Normal Newborn Management Flashcards
normal NB Hgb
14.0-20.0
normal NB Hct
43-63%
normal NB WBC
10-30,000
normal NB platelet count
150-350,000
What is a concerning newborn blood sugar level?
<45-50 mg/dL
What can be expected of a NB’s blood glucose in the first 2h PP?
can fall to nadir of ~40 mg/dL
normal NB urinalysis
- low specific gravity
- no protein
- no blood
direct vs indirect bilirubin
indirect = unconjugated = non-water-soluble –> direct = conjugated = water-soluble - can be excreted through urine and stool
What is a normal total bilirubin for a NB at day 1?
<5 mg/dL
When do bilirubin levels peak in NBs?
b/w 48-92h PP
average value = 7-9 mg/dL
What are the rare metabolic disorders included on the standard NB screen?
1) phenylketonuria (PKU)
2) maple syrup urine disease (MSUD)
3) galactosemia
What does the direct antiglobulin test (DAT)/direct Coombs test look for?
antibodies directly bound to NB’s RBCs
What does a negative direct Coombs test indicate?
normal!
positive = BAD!
What is the expected number of stools for the breastfed NB?
Once lactation is established, 3-4 stools/day
When should one be concerned about a NB’s elimination frequency?
If no BM or urine w/in 24-48h, call pediatric provider
What is the expected number of stools for the formula-fed NB?
2-4 stools/day in 1st month –> become less frequent (1-3/day) as infant gets older
How does breastfeed NB stool look compared to the formula-fed NB?
formula-fed = firmer, darker, smellier
How often should a NB urinate?
at least 6x/day
How much formula should be given to NBs in the first weeks?
2-3 oz q3-4h
How long should the first bath be delayed?
According to WHO, at least 6h
How should cords be cared for?
just keep it dry!
How should circumcisions be cared for?
- cleanse daily w/ cotton balls dipped in tap water
- apply small amount of petroleum jelly to tip for first 2-3 days w/ each diaper change
How long can NBs sleep?
- 16-18h/day for first few days
- 8-20h/day at 4wks PP
When is the soonest a NB will likely sleep more at night?
at 12wks
true or false:
NBs do not know day from night
false-ish
NBs are less confused than they are not as governed by circadian rhythms
Why do NBs sleep so much during the day?
sleep associated w/ eating
What indicates a NB is overheated?
- red skin
- irritability
- body warmth
- lethargy
What are danger s/sx in the NB and should be reported?
1) axillary temp > 99.3F or < 97.5F
2) tachypnea (>60 breaths/min) for > 1 min
3) periodic apnea (pauses >20s)
4) abnormal respirations (e.g retractions, wheezing)
5) umbilicus infection
6) eye infection
7) jaundice
8) GI: projectile vomiting, bile-stained vomit, no stools/urination since birth, taut/swollen abdomen
8) diarrhea (>6 stools/24h)
9) general signs of illness
How can diaper rash be treated pharmacologically?
topical antifungals (miconazole) or topical steroids (hydrocortisone) applied at every diaper change until rash gone + 1-2 days after
How can thrush be treated?
- nystatin suspension PO 4x/day
- gentian violet 1-2% aqueous sol’n applied 2x/day until 1-2 days after white patches gone
- put sol’n on nipples if breastfeeding
What are potential benefits of circumcision?
1) cleaner glans penis
2) lower chance for UTI
3) reduced incidence of penile cancer, phimosis, balanitis, adhesions, and occlusion of urethral meatus
