The Fetus and Newborn Flashcards
What is an AGA baby?
> 10% and less than < 90% in birth weight
What is meant by live birth?
Complete expulsion from mother, baby breathes or shows evidence of life
What is preterm?
Infant born before the last day of the 37 week (259 day) of gestation
What is low birth weight?
< 2,500 gm regardless of gestational age at birth
What is meant by fetal death?
Death that occurs before the infant is fully expelled, not including abortion.
What is infant death?
Death that occurs at any time between birth and 1 year of age.
What is perinatal death?
Death from 28 weeks gestation to 28th day of life.
What ethnic group has the highest mortality rates?
African-Americans followed by native Americans.
Which specific group has the highest mortality rate?
Caucasian infants < 500 grams
What maternal factors are associated with neonatal mortality?
Prenatal care delayed until first trimester, > 40 years of age who did complete high school, teen pregnancy, unmarried, smokers, and having underlying disease
For premature infants what independent factors are associated with increased mortality?
Male, 5 min APGAR < 4, lack of antenatal steroids, bradycardia for 5 minutes, hypothermia, and IUGR.
What is the leading cause of infant death in the US?
Congenital malformation, 25% of infant deaths.
What is the most common umbilical abnormality?
Single artery, 40% have a major congenital abnormality, trisomy 18 is common.
What is placental abrupt ion.
When a firm layer of blood forms after a retro placental hemorrhage
What is the monochromic membrane found in what condition?
Seen in monozygotic twins when there is initially 1 ovum before division.
What type of twins are dichotomies?
Associated with fraternal twins, but identical twin can also be dichorionic if twins separated early- before day 3.
What are the guidelines for GBS prevention?
All pregnant women get vaginal/rectal GBS screening at 35-37 weeks and then prophylax if culture is positive unless she is going to have a C-section, has not had active labor and membranes are intact.
What other conditions would GBS prophylax be required?
Previous baby with invasive GBS disease, unknown status-delivery of < 37 weeks, membrane rupture >18 hours and intraoaetum temp > 100.4
What is the greatest risk factor for preterm delivery?
Previous preterm delivery
What is the management of PROM in > 34 weeks gestation?
Evaluate mother via speculum exam, check fetus with fetal heart rate and look at fetal presentation.
What is done for a fetus < 28 weeks and PROM?
Toxo lysis and steroid therapy.
What is given for seizures to the mother if she has preeclampsia?
Magnesium sulfate
In gestational diabetes, the incidence is most closely associated with what finding?
Degree of hyperglycemia prior to conception.
What is the simplistic screening mention for IUGR?
Fundal height measurement- from the top of the uterine funds to the symphysis pubis.
At what age should ultrasound be performed?
All fetuses grow at the same rate for the first 20 weeks. So ultrasound best at 18-20 weeks.
Maternal fever in association with fetal tachycardia >180 bpm is associated with what?
Chorioamnionitis
What defines fetal bradycardia?
Baseline heart rat of < 120 bpm
What causes early de cels?
Fetal head compression during uterine contraction and creates vagal stimulation and slowing of the heart rate.
What are late decels?
A fall in FHE either before or after peak of uterine contraction-all late decels are considered potentially ominous
What does a heart rate of < 80 bpm?
If > 3 minutes considered ominous and indicates significant hypoxia.
What are the common reasons for C-sections in the US?
Previous C-section, dystonia, fetal distress, malpresentation, “other”
Which lobe of the liver has a higher oxygen level?
Left lobe of the liver as it get its blood supply from the umbilical vein
At birth what happens to pulmonary pressures and flow?
Mean pulmonary artery pressure drops, mean pulmonary blood flow increases, and pulmonary vascular resistance drops.
Does altitude alter patent ductus closure?
Infants born above 3,000 feet have an increased incidence.
Under most conditions does the fetus synthesize glucose?
No, it gets all glucose from mother.
What is the water content in a newborn?
75-80% water, 2/3rd ones cellular
What are the APGAR scoring categories?
Heart rate, respiration, muscle tone, reflex irritability, and color.
In infant resuscitation where should you keep PaO2?
At 50-70 mmHg, too much oxygen causes damage.
What size endotracheal tube?
< 1.5 kg=2.5 mm
1.5-2.5 kg=3 mm
>2.2 kg=3.5 mm
How does epinephrine work?
Alpha adrenergic
Enhances heart contractility
Constricts peripheral circulation
Beta adrenergic effects on heart-increases rate and effectiveness of cardiac contraction.
What two medications can be given via endotracheal tube?
Epinephrine and atropine
