Medical Issues of the Newborn

Question 1

At what times are infants APGAR scores assessed?

Answer 1

1 and 5 minutes

Question 2

What is assessed as part of APGARs?

Answer 2

A - activity (muscle tone)
P - pulse
G - grimace (reflex irritability)
A - appearance (skin color)
R - respiration

Question 3

An APGAR score < 4 indicates what?

Answer 3

Resuscitation

Question 4

What is a normal pulse rate in a full term neonate?

Answer 4

110-160 (term neonates when asleep can be 85-90)

Question 5

What is a normal BP in a neonate?

Answer 5

65-85 / 35-55

Question 6

What is a normal respiratory rate in a neonate?

Answer 6

30 - 40

Question 7

What are the benefits of immediate skin to skin for baby?

Answer 7

• Thermoregulation
• Glucose regulation
• Lower/more stable HR
• Increase oxygenation and decrease apnea
• Neurobehavioral organization

Question 8

What interventions are included in “Eyes and Thighs” and should be given by 1 hour of life?

Answer 8

• Erythromycin ophthalmic ointment to prevent neonatal GC conjunctivitis
• 1 mg IM Vitamin K to prevent vitamin K deficient bleeding
• Hepatitis B vacine

Question 9

Is the HBV vaccine effective in preventing perinatal transmission when given within 24 hours of birth?

Answer 9

Yes

Question 10

Who should have glucose screening?

Answer 10

Infants at high risk:
- GA < 37 or > 42 weeks
- LGA or SGA
- Infants of diabetic mothers
- Family history of hypoglycemia
- Mothers treated with beta adrenergic or oral hypogycemic agents

Question 11

Are babies born to diabetic mothers more likely to be hypoglycemic or hyperglycemic?

Answer 11

Hypoglycemic

Question 12

How many hours do newborns sleep per day?

Answer 12

16-18 hours/day until 3 months

Question 13

A newborn typically loses 8-10% of their body weight but should be back to birth weight by when?

Answer 13

2 weeks

Question 14

When should NBS be performed?

Answer 14

24-48 hours of life (36 hours ideal)

Question 15

Can parents refuse NBS?

Answer 15

Yes, but must sign refusal form

Question 16

Hearing implement services should be initiated by what age in those who fail newborn hearing screens?

Answer 16

6 months of age is the goal

Question 17

The goal of newborn hearing screening is to diagnose any hearing abnormality by what age?

Answer 17

< 3 months

Question 18

What is the newborn recommendation for oximetry screening for congenital heart disease?

Answer 18

Perform pre-ductal (RIGHT hand) and post-ductal (either foot) saturations between 24-48hrs

Question 19

Where is the oximeter probe placed to screen pre-ductal saturations?

Answer 19

Right hand

Question 20

What criteria are included in a positive oximetry screen?

Answer 20

• O2 sat < 90% at anytime
• O2 sat 90-94% in both extremities on 3 seperate measurements
• O2 sat with >/= absolute difference between right hand and either foot on 3 separate measurements

*each measurement should be separated by one hour

Question 21

What are the risk factors for neonatal sepsis?

Answer 21

• Maternal intrapartum temp >/= 38 C (100.4 F)
• Membrane rupture of 18 hours
• Delivery before 37 weeks
• Chorioamnionitis
• Maternal GBS colonization

Question 22

The newborn head exam reveals a firm and fluctuant mass, what are you concerned for?

Answer 22

Subgaleal hemorrhage

Question 23

Where is the PMI felt in a newborn?

Answer 23

Lower left sternal border (RV is dominant)

Question 24

What is the Moro Reflex?

Answer 24

Sudden, slight dropping of head from slightly raised supine position: open hands, extension and abduction of arms (and legs), then flexion of arms (and legs) and crying

Question 25

What is the last primitive reflex to disappear in babies?

Answer 25

Babinski, usually lasts until about 2 years while all others typically disappear around 6 months

Question 26

What tool is used to predict bilirubin levels in a newborn?

Answer 26

Bhutani nomogram

Question 27

What are some hepatocellular diseases that can cause direct (conjugated) hyperbili?

Answer 27

- Hepatitis - TPN (cholestasis) - Hepatic ischemia - Erythroblastosis fetalis - Metabolic disorders

Question 28

What is the treatment for hyperbili?

Answer 28

Phototherapy

Question 29

Infants with severe hyperbili should receive what treatment?

Answer 29

Exchange transfusion

Question 30

What are some causes of peripheral cyanosis?

Answer 30

- Cold exposure - Acrocyanosis - Shock - Sepsis - Neonatal polycythemia

Question 31

What are signs of respiratory distress?

Answer 31

- Retractions - Grunting - Nasal flaring - Stridor (laryngeal)

Question 32

What is the initial management for cyanosis?

Answer 32

- IV, O2, Monitor

Question 33

What is the initial work-up for cyanosis in the newborn?

Answer 33

- ABG - CBC with diff (low WBC may indicate sepsis) - Glucose - Blood cultures - CXR - Echo

Question 34

What are common pulmonary causes of respiratory distress in full-term infants?

Answer 34

- TTN - Meconium aspiration - PPPHN

Question 35

What is transient tachypnea of the newborn (TTN)?

Answer 35

Inadequate clearance of fluid in lungs at birth

Question 36

What are the CXR findings of TTN?

Answer 36

- Increased lung volumes, flat diaphragms, prominant central vascular markings, fluid in the fissures, and possible pleural effusion

Question 37

What is the treatment for TTN?

Answer 37

Management is supportive, and typically resolves in 24-72 hours - O2 - Neutral thermal environment - Nutrition

Question 38

What is the diagnosis and work-up for Meconium aspiration?

Answer 38

- CXR - ABG - CBC - Blood culture - ECHO

Question 39

What are the typical CXR findings of meconium aspiration?

Answer 39

- Initially: streaky densities - Progressive changes: hyperinflation and patchy densities

Question 40

What is the management of MAS?

Answer 40

- Maintain oxygenation and ventilation (surfactant, NO, or ECMO maybe needed) - Broad spectrum abx

Question 41

How can you definitively diagnose PPHN?

Answer 41

ECHO

Question 42

What is the treatment for PPHN?

Answer 42

- Treat underlying condition - 100% O2 to reverse vasoconstriction, titrate to pre-ductal sats of 90-95% - NO? - Consider ECMO

Question 43

True or False: all neonates with fever require a full evaluation for sepsis

Answer 43

True

Question 44

How is early onset sepsis defined?

Answer 44

First 7 DOL (often beings in-utero)

Question 45

What is the evaluation of early onset sepsis?

Answer 45

- Blood culture - LP - CBC with Diff, glucose, VBG (lactate) - CXR

Question 46

What is the evaluation for late onset sepsis?

Answer 46

Same as early onset plus: U/A

Question 47

How is failure to thrive defined?

Answer 47

- Weight that falls or remains below 3rd %ile - Weight that decreased 2 major percentile lines on growth chart - Weight that is < 80% of the median weight for height

Question 48

What ages is SIDS more common?

Answer 48

2-4 months of age

Question 49

A full-term male newborn is brought to the emergency department with signs of respiratory distress shortly after birth. On examination, he appears cyanotic, has nasal flaring, grunting, and subcostal retractions. His mother had an uneventful pregnancy, and prenatal ultrasounds showed no anomalies. What is the most likely diagnosis? | What should be the first line treatment?

Answer 49

TTN | Self-limited, Oxygen therapy support with 30-40% FIO2