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z OB > newborn complications > Flashcards

newborn complications Flashcards

1
Q

apgar score: definition

A

reflects immediate adjustment to extrauterine lifeA ctivityP ulseG rimaceA ppearanceR espirations

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2
Q

apgar scoring levels (3)

A

0-3: severe distress4-6: moderate difficulty7-10: adjusting to extrauterine life without difficulty

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3
Q

hyperbilirubinemia

A

excessive level of accumulated bilirubin in blood

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4
Q

bilirubin

A

breakdown product of hemoglobin secondary to red blood cell destruction

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5
Q

unconjugated bilirubin

A

(indirect) insoluble, usually bound to albumin in plasma- highly toxic to neurons

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6
Q

conjugated bilirubin

A

(direct) soluble, usually excreted/eliminated

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7
Q

free bilirubin

A

the only shit dat can cross the blood brain barrier, yo!

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8
Q

jaundice/icterus

A

yellow discoloration of skin, sclera, nails

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9
Q

jaundice observable at what bilirubin level?

A

> 5 mg/dL

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10
Q

acute bilirubin encephalopathy

A

acute manifestations of bilirubin toxicity that occur during the first weeks after birthcan lead to eventual intellectual disability, cerebral palsy, ADD/ADHD

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11
Q

bilirubin encephalopathy: s/s

A

CNS depression OR excitement

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12
Q

kernicterus

A

yellow staining of brain cells occuring when serum concentration of bilirubin reaches a toxic leveldiagnosis post-mortem = true kernicterus

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13
Q

physiologic jaundice

A

transitory jaundice that affects some infants for the first few days after birth, results from hyperbilirubinemia

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14
Q

hyperbilirubinemia causes (7)

A
  • physiologic hyperbilirubinemia- breastfeeding (the milk!)- genetic predisposition: native american, asian- birth injury- disturbed capacity of liver to secrete conjugated bilirubin- disease states (congenital hypothyroidism, G6PD)- excessive production of bilirubin (hemolytic disease)
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15
Q

physiologic jaundice

A
  • appears on day 2-3*- not associated with pathophysiologic process- mild, usually self-limited
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16
Q

pathologic jaundice

A
  • appears within the first 24 hours- significant for sepsis, hemolytic disease of the newborn
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17
Q

breastfeeding jaundice: early

A
  • day 2-4caused by insufficient production or intake of breast milkDON’T STOP BREASTFEEDING
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18
Q

breastfeeding jaundice: late

A
  • day 4-7characterized by indirect hyperbilirubinemia in a breastfed newborn that persists longer than physiologic jaundice and has no other identifiable cause– can persist for 3-13 weeks– rarely causes kernicterus in healthy, full-termDON’T STOP BREASTFEEDING
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19
Q

caput succedanuem

A

generalized edema of the scalp

20
Q

cephalohematoma

A

bleeding between the periosteum and skull(increases bilirubin because breakdown of RBC involved!)- swelling limited by margins of cranial bone affected

21
Q

periosteum

A

membrane covering the outer surface of bones

22
Q

Rh incompatibility

A

problem with mom is Rh- and infant Rh+hemolytic disease of the newborn causing hyperbilirubinemia

23
Q

ABO incompatibility

A

most commonly mom: O and infant: A or Bhemolytic disease of the newborn causing hyperbilirubinemia

24
Q

indicators of non-physiologic hyperbilirubinemia

A
  • jaundice first 24 hours- jaundice persistent in term, bottle fed > 2 weeks- total serum bilirubin:– >12.9 term– 15 preterm– > 15 breastfed- increase in serum bilirubin of 5 mg/dl/day- conjugated (direct) bilirubin > 1.5-2.0
25
Q

phototherapy

A

main treatment for hyperbilirubinemia; light increases bilirubin excretion by helping to conjugate bilirubin- overhead, bili blanket

26
Q

meconium

A

first intestinal discharge/stool passed by a newborn, typically not passed until after birth

27
Q

intrauterine distress

A

can lead to passage of meconium into amniotic fluid before birth - if aspirated in delivery, can lead to respiratory distress which can progress to respiratory failure!

28
Q

meconium aspiration: possible results

A
  • airway obstruction- chemical pneumonitis- surfactant dysfunction (can strip surfactant from lungs)
29
Q

neonatal sepsis

A

generalized bacterial infection in bloodstream- neonates are HIGHLY susceptible- can lead to meningitis, permanent neurological deficits, death- EARLY diagnosis and treatment ESSENTIAL to increase chance of survival”something’s just not right with the baby” - THINK SEPSIS

30
Q

“something’s just not right with the baby”

A

SEPSIS?!?!?!?!?!!??!!?!

31
Q

neonatal sepsis: source of infections - prenatal

A
  • across palcenta- prolonged rupture of membranes
32
Q

neonatal sepsis: source of infections - perinatal (early)

A

birth - 6 days- direct contact with maternal organisms from GI, GU tracts- e coli, group b strep

33
Q

neonatal sepsis: source of infections - perinatal (late)

A

> 7 days after birth

34
Q

febrile neonate

A
  • fever in newborn up to 60 days of age- can be indicator of sepsis, serious bacterial infection
35
Q

fever

A

complete evaluation, admit for conservative therapy (aggressive until we figure out what’s going on)- diminished immunity- high risk of mortality

36
Q

fever 1-2 months old

A

may not be admitted if:- appears healthy- benign labs- focus of infection

37
Q

neonatal sepsis: s/s

A

can be vague, nonspecific, subtle: LOOK AT WHOLE CHILD- fever (>100.4/38C) or hypothermia- lethargy, irritability- change in: activity, feeding, color, uop- apnea- vomiting, diarrhea

38
Q

fever in babby (numbers)

A

> 100.4F or 38C

39
Q

HARBINGERS OF IMPENDING DOOM

A

TOXIC APPEARANCE =LETHARGYPOOR PERFUSIONHYPOVENTILATION, HYPERVENTILATIONCYANOSIS

40
Q

neonatal sepsis: treatment

A

ALL ill-appearing infants should be considered SEPTIC until proven otherwise- early abx in most ill-appearing infants: after blood drawn for labwork- positive culture = treat with abx for 12-21 days

41
Q

sudden infant death syndrome

A

sudden death in infant under 1 year of age, cause unknown- peak age: 2-4 mo, 95% occur by 6 mo

42
Q

sids: higher incidence in…

A

preterm, low birth weight, multiple births, low apgar scores

43
Q

sids: maternal risk factors

A

young age, cigarette smoking, poor prenatal care, substance abuse, sleep environment

44
Q

sids: sleep environments increasing risk

A
  • prone- pillow, soft bedding- non-infant surface (sofa)- co-sleeping- tobacco smoke exposure
45
Q

sids: protective feeding habits

A
  • breastfed (lower incidence)- pacifier during sleep may be protective

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