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NM 717 Comps > Module 7 Newborn Canvas > Flashcards

Module 7 Newborn Canvas Flashcards

1
Q

Describe the stages of lung development of a fetus/newborn.

A

2nd canalicular stage: 16-24 weeks
3rd Saccular Stage 28-36 weeks
Alveolar period: 36 weeks through childhood

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2
Q

When does surfactant begin to line the alveoli in the fetus?

A

28-36 weeks

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3
Q

What events occur in the lungs after birth?

A
  1. Clearance of alveolar fluid (begins days before labor)
  2. Lung expansion (occurs in the second stage from “the squeeze”
  3. Circulatory changes that increase pulmonary perfusion
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4
Q

What occurs with the newborns first breath?

A
  1. assists with the conversion from fetal to adult circulation
  2. further empties the lungs of liquid
  3. establishes neonatal lung volume and pulmonary function of the newborn
    **4. decreases pulmonary artery pressure
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5
Q

When should suctioning be performed on a newborn?

A

Use of a suctioning device such as a bulb syringe or wall suction should be limited
only use if newborn’s respiratory efforts are diminished

I.e. when performing NRP

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6
Q

What are classic signs of respiratory distress in the newborn?

A

flaring, grunting, and retracting are CLASSIC signs of respiratory distress and warrant prompt evaluation by peds

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7
Q

Why should we use room air when resuscitating a newborn?

A

100% o2 can create free oxygen radicals that exacerbate reperfusion injury and decrease cerebral perfusion.

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8
Q

What changes occur when the umbilical cord is clamped?

A

clamping of the umbilical cord -Shuts down the low-pressure fetal-placental circulatory system
blood flow from placenta stops = rise in systemic vascular resistance

pulmonary vascular relaxes = decrease in pulmonary vascular resistance (PVR)
as systemic vascular resistance (SVR) is increasing

ductus arteriosus closes
foramen ovale closes from the increased blood flow in the left side of the heart

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9
Q

What are the three ways the neonate can create heat?

A
  1. voluntary muscle activity
    limited benefit in increasing temp
  2. shivering
    only seen in SEVERE cold stress
  3. nonshivering thermogenesis.
    utilization of brown fat for heat production
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10
Q

What babies can’t efficiently use brown fat?

A

**Newborns with hypoglycemia or thyroid dysfunction can’t efficiently use brown adipose stores.

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11
Q

What can result from cold stress?

A

hypoglycemia
hypoxia
acidosis
respiratory distress

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12
Q

What are neonatal risk factors for hypoglycemia?

A

growth restriction
Large for gestational age
PreTerm
Post-term
Newborns who have experienced some form of distress prior to birth
newborns who have experienced some for of distress AFTER birth
Nadir in neonatal blood glucose levels is 1-2 hours after birth
Levels stabilize at about 3-4 hours after birth

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13
Q

What can result from neonatal hypoglycemia?

A

damage to the occipital area of the brain = seizures
intellectual disability
attention-deficit disorder

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14
Q

What level TSB at 96 hours old is considered pathologic jaundice?

A

> 17 TSB

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15
Q

When do we suspect pathologic jaundice/have significant concern?

A

Any sign of jaundice in the first 24 hours of life.

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16
Q

What causes physiologic jaundice in the newborn?

A
  1. newborn RBC’s have a short lifespan of 80 days (120 days in adults)
  2. The protein uridine diphosphate glucuronosyltransferase (UGT) helps conjugate bilirubin [newborns have a reduction in the activity of UGT]
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17
Q

What is the main weakness of the newborn immune system?

A

MAIN WEAKNESS OF NEWBORNS- INABILITY TO LOCALIZE INFECTION-

**SYSTEMIC INFECTION IS A HIGH RISK

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18
Q

What are the signs of infection in the newborn?

A

often subtle: Changes in:
activity, tone, color, or feeding

**LACK OF FEVER does NOT exclude the possibility of infection!!!

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19
Q

How are T-cells different in the newborn?

A

found in HIGH levels in newborns, but are slow to respond

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20
Q

How much urine is expected in a newborn in the first 48 hours of life?

A

as little as 30 to 60 mLs of urine is excreted
the urine should not contain any blood or protein
large amounts of debris may indicate injury or irritation in the renal system

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21
Q

Blood travels from the placenta to the baby via the:

A

Umbilical vein

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22
Q

From the umbilical vein, blood travels through the:

A

Ductus venosus

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23
Q

After the ductus venosus, blood travels onto the:

A

Inferior vena cava

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24
Q

From the inferior vena cava, blood flows into the:

A

Right atrium

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25
Q

Blood flows from the right to left atrium via the:

A

Foramen ovale

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26
Q

Blood flows from the right ventricle to the pulmonary arteries. Only a small amount goes to the developing lungs, which have this type of resistance:

A

High pulmonary vascular resistance

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27
Q

From the right ventricle, blood is shunted away through the ____________ and back to aorta.

A

ductus arteriosus

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28
Q

What assessment can assess fetal status prior to birth and predict newborn outcomes?

A

umbilical cord gases

Key: APGAR is not a measure of prebirth acidemia

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29
Q

What APGAR is a good indication of the absence of fetal acidemia prior to birth?

A

5min APGAR of 7+

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30
Q

When do APGAR scores reliably predict newborn outcomes?

A

Apgar scores do not reliably predict newborn outcomes except in the extreme range of less than 5 at 5 minutes

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31
Q

Why are newborns predisposed to hypothermia?

A

large surface area per unit of body weight (compared to adults)

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32
Q

What is the best source of heat for a newborn?

A

SKIN-TO-SKIN provides the BEST source of heat for a newborn

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33
Q

What temp should the room be set to for term and preterm newborns?

A

77 °F (25°C) for term newborns
79-82° F (26-28° C) for premies

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34
Q

What type of temp is recommended for the newborn?

A

Axillary temps:
normal: 36.5°-37.5° C (97.7-99.0° F)

RECTAL TEMPERATURES are NO LONGER RECOMMENDED

Infrared Tympanic thermometers -least reliable for newborns

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35
Q

How should resuscitation be done on a newborn outside of the hospital?

A

resuscitate the newborn at the perineum while maintain an intact cord
place newborn on clean pad at the perineum or below the level of the placenta to accelerate placental transfusion
Once the newborn is breathing, place skin-to-skin with mom

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36
Q

If delayed cord clamping is not possible, what can be done?

A

the cord can be milked 3-5x toward the newborn to accelerate transfer of blood volume before clamping
move newborn to warmer
Initiate NRP

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37
Q

What Is common in newborns that receive NRP/advanced resuscitation?

A

Hypoglycemia is common in infants who have received advanced resuscitation and is associated with poorer outcomes.8 These infants should be monitored for hypoglycemia and treated appropriately.

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38
Q

When should epi be given during NRP?

A

After effective PPV of 100% O2 and chest compression with a heart rate remaining under 50 bpm

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39
Q

What is the IV vs endotracheal dose of epi for newborns?

A

IV Dose: 0.02 mg/kg

ET: 0.1 mg/kg

Every 3-5m

40
Q

How many newborns require assistance to breath after birth?

A

10%

every birth should be attended by at least 1 person whose primary responsibility is the newborn and who is trained to begin PPV without delay.

41
Q

How man newborns that require PPV show evidence of risk prior to birth?

A

Up to half

42
Q

What are proprioceptive reflexes?

A

Gross motor reflexes (can be evoked at any time)
Ex. Moro

*complete absence of any of these reflexes is a cause for alarm

43
Q

What are exteroceptive reflexes?

A

best evoked with the infant is quiet and alert

stimulated by light touch
Examples:
rooting
grasping
plantar
superficial abdominal

loss of a previously strong reflex in the 1st mo. of life?=cause for alarm- prompt report to pediatric provider

44
Q

When assessing the moro reflex, what result should result in peds consult?

A

**Any deviations in Moro reflex necessitate pediatric consultation and possibly full neuro workup

Examples:
absence of Moro (intracranial lesion?)
asymmetrical response (birth injury?)
abnormal persistence of “embrace gesture” (hypertonicity)
persistence of Moro after 4 months (delay in neurologic maturation)

45
Q

What is the current universal standard for assessing gestational age?

A

New Ballard Scale- THE UNIVERSAL STANDARD NOW

accurate within a range of 2 weeks
takes 2-3 minutes to perform

46
Q

What gestational ages can midwives care for vs wen they have to collab/refer?

A

*Midwives generally care for term infants but may be involved in collaborative care of late preterm newborns (34 to 36 6/7 weeks’ gestation) and early-term newborns (37 to 38 6/7 weeks gestation)

47
Q

What are early cues of hunger in the newborn?

A

increased alertness, rooting, flexing, sucking, mouthing

48
Q

What are late cues of hunger in the newborn?

A

hands and fists move toward the mouth,
increased rooting
whimpering and other vocalizations of distress- full cry

49
Q

What is the normal newborn elimination pattern once the milk comes in.

A

3-5 voids and 3-4 stools per day by 3-5 days:
onset of yellow, seedy milk stools by 4-5 days

50
Q

When should food be introduced to the newborn?

A

Reinforce delaying the introduction of solid foods until at least 6 months.

51
Q

Per the CDC, what should be given to prevent blindness from G/C?

A

Erythromycin 0.5% ophthalmic ointment per CDC rec

52
Q

When/How should Erythromycin 0.5% ophthalmic ointment be given to the newborn?

A

Should be applied within 2 hours of birth
Can delay 30 minutes to promote en face interactions with parents and newborns

How:
place medication on each of the lower conjunctival sacs and spread with gentle massage of the eyelids.
Can wipe away excess ointment after 1 minute
eyes should not be irrigated.

53
Q

How should you respond if a newborn is bleeding from the umbilicus or an injection site?

A

Be suspicious for early HDN or VKDB and consult peds immediately!!

54
Q

What is the AAP’s stance on circumcision?

A

Health benefits of circumcision outweigh the risks

55
Q

What state should the newborn be in for the The Neonatal Behavioral Assessment Scale (NBAS)?

A

begins with the infant in a sleeping state

56
Q

What are the key danger signs in a newborn that parents should know?

A

Temp. instability (tachypnea, apnea >20s)
Abnormal respirations (retractions, wheezing, grunting)
Umbilicus infection (Odor, drainage, bleeding)
Eye infection (discharge)
Jaundice
GI problems (Projectile vomiting, bile vomiting, no stool/urine PP, swollen abd)
Diarrhea (>6 stools per 24h/bloody or watery)
Signs of illness (cough, poor tone, inability to rouse, poor suck)

57
Q

What SPO2 is normal in the newborn and expected difference in foot and hand?

A

oxygenation should be higher than 95%
Less than 3% difference between the foot and han

58
Q

What cord gas components are the most useful?

A

Umbilical ARTERY cord pH and base deficit are the MOST USEFUL measurements for determining the presence or absence of fetal acidemia at the time of birth

59
Q

What pH level and BD level indicate pathologic acidemia?

A

pH of less than 7.0
base deficit of greater than 12 m Eq/L

60
Q

What are the normal levels of pH, PCO2, Bicarb and BD?

A

Normal pH = 7.19-7.33
Normal PCO2 = 43-63
Normal Bicarb = 18.4-25.6
Normal BD = 1-7

61
Q

What are normal newborn H/H, MCV, WBC, and Plts?

A

H/H: 14-20/43-64%
MCV: 100-120
WBC: 10,000-30,000
Plts: 150,000-350,000

62
Q

What should be done with newborns of HIV+ mothers?

A

treatment of newborns born to HIV+ mothers with zidovudine (AZT, Retrovir) reduced the infants’ risk of developing the infection

Breastfeeding is CONTRAINDICATED when safe alternatives are available

63
Q

What is the leading cause of neonatal sepsis in the US?

A

Maternal colonization with Group B Streptococcus

1 in 100-200 (0.5% -1%) of newborns will develop sepsis if the mother is NOT treated in labor

64
Q

What are the signs and symptoms of NAS?

A

central nervous system irritability
tremors
excess hunger and salivation
sweating
yawning
sneezing
fist sucking
temperature regulation problems

seizures
profuse vomiting and diarrhea

65
Q

What should be done with the newborn when the mother is positive for Hep B?

A

hepatitis B vaccine (HBV)
hepatitis B immune globulin (HBIG)
within the first 12 hours of birth
administered in 2 separate sites

66
Q

What should be done for the newborn if the mother has an unknown Hep B status?

A

infant gets HBV within 12 hours of life
maternal blood should be tested for HBsAg ASAP and if positive infant gets HBIG immediately (within the 1st week of life)

67
Q

Describe caput succedaneum.

A

edematous collection of serosanguineous and subcutaneous fluid
on the presenting part of the head
poorly defined margins
crosses suture lines (like a baseball CAP-memory hint)
not markedly tense

68
Q

Describe a cephalohematoma.

A

a collection of blood under the periosteum of one of the cranial bones (usually parietal)
the blood DOES NOT cross the suture line
sometimes occur with skull fractures

69
Q

Describe a subgaleal hemorrhage.

A

an accumulation of blood below the scalp but above the periosteum
rare but life-threatening complication
newborn can lose a great deal of blood quickly
sign: diffuse swelling in the head that shifts independent of movement

70
Q

Describe a facial palsy in the newborn.

A

a temporary condition - asymmetry of the face
with a brachial plexus injury, the newborn may be in pain
manifestation depends on the nerve root that was injured and to what degree

71
Q

Describe erb-duchenne paralysis.

A

generalized loss of movement in the affected arm with an adduction of the lower part of the arm
“waiter’s tip” sign -
internal rotation of the lower portion of the arm with the finger and wrist flexed
grasp reflex is intact
Moro reflex is weak on the affected side
cervical roots C5 and C6

72
Q

Describe klumpley’s paralysis.

A

the grasp reflex is absent
infant’s hand is kept in a claw-like posture
roots C8 and T1

73
Q

What is key to tell parents about prenatal tests?

A

It is important to explain to parents that most prenatal tests are screening tools meant to detect an increased risk for specific common disorders rather than being able to detect ALL possible birth defects**

74
Q

What is gastroschisis?

A

eviscerated abdominal organs are not covered by a peritoneal membrane sac

75
Q

What is an omphalocele?

A

abdominal organs are external but are covered by peritoneal membrane that protects the intestines from exposure to amniotic fluid and after birth, ambient air

76
Q

What is a meningocele?

A

bony defect of the spinal cord

77
Q

What is a Meningomyelocele (spina bifida)?

A

the vertebra is defective and the spinal cord and spinal roots are externally located in a meningeal sac
found in the lower spine, lumbar and sacral areas

78
Q

What is a diaphragmatic hernia and the s/s associated?

A

herniation of abdominal contents into the chest cavity-can cause pulmonary hypoplasia

decreased left-sided breath sounds
heart sounds on the right side
severe respiratory distress at birth s/t persistent pulmonary hypertension

79
Q

WHy do bilirubin levels ride during the first few days of life?

A

the newborn has more red blood cells than an adult
shorter RBC lifespan
fetal red blood cells break down so that fetal Hgb can be replaced with adult Hgb
this causes catabolism that produces bilirubin as a byproduct
Conjugated bilirubin must be broken down further by intestinal bacteria to be excreted
the sterile GI tract of the newborn reabsorbs the conjugated bilirubin

80
Q

What is physiologic jaundice?

A

physiologic jaundice is the result of increased production of bilirubin at a time when elimination is delayed

81
Q

When is the expected peak and what level is expected of bilirubin PP in the newborn?

A

the mean peak of total bilirubin plasma levels is 48-92° after birth (2-3.5 days)
the average value is 7-9 mg/dL

82
Q

How can jaundice be prevented?

A

early and frequent feedings to promote the passage of meconium

83
Q

What are the signs and symptoms of pathologic jaundice?

A

vomiting
lethargy
poor feeding
weight loss
hepatosplenomegaly
apnea
temperature instability
tachypnea
dark urine
urine positive for bilirubin
light-colored stools
jaundice that persists for more than 3 weeks

84
Q

What is bilirubin-induced neurologic dysfunction (BIND)

A

occurs when bilirubin crosses the blood-brain barrier and binds to brain tissue.
unconjugated bilirubin is highly neurotoxic

85
Q

What is Acute bilirubin encephalopathy (ABE)?

A

cerebral symptoms associated with hyperbilirubinemia
irritability
high-pitched cry
hypertonia or hypotonia
seizures
possibly death if left untreated

86
Q

What is Kernicterus?

A

chronic and permanent sequelae of ABE in infants who sustain permanent cerebral damage
Incidence: exceedingly rare- (even for those that develop ABE)

87
Q

What are some risk factors for pathologic jaundice?

A

ABO blood-type incompatibility
Accelerated RBC breakdown from a large cephalohematoma
RBC membrane defects
enzyme defects like **(G6PD) deficiency
newborn sepsis
maternal diabetes
feeding problems

88
Q

When does breast milk jaundice occur?

A

Mild jaundice beyond the first week of life that slowly declines.

89
Q

What causes breastfeeding failure jaundice?

A

Results from inadequate intake! AKA dehydration in the first week of life. Treat with good lactation

90
Q

How should the APRN/CNM manage any signs of heart disease in the newborn?

A

**Midwifery Management for any signs of heart disease **Immediate consultation with the pediatric team

91
Q

What type of seizure is most common in the newborn?

A

Subtle: evidenced as short, repetitive bursts of activity

sucking motions
chewing
bicycling of limbs
drooling
apnea
deviation of the eyes
eyelid fluttering

92
Q

What newborn glucose level should be verified with a venous sample?

A

***Heel stick glucose value of 45-50 mg/dL or lower should be verified immediately via a venous sample

93
Q

What actions should be taken with a glucose level below the recommended threshold?

A

First step: Verify with venous sample
Second step: (while waiting for labs results) feed the infant)
Third step: repeat glucose test 30 min after feeding
if low value is confirmed:
Pediatric Consult*****

94
Q

At what macrosomic size should induction be recommended?

A

Trick question!!

*****ACOG DOES NOT recommend induction of labor for suspected macrosomia

95
Q

What is the difference between SGA and FGR?

A

SGA is when the newborn at term is below the 10th % for their GA (Note: does not distinguish the constitutionally small)

FGR is when the EFW is >10th% for their GA

96
Q

Which type of FGR is more concerning?

A

Symmetric: the delay becomes more pronounced

Asymmetric is considered “brain sparing” because the head is >10th%

97
Q

What cooccurring symptom is extremely concerning with FGR?

A

FETAL GROWTH RESTRICTION WITH ABSENT OR REVERSED END-FLOW DOPPLER VELOCIMETRY INDICATES A FETUS AT GREAT RISK*

NM 717 Comps (31 decks)

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