01: Newborn male infant evaluation and care

Question 1

Which substance exposure causes low birth weight but no facial abnormalities?

Answer 1

Tobacco exposure

Question 2

Which substance exposure causes cognitive and learning problems, facial abnormalities, and CNS dysfunction?

Answer 2

Alcohol exposure

Question 3

What effects does marijuana have on the fetus?

Answer 3

Hasn’t been studied yet

Question 4

Which substance exposure causes growth restriction, placental abruption, preterm passage of meconium, and irritability, poor feeding, high pitched cry?

Answer 4

Heroin and opiates

Question 5

Which substance exposure causes low birth weight, placental insufficiency, and later cognitive effects?

Answer 5

Cocaine

Question 6

What strep is a cause of neonatal bacterial sepsis?

Answer 6

GBS

Question 7

20% of pregnant women have vaginal or rectal colonization of what?

Answer 7

GBS

Question 8

Without antibacterial prophylaxis, what percent of infants born to colonized women develop invasive disease?

Answer 8

1-2%

Question 9

Any ill-appearing neonate should received which 4 diagnostic items?

Answer 9

1. CBC
2. Blood culture
3. CXR
4. Lumbar puncture

Question 10

What does the “A” in APGAR stand for?

Answer 10

Appearance (skin color)

Question 11

What does the “P” in APGAR stand for?

Answer 11

Pulse

Question 12

What does the “G” in APGAR stand for?

Answer 12

Grimace (reflex irritability)

Question 13

What does the second “A” in APGAR stand for?

Answer 13

Activity (muscle tone)

Question 14

What does the “R” in APGAR stand for?

Answer 14

Respiration

Question 15

What’s the scoring for each letter in APGAR?

Answer 15

0, 1, or 2

Question 16

An APGAR score below __ at 5 minutes should prompt continued resuscitation, with re-assessment every 5 min?

Answer 16

Below 7

Question 17

Does the APGAR score predict neurologic outcome or mortality?

Answer 17

No

Question 18

What assessment tool uses signs of physical and neuromuscular activity to estimate gestational age?

Answer 18

The Ballard Assessment Tool

Question 19

What’s the definition of SGA?

Answer 19

Weight below 10th percentile at gestational age

Question 20

What is symmetric vs asymmetric IUGR?

Answer 20

Symmetric: head, length, and weight are decreased proportionately
Asymmetric: greater decrease in length or weight without affecting head

Question 21

What may decreased glycogen stores, heat loss, possible hypoxia, and decreased gluconeogenesis cause in SGA newborns?

Answer 21

Hypoglycemia

Question 22

What may cold stress, hypoxia, hypoglycemia, increased surface area, or decreased subcutaneous insulation cause in SGA infants?

Answer 22

Hypothermia

Question 23

What may chronic hypoxia, or maternal-fetal transfusion cause in SGA newborns?

Answer 23

Polycythemia

Question 24

Which reflex involves the newborn turning his head toward your finger when you touch his cheek?

Answer 24

Rooting

Question 25

Which reflex involves the newborn sucking on your finger when you touch the roof of his mouth?

Answer 25

Sucking

Question 26

Which reflex involves dropping the infant's head 10cm and catching it, which causes the newborn to flex his thighs and knees, and fan and clench his fingers, with arms first thrown outward and then brought together as though embracing something?

Answer 26

Startle (Moro)

Question 27

Which reflex involves the newborn grasping your finger when you stroke it against the palm of his hand or plantar surface of his foot?

Answer 27

Palmar and plantar reflexes

Question 28

Which arm flexes in the asymmetrical tonic neck response (fencer reflex)?

Answer 28

The contralateral

Question 29

Which reflex involves the newborn's legs making a stepping motion when you hold him vertically above the table and stroke the foot against the table?

Answer 29

Stepping response

Question 30

What are 5 causes of an absent red reflex in an infant?

Answer 30

1. Cataract 2. Opacified cornea 3. Inflammation of anterior chamber 4. Developmental anomalies of eye 5. Retinoblastoma

Question 31

Early VKDB occurs in what fraction of newborns?

Answer 31

1/60-1/250 of newborns

Question 32

Infants who do not receive a Vitamin K shot are ____ x more likely to develop hemorrhage than those who do?

Answer 32

81x

Question 33

When does early VKDB occur?

Answer 33

0-24 hours after birth

Question 34

What drugs did the mother likely take if the neonate has early VKDB (2)?

Answer 34

1. Antiepileptics | 2. Isoniazid

Question 35

When does classical VKDB occur?

Answer 35

1-7 days after birth

Question 36

Which type of VKDB causes bruising and bleeding from the umbilical cord?

Answer 36

Classical

Question 37

When does late VKDB occur?

Answer 37

2-12 weeks after birth

Question 38

In what infants does late VKDB tend to occur?

Answer 38

Breastfed only babies who haven't gotten the Vitamin K shot

Question 39

When should neonates weighing more than 2000 grams born to mothers positive to Hep B surface antigen get the Hep B vaccine and Hep B immune globulin?

Answer 39

Within 12 hours of delivery and then routine vaccine again at age 1 month

Question 40

When should infants born to mothers not tested for Hep B get the Hep B vaccine and Hep B immune globulin?

Answer 40

Within 12 hours of delivery, and then can wait on the immune globulin until mother has been tested (still effective within 7 days of birth)

Question 41

What are the 3 routine newborn medications?

Answer 41

1. Vitamin K 2. Hep B vaccine 3. Erythromycin

Question 42

What lab tests should you look for in the maternal record?

Answer 42

``` Blood type Rh and Ab screen Rubella Hep B surface Ag HIV Ab RPR or VDRL NAAT for chlamydia or gonococcus GBS Hep C Ab Tb test ```