week 8 - newborn complications

Question 1

what is jaundice?

Answer 1

The clinical manifestation of elevated serum unconjugated bilirubin levels

Question 2

what are the two types of jaundice?

Answer 2

physiologic vs. pathologic

Question 3

what is physiologic jaundice?

Answer 3

“Physiological or nonpathological jaundice. APPEARS AFTER 24 HOURS AGE. and usually resolves without treatment”
Not due to an underlying condition
60% of term newborns & 80% of preterm newborns experience physiologic jaundice

Question 4

what are potential outcomes of jaundice?

Answer 4

neurotoxicity - acute encephalopathy and or chronic encephalopathy

Question 5

when would we teaqch families that jaundice might peak?

Answer 5

before about 5 days, at which point it plateaus

Question 6

warning signs for jaundice to teach families:

Answer 6

decreased LOC, decreasing urine/stool, yellow

Question 7

teach parents to do THIS to prevent jaundice?

Answer 7

more feeding! (results in more pooping to remove bilirubin)

Question 8

risk factors for jaundice: (there are lots, try to name a few)

Answer 8

-preemie
-exclusive BF - not well established
-sibling with neonatal jaundice
-visible bruising
-cephalohematoma
-DAT or other hemolytic disease
-east asian background
-low apgar
-acidosis
-albumin <30g/L
-sepsis
-temp instability
-lethargy/poor feeding

Question 9

what would acute neurotoxicity look like?

Answer 9

loss of startle reflex, poor feeding, lethargy, poor muslce tone, high pitched cry, irritability, seizures

Question 10

treatment for jaundice with levels above threshold:

Answer 10

phototherapy

Question 11

what is pathologic jaundice?

Answer 11

pathologic in origin or too severe. ALWAYS CONSIDERED PATHO IF PRESENTS BEFORE 24 HOURS.

Question 12

what TBS level is considered jaundice?

Answer 12

> 256mcmol/L or increased to more than 100 in 24 hrs

Question 13

what is Hemolytic disease of the newborn (HDN)?

Answer 13

What is it?
“Hemolytic disease of the newborn (HDN), also called erythroblastosis fetalis, is a condition in which red blood cells (RBC) are broken down or destroyed.”
Results into:
RBCs are destroyed quickly
Anemia
Higher rates of bilirubin production and subsequent jaundice

Question 14

when is jaundice r/t breastfeeding considered “early”? what cacuses this?

Answer 14

days 2-5, usually d/t poor feeding/latch

Question 15

when would we need to send a serum for assessing jaundice instead of TcB?

Answer 15

if bb is very bruised/discolored and can’t use the sternum, or if doesn’t match clinical picture, or if its before 24 hrs and they scored on the graph as higher risk

Question 16

when is weigt loss concerning?

Answer 16

if losing >7%

Question 17

when do we get concerned with stools and voids?

Answer 17

<3 stools/day by day 4, <4-6/voids/day by day r4

Question 18

true or false: we use TcB to test bilirubin levels before and while on phototherapy

Answer 18

false. we use TSB once phototherapy is initiated

Question 19

how much of the skin do we want exposed during phototherapy?

Answer 19

around 80%

Question 20

last line of defence for treatment when phototherapy isn’t working

Answer 20

exchange transfusion

Question 21

three indications for exchange transfusion

Answer 21

-phototherapy inadequate
-HDN
-acute bili encephalopathy signs

Question 22

when conducting an assessment on a 35w gest. newborn, a heart murmur is heard. why?

Answer 22

because they have a patent ductus arteriosus

Question 23

what do we do for a baby at risk of hypoglycemia after birht?

Answer 23

get bb to feed right away

Question 24

what’s the protocol for checking BG for an IDM immediately after birht?

Answer 24

put bb skin to skin, feed them asap, and check BG 2 hours after birth, after first feed

Question 25

normal serum blood glucose for bb

Answer 25

> or = 2.6

Question 26

risk factors for infant hypoglycemia:

Answer 26

• preterm
  -SGA infants
  -IDM
  -LGA
  -asphyxia
  -any maternal exposure to labetalol in2 weeks before delivery
  -late preterm exposure to antental steroiroid 2 weeks before delivery

Question 27

after initial feed, how do we check blood glucose?

Answer 27

if first check is clear and no symptoms, check q 2-3 hours before feeds, still want it to be greater than 2.6

Question 28

most common infection in a neonate:

Answer 28

pneumonia

Question 29

which drugs can cause NAS if used within 72 hours prior to birth

Answer 29

narcotics, alcohol, barbiturates, benzos, inhalants, SSRIs

Question 30

a baby at risk for NAS doesn’t score at two hours on the finnegan scale. are they at risk?

Answer 30

yes, because onset can be at 72 hours or longer