Problems Common to Newborn Flashcards
What is the most common cause of Respiratory Distress of a newborn?
Hyaline Membrane Disease
Hypoglycemia: General Characteristics
Defined as blood glucose
Hypoglycemia: Pathophysiology
Infant does not have sufficient glycogen stores in muscle or liver nor sufficient fat for release of fatty acids for energy
Hypoglycemia: Signs & Sx’s
Asymptomatic Poor feeding Lethargy Tremulousness Irritability Apnea Seizures
Hypoglycemia: Diagnostic Studies
Heel blood tested w/glucometer
Abnormal results should be confirmed w/ serum blood glucose
Normal glucose level is 50-80 mg/dL @ 3 hrs of age
Abnormal level is glucose
Hypoglycemia: Treatment
- Bolus of dextrose & water (D10W) & IV glucose as needed
- Continue to monitor
- Usually resolves by day 5
- Failure to resolve should prompt investigation for less likely causes
Neonatal Jaundice: Bilirubin Pathophysiology
- Bilirubin is final product of heme degradation
- Insoluble in plasma & requires protein binding w/ albumin
- After conjugation in liver, it’s excreted in bile
- Newborns produce bilirubin 2X the rate as adults
- Due to polycythemia & ↑ RBC turnover
- ↓ to adult level w/in 10-14 days after birth
Neonatal Jaundice: General Characteristics
- Total serum bilirubin > 5 mg/dL
- Typically results from deposition of unconjugated bilirubin pigment in the skin & mucus membranes
Pathologic if:
- Presents w/in 1st 24 hrs after birth
- Total serum bilirubin rises by > 5 mg/dL per day
- > 17 mg/dL
- (+) signs & sx’s suggestive of serious illness
> 65% of infants have bilirubin level > 5 mg/dL in first week of life
Neonatal Jaundice: Most common causes
- Physiologic
- Appears after 24 hr
- Peaks @ 3-5 days - Prematurity
- Appears w/in 24 hr of birth - Breast feeding
- Appears 2nd – 3rd day of life
- ↓ volume & frequency of feedings → dehydration & delayed passage of meconium
Neonatal Jaundice: Etiology
- Overproduction of bilirubin
a. Elevated reticulocyte count
- Hemolysis 2° to blood group sensitizations
- (+) Coombs test
- ABO incompatibility
- Rh incompatibility
b. Hemolysis 2° to congenital hemolytic anemia
- (-) Coombs test
- Hereditary spherocytosis
- G6PD deficiency
c. Hemolysis 2° to sepsis - Decreased rate of conjugation
a. Normal reticulocyte count
- Physiologic jaundice 2° to ABO incompatibility
- Bilirubin increases by
Neonatal Jaundice: Physical Exam
- Jaundice begins @ head
a. Extends to chest & extremities as bilirubin increases - Scleral icterus & jaundiced oral mucosa help distinguish jaundice in dark skinned infants
- Splenomegaly may be present in hereditary spherocytosis
Neonatal Jaundice: Diagnostic Studies
- CBC
a. Anemia
- Monitor H&H if acute hemolysis - Peripheral smear
a. Poikilocytosis, schistocytes, nucleated RBC’s - Bili – total, direct, indirect
- Retic count
- Coombs test
- G6PD test
a. African, Asian or Mediterranean descent - Septic work-up if indicated
Neonatal Jaundice: Complications
- Kernicterus
- Abnormal accumulation of bile pigment in the brain & other nerve tissue
- Leads to encephalopathy
- Bilirubin > 20-25 mg/dL
Early Effects of Bilirubin Toxicity
Lethargy
Poor Feeding
High-pitched cry
Hypotonia
Late Effects of Bilirubin Toxicity
Irritability Opisthotonos Seizures Apnea Hypertonia Fever
Chronic Effects of Bilirubin Toxicity
Cerebral Palsy High Frequency hearing loss Paralysis of upward gaze Dental dysplasia Mild mental retardation
Neonatal Jaundice: Treatment
- Rh incompatibility
- Transfusion
- Phototherapy - Hereditary spherocytosis
- Phototherapy - G6PD deficiency
- Phototherapy - Physiologic jaundice
- Usually resolves w/out intervention if bili 10 mg/dL or not decreasing) - Breast feeding jaundice
- Supplement w/ formula
- Phototherapy if bili > 10 mg/dL
What is phototherapy treatment (for neonatal jaundice)?
- Blue wavelengths of light alter unconjugated bilirubin in the skin
- Bilirubin is converted to less toxic water-soluble photo-isomers that are excreted in bile & urine w/out conjugation
-Phototherapy instituted when the total serum bilirubin level is:
≥ 15 mg/dL if 25-48 hours old
18 mg/dL if 49-72 hours old
20 mg/dL if > 72 hours old
- D/C when total serum bilirubin level
Respiratory Distress in the Newborn: Etiology
- Pulmonary causes
a. Chonal atresia
b. Transient tachypnea of newborn
-Resolves in 24 hr
c. Fluid aspiration
-Blood or meconium
d. Hyaline membrane disease
-Most common cause of resp distress in preterm infant
-Deficiency of lung surfactant -
Poorly developed pneumocytes cause low surfactant production needed to keep alveoli open - Cardiovascular causes
a. Cyanotic lesions
- Tetralogy of Fallot
- Tranposition of great arteries
b. Mild cyanosis
- Hypoplastic left heart syndrome
- Coarctation of aorta - Other common causes
a. Hyperthermia or hypothermia
- Premature infants
b. Intrauterine exposure to cocaine
c. Metabolic acidosis
d. Hemorrhage or asphyxia resulting in damage to CNS
- Traumatic delivery
Respiratory Distress in the Newborn: Physical Exam
- Cyanosis
a. If improves w/ oxygen, suspect pulmonary or non-cardiac cause - RR > 60 breaths/min
- Grunting
a. Usually occurs w/ nasal flaring, intercostal & sternal retractions
Respiratory Distress in the Newborn: Diagnostic Studies
- CXR
a. Air bronchograms, diffuse atelectasis causing ground glass appearance, & doming of diaphragm
- Classic CXR in hyaline membrane disease - Pulse oximetry
- ABG
- CBC & blood cultures
a. If sepsis suspected - CMP
- ECHO
Respiratory Distress in the Newborn: Treatment
- Supplemental oxygen
- Administration of exogenous surfactants
- Intubation & mechanical ventilation if necessary
a. Recommended treatment for hyaline membrane disease - Determine underlying cause & treat appropriately
