Week 11 Hospital discharge and Newborn Assessment Flashcards
What are thigh injections prior to newborn d/c?
Vitamin K
Hep B vax
What do you give to the eyes prophylaxis?
CT & GC
1% tetracycline ointment
erythromycin ointment
What would you administer to a baby with Hep B negative mother?
Hep B vax any infant >2g within 1st 24 hours
<2g administer at 1 month old or at hospital dc…whatever comes first
what would you administer to baby of a mother positive for HEP B?
Hep B vaccine to ALL infants within 24 hrs regardless of weight
AND
admin Hep B Immunoglobulin
What does the newborn screen look for?
When is it done
Disorders that are…
- metabolic
- hormonal
- hematologic
- infectious
within 48 hrs birth
What are factors that effect newborn screening results?
- obtaining too early
- abx
- blood transfusion
- failure to wipe away 1st drop blood
- not enough feeding “fed state”
- inadequate sample
What 2 diseases need immediate treatment for if positive on newborn screen?
Galactosemia
Maple syrup urine disease
What are the maternal factors for “at risk infants” that warrant glucose screening?
What are neonate factors?
Maternal Factors
- diabetic or GD baby (will have increased insulin levels at birth)
- Preeclampsia
- substance abuse
- Exposure to medications
Neonate factors
- Prematurity-esp 34 to 37 weeks
- LGA or SGA
- HIE event or birth injury
- sepsis
- congenital cardiac, endocrine, inborne errors of metabolism
What are common symptoms of hypoglycemia in neonate?
What are rarer symptoms?
Common
- irritability
- tremors
- Lethargy
Rarer
- SZ
- hypotonia
- feeding difficulty
- Respiratory distress
- high pitched cry
When do you do a newborn hearing screen?
Screen at 1 month,
Identify deficit by 3 months
Receive tx by 6 months
What are the three fetal shunts?
Ductus venosus
Foramen ovale
Ductus arteriosus
When is congenital heart disease screening done?
How is this done?
After 24 hours
Pre and Post ductal pulsox screening
What is a normal pre and post ductal pulsox screening?
R hand & L foot
Normal: both hands & foot >95% with <3% difference between them
If abnormal = URGENT referral ped cardiology
What is the newborn discharge criteria? 5
- Stable VS = axillary 36.5-37.4, RR <60, HR 80-180
- Established feeding = 2+ feedings
- Established elimination = 1 void 1 stool
- Screening and therapies completed
- Parent education completed
If an infant fails initial hearing screen a repeat screen should be done within ___ months
Congential Heart Disease screening is considered normal if pre/post ductal sats are ____ and there is less than ___ discrepancy between hand and foot
If an infant fails initial hearing screen a repeat screen should be done within 3 months
Congential Heart Disease screening is considered normal if pre/post ductal sats are >95% and there is less than 3% discrepancy between hand and foot
Every infant should be screened for hyperbilirubinemia prior to hospital d/c or at first primary care visit if discharged before ____ of life
The metabolic newborn screen should be obtained within ____ after birth
Every infant should be screened for hyperbilirubinemia prior to hospital d/c or at first primary care visit if discharged before 72 hours of life
The metabolic newborn screen should be obtained within 24 hours after birth
What is APGAR?
what are normal scores?
When do you score?
- Appearance (color)
- Pulse (HR)
- Grimace (reflex irritability/response)
- Activity (muscle tone)
- Respiration (breathing ability)
Normal 7-10
1 min & 5 min after birth THEN Q5 min for 1st 20 mins if <7
What are factors that can influence APGAR?
- maternal sedation
- congenital conditions
- gestational age
- trauma
- subjectivity score of clinician
What are normal vital signs in a newborn?
T = 97.7 - 99
HR 80 - 180
RR 30-60
Bp not done
Pain = FLACC
What is a normal ___ for a FT infant?
Head circumference
Weight
Length
Head Circumference: 12 to 15 inches
Weight: 5 lbs 8 oz - 8 lbs 13oz
Length: 18 - 22 inc
What are pathologic heart sounds?
Holosystolic, diastolic, grade 3+ or harsh
Describe a Still’s murmur
Where is it heard?
How to make it louder?
Benign & most common
- vibratory
- musical
- Hear at L sternal border
- Louder when supine
Describe a Patent ductus arteriosus? where to auscultate
- Continuous machine-like murmur
- Upper L sternal border
Describe an atrial septal defect and where to auscultate
- Grade 2 - 3 systolic ejection murmur
- Split S2
- Upper L Sternal Border
Describe a ventral septal defect and where it can be heard
- harsh systolic
- Palpable thrill
- Left Lower Sternal border
What are findings in the newborn that require further investigation?
Hemangioma
Cafe au lait spots
Petechaie
Vesicular Rash
When is petechiae normal on a newborn?
What can it be associated with?
Requires IMMEDIATE referral for work up
- Normal on presenting parts but resolve within 48 hours AND don’t get new sites
- Associated with TORCH infection & sepsis
What can a vesicular rash on a newborn mean?
Would you treat it?
- HSV
- Varicella
- *can both present in a few days
- Bacterial Staph & strep infection
Treat IV acyclovir
Difference between Caput Succedaneum and Cephalohematoma
Caput Succedaneum (scalp edema)
- pitting
- resolves in 48 hours
Cephalohematoma
- Does NOT cross suture lines
- Risk factor for jaundice & sepsis
- worse before better 3 to 4 months to resolve
What type of murmur has a machine line sound quality?
PDA
When should the umbilical cord fall off?
When should the diastasis recti resolve?
7 to 10 days
1st few weeks
When should the testicles descend?
descend by 3 to 6 months
How do you test CN III, IV, & VI in a newborn?
Eye movements
Vestibulo-ocular reflex “doll’s eyes maneuver”
- Head turned there is conjugate eye movement in opposite direction
How do you assess CN V, VII, IX & X?
Feeding
assesses sucking and swallowing
If an infant is crying you assess _____ for symmetry
What cranial nerves are assessed with the quality and strength of a cry?
If an infant is crying you assess CN VII for symmetry
CN IX & X are seen with quality & strength of cry
When should the Moro Reflex be gone?
Sucking reflex?
Moro: 4-6 months
Sucking 2 to 3 months
When should the rooting reflex be gone?
Plantar grasp?
Palmar grasp?
Rooting: 4 months
Plantar grasp: 9 to 12 months
Palmar grasp: 5 to 6 months
Up to what age should the babinksi reflex be positive?
Disappear at 2 years
True or false
- Torticollis and clavicle fractures occur as a result of birth trauma?
- Unilateral or bilateral undescended testes on newborn exam require immediate referral to surgery for further monitoring?
- It is common to see diastasis recti & umbilical hernias on PE of a premature infant?
- The Moro reflex disappears by 12 months of age?
- True
- False; evaluation at 3 months if not descended
- True
- False; disappears by 6 months
