Newborn Screen Flashcards
Maternal/OB hx includes:
- Maternal age
- Medical hx (DM, epilepsy) & OB hx
- G (# pregnancies) P (# deliveries > 20 wks) Term Abortions Live
- Previous complications
- Prenatal care & duration
- Meds during pregnancy
- Infectious diseases (HIV/AIDS, hepA/B, measles, MRSA, pertussis, STD, TB, west nile, zika)
- Coombs/DAT
- ABO or Rh incompatibility (mom Rh- baby Rh+)
- Substance use
- Blood type
- VDRL RPR for syphilis: results, date
- Contraception use
- Planned pregnancy
Common maternal I&D
Toxoplasmosis Other (syphilis) Rubella Cytomegalovirus (CMV) Herpes
Newborn delivery:
- vaginal, cesarian
- instrumentation (vacuum, forceps)
- labor spontaneous or induced
- APGARS
- AROM, SROM, PROM?
- gestational age & birth weight (SGA, LGA)
- AGA 2500-4000g
- IUGR? Need for resuscitation?
- premature <37 weeks gestation
- post-maturity (risk for mec aspiration)
- Adm vitamin K & eye prophy.
- Metabolic/hearing test results
- Newborn screen consent
Delivery complications:
- fetal distress, oligohydraminos, polyhydraminos
- infection
- postpartum bleeding
- cord prolapse
- breech
- shoulder dystocia
- placenta previa (over cervix)
- placenta accreta (to muscular lining vs uterine)
LGA health risk
hypoglycemia (maternal diabetes) broken clavicles brachial plexus injury skull injury, facial palsy resp distress hyperbilirubinemia mec asp polycythemia
SGA health risk
hypoglycemia decreased O2 / resp distress low APGAR poor feeding hypothermia mec aspiration polycythemia
Blood sugar < 40 mg/dL due to
infection, infant DM, LGA infant
Blood sugar >80 mg/dL due to
neonatal distress
Newborn reflexes
- Sucking
- Rooting
- Palmer grasp
- Plantar grap
- Stepping
- Babinski
- Moro
- Galant
- Tonic neck (fencing)
Neuro exam
Symmetry
Tone
Reflexes
Jaundice
- Buildup of bilirubin from RBC breakdown and immature liver
- Cephalocaudal (sclera and mucous)
- Peaks at day 3-5, usually resolves in 10 days
- Diagnostic testing: R/O hemolysis disease of newborn
1. TSB, TcB (> 5 mg/dL)
- Blood typing to detect ABO incompatibility
(concerned when mom type O & fetus type A,B,AB & mom develops antibodies against fetus = RBC hemolysis) - Coombs/DAT - direct antibody test on cord/newborn
(test for foreign antibodies against RBC = immunohemolytic anemias or Rhesus disease of newborn; common in caucasians; If mom Rh- and baby Rh+ then tx with Rh(D) rhogam @ 28 wks or 72 hours pre delivery, pre amnio or post abd injury + Q12 weeks)
- Tx: hydration, feeding 8-12x, phototherapy, IVig (if mom/baby blood incompat) or exchange infusion
- R/O biliary atresia, G6PD, sepsis, hypothyroid
Jaundice risk factors
Jaundice in first 24 HOL A sibling with hx of jaundice Undetected hemolysis Non optimal sucking or feeds Deficiency G6PD Infection Cephalohematoma or bruising East asian
also premature & breastfeeding
Phototherapy criteria per age
> 15 mg/dL (25-48 HOL)
18 mg/dL (49-72 HOL)
20 mg/dL (>73 HOL)
Jaundice risk if untreated
Acute bilirubin encephalopathy
Kernicterus
Normal children bilirubin
<1 mg/dL
Neonatal hyperbilirubinaemia
Breastfed babies moderate jaundice
Severe hyperbilirubin
> 5 mg/dL
12-20 mg/dL
20 mg/dL (<2%)
Inpatient admit for bilirubin >
25 mg/dL
–> type & crossmatch, blood in case of exchange infusion
Outpatient follow up for jaundice should not go more than 2 days without being seen since discharge!
Some infants d/c’ed before 48 HOL may need 2 F/U:
- between 24-72 hours
- between 72-120 hours
Education of jaundice
- Call PCP if unwell, poor feeds, pale poo, dark pee
- Phototherapy is light that breaksdown bilirubin, 2-3 days, naked and covers eye
- Good response; mild rash, diarrhea, dehydration
Common normal variants of newborn skin
- Bruising vs mongolian spots
- Newborn acne (onset 3-4 days to 4-6 mo from maternal androgen transfer)
-Erythema toxicum
(1/2-1 inch erythematous papules/vesicles on any body surface, briefly on trunk/perineum)
Difference between cephalohematoma & caput
Caput - crosses suture lines
Common health problems in first week of life
Weight loss (less than 6-8 wet cloth diapers or 5 very wet disposables in 24 hours; poos every day if he’s younger than 6-8 weeks old; older baby is likely to do fewer poos)
Sticky eyes (blocked tear ducts = self-limiting) → gentle cleansing & massaging; PCP if red or sticky)
Rashes (cradle cap, nappy rash, heat rash, eczema, milia, dry skin)
Check BP < 3 years if:
Renal or CV abnormality
Newborn screening
Hypothyroidism PKU Galactosemia Hemoglobinopathies (sickle cell disease) Maple syrup urine disease Homocystinuria Biotinidase deficiency Tyrosinemia Congenital adrenal hyperplasia CF Toxoplasmosis
- must obtain < 24 HOL, no more than 7 days old
- if discharged before 24 HOL, recommend 2nd screen
- infants with + screen result need close F/U with additional confirmatory studies performed
