonly d/t birth trauma resulting in rupture of vessels beneath the periosteum: subperiosteal collections of blood

A

cephalohematomas

59
Q

distinguish between caput succedaneum vs. cephalohematomas vs. subgaleal hemorrhrages

A

caput and subgaleal hemorrhages- swelling can cross suture lines. cephalohematomas- swelling does NOT cross suture lines because between bone and periosteum

60
Q

subgaleal hemorrhages occur from disruption to..

A

emissary veins resulting in blood accumulation between aponeurosis and the periosteum of the skull

61
Q

facial palsies may occur in newborns from…

A

forceps delivery of in prolonged delivery in mothers with a prominent sacral promontory

62
Q

how does facial palsy present

A

loss of nasiolabial fold, partial closing of eye, and droopy mouth. diminished movement on affeced side of face (mandibular branch of facial n. affected)

63
Q

distinguish asymmetric crying facies vs. facial palsies

A

facial palsies- 3 signs of droopy mouth, partial closing of eye, and loss of nasiolabial fold. asmmetric crying facies- upper face normal.

64
Q

asymmetric crying facies results from congenital absence or hypoplasia of

A

depressor anguli oris muscle which leads to asymmetry of the face when crying

65
Q

corneal enlargement in newborn could indicate

A

glaucoma

66
Q

when might you see blue sclera in newborn

A

light blue- if premature. dark blue- a/w osteogenesis imperfecta

67
Q

asymmetric eye mmovement common in 1st month, but may also indicate

A

CN abnormality of with brain

68
Q

nystagmus persistent may indicate

A

poor vision or CNS disease

69
Q

absence or abnormality in the red reflex -

A

refer to opthalmologist

70
Q

congenital ptosis

A

may occur d/t birth trauma, CN III palsy, or mechanical problems

71
Q

purulent nasal discharge at birth suggests

A

congenital syphilis

72
Q

what are common findings in mouth exam of newborns

A

epstein’s pearls- small, white, benign retension cysts and mucus retention cysts- on gums or floor of the mouth

73
Q

prominent tongue may be a/w

A

congenital syndromes

74
Q

oral equivalent of milia on skin in the mouth=

A

Epstein’s pearls

75
Q

natal teeth are usually

A

primary mandibular incisors

76
Q

isolated palpable cervical lymph nodes upto 12 mm in diameter

A

common in healthy infants

77
Q

pectus excavatum vs. pectus carinatum

A

excavatum- funnel chest. carinatum- pigeon chest

78
Q

most common cause of neonatal respiratory distress

A

respiratory distress syndrome

79
Q

what kind of infants is neonatal resp distress syndrome most common in

A

premature- babies born before 28 weeks gestation

80
Q

neonatal resp distress syndrome caused by

A

deficiency of surfactant

81
Q

premature neonate presents with cyanosis, apnea, decreased urine output, and signs of respiratory distress. what next?

A

suspect neonatal resp distress syndrome. get ABG, blood cultures, CBC, sequential CRP levels to evaluate for sepsis. get CXR- may show atelectasis, diffuse ground glass appearance, and low lung volume

82
Q

tx of neonatal resp distress syndrome

A

neonatal resuscitation including supplemental oxygen, CPAP, or intubation with mechanical ventilation. delivery of exogenous surfactant- best if given 30-60 minutes of life - can only give by ET tube, but want to try CPAP first

83
Q

complication of neonatal resp distress syndrom

A

bronchopulmonary dysplasia is the main chronic complication of RDS

84
Q

prognosis of neonatal resp distress syndrome

A

condition often worsens for 2-4 days after birth then slow improvement thereafter.

85
Q

when does death most commonly occur in neonatal RDS

A

day 2 through 7

86
Q

2 most common presentation of heart disease in the newborn infant are

A

cyanosis and heart failure w/ abnormalities of pulses and perfusion

87
Q

scaphoid/concave abdomen may indicate

A

diaphragmatic hernia

88
Q

distended abdomen may indicate

A

intestinal obstruction, organomegaly, or ascites

89
Q

most palpable abdominal masses are

A

enlarged kidneys, but may also be d/t tumors

90
Q

small cord may indicate

A

poor maternal nutritional status or intrauterine compromise

91
Q

single umbilical a a/w

A

increased rate of chromosomal and other congential abnormalities

92
Q

erythema surrounding stump and/or odorous may indicate

A

omphalitis- infection of umbilical cord stump

93
Q

decreased amount of wharton’s jelly within cord may indicate

A

poor fetal nutrition

94
Q

whitish vaginal discharge with or w/o blood in female newborn may indicate

A

if in first days of life- d/t maternal hormones

95
Q

labial adhesions in female neonates

A

paper thin adhesions that often disappear without tx

96
Q

most common cause of vaginal outflow obstruction

A

imperforate hymen

97
Q

cryptorchidism

A

undescended testicle that usually descends by 6 months of age- may be present in male neonate

98
Q

what should you be concerned about if present in sacrococcygeal area?

A

if tuft of hair, hemangioma, sacral dimple, or discoloration in that area may suggest underlying vertebral/spinal cord defect

99
Q

simean crease a/w

A

newborns with trisomy 21

100
Q

what are 6 signs of severe neurologic dz?

A

extreme irritability, persistent asymmetry of posture, constant turning of head to 1 side, marked extension of head, neck, and extremities, severe flaccidity, and limited response to pain

101
Q

when are tremors concerning in newborns?

A

normal in first 2-3 days. if resting tremor more than 4 days, can indicate CNS disease

Peds/Geriatrics (3 decks)

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