Test 4 part 2

Question 1

Hyperbilirubinemia neurologic toxicity – high levels of bilirubin will cross blood brain barrier and cause bilirubin-induced neurologic dysfunction (BIND) by damaging brain tissue

Answer 1

kernicterus

Question 2

a graph chart used for prediction of hyperbilirubinemia risk levels in newborns according to hours of life and bilirubin levels

Answer 2

Nomogram

Question 3

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

Answer 3

ABO incompatibility

Question 4

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

Answer 4

Rh incompatibility

Question 5

occurs when the immune system encounters an antigen for the first time and mounts an immune response

Answer 5

Isoimmunization or sensitization

Question 6

a condition that is the consequence of a previous disease or injury

Answer 6

Sequelae

Question 7

Birth trauma due to cephalopelivic disproportion

Answer 7

Shoulder dystocia
Brachial plexus injuries
Cephalohematoma
Other hematomas and bruising

Question 8

treatment for polycythemia

Answer 8

Normal saline
Plasmanate
5% albumin
Fresh frozen Plasma

Question 9

Polycythemia exchange can be done via

Answer 9

UVC that is not in the liver
Low UAC
PIV

Question 10

LGA secondary to

Answer 10

Fetal hyperinsulinemia and polycythemia

Maternal pre and gestational diabetes

Question 11

SGA secondary to

Answer 11

Maternal renovascular disease

Vascular damage of placenta

Question 12

Blood glucose monitoring is required for

Answer 12

IDM
LGA
SGA

Question 13

Most common congenital anomalies with infants of diabetic mothers are

Answer 13

Cardiac
CNS
Skeletal

Question 14

Congenital anomalies with infants of diabetic mothers is caused by

Answer 14

high maternal glucose early in pregnancy

Question 15

Why do you observe for tetnay (hypocalcemia) in infants with diabetic mothers

Answer 15

possible delay in parathyroid hormone synthesis after birth

Question 16

SGA fetal factors

Answer 16

Congenital infections-TORCH
Discordant twins
2 vessel cord
Trisomies
Metabolic disease

Question 17

Types of IUGR

Answer 17

symmetrical and asymmetrical

Question 18

IUGR where there is a lack of blood flow through whole pregnancy

Answer 18

symmetrical

Question 19

IUGR where lack of blood flow in 3rd trimester

Answer 19

asymmetrical

Question 20

Risks for the SGA neonate

Answer 20

Asphyxia
Aspiration syndrome
Hypothermia
Hypoglycemia 
Polycythemia

Question 21

Post term infant risks

Answer 21

Increased size
CPD
Shoulder dystocia 
Cold stress
Hypoglycemia

Question 22

neonate born after 42 weeks

Answer 22

psotmature syndrome

Question 23

Caused by withdrawal from narcotics

Answer 23

Neonatal abstinence syndrome (NAS)

Question 24

how much meconium is needed for testing NAS

Answer 24

5 gms

Question 25

Test urine and meconium for NAS if mother

Answer 25

Has positive urine tox screen in hospital Has history of use or positive tox screen in pregnancy Any mother admitted intoxicated

Question 26

major sign of neonatal sepsis

Answer 26

unstable temperature regulation

Question 27

work up for neonatal sepsis includes

Answer 27

``` Blood culture from 2 different peripheral sites Spinal tap Urine culture CBC w/ differential WBCs CXR ```

Question 28

treatment for bacterial neonatal sepsis

Answer 28

Penicillin Ampicillin Used with Gentamicin

Question 29

treatment for fungal neonatal sepsis

Answer 29

amphotericin B

Question 30

How long is treatment for neonatal sepsis

Answer 30

7-14 days if bacterial longer if fungal

Question 31

when does jaundice first appear

Answer 31

bilirubin level 5 mg

Question 32

Severe hyperbilirubinemia related to

Answer 32

``` Hemolytic disease Primary liver disease Sepsis Viral exposure (CMV, rubella) Maternal use of oxytocin, sulfa drugs Large cephalohematoma ```

Question 33

Measures serum antibodies Used for antibody titer in prenatal labs (antibody screen) Rhogram screen What we are measuring in mom

Answer 33

Indirect coombs

Question 34

measures antibodies on the surface of the RBCs | What we are measuring in baby

Answer 34

Direct coombs

Question 35

Rh-mom that is isoimmunized or sensitized and has formed antibodies to Rh negative antigens to Rh + fetus

Answer 35

erythroblastis fetalis

Question 36

racial/ ethnic/ environmental risk factors for hyperbilirubinemia

Answer 36

East asian Native american Greeks born in Greece Higher altitudes

Question 37

how far should the phototherapy light be

Answer 37

no further than 20'' away

Question 38

with blue phototherapy light what needs to be monitored

Answer 38

apnea and or pulse oximetry

Question 39

Procedure involves the withdrawal and replacement of newborn blood with donor blood Gives non-susceptible cells, removes bilirubin in serum, adds albumin (binds bilirubin)

Answer 39

exchange transfusion

Question 40

when is APGAR done

Answer 40

after 1 minute and repeated at 5 min

Question 41

if respiratory system is compromised then what will follow

Answer 41

cardiac compromise

Question 42

preterm babies are at high risk for respiratory distress within the first

Answer 42

6 hours of birth

Question 43

signs of respiratory distress in preterm babies

Answer 43

grunting flaring retractions

Question 44

the basic problem in a preterm baby with RDS is

Answer 44

surfactant deficiency

Question 45

Treatment for RDS before birth

Answer 45

Corticosteroids give between 24-34 weeks

Question 46

Related to delayed clearance of amniotic fluids in lungs, so gas exchange is impaired leads to

Answer 46

acidosis

Question 47

what needs to be rules out if TTN continues

Answer 47

sepsis

Question 48

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

Answer 48

oomphalocele

Question 49

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

Answer 49

gastroschisis

Question 50

airway problems with gastroschisis must be taken care with

Answer 50

immediate intubation and ventilator

Question 51

what to do for infection prevention for gastroschisis

Answer 51

Kerlix soaked in warm saline covered with plastic warp

Question 52

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

Answer 52

neural tube defects NTD

Question 53

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

Answer 53

Anencephaly

Question 54

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.

Answer 54

Encephalocele

Question 55

Protrusion of the meninges with CSF fluid in sac (no nerves) | Most of these infants require ventricular shunts

Answer 55

Meningocele

Question 56

protrusion of meninges, CFS, and nerves Poorer prognosis Lower/limb weakness/paralysis and bladder control issues are common Will also require ventricular shunt

Answer 56

Myelomeningocele

Question 57

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

Answer 57

cleft lip and palate

Question 58

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

Answer 58

Congenital heart defects CHD

Question 59

critical congenital heart defects cause what in newborns

Answer 59

low levels of O2

Question 60

when should screening for CCHD be done

Answer 60

24 hours