Complicated Newborn Care Flashcards
What is the pathos for Hyperbilirubinemia?
- Increased RBC volume and short life span, results in increased RBC hemolysis after birth
- Excessive erythrocyte destruction (RH incompatibility, infections)
- Increased extravascular blood (cephalohematoma, ecchymoses)
Peaks 3-5 days. resolved by 8 days
Evidence of Jaundice in first 24hours is PATHOLOGICAL (Which is TCB is checked at 24hour mark)
What are the Risk factors for hyperbilirubinemia?
- Visible Jaundice
- Fam hx (previous siblings)
- Visible bruising/cephalohematoma
- Exclusive/partial breastfeeding
- Asian, African, mediterranean
- Dehydration/Weight loss after birth
- < 37 weeks gestation
- Rh/ABO incompatibility
What is the assessment process for Hyperbilirubinemia/
- Visual inspection (Cephalocaudal progression) head to toe
- TCB
- TSB (must be drawn within 24-72hrs)
What is Phototherapy and treatment?
Assists with breakdown of bilirubin
- Only in diaper
- Turn regularly
- Isolette for thermoregulation
- Eye protection
- Monitor Temp and hydration
- Ligjt off when blood drawn
- Overhead lights or Phototherpy blankets
- Breastfeeding should continue
What are the complications of Drug-Using Mothers?
Amphetamines: LBW, premature, intracranial hemorrhage
Alcohol: FASD/FASE, withdrawal lasting until 18m
Cocaine: Placenta abruption, anemia/fetal death/ SIDS
Cigar: SGA, SIDS, respiratory, behavioural problems
Marijuana: Postdates, SGA, increased prolactin (affects breastfeeding)
What is Small for Gestational Age?
- May be d/t? Risks?
<10th%
May be related to IUGR
May be d/t: maternal, uterine/placental, fetal factors
Risks: hypoglycemia, hypothermia
What is Large for Gestational Age?
- Risks
> 90th%
Risks: birth trauma, shoulder dystocia, assisted delivery/ c/s, hypoglycemia, skeletal anomalies
Which Newborns are at risk for Hypoglycemia?
-Monitor?
Of diabetic Mothers: monitoring for 12hr and can only be discontinued after 12hr if 2 readings are >2.6
SGA: monitoring for 36hrs and can only be discontinued after 36hrs if 2 readings are >2.6
LGA: monitoring for 12hrs and can only be discontinued after 12hrs if 2 readings are >2.6
Preterm(<37wks): monitoring for 36 hours and can only discontinue after 36hrs if 2 readings are >2.6
What is the management for hypoglycemia?
- Should feed within 30 minutes of birth
- if asymptomatic, test at 2hrs of age, or test earlier if unwell or symptomatic
- Symptoms: jitters, poor feed, lethargy, high pitched crying, cyanosis, sudden pallor, hypothermia, tachypnea, and or apneic spells
What is preterm?
<37 weeks
34-37 is late preterm
<30 weeks is early or very preterm
What are the characteristics for Preterm newborns?
- Ruddy, permeable skin
- Shiny heels, palms, a few creases
- Large fontanelles
- Little to no breast tissue
- Widely separated external labia
- Undescended testes
[Preterm] What is Cold Stress
- Immature CNS
- decreased brown fat, decreased subcut, poor muscle development, less flexed tone, inability to shiver, permeable
[Preterm] What is Necrotizing Entercolitis?
- Inflammatory disease of the Gi mucosa
- Decreased oxygen - mucus secreting cells, of the bowel system are inactivated and bacteria invade muscular layer of bowel wall
[Preterm] What are respiratory Complications?
- Risks?
- Lack of surfantant
- Immature development
Risks:
- Respiratory Distress Syndrome
- Bronchopulmonary Dysplasia
[Preterm] What is Persistent patent ductus arteriosis?
- Treatment?
- May remain open d/t respiratory distress
Treatment: indomethacin/ibuprofen or surgical ligation
