W12 - Newborn Complications Flashcards
1
Q
What are some Trauma-Informed Care Examples for newborns?
A
Keep dyad together
Responding in a consistent manner
Managing pain in a timely manner
Protecting sleep
Supportive environment that allows for regulation of sensory input
2
Q
What is Trauma Informed Age-Appropriate Care (TIAAC)?
A
An approach to neonatal care that minimizes stress and trauma during a critical period of brain and epigenetic development by promoting responsive, supportive, and developmentally appropriate practices.
3
Q
What is toxic stress in neonates?
A
Toxic stress is prolonged or intense stress without adequate support
can disrupt brain development and alter gene expression in early life.
4
Q
How does toxic stress affect development in neonates?
A
It can
- alter the epigenetic expression of DNA
- impair brain development
- negatively impact emotional and cognitive outcomes later in life.
5
Q
What are sources of stress for newborns?
A
Separation from caregivers
Inconsistent or unresponsive care
Overwhelming sensory environments (e.g., noise, bright lights)
Poor temperature regulation
6
Q
What are key strategies used in the NICU to reduce neonatal stress?
A
Minimizing noise and light
Clustering care around feeds to promote uninterrupted sleep
Promoting skin-to-skin contact
Teaching parents how to recognize stress cues
7
Q
Why is skin-to-skin contact important in neonatal care?
A
- promotes temperature regulation
- bonding
- helps reduce stress in newborns.
8
Q
What are common neonatal stress cues parents should be taught to recognize?
A
Turning head away
Closing fists
Arching back
Hiccupping or yawning
Changes in skin color
9
Q
Pregnancy-related risks that increase the risk of preterm birth (many)
A
Placenta previa - Substantial vaginal bleeding, hypoxia
Substance use
<18 or >35
Multiples
Preeclampsia
PPROM
History of preterm birth
Chorioamnionitis
Physical trauma (abruption/PROM)
Cervical insufficiency
Gestational Diabetes –> Preeclampsia etc
Pregnancy intervals (<6 months from last conception)
Underweight/overweight
Chronic stress/cortisol
10
Q
What is Health Canada’s recommendation regarding cannabis use in pregnancy?
A
Health Canada recommends abstaining from cannabis use during pregnancy due to associated fetal and developmental risks.
11
Q
What are the perinatal risks of cannabis use in pregnancy?
A
Fetal growth restriction
Preterm birth
Anemia
Neural tube defects
Developmental delay
12
Q
What are the effects of intrauterine cannabis exposure from ages 0–3?
A
Sleep disturbances
Exaggerated startle reflex
13
Q
What are the effects of intrauterine cannabis exposure from ages 3–6?
A
Poor memory
Shortened attention span
Impulsivity
Difficulty following instructions
14
Q
What are the effects of intrauterine cannabis exposure from ages 6–10?
A
Hyperactivity
Impulsivity
Increased risk of depression/anxiety
Decreased attentiveness
15
Q
What are the adolescent outcomes (ages 14–18) of prenatal cannabis exposure?
A
Poor school performance
Increased likelihood of early cannabis use
16
Q
What is Neonatal Abstinence Syndrome (NAS)?
A
NAS is a condition caused by in utero exposure to substances, resulting in withdrawal symptoms after birth.
17
Q
What body systems are affected by NAS?
A
Central nervous system, gastrointestinal system, and respiratory system.
18
Q
When do symptoms of NAS typically appear?
A
Between 24–48 hours and up to 5–10 days after birth
depending on the substance and amount used.
19
Q
What types of substances are associated with NAS?
A
Opioids (e.g., heroin, codeine, oxycodone)
Stimulants (e.g., amphetamines, cocaine)
Antidepressants (e.g., SSRIs)
Depressants (e.g., barbiturates, alcohol, cannabis)
Nicotine
20
Q
Why is screening and monitoring important in NAS?
A
Because withdrawal symptoms may be delayed and vary depending on the substance, early detection and management are crucial.
21
Q
What are common signs of withdrawal in a newborn (Neonatal Abstinence Syndrome)?
A
- Tremors (trembling)
- Irritability and high-pitched crying
- Sleep disturbances, poor ability to enter deep sleep
- Tight muscle tone (rigidity), hypertonia
- Hyperactive reflexes and exaggerated startle reflex
- Seizures
- Yawning, sneezing, nasal congestion
- Vomiting and diarrhea
- Dehydration
- Sweating
- Temperature instability (low or high)
22
Q
What are common CNS signs of neonatal withdrawal?
A
- Tremors (trembling)
- Irritability (excessive crying)
- Sleep problems
- Tight muscle tone (rigidity)
- High-pitched crying
- Seizures
- Hyperactive reflexes
- Exaggerated startle reflex
23
Q
What are common GI signs of neonatal withdrawal?
A
- Poor feeding
- Vomiting
- Diarrhea
- Dehydration
24
Q
What are common autonomic signs of neonatal withdrawal?
A
- Sweating
- Temperature instability (low or high)
- Yawning, sneezing, nasal congestion
25
What is the purpose of the Eat, Sleep, Console (ESC) care tool?
To support neonates exposed to substances in achieving normal
- eating
- sleeping
- consoling
- weight gain
milestones using a function-based approach.
26
What FOUR red flags are monitored under the ESC tool?
* Weight loss >10%
* Feeding difficulties (fussiness, tremors, uncoordinated suck, excessive rooting)
* Inability to sleep >1 hour after feeding (due to fussiness, restlessness, increased startle)
* Unable to console within 10 minutes or stay consoled >10 minutes
27
What nonpharmacological interventions are used in the ESC model?
* Dim lighting, reduce noise
* Keep caregiver nearby
* Teach parents to respond to early cues
* Non-nutritive sucking (pacifier)
* Swaddling or firm cuddling to reduce startle reflex
* Rocking or deep pressure massage
28
Other non-pharmacological interventions for supporting newborns exposed to substances (even more)
* Rooming-in with caregiver
* Protect sleep-wake cycles; avoid waking for routine care
* Feed at early hunger cues
* Cue-based, newborn-centered care
* Skin-to-skin contact
* Infant held by parent/caregiver
* Safe swaddling
* Quiet, low-light environment
* Non-nutritive sucking (pacifier)
* Rhythmic movement
* Additional in-room support
* Encourage
caregiver self-care and rest
29
If a client uses cannabis, can they still breastfeed?
A) Yes, but only if occasionally and in small amounts
B) Yes, but only if used for medical purposes
C) No, it is contraindicated
D) Depends on the individual's risk/benefit
D) Depends on the individuals risk/benefit
Cannabis use while breastfeeding is not strictly contraindicated, but **urge caution** due to concerns about THC transfer through breast milk and its potential effects on neurodevelopment.
The decision depends on a clinical assessment of the risks (e.g., frequency of use, developmental vulnerability of the infant) versus the benefits of breastfeeding.
Health Canada advises caution and **recommends abstaining when possible**.
30
Two Types of Neonatal Infections
Early-onset sepsis
Late-onset sepsis
31
When does early-onset neonatal sepsis typically occur and how is it acquired?
* Occurs within the first 72 hours (most often 24–48h)
* Acquired vertically through maternal GU/GI tract (e.g., amniotic fluid, vaginal delivery)
32
What are common causes of early-onset neonatal sepsis?
* GBS (most common in term infants)
* E. coli (most common in preterm)
* Haemophilus influenzae, HSV, chlamydia
33
What are risk factors for early-onset neonatal sepsis?
* Preterm labor
* Prolonged rupture of membranes
* Chorioamnionitis
* Maternal GBS colonization
34
When does late-onset neonatal sepsis typically occur and how is it acquired?
* Occurs after 72 hours (usually between day 7–30)
* Acquired horizontally from environment (hospital/community)
35
What are common sources of entry for late-onset neonatal sepsis?
* Umbilical cord
* Skin
* Mucous membranes
36
What are common causative organisms in late-onset neonatal sepsis?
* Staphylococci, Klebsiella
* Enterococci, E. coli
* Pseudomonas, Candida
37
What are risk factors for perinatally acquired infection?
* History of maternal group B streptococcal infection
* Early rupture of membranes
* Maternal intrapartum fever >38°C
* Use of antibiotics for infection before delivery
* Untreated maternal UTI
* Preterm newborn
* No prenatal care
* Intrauterine infection
38
**IMPORTANT** Which sign may indicate an infection in utero
Clear, foul smelling amniotic fluid
39
T/F: A client with active HSV outbreak to her genitals can trial a vaginal delivery as long as she is on antivirals at the time of birth
FALSE
If a client has an active genital herpes outbreak at the time of birth, a cesarean section is recommended to prevent neonatal herpes.
Antiviral therapy is typically used starting at **36 weeks** to suppress outbreaks and reduce the likelihood of lesions at delivery, but the presence of lesions at the time of labor contraindicates vaginal delivery due to the high risk of vertical transmission through the birth canal.
40
What does TORCH stand for in perinatal infection screening?
T = Toxoplasmosis
O = Other (Parvovirus, Varicella, Measles, Mumps, Syphilis)
R = Rubella
C = Cytomegalovirus (CMV)
H = Herpes Simplex Virus (HSV)
41
How is toxoplasmosis typically transmitted and what risks does it pose to the fetus?
Transmitted through cat feces (parasitic infection).
Fetal risks: vision loss, developmental delay.
42
What infections are included under the “O” in TORCH and what are their potential effects?
Parvovirus, varicella, measles, mumps, syphilis.
Risks: early miscarriage, stillbirth, congenital rubella syndrome (deafness, heart defects, LBW, rash), and congenital syphilis (anemia, jaundice, hearing/vision loss, stillbirth).
43
What are the fetal risks of congenital CMV infection?
Hearing loss, cognitive impairment, and rash
Detected by swabbing the newborn’s mouth shortly after birth
44
What is the typical maternal presentation of CMV?
Most pregnant women are asymptomatic.
45
How is congenital syphilis screened in pregnancy?
Typically screened in first and third trimester, and sometimes at birth (varies by province in Canada).
46
What is a key visible sign of congenital CMV infection?
Petechial or purpuric rash (“blueberry muffin” appearance).
47
How is neonatal herpes simplex virus (HSV) typically transmitted?
85% of neonatal HSV infections are transmitted through contact with lesions in the vaginal canal during delivery (vertical transmission).
48
What are the clinical presentations of neonatal HSV infection?
Skin, eye, and mouth lesions; may also involve the central nervous system (CNS), leading to serious complications like encephalitis.
49
What is the recommendation for breastfeeding with HSV?
Breastfeeding is permitted unless there are active lesions on the breast.
If present, express and discard milk from the affected side until healed.
50
What is the standard preventive approach for HSV-positive pregnant clients nearing term?
Antiviral therapy (e.g., acyclovir) starting at 36 weeks gestation to reduce the risk of an active outbreak during delivery.
51
What are respiratory signs of neonatal sepsis?
Apnea
Increased work of breathing
Tachypnea
Oxygen desaturation
Cyanosis
52
What are cardiovascular signs of neonatal sepsis?
Poor perfusion
Prolonged capillary refill
Cyanosis
Hypotension
Tachycardia (early)
Bradycardia (late)
53
What are central nervous system signs of neonatal sepsis?
Decreased level of consciousness
Lethargy
Hypotonia or hypertonia
Temperature instability (especially low temperature in neonates)
54
What are gastrointestinal signs of neonatal sepsis?
Poor feeding
Excessive weight loss
Decreased urine output
Jaundice
Vomiting or diarrhea
55
What are integumentary signs of neonatal sepsis?
Petechiae
Pallor
Cyanosis
56
T/F: Chlamydia infections can cause neonatal conjunctivitis and pneumonia.
True
Chlamydia trachomatis can be transmitted during birth and cause conjunctivitis and pneumonia in neonates.
57
T/F: CMV acquired during pregnancy can result in hearing loss and cognitive impairment.
True
Cytomegalovirus (CMV) acquired in utero is a leading cause of congenital hearing loss and cognitive impairment.
58
T/F: Parvovirus B19 increases the risk of fetal anemia.
True
Parvovirus B19 can infect fetal red blood cells, increasing the risk of fetal anemia and hydrops fetalis.
59
What are the common causes and prophylaxis for neonatal conjunctivitis?
* Commonly caused by exposure to Chlamydia or Gonorrhea during birth
* Erythromycin eye ointment is used prophylactically to prevent gonococcal conjunctivitis
* Erythromycin is not effective treatment for active conjunctivitis and is not used in those cases
60
Which is NOT a common complication of the late preterm infant?
A) Respiratory distress syndrome
B) Meconium aspiration
C) Jaundice
D) Feeding difficulties
B) Meconium aspiration
61
What is considered late pereterm?
34 weeks and 0 days to 36 weeks and 6 days
62
What are the common complications for LPT (Late Preterm) infants?
* Respiratory distress
* Jaundice
* Feeding difficulties
* Temperature instability
* Hypoglycemia
* Infection
63
What are some risk factors for hypoglycemia in a newborn?
Use of antenatal beta blockers (cross BBB, increase hepatic insulin, suppress glucagon)
Gestational diabetes
Low birth weight
64
What are clinical symptoms of hypoglycemia in a newborn?
Lethargy
Poor feeding
Low temperature
Poor tone
Tremors
Seizures
65
What gestational age defines a Late Preterm Infant (LPI)?
Born between 34 and 36+6 weeks gestation.
66
What percentage of preterm infants are Late Preterm Infants?
Late preterm infants make up 70% of the total preterm infant population.
67
Why are late preterm infants sometimes called “great imposters”?
They often appear full-term in size but have immature systems, leading to overlooked risk factors and higher complication rates.
68
What are common complications in late preterm infants?
Respiratory distress
Hypoglycemia
Temperature instability
Poor feeding
Jaundice
Infections
69
Why does respiratory distress occur in late preterm infants?
Immature lungs may lack adequate surfactant, leading to alveolar collapse and increased work of breathing.
70
Why are late preterm infants at risk for hypoglycemia?
They have lower glycogen stores, immature liver function, and may experience poor feeding, all of which impair glucose regulation.
71
Why do late preterm infants experience temperature instability?
Reduced brown fat, larger surface area-to-volume ratio, and immature thermoregulatory mechanisms increase heat loss.
72
Why do late preterm infants have poor feeding?
Underdeveloped suck-swallow-breathe coordination and low energy levels reduce feeding effectiveness.
73
Why are late preterm infants at increased risk of jaundice?
Immature liver enzymes slow bilirubin conjugation and clearance, increasing the risk of hyperbilirubinemia.
74
Why are late preterm infants more susceptible to infections?
An immature immune system and possible maternal infection exposures reduce their ability to mount an effective response.
75
What defines hypoglycemia in a newborn?
Blood glucose concentration lower than required for normal neurological, organ, and tissue function.
76
Which infants are at risk for hypoglycemia?
Preterm infants (especially <36.6 weeks)
SGA, IUGR, or LGA infants
Infants of diabetic mothers (T1DM, T2DM, GDM)
Infants exposed to maternal beta blockers (e.g., labetalol)
Infants with perinatal asphyxia
Infants with metabolic syndromes or congenital malformations
77
What neonatal factors increase the risk of hypoglycemia?
Hypoxia
infection
hypothermia
polycythemia
SGA
LGA
congenital malformations.
78
What is a major complication of neonatal hypoglycemia?
Neurological injury
79
How long should infants of diabetic mothers be screened for hypoglycemia?
For at least 12 hours
stop if blood glucose is greater than 2.6 mmol/L.
80
How long should preterm and SGA infants be screened for hypoglycemia?
For at least 24 hours
stop if feeding is well established and blood glucose is greater than 2.6 mmol/L.
81
When should symptomatic or unwell infants be tested for glucose?
Immediately upon recognition of symptoms.
82
What are clinical signs and symptoms of neonatal hypoglycemia?
Jitteriness
Lethargy
Poor feeding
Abnormal cry
Hypotonia
Temperature instability
Respiratory distress
Apnea
Eye rolling
Seizures
83
Can hypoglycemia be present without clinical symptoms in neonates?
Yes, hypoglycemia can be present in the absence of clinical manifestations.
84
What are first-line non-pharmacologic interventions for neonatal hypoglycemia?
Skin-to-skin contact
Maintaining thermoregulation
Feeding (breastfeeding, expressed breastmilk, or formula)
85
What is the role of skin-to-skin contact in managing neonatal hypoglycemia?
Helps regulate the infant’s temperature, which supports glucose stability.
86
When is IV dextrose indicated in neonatal hypoglycemia?
When oral or buccal interventions are ineffective or if the infant is symptomatic and severely hypoglycemic.
87
What is the role of dextrose gel in neonatal hypoglycemia management?
40% dextrose gel is applied intrabuccally to rapidly increase blood glucose levels.
88
Two antepartum risk factors that contribute to restricted birth weight
Cannabis use
preeclampsia
89
What is the purpose of newborn hearing screening?
To identify newborns with permanent hearing loss
To enable early intervention and support language development
90
What are risk factors for congenital hearing loss in newborns?
Genetic predisposition
Intrauterine exposure to cytomegalovirus (CMV)
91
When is newborn hearing screening typically performed?
Before discharge from the hospital, usually within the first few days of life.
92
What is the most common congenital disorder identified in newborn screening?
Hearing loss
93
What does pale-colored stool in a newborn indicate and why?
Pale or clay-colored stool suggests biliary atresia or cholestasis, which occurs when bile flow from the liver is blocked, preventing normal digestion and causing poor fat absorption.
This can be a sign of serious liver or biliary system dysfunction.
94
How are hearing loss and pale-colored stools connected?
Congenital CMV can cause **both** sensorineural hearing loss and hepatobiliary involvement.
Viral damage to the auditory system leads to hearing impairment
AN D
Liver and bile duct inflammation may result in cholestasis, causing pale (acholic) stools.
**Both findings in a newborn should prompt evaluation for CMV.**
95
What is critical congenital heart disease (CCHD)?
A group of structural heart defects that impair circulation of oxygenated blood.
96
When is CCHD screening typically performed in newborns?
After 24 hours of life, once the ductus arteriosus has closed.
97
What are the clinical signs of CCHD in a newborn?
* Central cyanosis
* Tachycardia
* Poor feeding/sucking
* Low birth weight or delayed weight gain
* Tachypnea or increased work of breathing
98
Why might CCHD go undetected at birth?
Some cases are missed on prenatal ultrasound and newborns may appear asymptomatic initially.
99
Why is CCHD screening performed after 24 hours of life?
To ensure the ductus arteriosus has closed, improving test accuracy.
100
Where are pulse oximeters placed when screening for critical congenital heart disease (CCHD)?
One on the right hand (pre-ductal) and one on either foot (post-ductal).
101
Why is the right hand used for pre-ductal oxygenation during CCHD screening?
It reflects oxygen saturation before blood passes through the ductus arteriosus.
102
What does a difference between pre- and post-ductal oxygen saturation suggest?
Possible presence of a critical congenital heart defect affecting systemic circulation.
103
What is the minimum oxygen saturation both readings must exceed to pass CCHD screening?
Both must be greater than 90%.
104
What is the minimum oxygen saturation required for at least one reading in CCHD screening?
At least one value must be 95% or higher.
105
What is the maximum allowable difference between pre- and post-ductal saturations to pass CCHD screening?
3% or less.
106
What happens if either oxygen saturation value is below 90% during CCHD screening?
The infant must be referred immediately for physician assessment.
107
CCHD Screening Rules (Overview)
Both must be greater than 90
One must be greater than 95
If both values are between 90-94, repeat
Difference between the two values must be 3% or less.
If difference > 3% but both values >90%, repeat
Any value lower than 90% requires immediate physician referral
108
CCHD Example: Right hand 97%, Left foot 99%
Normal
Both values over 90
At least one value over 95
Difference is < 3%
109
CCHD Example: Right hand 95%, right foot 89%
Refer
One value is < 90%
110
CCHD Example: Right hand 98%, Left foot 94%
Repeat
Difference is > 3% but both values are >90%
111
T/F: Pathological jaundice typically occurs within the first 24 hours
True
Jaundice in the first 24 hours often has a pathological reason, different from physiological jaundice.
112
What is the acceptable limit for weight loss in a newborn before intervention is required?
Up to 7% of birth weight is considered acceptable in the first few days.
Weight loss greater than 7% may require closer monitoring or intervention.
113
How may pathological jaundice occur in the first 24 hours?
Pathological jaundice within 24 hours is often due to hemolysis frequently caused by blood group incompatibility (e.g., ABO or Rh incompatibility).
This leads to a sudden rise in bilirubin that exceeds normal newborn liver processing capacity.
114
Helpful flowchart for RBC processing
115
Why are newborns more susceptible to jaundice in the first few days of life?
Newborns experience rapid red blood cell breakdown after birth, releasing large amounts of heme.
The liver, which is still immature, has limited glucuronyl transferase activity and cannot keep up with conjugating all the unconjugated (fat-soluble) bilirubin.
This unconjugated bilirubin accumulates in the blood and skin, causing visible jaundice.
116
Risk associated with newborn jaundice
If levels get too high, it can cross the blood-brain barrier and cause bilirubin encephalopathy
117
Two Types of Hyperbilirubinemia
Physiological
Pathological
118
Physiological jaundice
* Appears after 24 hours (usually days 3–5)
* Transient and usually resolves on its own
* Due to immature liver enzyme systems delaying bilirubin conjugation
* Seen in 60% of term and 80% of preterm infants
119
Pathological jaundice
* Appears within the first 24 hours
* Due to increased hemolysis or impaired excretion
* Causes include blood type incompatibility (e.g. ABO, Rh), G6PD deficiency, congenital anomalies (e.g. Hirschsprung), or liver dysfunction
* Can lead to bilirubin encephalopathy (kernicterus) if untreated
120
When does pathological jaundice typically appear and why is it concerning?
Within the first 24 hours; it’s often due to excessive hemolysis or impaired bilirubin excretion and may lead to kernicterus.
121
What causes pathological jaundice from blood incompatibility?
Rh or ABO incompatibility leads to antibody-mediated RBC destruction and increased bilirubin.
122
What maternal-fetal blood type combination increases risk of jaundice?
Mother with type O; baby with type A, B, or AB.
123
What enzyme deficiency increases hemolysis and jaundice risk in newborns?
G6PD deficiency.
124
What congenital issues can impair bilirubin excretion and cause jaundice?
Anorectal malformations (e.g. imperforate anus)
Hirschsprung
hepatic obstruction.
125
Breastfeeding-Associated Jaundice
Onset: Day 2–5
Cause: Ineffective breastfeeding → low caloric/fluid intake → dehydration
Result: Decreased stool output → increased reabsorption of bilirubin from the intestine
Prevention:
Early and frequent feeding
Unrestricted breastfeeding
Skin-to-skin contact
Support milk production
126
Onset: Day 5–10
Duration:
May persist 3–12 weeks
Infant is feeding well and gaining weight
Etiology: Thought to be due to substances in breastmilk that inhibit conjugation or delay excretion of bilirubin
Typically benign; does not usually require treatment
127
What causes breastfeeding-associated jaundice?
Ineffective breastfeeding leads to low intake, dehydration, decreased output, and increased bilirubin reabsorption.
128
When does breastfeeding-associated jaundice typically appear?
Between days 2–5 of life.
129
How can breastfeeding-associated jaundice be prevented or managed?
Early, frequent feeds, skin-to-skin contact, and supporting milk production.
130
What is breastmilk jaundice?
A late-onset, prolonged jaundice in well-fed infants caused by factors in breastmilk that inhibit bilirubin conjugation or excretion.
131
When does breastmilk jaundice typically appear and how long can it last?
Starts between days 5–10 and may persist up to 12 weeks.
132
Risk Factors for Hyperbilirubinemia
Blood group incompatibility (ABO or Rh) → hemolysis
Prematurity → immature liver can’t conjugate bilirubin efficiently
Liver immaturity → slower bilirubin metabolism
Delayed feeding → decreased bilirubin excretion in stool
Birth trauma (e.g., cephalohematoma) → increased RBC breakdown
Metabolic disorders → impair bilirubin processing
Sepsis → affects liver function and increases hemolysis
Congenital RBC abnormalities → increase breakdown of RBCs
133
Phototherapy for Hyperbilirubinemia
Bili blanket:
Wraps around baby’s back
Delivers continuous phototherapy through high-frequency light
Alters structure of bilirubin to aid excretion
Allows continued breastfeeding and bonding
Overhead phototherapy lights:
Baby must remain under lights in close proximity
Used for more intense treatment
134
Escalation of Therapy for Hyperbilirubinemia
**Exchange transfusion:**
Removes baby’s blood and replaces with donor blood
Used when phototherapy fails
Reduces bilirubin and antibodies (if immune-mediated)
**IV immunoglobulin (IVIG):**
Considered if hemolytic anemia is the cause
Slows RBC breakdown by blocking antibody-mediated hemolysis
135
How does conventional phototherapy differ from a bili blanket?
Conventional phototherapy uses overhead lights and requires the baby to stay under them with only a diaper on for effective exposure.
136
What is the purpose of exchange transfusion in neonatal jaundice?
It removes the baby’s bilirubin-rich blood and replaces it with donor blood to rapidly lower bilirubin levels.
137
When might IV immunoglobulin be used in the treatment of neonatal jaundice?
When jaundice is due to hemolytic disease, such as Rh or ABO incompatibility, to reduce antibody-mediated RBC destruction.
138
What is Sudden Infant Death Syndrome (SIDS)?
The sudden, unexplained death of an infant under 1 year of age, most often occurring within the first 6 months.
139
What is the incidence of SIDS in Canada?
0.3 per 1000 live births.
140
What are risk factors for SIDS?
Preterm birth
low birth weight (LBW)
multiple births
low Apgar scores
CNS disturbances
family history
141
What interventions have decreased SIDS incidence?
Back to Sleep Campaign, increased breastfeeding rates, and reduced maternal smoking during pregnancy.
142
T/F: 1/3 of all SIDS cases could be avoided if pregnant women did not smoke
True
143
T/F: Exclusive breastfeeding for the first 6 months can lower the risk of SIDS by up to 50%
True
144
Guidelines for Safe Sleeping
* Infant should always be placed on their back to sleep
* Mattress must be firm and free of blankets or soft bedding
* Only one adult in the bed with the baby
* No pillows, stuffed animals, bumper pads, or loose fabric near the infant
* Avoid heated blankets or cords (strangulation risk)
* Sleep sacks should fit well with no excess material
* Never leave a baby to sleep unattended in a car seat due to airway obstruction risk
* If traveling, ensure baby is monitored (e.g., mirror or adult in back seat)
145
What are key elements of a safe sleep environment for infants?
* Always place baby on their back to sleep
* Keep environment smoke-free
* Encourage breastfeeding
* Use a firm, flat sleep surface
* No pillows, quilts, toys, or bumper pads in crib
* Use approved crib, cradle, or bassinet for co-sleeping
* Avoid unsupervised sleep in swings, bouncers, strollers, or car seats
* Use harm-reduction if families choose to bed share (educate on minimizing risk)
146
