Routine Neonatal Care

Question 1

If a newborn does not receive Vitamin K prophylaxis, what bleeding disorder is the infant at risk for?

Answer 1

Vitamin K Deficiency bleeding (VKDB) aka “hemorrhagic disease of the newborn”

Typically presents in 1st month of life, presents as bleeding from the mucous membranes, GI tract, circumcision site, and/or intracranial hemorrhage.

Vitamin K is essential cofactor for Factors 2, 7, 9, 10, and proteins C and S.

Maternal risk factors: liver disease, anticonvulsants, and strict veganism.

Question 2

What should an infant born to a mother who is positive for Hepatits B surface antigen receive soon after delivery?

Answer 2

Hepatitis B Immunoglobulin (HBIG) in addition to the vaccine within the first 12 hours of life.

Question 3

Which newborns should be screened for hypoglycemia?

Answer 3

Infants of a diabetic mother, toxemic mother, LGA, SGA, Premie (<37W), LBW (<2500g), Polycythemia (Hct >70%), hypothermia, birth depression (Apgar <5 at 1 min), acute illness (sepsis, respiratory distress), discordant twin

Clinical: tremors, jitteriness, irritability, high-pitched or weak cry, lethargy, hypotonia, poor suck, cyanosis, apnea, tachypnea, seizures

Question 4

What are the current intervention levels for hypoglycemia?

Answer 4

Plasma glucose <40mg/dL during first 24 HOL and <50 after 24 HOL

Treatment: D10 bolus (2cc/kg or 200 mg/kg), if seizures increase dose to 4cc/kg. After stabilization maintenance glucose gtt should begin at 6-8 mg/kg/min

Question 5

What screening test can a blood transfusion interfere with?

Answer 5

Inborn errors of metabolism or hemogloniopathies

Question 6

When does the AAP recommend neonates have a hearing screen?

Answer 6

All neonates be screened prior to discharge

Question 7

What type of placenta do conjoined twins have?

Answer 7

Monoamniotic, monochorionic

Question 8

For twin-to-twin transfusion syndrome, which type of placenta must be present

Answer 8

Monochorionic placenta

Question 9

What are the maternal risk factors for an SGA infant?

Answer 9

Severe malnutrition, hypoxemia, uteroplacental dysfunction, TORCH infections, substance abuse, and toxis.

Question 10

What re some of the perinatal complications that an SGA infant can have?

Answer 10

Perinatal asphyxia, meconium aspiration, persistent pulmonary hypertension, NEC, RDS, intracranial hemorrhage, temperature instability, hypoglycemia, polycythemia/hyperviscosity, impaired immune function, impaired protein and lipid metabolism, neurodevelopmental abnormalities