NPS- Assessment of the Neonate Flashcards
Dubowitz Method
Uses combo of 7 physical and 6 neurological findings
Higher scores indicate longer gestation
A maturity rating of 40 indicates a term infant ( 40 weeks gestational age)
When is the New Ballard Score used?
used when infant is less than 28 weeks gestation and/or birth weight is < 1500 g.
modification of dubowitz method
Describe Apgar scoring
How an infant is evaluated after birth
Done at 1 & 5 minutes
Five factors are evaluated: color, HR, reflex irritability, muscle tone, and RR
Explain APGAR Scoring
7-10 No depression
4-6 Moderate depression
0-3 Severe depression
Low is not good & if not breathing @ birth do not wait 1 minute to do second APGAR
When should you initiate compression’s on an newborn ?
If HR is less than 60, despite 30 seconds of effective positive pressure ventilation.
When should epinephrine be given in a newborn with a low APGAR score?
administer epi if HR is less than 60 despite giving PPV and chest compression’s
What is the main thing you should do for an infant with a moderate (4-6) APGAR score?
Continue monitoring and administer 02 according to target sp02.
what does the Silverman Anderson Scoring evaluate?
Evaluates severity of respiratory distress in neonates
Is a high score in the silverman anderson scoring good or bad?
Bad- indicates severe respiratory distress
What does Pre and Post Ductal blood gas show?
right to left cardiac shunt
What does a pre-ductal Pa02 of 15 or more indicate?
indicates a R to L shunt
Most common issue is a patent ductus arteriousus (PDA)
Can be evaluated using trans-cutaneous monitors or 2 pulse ox with an sp02 difference greater than 10%.
Normal infant temp (skin is most accurate)
36.0 C- 36.5 C
Infant body core temp is 36.0 C. What does that mean?
Hypothermia- most common problem in pre-term infants
Sometimes occurs with infection
Define NTE
Neutral thermal environment
Why is it important to maintain NTE in an infant?
to minimize oxygen consumption
What is the main thing to remember where there is a metabolism issue?
control diet
What is normal HC03 and why is it important?
normal bicarb is 19-24 mmol/L
Important because controls muscle function and can cause arrhythmias
Normal Na+ (sodium)
133-149 mmol/L
Normal K+ (potassium)
Normal range 5.3-6.4 mmol/L
Higher in premature newborns
What do BUN and creatinine relate to ?
Kidney function
Normal BUN- 4-17 mg/ dL
Normal creatinine- 0.11-0.68 g/24 h.
Normal urine output in newborns
1 mL/kg/hour
If urine OP changes then this creates fluid OL
Normal RBC in newborns
4.1-5.7 mm
Define Polycythemia
high Hb
Define anemia
low Hb
What are the most common abnormal hemoglobin?
Hemoglobin S: present in sickle cell disease
Hemoglobin C: does not carry 02 well
Hemaglobin F
Fetal hgb
Has higher affinity for oxygen than hbg A
Hemoglobin A
Most common type found in adults
What is an electrophoresis test?
It is a procedure to check for different types of hbg in the blood. Most abnormal and common are hbg s and c.
What does a WBC count of 30k or higher indicate?
septic shock
normal range of WBC
10-30,000 mm
What is the byproduct of the breakdown of RBC by the liver
Bilirubin
How does jaundice happen?
Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and releases it into the intestines as bile.
What is normal bilirubin levels in cord blood range?
1.4-1.9 mg/ dL
How is hyperbilirubienemia treated?
phototherapy, Vitamin E, and exchange transfusion
Normal blood glucose levels in infants
50-100 mg/dL
Hyperglycemia
glucose >160 mg/dL
Hyperglycemia is an early sign of what in infants?
Septicemia
Hypoglycemia
Glucose < 40 mg/dL
Why is glucose is important ?
Maintaining glucose is important for development of baby’s brain
What is hypoglycemia directly related to?
hypothermia
What is the A/G ratio related to? and what is the AG ratio?
A- albumin G-Globulin
They are proteins present in the blood
Related to liver and renal failure
When an infant has a fever and looks septic, what should be thought about ?
Group Beta Streptococcus (GBS)- weather or not mother has been treated can result in neonatal pneumonia
What does GBS stand for?
Group B Steptococcus
