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Newborn > Newborn Screen > Flashcards

Newborn Screen Flashcards

1
Q

Maternal/OB hx includes:

A
  • 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
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2
Q

Common maternal I&D

A 
Toxoplasmosis 
Other (syphilis)
Rubella
Cytomegalovirus (CMV)
Herpes
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3
Q

Newborn delivery:

A
  • 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
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4
Q

Delivery complications:

A
  • fetal distress, oligohydraminos, polyhydraminos
  • infection
  • postpartum bleeding
  • cord prolapse
  • breech
  • shoulder dystocia
  • placenta previa (over cervix)
  • placenta accreta (to muscular lining vs uterine)
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5
Q

LGA health risk

A 
hypoglycemia (maternal diabetes)
broken clavicles
brachial plexus injury
skull injury, facial palsy
resp distress
hyperbilirubinemia
mec asp
polycythemia
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6
Q

SGA health risk

A 
hypoglycemia
decreased O2 / resp distress
low APGAR
poor feeding
hypothermia
mec aspiration
polycythemia
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7
Q

Blood sugar < 40 mg/dL due to

A

infection, infant DM, LGA infant

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8
Q

Blood sugar >80 mg/dL due to

A

neonatal distress

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9
Q

Newborn reflexes

A
  1. Sucking
  2. Rooting
  3. Palmer grasp
  4. Plantar grap
  5. Stepping
  6. Babinski
  7. Moro
  8. Galant
  9. Tonic neck (fencing)
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10
Q

Neuro exam

A

Symmetry
Tone
Reflexes

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11
Q

Jaundice

A
  • 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)
  1. Blood typing to detect ABO incompatibility
    (concerned when mom type O & fetus type A,B,AB & mom develops antibodies against fetus = RBC hemolysis)
  2. 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
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12
Q

Jaundice risk factors

A 
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

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13
Q

Phototherapy criteria per age

A

> 15 mg/dL (25-48 HOL)
18 mg/dL (49-72 HOL)
20 mg/dL (>73 HOL)

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14
Q

Jaundice risk if untreated

A

Acute bilirubin encephalopathy

Kernicterus

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15
Q

Normal children bilirubin

A

<1 mg/dL

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16
Q

Neonatal hyperbilirubinaemia
Breastfed babies moderate jaundice
Severe hyperbilirubin

A

> 5 mg/dL
12-20 mg/dL
20 mg/dL (<2%)

17
Q

Inpatient admit for bilirubin >

A

25 mg/dL

–> type & crossmatch, blood in case of exchange infusion

18
Q

Outpatient follow up for jaundice should not go more than 2 days without being seen since discharge!

A

Some infants d/c’ed before 48 HOL may need 2 F/U:

  • between 24-72 hours
  • between 72-120 hours
19
Q

Education of jaundice

A
  • 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
20
Q

Common normal variants of newborn skin

A
  • 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)

21
Q

Difference between cephalohematoma & caput

A

Caput - crosses suture lines

22
Q

Common health problems in first week of life

A

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)

23
Q

Check BP < 3 years if:

A

Renal or CV abnormality

24
Q

Newborn screening

A 
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

Newborn (4 decks)

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