Test 4 part 2 Flashcards
Hyperbilirubinemia neurologic toxicity – high levels of bilirubin will cross blood brain barrier and cause bilirubin-induced neurologic dysfunction (BIND) by damaging brain tissue
kernicterus
a graph chart used for prediction of hyperbilirubinemia risk levels in newborns according to hours of life and bilirubin levels
Nomogram
mother’s antibodies attack newborns RBC. It is common for mothers with O+ type blood to have naturally occurring anti-A or anti-B antibodies (IgG class) that can cross the placenta and attack fetal RBC with blood types A, B, or AB
ABO incompatibility
differs from ABO and is more severe. Pregnancies at risk of Hemolytic disease of the newborn (HDN) are those in which an Rh D negative mother becomes pregnant with an RhD positive child (the child having inherited the D antigen from the father). The mother’s immune response to the fetal D antigen is to form antibodies against it (anti-D). These antibodies are usually of the IgG type, the type that is transported across the placenta and hence delivered to the fetal circulation
Rh incompatibility
occurs when the immune system encounters an antigen for the first time and mounts an immune response
Isoimmunization or sensitization
a condition that is the consequence of a previous disease or injury
Sequelae
Birth trauma due to cephalopelivic disproportion
Shoulder dystocia
Brachial plexus injuries
Cephalohematoma
Other hematomas and bruising
treatment for polycythemia
Normal saline
Plasmanate
5% albumin
Fresh frozen Plasma
Polycythemia exchange can be done via
UVC that is not in the liver
Low UAC
PIV
LGA secondary to
Fetal hyperinsulinemia and polycythemia
Maternal pre and gestational diabetes
SGA secondary to
Maternal renovascular disease
Vascular damage of placenta
Blood glucose monitoring is required for
IDM
LGA
SGA
Most common congenital anomalies with infants of diabetic mothers are
Cardiac
CNS
Skeletal
Congenital anomalies with infants of diabetic mothers is caused by
high maternal glucose early in pregnancy
Why do you observe for tetnay (hypocalcemia) in infants with diabetic mothers
possible delay in parathyroid hormone synthesis after birth
SGA fetal factors
Congenital infections-TORCH Discordant twins 2 vessel cord Trisomies Metabolic disease
Types of IUGR
symmetrical and asymmetrical
IUGR where there is a lack of blood flow through whole pregnancy
symmetrical
IUGR where lack of blood flow in 3rd trimester
asymmetrical
Risks for the SGA neonate
Asphyxia Aspiration syndrome Hypothermia Hypoglycemia Polycythemia
Post term infant risks
Increased size CPD Shoulder dystocia Cold stress Hypoglycemia
neonate born after 42 weeks
psotmature syndrome
Caused by withdrawal from narcotics
Neonatal abstinence syndrome (NAS)
how much meconium is needed for testing NAS
5 gms
Test urine and meconium for NAS if mother
Has positive urine tox screen in hospital
Has history of use or positive tox screen in pregnancy
Any mother admitted intoxicated
major sign of neonatal sepsis
unstable temperature regulation
work up for neonatal sepsis includes
Blood culture from 2 different peripheral sites Spinal tap Urine culture CBC w/ differential WBCs CXR
treatment for bacterial neonatal sepsis
Penicillin
Ampicillin
Used with Gentamicin
treatment for fungal neonatal sepsis
amphotericin B
How long is treatment for neonatal sepsis
7-14 days if bacterial longer if fungal
when does jaundice first appear
bilirubin level 5 mg
Severe hyperbilirubinemia related to
Hemolytic disease Primary liver disease Sepsis Viral exposure (CMV, rubella) Maternal use of oxytocin, sulfa drugs Large cephalohematoma
Measures serum antibodies
Used for antibody titer in prenatal labs (antibody screen)
Rhogram screen
What we are measuring in mom
Indirect coombs
measures antibodies on the surface of the RBCs
What we are measuring in baby
Direct coombs
Rh-mom that is isoimmunized or sensitized and has formed antibodies to Rh negative antigens to Rh + fetus
erythroblastis fetalis
racial/ ethnic/ environmental risk factors for hyperbilirubinemia
East asian
Native american
Greeks born in Greece
Higher altitudes
how far should the phototherapy light be
no further than 20’’ away
with blue phototherapy light what needs to be monitored
apnea and or pulse oximetry
Procedure involves the withdrawal and replacement of newborn blood with donor blood
Gives non-susceptible cells, removes bilirubin in serum, adds albumin (binds bilirubin)
exchange transfusion
when is APGAR done
after 1 minute and repeated at 5 min
if respiratory system is compromised then what will follow
cardiac compromise
preterm babies are at high risk for respiratory distress within the first
6 hours of birth
signs of respiratory distress in preterm babies
grunting
flaring
retractions
the basic problem in a preterm baby with RDS is
surfactant deficiency
Treatment for RDS before birth
Corticosteroids give between 24-34 weeks
Related to delayed clearance of amniotic fluids in lungs, so gas exchange is impaired leads to
acidosis
what needs to be rules out if TTN continues
sepsis
Failure of the intestines to return into the abdominal cavity from the umbilical cord during development
Normally occurs at 10-12 weeks
Usually has membranous covering
Bowel appears normal unless sac ruptured
oomphalocele
Bowel herniates through an abdominal wall defect
Usually to right of umbilical cord
Defect has no membranous covering
Bowel appears edematous matted
Term or near term gestation infants, but IUGR common
gastroschisis
airway problems with gastroschisis must be taken care with
immediate intubation and ventilator
what to do for infection prevention for gastroschisis
Kerlix soaked in warm saline covered with plastic warp
a group of anomalies involving the brain and spinal cord
Failure of the cranial end of the neural tube to close causes anencephaly
Failure of the caudal end of the neural tube to close causes spina bifida
neural tube defects NTD
Cephalic (head) anterior neural tube closure fails/arrests
Usually occurs between the 23rd and 26th days
Results in the absence of a major portion of the brain, skull, and scalp
Not compatible with life
Anencephaly
Bones of the skull do not close completely – common location is occipital lobe and often includes areas of disturbance in posterior fossa, cerebellum, and superior mesencephalon
Meninges, cerebral spinal fluid (CSF), & possibly brain tissue protrude into a sac-like formation.
Encephalocele
Protrusion of the meninges with CSF fluid in sac (no nerves)
Most of these infants require ventricular shunts
Meningocele
protrusion of meninges, CFS, and nerves
Poorer prognosis
Lower/limb weakness/paralysis and bladder control issues are common
Will also require ventricular shunt
Myelomeningocele
When embryonic structures of the upper lip, nose, and hard and soft palate fail to close
Results after failure to fuse by the end of 7 to 8 wks gestation
cleft lip and palate
The most commonly occuring birth defect
Either occur as change the direction of blood flow or Change the normal structure and function of the heart chambers or great vessels
Congenital heart defects CHD
critical congenital heart defects cause what in newborns
low levels of O2
when should screening for CCHD be done
24 hours
