Caring For The Newborn

Question 1

How does the fetus transition into a newborn

Answer 1

As it begins to breathe, the lungs expand with air and pulmonary vascular resistance drops. Blood flows to the lungs for gas exchange. Anything that delays this can lead to delayed transition with hypoxia, possible brain damage and potentially death

Question 2

What does APGAR stand for?

Answer 2

Appearance (skin colour)
Pulse rate
Grimace
Activity
Respiratory

Question 3

Appearance scores

Answer 3

Completely pink -2
Body pink, extremities blue -1
Centrally blue, pale -0

Question 4

Pulse scores

Answer 4

> 100 - 2
<100 - 1
Absent -0

Question 5

Grimace scores

Answer 5

Cries- 2
-grimaces 1
No response 0

Question 6

Activity scores

Answer 6

Active motion -2
Some flexion of extremities -1
Limp - 0

Question 7

Respiratory scores

Answer 7

Strong cry -2
Slow and irregular - 1
Absent -0

Question 8

When to use OPAs

Answer 8

-Bilateral choanal atresia
-Pierre Robin Sequence

Question 9

What can cause Apnea

Answer 9

-prematurity
-GERD
-Drug-induced

Question 10

How to treat apnea

Answer 10

Respiratory support to minimize hypoxic brain damage

Question 11

What is a premature baby

Answer 11

Delivered before 37 weeks

Question 12

What is a low birth weight

Answer 12

Less than 2,500g

Question 13

Factors for prematurity

Answer 13

-genetic
-infection
Cervical incompetence
-uterine abnormalities
-abruption
Multiple gestations
Drug use by mother
Trauma

Question 14

Factors for low birth weight

Answer 14

Chronic maternal hypertension
Smoking
Placental anomalies
Chromosomal abnormalities

Question 15

What are the four types of seizures

Answer 15

-subtle seizure
-tonic seizure
-focal clonic seizure
-Myoclonic seizure

Question 16

What is a subtle seizure

Answer 16

Eye movement, sucking

Question 17

What is a tonic seizure

Answer 17

Constant contraction

Question 18

What is a focal clonic seizure

Answer 18

Contraction and relaxation of muscle group

Question 19

What is a myoclonic seizure

Answer 19

Jerking motion of extremities

Question 20

What does multifocal mean?

Answer 20

Refers to asynchronous, different areas

Question 21

What does generalized mean

Answer 21

Same presentation on both sides

Question 22

What are some causes of seizures

Answer 22

-hypoxic ischemic encephalopathy
-hypoglycemia
-hypocalcemia
-meningitis
-epilepsy

Question 23

What is hypoxic ischemic encephalopathy

Answer 23

Usually secondary to asphyxia just before or shortly after birth
The most common cause of seizures
Usually only occur in the first 24hrs as brain swelling usually goes down after this

Question 24

What causes hypoglycemia in infants?

Answer 24

Small infants
Large infants
Mothers who were diabetic during pregnancy

Question 25

What to do for Gastroschisis / omphalocele

Answer 25

Place newborn in a bag from the waist down, nurse infant on unaffected side, monitor colour of intestines

Question 26

What is the average normal temperature of a newborn?

Answer 26

37.5C

Question 27

What is non-shivering thermogenesis

Answer 27

Production of heat by metabolism of brown fat

Question 28

Ways in which babies lose heat

Answer 28

Evaporation Convection Conduction Radiation

Question 29

Evaporation prevention

Answer 29

Dry baby well and keep dry. Use dry sheets to wrap them in, not the ones used to dry them off

Question 30

Convection

Answer 30

The air passing over the baby

Question 31

Conduction

Answer 31

Placing baby on cold surfaces

Question 32

Radiation

Answer 32

Just being in a cold environment

Question 33

What is considered a fever in a newborn

Answer 33

Temperature greater than 38C

Question 34

What causes a fever

Answer 34

Overheating Dehydration is an important consideration in breast feeding babies They have a limited ability to control temperature -do not sweat to allow cooling -do not shiver to raise their temp

Question 35

What to do when you suspect a seizure

Answer 35

Observe the newborn for the presence or rashes Obtain a careful history Obtain the newborns vitals Remove additional layers of clothing and improve environmental ventilation

Question 36

Symptoms of hypothermia

Answer 36

-cool to the touch -Initially in the extremities -may be pale and have acrocyanosis May become lethargic

Question 37

What is considered hypoglycemic for an infant

Answer 37

BGL less than 2.6

Question 38

Symptoms of hypoglycemia

Answer 38

Cyanosis, apnea, irritability, poor sucking or feeding and hypothermia, tachycardia, tachypnea, vomiting

Question 39

Management of hypoglycaemia

Answer 39

-check BGL -direct medical control may order 10% dextrose solution -maintain temperature

Question 40

When is vomiting a concern

Answer 40

-if it is persistent or if it contains blood

Question 41

What are some causes of vomiting

Answer 41

Pyloric stenosis Esophageal atresia with or without distal fistula GERD Malrotation Hirschprung disease

Question 42

What is esophageal atresia

Answer 42

Congenital defect Infants are excessively mucousy May choke when attempting to feed

Question 43

GERD presentation

Answer 43

Most commonly seen in infancy May vomit immediately or a few hours after a feeding

Question 44

What is pyloric stenosis

Answer 44

Narrowing of opening between stomach and intestine Hypertrophy and hyperplasia of the pylorus Stomach muscles contract forcibly causing vomiting

Question 45

What is malrotation

Answer 45

Congenital anaomaly of the midgut Small bowel is found on the right side of the abdomen

Question 46

What is hirschsprung disease

Answer 46

Meconium plug syndrome Last segment of colon fails to relax Usually a history of not passing meconium in the first 24hrs of life

Question 47

How many stools per day is normal for an infant

Answer 47

5-6

Question 48

What causes acute diarrhea

Answer 48

-Viral infection Gastroenteritis Lactose intolerance Neonatal abstinence syndrome (withdrawal) Thyrotoxicosis (hyperthyroidism) Cystic fibrosis

Question 49

Symptoms of severe diarrhea

Answer 49

Generally look ill Poor vitals Delayed cap refill Dry mucous membranes Absent tears Weight loss Low urine output

Question 50

Common injuries in the newborn

Answer 50

Caput succedaneum Chephalhemtotoma Linear fractures Brachial plexus injuries Spinal chord injury Intrapleural-abdominal injury

Question 51

What causes birth injuries

Answer 51

Big infant Primigravida Big head Prolonged or rapid labour Abnormal presentation Prematurity Low birth weight