Week 2 newborn Flashcards
1
Q
newborn transition period
- first
-
A
first 6-8 hours after birth
adapting to extrauterine life
2
Q
first period of reactivity
A
- first 30-60 mins after birth
- best time to breastfeed and bond
3
Q
characteristics of first period of reactivity (6)
A
- tachycardia
- irregular resps
- crackles
- alert, frequent moro reflex
- hypoactive bowel sounds
- sucking reflex present
4
Q
period of decreased responsiveness
A
- 1-3hrs after birth
- sleeps or becomes less active
5
Q
characteristics of period of decreased responsiveness (4)
A
- decreased motor activity
- resps up to 60/min
- normal HR
- audible bowel sounds
6
Q
Second period of reactivity
A
- after a deep sleep infant responsive and alert
- 3-8 hours after birth
7
Q
characteristics of second period of reactivity (5)
A
- abrupt, brief change in color and muscle tone
- tachypnea, tachycardia
- oral mucus
- responsiveness to external stimuli
- passage of meconiumum
8
Q
adjustment to extrauterine life can be impacted by
_
_
_
A
- infants genetic background
- health of the mother during pregnancy
- what happens during birth
9
Q
resps stimulated by
A
cold
chemical changes in the blood
10
Q
normal baby vitals
A
temp: 36.5-37.5
RESPs: 30-60
HR: 100=160
11
Q
hypothermia can lead to
A
- hypoglycemia (use glucose stores to generate heat)
- respiratory distress (higher metabolic rate consumes more oxygen, sometimes beyond the newborn’s ability to supply it.
12
Q
heat can be lost by (4)
A
- evaporation of liquids from skin
- conduction caused by contact with a cold surface
- convection of heat away from body surfaces from drafts
- radiation from being near a cold surface but not directly touching it.
13
Q
when do give first bath
A
- at least 24 hours when body temp temperature regulates
14
Q
sweat glands in newborn
A
don’t work= risk of elevated temperature
15
Q
overheating causes
A
red skin rash
16
Q
A quivering or shivering-like tremor of the chin may be noticed
A
evidence of an immature neurological system not from cold
17
Q
skin preterm and posterm
A
- Thin somewhat transparent (preterm)
- Peeling (post-term or possible intrauterine growth restrictions)
18
Q
vernix
- preterm
- term
- posterm
A
- Cheesy substance covering most of the skin surface (preterm)
- only preent in skin creases
- absent in post-term
19
Q
greenish vernix indicates
A
meconium was passed before birth which may indicate post-term or had poor placental support.
20
Q
hair
- preterm
- term
- dark skinned
A
- Covered with fine lanugo hair (preterm)
- Hair only in a few places (term)
- Dark-skinned newborns often have more lanugo than light-skinned ones.
21
Q
Ears
- preterm
- term or posterm
A
- When folded toward the lobe do the ears spring back slowly (preterm) or quickly (term or postern)
22
Q
breast tissue
- preterm
- term
A
- No or minimal breast tissue under the nipple (preterm)
- Or is there a palpable mass of tissue 5 mm or more (term)
(a millimeter is about the thickness of a dime)
23
Q
genitalia
male: preterm, term
female: preterm, term
A
- Males is the Scrotum smooth and small (preterm)
- Pendulous and covered with rugae or ridges (term?)
- Females are the labia majora and labia minora of nearly equal size (preterm)
- Do the labia majora cover the labia minora (term)
24
Q
Sole creases
A
- Are the sole creases on the anterior third of the foot only (preterm)
- Over the anterior two-thirds (terms)
- Or over the full foot (term or post-term)
- Peeling skin may be obvious on the feet in post-term or IUGR
25
slight increase in resps.
is normal during the transition of the newborn period
26
If below 36.5 or greater than 37.5
place skin to skin and reassess within 30 mins
27
Persistently low temp in a newborn can indicate
infection
28
normal term BP=
only done when
S: 65-95
D: 30-60
only done when (tachycardia, central cyanosis, murmurs)
29
normal birth weight
2500-4000g
30
calculating weight loss
birthweight-current eight
------------------------------------------
Birthweight
times 100= % weight loss
31
function of fontanelles (2)
- allow molding during birth
- brain growth
32
anterior fontanelles closes when
12-18 months
33
posterior fontanelle closes when
- usually between second and third month
34
if large space between sutures
could indicate hydrocephalus
notify primary HCP
35
eye colour
blue or grey and permanent color usually between 6 and 12 months
36
how does newborn react to sounds (3)
increase pulse rate, resps or startle reflex
37
Variations in the state of consciousness of infants are called
sleep-wake states
- deep sleep
- light sleep
- drowsy
- quiet alert
- active alert
- crying
38
deep sleep
the infant sleeps and does not move
39
light sleep
REM sleep: respirations are more irregular during REM
eyelid, limb and mouth movement
40
drowsy
maybe quiet, and relaxed but not very responsive to the environment
41
quiet alert
awake, relaxed, and quiet
most responsive to stimulation and responds to people talking to them.
42
active alert
displays diffuse motor activity.
43
crying
The infant's cry is accompanied by the vigorous motor activity of extremities.
44
CRIES
pain assessment tool
C=cry
R=requires oxygen
I= increased vs
E= expression on face
S= sleeplessness
45
FLACC
measures the pain of infants.
The parameters include face, legs, activity, cry, and consolability.
Each parameter is scored from 0 to 2, with a higher cumulative score indicating increased distress.
46
PIPP
The Premature Infant Pain Profile is based on scales similar to the CRIES scale.
This rates eye squeeze, nasal labial furrow, heart rate, oxygen saturation, and the brow furrow on a 0-to-3 scale, with 21 indicating the worst level of pain.
47
NIPS
6 assessments
The Neonatal Infant Pain Scale is based on scales similar to the CRIES scale.
This scale rates facial expression, arm movement, cry, leg movement, respiration, and arousal on a 0-to-2 scale, with a score of 7 indicating the worst level of pain.
48
NPASS: The Neonatal Pain, Agitation, and Sedation Scale
considers the previous criteria, in addition to behavior, and is considered to be a very reliable and valid assessment tool, even for premature infants on ventilators.
Scores are given for crying or irritability, behavioral state, facial expression, tone of extremities, vital signs, and oxygen saturation
Scores in each category range from -2 for sedated infants to +2 for agitated infants.
A normal response indicating no pain or sedation is scored as 0 (zero).
49
pain relief mesaures for newborn
- non-nutritive sucking, oral sucrose, skin to skin, breastfeeding
- touch, massage, rocking, holding and low noise and light
50
medications for pain relief
non-opioids (acetaminophen)
topical anesthetics for mild to mod pain
morphine or fentanyl for severe pain
51
conditioned responses
one that is learned over time.
52
newborn blood volume
300 ml
53
if shunts do not close
infants may become cyanotic from some blood not going to lungs to pick up oxygen
54
Organic murmurs are caused by
blood passing through abnormal openings
55
plagiocephaly
flattening of the back of head
too much time on back
56
constant tremors in sleep
may be pathological
57
first void may look
cloudy
normal due to mucus
58
smegma
white cheesy substance under foreskin\
bacteriostatic
59
pseudo menstruation
blood tinged mucus may be present
hormonal withdrawal from mother
60
less vernix present on
term newborn
61
Epstein pearls
on midline of hard palate
collection of epithelial cells
62
Telangiectatic nevi (stork bites)
flat red areas on nape of neck and on eyelids
result from dilation of small vessels
63
Mongolian spots (4)
- bluish discoloration of the skin
- common in nonwhite infants
- found on sacral and gluteal areas
- disappear spontaneously during early years of life
64
differentiate Mongolian spots from hematoma
- hematoma will change colour and spots will not and stay for years
65
physiological jaundice (5)
- a yellow tinge of the skin
- 2nd or 3rd day of life
- lasts about a week
- rapid destruction of excess RBC that it no longer needs
- breakdown releases bilirubin
66
high levels of bilirubin can cause
kernicterus
67
jaundice assessed with
1. TcB- noninvasive
2. all healthy newborns over 35 weeks' gestation have blood work drawn using hour-specific serum bilirubin levels prior to discharge from the hospital.
68
Cutis marmorata
- lacelike red or blue pattern on skin
- normal response to low temp
- place skin to skin
69
desquamation
- peeling of skin in post-term newborns or early removal of vernix
70
erythema toxicum
- splotchy erythema with firm yellow-white papules that have a red base
- no intervention
71
harlequin colour change
- imbalance of automatic vascular regulatory mechanism
- deep red color over half the body
- preterm infants placed on side
72
port wine stain
collection of capillaries in the skin
flat red-purple lesion that does not blanch on pressure
permanent, darkens as age
73
bowel movement of formula fed are
- more solid than breastfed
- yellow to brown
74
stool when receiving iron and phototherapy
darker
green
75
The immature cardiac sphincter of the stomach may cause
regurgitation
76
Deficiency of pancreatic enzymes such as
lipase decreases fat absorption
77
Breastmilk contains all
the vitamins newborns need except vit d
78
glucose levels in newborn
- after birth
- by 2 hours
after birth 2.0 mmol/l
by 2 hours glucose should be 2.6 mmol/l
79
first treatment for hypoglycemia
skin to skin
encourage breast feeding
80
risk for low blood sugar (6)
preterm
post term
SGA
LGA
newborns of diabetic mothers
stressed because of hypoxia
81
signs of hypoglycemia (9)
* Jitteriness
* Poor muscle tone
* Sweating
* Respiratory difficulty
* Low temperature (which can also cause hypoglycemia)
* Poor suck
* High-pitched cry
* Lethargy
* Seizures
82
IgG
- pass to fetus when
- _____ immunity
- rarely lasts
pass to fetus in utero
passive immunity
rarely lasts longer than 3 months
83
IgM
- produced by
- important against
- if elevated indicates
- produced by the newborn and reaches the adult level by 2
- important against bloodborne infections
- elevated level indicates serious infection
84
IgA
- where
- function
in breastmilk and provides some resistance to GI and resp infections
85
PKU
- mandatory in all provinces
- If this disorder can give a specific formula begun early in life can reduce disability and prevent severe cognitive deficiencies
86
most newborns discharged at ____ and should be seen
24 to 48 hours
within 2 days
87
parents need to call the pediatric health care provider if
- temp over 38
- refusing 2 feeds in a row
- 2 green watery stools
- frequent or forceful vomiting
- lack of voiding or stooling
- change in usual behavior
88
SIDS is highest in (5)
- male
- premature
- low birth weight
- socioeconomic disadvantages
- Indigenous
89
decrease the risk of SIDS
* Infants must be placed on their back to sleep (for all sleep)
* Infants should not be exposed to tobacco smoke, before and after birth
* Infants should sleep in a crib, cradle, or bassinet that meets current Canadian Safety Association (CSA) standards.
* Pillows, stuffed animals, bumper pads, and blankets should not be placed in the crib of the newborn.
* Infants should not be overdressed, or overheated by blankets, as this increases the risk for SIDS.
* Infants should share a room (but not bed) with a parent or caregiver for 6 months.
* Breastfeeding provides some protection for newborns from the risk of SIDS.
* Pacifiers appear to provide a protective effect for SIDS. Their use does not seem to impair breastfeeding; however, delaying the introduction of a pacifier is best left until breastfeeding is well established.
* Bed sharing is when a newborn sleeps on the same sleeping surface, such as an adult bed, sofa, or arm-chair, as that of an adult or another child. Sharing a sleeping surface increases the risk of SIDS. The risk is particularly high for infants less than 4 months of age. Thus bed sharing is not recommended.
90
CPS safe swaddling guidelines
* Don't overdress the baby. Use light blankets so the baby doesn't overheat.
* Stop swaddling when the baby shows signs of rolling over.
* Make sure the baby's nose and mouth are not covered.
* Make sure the baby can still move their legs, to avoid hip dysplasia (an abnormality of the hip joint where the socket does not fully cover the ball portion, which can increase the risk for dislocation).
91
rising total bili of___ mcmol/L is considered pathological
86
92
pathological jaundice
- occurs within 24 hours of birth
- secondary to an abnormal condition ( ABO- Rh incompatibility, G6PD)
93
TSB usually peaks
3-5 days after birth
94
tx for jaundice
- increase fluids
- phototherapy
95
severe jaundice treated with
IVIG
96
ABO compatibility
O mother gives birth to A or B blood group
97
when is Rh D immunoglobulin given
72 hours after birth of Rh positive infant
28 weeks gestation
- after abortion
- after amniocentesis
- bleeding during pregnancy
98
direct coombs test detects
damaging antibodies
99
symptoms of HDN (5)
anemia (lysis of large numbers or RBC)
jaundice (24 hours after birth)
enlarged spleen and liver and extensive edema may develop
blood usually has lots of erythroblasts to compensate
shock or HF- from decreased O2 carrying capacity, and blood volume
100
increased bilirubin excretion causes
frequent stools
101
homephototherapy
jaundice can often happen third day after birth
provides therapy at home and not in hospital where mom and baby could be separated
102
risk for jaundice (2)
- infants who are breastfed
- preterm
103
meconium in utero
when fetal distress
fetal circulation interrupted
prolonged birth
104
If asphyxia and acidosis occur in utero
the fetus may make gasping movements that draw meconium- stained amniotic fluid into the lungs
105
Meconium aspiration can be prevented by
- promoting identification of fetal distress
- rapid birth when the fetal heart tracings show an abnormal tracing.
106
Symptoms of MAS
- respiratory distress
- nasal flaring
- retractions
- cyanosis
- grunting
- rales
- rhonchi
- tachypnea may persist for several weeks
107
treatment MAS
- supportive care with warmth, supplemental O2, energy conserving POC
- intubation and mechanical ventilation may be required
108
principle signs of NOWS (6)
body tremors
hyper irritability
wakefulness
diarrhea
poor feeding
sneezing, and yawning may also be present
109
treatment of NOWS
non pharm
- skin to skin
- swaddling and holding the infant in a c position
- vertical rocking
- decreasing environmental stimulation
- breastfeeding (decrease severity of symptoms)
meds if symptoms not controlled
110
feeding babies with NOWS
may be impaired
may require more frequent and smaller feeds
supplementation with concentrate to increase caloric intake
gavage feeding (NG tube)
111
complications of poorly controlled GDM
- hyperinsulinism (>4000g) = LGA macrocosmic - - after birth often hypoglycemic
- infant appears lethargic, chubby
- may suffer from RDS or congenital abnormalities
- SGA from poor placental perfusion
- often hypoglycemia, hypocalcemia, and hyperbilirubinemia.
112
hypoglycemia in the first days of life is considered (number)
less than 2.6 mmol/L
113
The newborn with Turner syndrome or Klinefelter syndrome may have
impaired physical growth and sexual development.
114
most common chromosomal abnormalities, In Canada
down syndrome
115
3 phenotypes of down syndrome
1. trisomy 21 (most common)
2. mosaicism (less affected in physical appearance and intellectually)
3. translocation of a chromosome (highest rate of recurrence in pregnancy)
116
Screenign for down syndrome
offered 11-14 weeks
US to see nuchal thickness
blood work
positive screening may indicate the need for amniocentesis
117
signs of down syndrome at birth
- close-set upward slanting eyes
- small head
- round face
- flat nose bridge
- protruding tongue that interferes with sucking
- mouth breathing
- deep straight line across the palm which is called a simian crease
- hands are short and thick, the little finger is curved
- wide space between the first and second toe
118
symptoms of metabolic defects
| HOTPLV
- lethargy
- poor feeding
- hypotonia
- the unique odor of the urine or body
- tachypnea
- vomiting
119
Phenylketonuria caused by
- faulty metabolism of phenylalanine
- The hepatic enzyme phenylalanine hydrolase, which is normally needed to convert phenylalanine into tyrosine, is missing.
- When the infant is fed breastmilk or formula, phenylalanine begins to accumulate in the blood.
- Its byproduct, phenyl pyruvic acid, appears in the urine within the first weeks of life.
120
manifestations of PKU
- abnormally high levels of phenylalanine.
-
121
Classic PKU can result in
severe cognitive disability
122
later signs of PKU
- FTT
- eczema or other skin conditions
- peculiar musty odor
- personality disorders.
- 1/3 have seizures
123
PKU occurs mainly in
blonde and blue-eyed children; these features result from a lack of tyro-sine, a necessary component of the pigment melanin.
124
test for PKU
The Guthrie blood test is widely used and is currently, considered the most reliable test
recommended to obtain blood within 24 to 48 hours of life
125
PKU: If the infant is discharged before 24 hours
the test should be done prior to discharge and repeated by 2 weeks of life.
126
Treatment of PKU consists of close
dietary management and frequent evaluation of blood phenylalanine levels.
- a food that provides enough protein for growth and tissue repair, but little phenylalanine, must be substituted.
127
medication for PKU
Sapropterin dihydrochloride (Kuvan)
128
maple syrup urine disease is caused by
a defect in the metabolism of branched-chain amino acids, leading to marked serum elevations of leucine, isoleucine, and valine
129
maple syrup disease results in
acidosis, cerebral degeneration, and death within 2 weeks if left untreated.
130
Manifestations of maple syrup disease
Infant appears healthy at birth but soon develops
- feeding difficulties
- loss of the Moro reflex
- hypotonia
- irregular respirations
- convulsions.
urine, sweat, and (earwax) have a characteristic sweet or maple syrup odour
131
diagnosis of maple syrup disease confirmed by
blood levels and urine test for high levels of leucine, isoleucine, and valine
132
initial treatment of maple syrup disease
removing the amino acids and their metabolites from the tissues of the body through hydration and peritoneal dialysis to decrease serum levels.
133
Galactosemia body cant
use carbohydrates galactose and lactose
lack enzyme that converts galactose to glucose
134
galactosemia can cause
cirrhosis of the liver, cataracts, and developmental delays if left untreated.
135
early signs of galactosemia
lethargy, vomiting, hypotonia, diarrhea, and failure to thrive.
start as newborn begins breastfeeding or ingesting formula
136
treatment of galactosemia
milk and lactose-containing products are removed
stop breastfeeding
137
AGA
5lb to 8lb 12 oz
2.5kg to 4kg
138
SGA will se
- decreased glycogen and fat stores prone to hypoglycemia after birth
- polycythemia ( increase in all blood cells)
139
common etiology of poor fetal growth
decreased uteroplacental function related to pregnancy induced HTN
140
polycythemia in
SGA and LGA
141
green breastmilk
- RBC may leak into breastmilk in early lactation
- seaweed, green-colored sports drinks, herbal vitamins and iron tabs
142
Exclusively breastfed infants should have transitional stools by day
4 if feedings are adequate
