Normal newborn Flashcards
Criteria for discharge
9
- uncomplicated course
- SVD, singleton, 37 weeks, AGA
- stable VS past 12 hrs
- normal PE
- at least 1 UO and BM
- established proper latch and milk transfer
- no jaundice in first 24 hrs
- educability and ability of parents to care for bb
- able to follow-up in next 48 hrs
Breast milk storage
Room temp < 25C - 4 hrs
Room temp > 25C - 1 hr
Ref (4C) - 8 days
Freezer 1 door - 2 weeks
Freezer 2 door - 3 mos
Deep freezer -20C - 6 mos
in sterile polypropylene containers labeled with date and time of collection
satisfaction in BF
5
- seems satisfied postfeed
- sleeps 2-4 hrs after
- wt gain 25g/d x first 3 mos
- 6 diaper/d, pale yellow UO
- 2-3 stools/day, yellow pasty
BCG, Hep B, Vit K doses
BCG 0.05 ml ID
Hep B 0.5ml IM
Vit K 1 mg IM; 0.5mg for < 1500g
Pathologic jaundice
- within 24 -36 hrs
- rate of rise > 0.2mg/dl/hr or 5mg/dl/day
- DB > 2 mg/dl
- peak total bili > 12 mg/dl term; 10-14 mg/dl preterm
Indications for DVET
4
- ongoing hemolysis and TB fails to decline despite 4-6h of intensive phototx
- rate of increase of TB indicates that the level will reach 25mg/dL within 48h
- signs of bilirubin encephalopathy
- severe hemolysis causing anemia and hydrops fetalis
Indications for ROP screening
- 32 wks or below; 1500g or less
- 32-36 wks if with STOP (sepsis, transfusion, O2, preterm with stormy course)
Cranial UTZ indication
- 32 wks below, 1500g or less
1st on D 3-7
repeat on D28-30 or PTD
EINC
- immediate and thorough drying
- skin to skin contact
- properly timed cord clamping
- non-separation of mother and baby
Components of surfactant; synthesis and maturity
- dipalmytoil phosphatidylcholine (lecithin), sphingomyelin, phosphatidylglycerol
- synthesis at 24-28 wks
- maturity by 35 wks
MOA of phototherapy
converts bilirubin into nontoxic, easily excreted form via photoisomerization
proper breastfeeding technique
7
- face-to-face, chest-tochest, and tummy-to-tummy with mother
- Stimulate infant to open mouth wide by stroking corner of baby’s lips
- chin touches breast and lower lips outward
- baby grasps entire nipple plus 1 inch of surrounding areola
- allow baby to suck 15 to 30 minutes per breast
- empty breast 8 to 10 times or more a day to ensure adequate milk supply
- C hold: support breast with hand of opposite arm with thumb above and 4 fingers under breast
BF positions
Cradle hold: ipsilateral arm supports baby’s back, contralateral hand supports the breast with thumb above and 4 fingers under breast Cross-cradle hold: same as cradle hold but with the roles of the arms switched. Allows more control over how baby latches.
Side-lying: lower arm cradles the baby, other arm supports the breast
Football hold: ipsilateral hand supports baby’s neck and nestles baby closely to the side with feet and legs tucked under arm
10 steps to successful breastfeeding
- written breastfeeding policy
- train all healthcare staff
- inform all pregnant moms about benefits of bf
- help moms initiate bf within 30 mins
- show moms how to bf and maintain lactation
- no food or drink for nb
- rooming in 24/7
- encourage bf per demand
- no artificial teats or pacifiers
- foster establishment of bf support groups
benefits of breast milk
- always available
- comlete nutrients for growth and dev
- easily digested and absorbed
- contains antibodies to protect bb
- contains DHA for brain dev
advantages of breastfeeding
emotional bonding
financial savings
protection from CA, obesity, postpartum hemorrhage
early return to prepregnancy wt
tests to conduct prior to discharge
NBS
OAE
CCHD
ROR
BT
If indicated
- ROP
- screening for hypogly
- screening for hyperbili
- screening for sepsis
Expanded newborn screening
Congenital hypothyroidism
Congenital adrenal hyperplasia
MSUD
PKU
Galactosemia
Homocystinuria
G6PD
Hemoglobinopathies
Urea cycle defects
Organic acid disorders
Fatty acid disorders
