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N352: Practice of Nursing I > OB Module 5: Complications of the Newborn > Flashcards

OB Module 5: Complications of the Newborn Flashcards

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1
Q

How has fertility rate in the US recently

A

it hit a 3% drop from 2016 to 17 leading to a historic low

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2
Q

Birth rates have lowered in all age groups except…

A

women in their 40s

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3
Q

In 2017 pre term ___ ___rose 9.93%

A

birth weight

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4
Q

How many deaths per 100,000 live births occur in the US

A

597

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5
Q

Leading Causes of Infant Death

A
  1. Congenital Malformations, Deformations, and Chromosomal Abnormalities
  2. Disorders related to short gestation and low birthweight: not elsewhere classified
  3. SIDS
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6
Q

Infant Morality means…

A

infant death before their first birthday

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7
Q

Infant morality gives information…

A

on maternal and infant health and is also an important marker for overall health of society

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8
Q

What is the importance of the NICU

A

they were made in the US in the 1960s and newborn mortality rate

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9
Q

Maternal Risk Factors

A

Low Socioeconomic Status (effects the below point)

Limited access to health care, especially prenatal care

Environmental exposure; high altitude (affects oxygenation)

grand multiparity (exhaustion from so many babies)

multiple gestation pregnancy

poor maternal nutrition

pre existing maternal conditions

maternal age and parity

complications of pregnancy

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10
Q

___ and ___ mothers are at the highest risk for complications

A

youngest and oldest

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11
Q

What are some pre existing maternal conditions that are risk factors for complications

A

heart disease

DM

HGTN

preeclampsia

renal disease

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12
Q

What are some neonatal risk factors for complications

A

birth weight

gestational age

type and length of newborn illness

environmental exposures in uteri

delayed bonding

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13
Q

SGA

A

small for gestational age

less than 2500 grams or 10th percentile on birth chart - so about 5.5 pounds or less

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14
Q

LGA

A

large for gestational age

greater than 4000 g and 90th percentile -8.8 pounds or more

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15
Q

Less than ___ weeks is preterm

A

37

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16
Q

Early Term is when

A

between 37-38 weeks and 6 days

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17
Q

Full term is when

A

39 weeks to 40 weeks and 6 days

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18
Q

Late term is when

A

41 weeks to 41 weeks and 6 days

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19
Q

Post term is when

A

anything beyond 42 weeks

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20
Q

What is essential to picking up complications early in the newborn period

A

regular assessments and vital sign checks

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21
Q

What is essential to do since newborns have little reserve

A

it is essential to address complications as they start in order to minimize potential long term impacts

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22
Q

What are the categories of Risk factors for Newborn Complications?

A
  1. Prenatal or Antenatal (during pregnancy) -maternal or fetal
  2. Intrapartal (during delivery)
  3. Postpartum (after delivery)
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23
Q

SGA is under ___ g or ___ pounds. that is the ___ percentile

A

25000 g or 5.5 lbs. 10th percentile

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24
Q

SGA is based on ___ not ___

A

weight not time (it can be pre term or post)

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25
Q

What is associated with SGA

A

decreased placental function

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26
Q

IUGR

A

Intrauterine Growth Restriction

SGA + Additional Complication

May be thin, pale, loose dry skin, umbilical cord thin and dull instead of thick and shiny

May appear small all over or malnourished

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27
Q

IUGR is related to what things?

A

Gestational Diabetes / Uncontrolled Diabetes

rubella

CMV

toxoplasmosis

syphilis

malnutrition

lung disease

HTN or heart disease

kidney disease

anemia

sickle cell anemia

smoking

drinking alcohol or drug abuse

chromosomal defects in the fetus

multiple gestations - twins or triplets

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28
Q

What things can cause SGA

A

asphyxia

aspiration syndrome

hypothermia

hypoglycemia

polycythemia

things associated with decreased placental perfusion/function

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29
Q

IUGR is SGA + Additional complications: What are some of the additional complications

A

congenital malformations

intrauterine infections

continued growth difficulties

cognitive difficulties

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30
Q

Example Nursing Diagnoses for IUGR/SGA

A

Risk for impaired gas exchange related to meconium aspiration

risk for ineffective thermoregulation secondary to decreased subcutaneous fast

altered nutrition

risk for altered parenting related to lack of knowledge of infant care and prolonged separation of infant and parent secondary to illness

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31
Q

Not all SGA is ___

A

IUGR

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32
Q

What are some risk factors for LGA

A

Infant of a diabetic mother

Erythroblastosis fetalis

cardiac etiology - transposition of great vessels

multiparity

prior history of macrocytic infant

postdate gestation

maternal obesity

male fetus

genetics

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33
Q

Complications of LGA infants

A

cephalopelvic disproportion

increased incidence of Cesarean birth and induction of labor

hypoglycemia, polycythemia, hyper-viscosity

jaundice secondary to hyperbilirubinemia

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34
Q

Cepalopelvic Disproprtion

A

when the babies head does not fit through the pelvis (LGA)

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35
Q

Characteristics of an infant of a diabetic mother

A

Macrosomia (over 4000g or 8.8 pounds) or SGA

ruddy in color

excessive adipose tissue

large umbilical cord and placenta

decreased total body water

excessive fetal growth from exposure to high levels of maternal glucose

potential Organomegaly (increased organ weight)

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36
Q

25-42% of diabetic pregnancies are macrosomia for the infant d/t…

A

insulin

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37
Q

Why can a diabetic mother give birth to an LGA or SGA infant

A

depends on blood flow and vascular impact of the diabetes on the mom before and after the pregnancy

SGA suffered from intrauterine malnutrition and have almost no glucose reserves for L&D - so uteroplacental circulation was impaired leading to poor growth patterns and hypoxemia –> Fetal distress in labor

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38
Q

Why are infants of diabetic mothers prone to shoulder dystocia

A

they have excessive fat on the shoulders and trunk oftentimes

this leaves them also predisposed to brachial plexus injury and overall body weight

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39
Q

LGA infants are often ___ in the first few hours post birth

A

hypoglycemic

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40
Q

Cephalopelvic Disproportion or Dysfunctional Labor pattern means…

A

a C Section may be needed

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41
Q

Complications in the Infant d/t the mother having diabetes

A

Hypoglycemia

Hyperbilirubinemia and Jaundice

Birth Trauma

Polycythemia

Respiratory Distress Syndrome

congenital Birth Defects like cardiac anomalies (most common), GI anomalies, and sacral agenesis

Poor eating habits

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42
Q

Why is birth weight NOT a reliable measure of maturity?

A

for example, LGA infants may not eat well and act like a preterm child despite looking past maturity

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43
Q

Erythroblastosis Fetalis

A

hemolytic disease of the newborn

results from a blood disorder like ABO incompatibility or Rh incompatibility

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44
Q

Most common incompatibility between mom and baby

A

ABO

Mom is O carrying Anti A and Anti B antibodies and the baby is A B or AB

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45
Q

Combs Test

A

a positive test will show agglutination and the baby will be jaundiced from high bilirubinemia (may need photolight therapy)

may cause slight anemia but should not need treatment - occurs with ABO incompatibility

also tests Rh incompatability

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46
Q

Rh Incompatibility

A

mom is Rh - and baby is Rh +

not usually a problem until subsequent pregnancies

1:1000 pregnancies

rarely seen now due to Rhogam in third trimester and after childbirth if baby is Rh+

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47
Q

___ and ___ increase with each pregnancy for a baby with Rh+ blood

A

risk and severity

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48
Q

What happens in a second pregnancy if this child is also an Rh + infant?

A

mild anemia to severe hemolytic anemia, edema, enlarged liver spleen and possible hydrops

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49
Q

Tests and treatments for erythroblastosis fetalis

A

Blood type

Coombs test

Rhogam

Phototherapy

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50
Q

Hydrops Fetalis

A

a severe abnormal accumulation of fluid in 2 or more fetal compartments including ascites, pleural effusion, pericardial effusion, and skin edema

rare but very fatal / high mortality

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51
Q

In some patients, hydrops fetalis is also associated with …

A

polyhydramnios and placental edema

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52
Q

Causes for Hydrops Fetalis

A

Hemolytic incompatibilities, severe anemias

Parovirus B19

Congenital Anomalies

Fetal Hemorrhage - intracranial intraventricular, hepatic laceration, subcapsular, placental subchorial

tumors

fetomaternal hemorrhage

twin to twin transfusion

isoimmune fetal thrombocytopenia

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53
Q

It used to be thought ___ ___ causes hydrops fetalis, but what disproved this?

A

Rh incompatibility - but Rhogam came in and it still occurs

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54
Q

How can twin to twin transfusion cause hydrops fetalis

A

if one identical twin receives too much blood and the other doesn’t get enough the hydrops can occur

early detection needs to see this to deliver the baby early

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55
Q

Isoimmune Fetal Thrombocytopenia causing Hydrops Fetalis

A

mom body recognizing non self antigens on fetal platelets and making antibodies to attack

the non self antigen comes from the dads side

if it is mild no treatment is needed, but severe cases cause fetal intracranial hemorrhaging leading to hydrops

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56
Q

Preterm infant

A

defined as an infant that is delivered less than 37 weeks gestation

could lead to needed NICU care

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57
Q

Preterm infant ability to survive is dependent on…

A

degree of prematurity and infants own strengths and weaknesses

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58
Q

In general infants born at less than ___ weeks are non viable

A

24 weeks

however some 23 week yo infants have survived but need serious help

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59
Q

If at delivery the infants eyes are fused and it weighs less than 500 grams…

A

general resuscitation is not done

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60
Q

Why do we bring pre term babies to the NICU

A

to see if the can maintain temperature, have respiratory efforts, can eat and tolerate food, maintain blood sugar etc

If all those things are ok then they can go to the normal nursery

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61
Q

Micro preemies need level ___ NICU

A

4

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62
Q

What are some complications associated with preterm infants in regard to alteration in respiratory and cardiac physiology?

A

apnea of prematurity

PDA - patent ductus arteriosus

RDS - respiratory distress syndrome

BPR - bronchopulmonary dysplasia

IVH - intraventricular hemorrhage

anemia of prematurity

aspiration

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63
Q

Apnea of Prematurity

A

no breathing for at least a full 20 seconds

if not a full 20 seconds than it is bradypnea

leads to bradycardia because of immature resp centers

turn blue color and may physical stimulation or O2 supports to get them to breath

typically this is outgrown

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64
Q

Anemia of Prematurity

A

exaggerated response from hypoxic state in utero to the hyperoxi state in utero

it is a normocytic, normochomic, hyperregenerative anemia

low serum erythropoietin levels occur despite low Hgb levels

cannot make new RBCs to mature

BASICALLY EVERYTHING IS IMMATURE (maybe from not enough building blocks)

Reticulocyte counts watched carefully but it tends to resolve in 3-6 months

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65
Q

A major complication of being a preterm infant in regard to alteration in thermoregulation is ___

A

hypothermia

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66
Q

What are some important preterm GI alterations

A

hypoglycemia

necrotizing enterocolitis

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67
Q

What are some important preterm immunologic alterations

A

neonatal infection

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68
Q

What are some important preterm neurologic alterations

A

reactivity periods and behavioral states

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69
Q

What are some important preterm ocular alterations

A

retinopathy of prematurity

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70
Q

Necrotizing Enterocolitis

A

when food is not moving through the intestines like it should and bacteria cause gas formation

this increases abdominal girth as a gas bubble gathers and increases risk for perforation leading to sepsis and can be fatal

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71
Q

What are some s/s of Necrotizing Enterocolitis

A

bradycardia

apnea

color changes

infant looks sick

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72
Q

Treatments for Necrotizing Enterocolitis

A

stop feedings

gastric tube suctions to keep GI tract empty

high doses of antibiotics

possible ventilatory support and intubation support

strict feedings to make sure food is digested

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73
Q

Necrotizing Enterocolitis may occur when what is done too quickly

A

feedings

so we should educate that when a preterm infant cries or does sucking motions it may not mean they are hungry but rather just have an innate need to suckle

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74
Q

What does quietness after anger and annoyance indicate in an infant

A

being overwhelmed

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75
Q

Retinopathy of Prematurity

A

normal vessels in the eye should grow following the curve of the retina

However, premies have vessels growing into the vitreous humor in fingerlike projections that become tortuous and twisted and engorged and if they rupture it can lead to blindness

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76
Q

Treatment for Retinopathy of Prematurity

A

careful eye exams and surgery if there are abnormalities in order to prevent blindness

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77
Q

Ductus Arteriosus

A

blood vessel allowing blood to go around the fetal lungs prior to birth

after birth the lungs fill with air and this closes within a couple of days after delivery

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78
Q

Patent Ductus Arteriosus

A

when the ductus arteriosus does not close

it leads to abnormal blood flow between the aorta and pulmonary artery

more common in girls

occurs in premies commonly

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79
Q

S/s of Patent Ductus Arteriosus

A

fast breathing

poor feeding

tiring easily

auscultated murmurs

tachycardia

SOB

poor growth

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80
Q

Intraventricular Hemorrhage

A

high incidence in infants under 30 weeks gestation

occurs since premie cerebral vessels are very fragile and bleed into the brain

this is important to consider when moving or transporting premies as their heads cannot take jarring movements

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81
Q

RDS

A

Respiratory Distress Syndrome

Caused by lung prematurity

chest xray shows the atelectasis as hazy lung fields

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82
Q

What sort of infants get RDS?

A

60-80% are <28 weeks will develop

But even a full term baby can have it occur if there is no surfactant in the lungs

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83
Q

Common Predictors for RDS

A

Prematurity

C Section without labor

IDM (diabetes in mom)

2nd Twin`

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84
Q

Antepartal complications d/t RDS

A

hemorrhaging

asphyxia

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85
Q

How to treat RDS

A

give chemical surfactant

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86
Q

Consequences of RDS

A

lung scarring

increased risk of asthma (d/t scarring)

BPD - bronchopulmonary dysplasia

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87
Q

BPD

A

bronchopulmonary dysplasia

can occur if infant was on ventilation or oxygen for a long time

it is a chronic lung condition

greater risk for lung infections, respiratory sysital virus, and permanent bronchial changes occur

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88
Q

S/S of Respiratory distress syndrome (RDS)

A

cyanosis

grunting

inspiratory stridor

poor feeding

tachypnea

lethargy

intercostal, subcostal, and/or suprasternal spaces retractions

89
Q

Hypothermia is a big problem in ____ and ___ infants since they lack …

A

preme and SGA infants since they lack brown fat

90
Q

Cold stress will cause…

A

hypoglycemia

hypoxia

metabolic acidosis

anaerobic metabolism

91
Q

Increased respiratory distress d/t hypothermia is caused by ___ and ___

A

hypoxia and acidosis

92
Q

Since there is so much energy used keeping themselves warm, there is no energy to ___ in the cold stressed child

A

eat

93
Q

Causes of Hypothermia

A

Prematurity

IUGR

Other stressors like sepsis, birth asphyxia, hypoglycemia, respiratory distress

94
Q

S/S of Hypothermia

A

respiratory challenges

bradycardia

seizure

feeding intolerance

lethargy

irritability

hypoglycemia

95
Q

Ways to prevent and treat hypothermia?

A

warmers, isolettes, hats and blankets, skin to skin contact with blankets on

96
Q

Most of the heat in an infant is lost from the ___

A

head

97
Q

Term infants maintain temperature well after __ hours, but premature infants will need a ___ or ___ to maintain temperature

A

24; isolette or warmer

98
Q

When is blood sugar lowest (when are they hypoglycemic) for infants?

A

1-2 hours after cord clamping

(may need an IV to compensate)

99
Q

Failure to increase blood sugar after ___ hours is pathologic for hypoglycemia

A

4 hours

100
Q

What is the difference between ability to compensate for blood sugar between term and preterm infants?

A

term infants can usually compensate

preterm infants do not have the brown fat stores to compensate and cannot tolerate early feedings sufficient to maintain blood sugar levels alone

101
Q

Any baby less than ___ mg/dL needs intervention like IV fluid feeding

A

40 mg/dL

102
Q

Causes of Hypoglycemia

A

prematurity

IUGR

delayed feedings

increased need for glucose

need an increased uptake of glucose

inborn errors

diabetic mothers

103
Q

What is interesting about the s/s presentation of hypoglycemia

A

you may not see any so you will need to check a chemstrip if indicated by history and protocol

104
Q

S/S of Hypoglycemia

A

tremors/jittery –> seizures

abnormal cry (high pitched or weak)

respiratory distress –> apnea, irregular respiration, tachypnea, cyanosis

stupor, hypotonia, refusal to eat (d/t decreased brain sugars)

105
Q

A cat like cry is indicative of…

A

cocaine addiction

106
Q

How to prevent and treat hypoglycemia

A

early feedings

frequent monitoring

prevention of causative factors through temperature stability, treating respiratory difficulties, early IV (emergency use)

107
Q

Why are infants so at risk for neonatal infection

A

because the immune system is immature, unable to produce adequate levels of antibodies, unable to localize infections, and incomplete mucosal defenses (like trapping) which allows the infant to be more readily colonized

108
Q

The term newborn does have some temporary passive immunity from…

A

the mother

109
Q

When can maternal infection be passed to the infant

A

transplacentally in utero

at time of delivery via contact contamination

after delivery through breast milk

110
Q

Bacterial infections are classified as ___ onset or ___ onset

A

early or late

111
Q

early onset neonatal infection

A

usually present from 24 hours to 1 week post birth (could be home by then)

tend to progress rapidly

10-25% risk of mortality

112
Q

What are some associated bacteria with early onset neonatal infections

A

Group B Streptococcus

H Influenza

Listeria Monocytogenes

E Coli

113
Q

Group B strep accounts for ___ % of neonatal infections

A

80%

114
Q

We test the mom for Group B strep at ___ weeks but if delivered early without testing we must do a ___ to check the baby

A

36 weeks

CBC

115
Q

What sort of things may be ordered with a neonatal infection

A

CBC

chemstrips

bilirubin levels

blood cultures

116
Q

Late onset neonatal infection

A

usually presents after 2 weeks but can occur after the first week - they are definitely home by then

it progresses slowly

lower mortality rate but a higher morbidity rate

117
Q

Associated organisms with late neonatal infection

A

S Aureus

S Epidermidis

Pseudomonas

Group B Streptococcus

118
Q

___ ___ ___ can be early or late onset

A

Group B Streptococcus

119
Q

Postmaturity

A

applies to any newborn born after 42 weeks gestation

120
Q

Complications with Postmaturity

A

Potential intra-partal problems:

Cephalopelvic disproportion (CPD)

Shoulder Dystocia

Meconium Passage in utero is common

Placental function deteriorates

Respiratory complications

Vernix gone - skin is wrinkly, dry, peeling

121
Q

Why is post maturity so rough on the placenta

A

it is supposed to deteriorate at term but after 40 weeks calcification begins and function deteriorates

this causes less O2 to the baby which leads to meconium passage

less O2 –> meconium in utero –> meconium is sterile but it is sticky and can be aspirated causing further respiratory issues

122
Q

Issus occurring d/t postmaturity

A

Fetus is exposed to poor placental function –> hypoglycemia and asphyxia

impairment of nutrition and oxygenation

123
Q

Postmaturity Syndrome

A

constellation of issues r/t to postmaturity including:

Hypoglycemia

Meconium Aspiration and Asphyxia

Polycythemia

Congenital Anomalies

Seizure Activity

Cold Stress

124
Q

Meconium Aspiration Syndrome (MAS)

A

Complete or partial airway obstruction from inhalation of the meconium that can affect term and near term infants

frightening

can cause atelectasis, hyperinflation, or pneumonitis

125
Q

What is required with meconium aspiration syndrome

A

intubation directly after birth to suction meconium from the airway

this is before breath is taken or crying begins so stimulation needs to be minimized until it is over

126
Q

Meconium

A

first stool

dark green black and sticky

made of dead blood cells

127
Q

How can we tell if meconium was passed in utero

A

if the amniotic fluid is green colored

128
Q

Common Predictors of MAS

A

term or post term infants

rarely seen in <36 week gestation (preterm) unless they are severely O2 deprived and stimulated to pass

129
Q

Complications arising from MAS

A

pneumothorax

pneumonia

persistent pulmonary HTN

bronchopulmonary dysplasia

neurologic complications

possible death

130
Q

What will MAS look like on a CXR

A

ill defined predominantly perihilar opacities

131
Q

Why can so many complications occur d/t MAS

A

because they are working hard to breath and the lungs are hyperinflated

132
Q

Transient Tachypnea of the Newborn (TTNB)

A

Amniotic fluid that got into the lungs (“Wet Lungs”)

occurs in term and near term infants

lasts 1-5 days

minimal hypoxia - self limiting

no meconium in the fluid

may need some O2 support

133
Q

Respiratory rates are generally what in TTNB?

A

> 100 breaths per minute

134
Q

Common predictors of TTNB

A

C sections without labor (no squeeze to rid of fluid)

Precipitous delivery

prolonged labor

Male

Second Twin

135
Q

What are the consequences of TTNB?

A

NO LONG TERM CONSEQUENCES - it is self limiting

They will be unable to nipple feed with a high RR and will need introduction to food slowly via IV or gavage (NG)

136
Q

Infant cannot nipple feed with an RR ___

A

> 70 (d/t aspiration risk)

137
Q

What is the morbidity and mortality like with TTNB

A

there is none

138
Q

What are the phases of TTNB

A

Phase 1 - grunting phase with grunting to open up the alveoli

Phase 2- tachypneic phase with RR 100-120

139
Q

What is the path of fetal circulation

A

Right ventricle –> pulmonary artery –> ductus arteriosus –> aortic arch –> Body

140
Q

Only __ to __% of R&L ventricular output goes to the pulmonary vessels. The rest bypasses…

A

5-10%; the lungs

141
Q

What occurs to pressure and circulation at birth

A

there is a rapid FALL in pulmonary vascular resistance and pulmonary artery pressure accompanied by a 10 fold increase in pulmonary blood flow

142
Q

Persistent Pulmonary Hypertension (PPN)

A

persistent fetal circulation after birth

occurs in near term, term, and post term infants

10-20% of the time it is idiopathic but can also occur from hypoxia or other delivery problems like abruption, meconium staining, etc

2 in 1000 children

143
Q

Consequences of PPN

A

pneumothorax

hypotension and CHF

impaired kidney function

DIC

seizures

144
Q

What are the interventions like for PPN

A

quite minimally invasive interventions but ones that are done to prevent lung damage

they need consistent oxygenation to prevent vasoconstriction - but if that occurs they need nitrous oxide on a level 4 NICU

145
Q

Pneumothorax

A

Happens with alveolar over distention and rupture

can be spontaneous or d/t assisted ventilation

frequently there is another underlying pulmonary disease at work

may or may not require intervention

146
Q

What is intervention in a pneumothorax like

A

they may or may not need it

if its less than 20% they will be able to recoup on their own but if more they need a chest tube - lung may reinflate on its own or require intervention

chest tube is attached to a continuous negative pressure system

147
Q

What are the consequences of pneumothorax dependent on

A

underlying pathology

148
Q

s/s of Respiratory Disorders (Global Symptoms)

A

tachypnea between 60-120 bpm with TTN

grunting

retracting

nasal flaring

hypoxia (cyanosis) - circumoral may occur first

transilluminator of a pneumothorax

149
Q

How can we see a pneumothorax?

A

via transillumination in a dark room

if placed in the armpit it will show light on the affected side with the pneumothorax (it lights up)

150
Q

Treatments for Respiratory Disorders

A

O2 support

continuous oximetry

chest PT (break up secretions)

keep temp, CS< fluids and electrolytes stable

monitor ABGs, CBC, BC

prophylactic antibiotics if questionable CBC or mom group B strep + (may be better than waiting 48 hours)

surfactant if RDS

chest tube if pneumothorax

151
Q

What are some ways of giving oxygen support

A

Hood - Mixed air

Heated Flow Cannula - air humidified and warmed

CPAP

Oscillator

Ventilator and ET Tube

ECMO

152
Q

CPAP

A

continuous positive airway pressure

baby is not intubated but a little pressure helps open the airways and get them breathing

153
Q

Oscillator

A

special machine that does 200 revolutions over the chest per minute

very sophisticated

can mean survival for some children

154
Q

ECMO

A

extracorporeal membrane oxygenation

quite specialized

it is like a baby version of a heart lung bypass where we oxygenate the blood for them

155
Q

TORCH

A

represents a group of congenital infections that cause birthd efects

156
Q

What does TORCH stand for

A

Toxoplasmosis

Other (infections)

Rubella

CMV

Herpes Simplex

157
Q

What is included under other infections in torch

A

Hep B

Syphillis

Herpes Zoster (chicken pox)

HIV

158
Q

TORCH is most serious when…

A

mom develops primary infection during pregnancy

may appear mild to her but has serious impacts on the baby

159
Q

When can an infant contract congenital infections / TORCH

A

1.infection crosses the placenta

  1. infant contracts while passing through the birth canal
160
Q

Severity of infection in the mom …

A

does not determine severity in the baby

161
Q

What groups of women tend to have TORCH infections

A

ANY woman - they are equal opportunity

unrelated to cleanliness or socioeconomic status

162
Q

Toxoplasmosis comes from

A

raw meat or cat litter

163
Q

If mom has active lesions of herpes at labor..

A

we deliver via C section to prevent infection

164
Q

PKU Test

A

newborn screening done on all babies (heel stick) to check for metabolic disorders

165
Q

What are some common things tested for with Metabolic Disorders?

A

Phenylketonuria

Galactosemia

Hypothyroidism

Sickle cell Anemia

Congenital Adrenal Hyperplasia (CAH)

HIV

166
Q

How many tests can be run on the small newborn screening blood samples

A

over 40 tests

167
Q

Phenylketonuria (PKU)

A

lack of an enzyme - phenylalanine hydroxylase - leads to irreversible brain damage in 24 hours if they eat food with phenylalanine in it

168
Q

Galactosomia

A

lack of enzyme that converts galactose to glucose

babies can get jaundice, weight loss, cataracts

169
Q

Buetler Test

A

checks for galactosemia

170
Q

A mom may refuse HIV testing, but…

A

we always test the baby in NYS - but we let mom know ahead of time

171
Q

Hyperbilirubinemia

A

Jaundice

Yellowing of the skin due to the accumulation of bilirubin - it also accumulates in the brain

it occurs when breakdown of RBC happens faster than the liver and GI tract can remove them

172
Q

Bilirubin

A

a byproduct of heme from the breakdown of Hgb

it is one of the components of bile and is yellow in color

173
Q

Why are infants more prone to juandice

A

they have a higher rate of production d/t shorter lifespan of RBC and higher RBC concentration than adults

they also have lower liver function leading to slower bilirubin metabolism and more reabsorption in the intestine due to delay of passage

174
Q

In most newborns, jaundice is…

A

physiological and considered harmless

175
Q

What % of term and near term infants will become visible jaundiced? What about preterm?

A

60-70% Term and Near Term

80% Preterm

176
Q

What is the leading cause of hospital readmission in the first 2 weeks of life

A

hyperbilirbinemia

177
Q

Hyperbilirubinemia is the major cause for what in an otherwise healthy newborn

A

prolonged hospitalizations

178
Q

Physiologic Causes of Hyperbilirubinemia

A

increased load of RBC breakdown from cephalohematoma, suction or forceps delivery, other bruising

liver immaturity

infant of diabetic mother

hepatic or bowel abnormalities

breastfeeding

179
Q

Hemolytic causes of Hyperbilirubinemia

A

blood group incompatibilities

Rh negative mom

ABO incompatibilities

G6PD Deficiency

180
Q

Breastmilk Jaundice - Type related to Poor Intake

A

most likely in first week of life

may not get adequate milk while establishing breastfeeding leading to elevated bilirubin due to increased reabsorption in the intestines

this also delays passage of meconium which has a lot of bilirubin in it that will be reabsorbed

181
Q

Breastmilk Jaundice - type related to unknown etiology

A

occurs in the 2nd or later weeks of life and continues for several weeks

exact mechanism unknown but substance in moms milk may inhibit liver processing of bilirubin

182
Q

What are some treatment options for breast milk jaundice

A

phototherapy

temporary supplementation with donor milk or infant formula or rarely interrupted breastfeeding

183
Q

G6PD

A

glucose 6 phosphate dehydrogenase deficiency

causes milk to severe jaundice – generally in males

passed via X chromosome

usually G6P helps process carbs and protects RBC from influence of harmful meds or infections

may not had any s/s

common in Sephardic Jewish and Mediterranean descent

184
Q

Complications from Extreme Hyperbilirubinemia

A

Neurological complications including:

seizure

poor suck reflex

irritability

abnormal muscle tone

185
Q

The major long term complication of extreme hyperbilirubinemia is ___

A

Kernicterus

186
Q

Kernicterus

A

When bilirubin levels are high (over 20) it can enter the brain and causes this syndrome of complications

irreversible

187
Q

What are some of the s/s of Kernicterus

A

seizure

hearing loss

motor deficits

vision loss

learning difficulties

death

188
Q

Premature infants need to be treated when in regard to their hyperbilirubinemia levels in reference to term infants

A

treated at lower levels than term infants

189
Q

Treatment for hyperbilirubinemia is evaluated in reference to…

A

how old the infant is in terms of hours and the babies size

190
Q

What are some complicating factors for hyperbilirubinemia treatment

A

hypoglycemia

sepsis

*both affect decision to treat

191
Q

How to test for Hyperbilirubinemia

A

Observation

transcutaneous Bilirubinometry

blood draws from a heel stick

192
Q

What observations can be made for hyperbilirubinemia

A

cephalocaudal progression (head down) of jaundice

easy but the most unreliable test

193
Q

Best way to test hyperbilirubinemia is via a …

A

blood draw via heel stick

it gives a direct bilirubin level in mg/dL and gives the neonatal or total bilirubin level in the infant

194
Q

Treatment options for hyperbilirubinemia

A

phototherapy

hydration - feeding via breast or bottle or IV

exchange transfusion

195
Q

Why can we not do phototherapy on an infant with high direct bilirubin levels

A

it can permanently bronze the skin

196
Q

Why do we need to make sure hyperbilirubinemia infants are well hydrated

A

so the concentration of bilirubin is less and they can pass it and rid of it more

197
Q

Why is exchange blood transfusion sometimes done in hyperbilirubinemia?

A

a partial or full exchange of blood from a donor after the PKU test may be done to replace a large amount (75) of blood to prevent kernicterus

198
Q

Complications Associated with Maternal Substance Abuse

A

Fetal Alcohol Syndrome (FAS)

Maternal Drug Use/Abuse

Maternal Tobacco Dependence

Exposure to HIV/AIDS (d/t risky behavior)

Congenital Heart Defects

Caffeine, Tobacco, Alcohol impacts

199
Q

Neonatal Abstinence Syndrome (NAS)

A

Withdrawal

Infants withdrawing from many substances - not just illicit drugs

200
Q

what substances may cause NAS

A

cigarettes

caffeine

prescription pain killers

alcohol

street drugs

antidepressants

201
Q

Characteristics of Infant NAS/Withdrawal

A

high pitched cry

colic - early on and prolonged

poor sleep patterns

increased muscle tone and tremors

seizure

diarrhea

temperature instability

poor feeding

sneezing

202
Q

When may NAS begin

A

sometimes after 24 to 48 hours when the infant may be home already

203
Q

Why is stigmatization of drugs harmful to mothers

A

many women with substance use disorders may have late or no prenatal care as a result which leads to poor outcomes

204
Q

What is recommended women do regarding their addiction while pregnant?

A

NOT abruptly stop or wean off opioids even if they want to

this is because maternal withdrawal can increase the risk of miscarriage or intrauterine death

However these risks are higher if the mom gets no treatment so we must do drug treatment

205
Q

What are the safest plans for drug treatment for pregnancies with substance use disorders

A

Methadone or Buprenorphine treatment

206
Q

What is the objective for a mother with a SUD (substance use disorder)

A

maintain healthy gestation and prevent use of street drugs

207
Q

What is the issue with maintenance drug treatment for maternal SUD

A

they are increased to prevent withdrawal but it continues to expose the infant leading to risk for preterm delivery, low birth weight, fetal distress, placental abruption, miscarriage, intrauterine death, severe HTN, or maternal/neonatal death

208
Q

Studies show what correlation between dose of opioid and level of NAS severity

A

no correlation between the two

209
Q

Nursing Considerations for NAS

A

Test infants when drug usage is suspected (urine and meconium drug screening)

Limit withdrawal symptoms (via morphine)

Involve social services

Monitor and support parental involvement

Treat other complications as necessary

210
Q

How do meconium and ursine testing capture differences in drug usage?

A

urine is more for short term usage (recent)

meconium can capture long term usage (throughout pregnancy)

211
Q

Why can meconium show long term / history of drug usage

A

because it begins to form in the 12-15th week of gestation

this can reveal up to the last 4-5 months of use

212
Q

Why do negative drug results not rule out drug exposure in the infant

A

because we do not have tests for every drug out there

213
Q

One infant ___ affects and causes another

A

complication

214
Q

It is important to do what in regard to infant complications

A

predict and act promptly

215
Q

___ infants need more proactive treatment than term infants

A

preterm

216
Q

The baby is a ___ in the NICU and we need to do what?

A

patient; so we must keep their best interest a priority but at the same time we also need to be supportive of the parent

217
Q

Always do what as much as possible in OB

A

promote parental involvement

218
Q

Parents need what

A

need to explain what is happening and what to expect

need frequent reinforcement due to the NICU environment

219
Q

Kangaroo Care

A

skin to skin contact

has positive outcomes when intubated

N352: Practice of Nursing I (14 decks)

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