module 9 Flashcards
1
Q
umbilical artery catheter
A
- placed into umbilical stump and progressed through the ductus venosus and into the inferior vena cava
- used to monitor ABG
- rarely left in place for than 1 wk
2
Q
umbilical venous catheter
A
- placed into the umbilical stump and progressed through the ductus venous and into the inferior vena cava
- 1 wk
- fluid and medication administration and can be used for blood pressure monitoring
- inserted right after delivery or else stump dries out
3
Q
PICC
A
- Peripherally inserted central like
- used when intermediate-term IV access is required
4
Q
CPAP
A
helps keep alveoli open so gas exchange is efficient
5
Q
risk for prematurity
A
- infection (mom has GI or GU infection)
- fetal anomalies
- preeclamspia/eclampsia (delivery only way to treat)
6
Q
gestational age at birth: preterm/premature
A
before 37 wk of gestation
7
Q
gestational age at birth: extremely preterm
A
before 38 wks of gestation
8
Q
gestational age at birth: very preterm
A
birth from 28-31 6/7 wk of gestation
9
Q
gestational age at birth : moderate-to-late preterm
A
birth 32-36 6/7 wk of gestation
10
Q
gestational age at birth: late preterm
A
birth from 34-36 6/7 wk of gestation
11
Q
gestational age at birth: early term
A
birth from 37 to 38 6/7 wk of gestation
12
Q
gestational age at birth: full term
A
39 to 40 6/7 wk of gestation
13
Q
gestational age at birth: late term
A
41 to 41 6/7 wk gestation
14
Q
gestational age at birth: postterm (or postmature)
A
42wk of gestation or later
15
Q
birth wt regardless of gestation age at birth: low
A
birth wt less than 2,500g (5.5 lb)
16
Q
birth wt regardless of gestation age at birth: very low
A
less than 1,500 g (3.3 lb)
17
Q
birth wt regardless of gestation age at birth: extremely low
A
less than 1,000g (2.2 lb)
18
Q
size for gestational age: appropriate
A
wt from 10% to 90% on a growth chart
19
Q
size for gestational age: small
A
wt less than 10% on a growth chart
20
Q
size for gestational age: large
A
wt greater than 90% on a growth chart
21
Q
respiratory distress
A
- baby has very small and immature resp system w/ narrow passageways
- alveoli are underdeveloped; little to no surfactant so gas exchange cannot occur well
22
Q
retinopathy of prematurity (ROP)
A
- immature/weak vessels
- leading cause of blindness
23
Q
factors that contribute to respiratory issues for preterm infants
A
- surfactant (responsible for alveoli expansion and facilitating gas exchange) production is decreased
- airway lumens small
- lack gag reflex = risk for aspiration
24
Q
apnea in preterm
A
- breathing stops for more than 20 seconds or is associated w/ either a HR less than 70 to 80 bpm or O2 sat below 80-85%
25
s/s of respiratory distress syndrome (RDS)
- low o2 sat
- decreased lung sounds
- nasal flaring
- use of expiratory grunting
- use of accessory muscles of breathing
26
clinical manifestations of respiratory distress syndrome
- tachypnea
- nasal flaring
- intercostal, subcostal, and subxiphoid retractions w/ inspiration
- grunting on expiration
- cyanosis (later sign)
- decreased breath sounds with auscultation
- pallor
- peripheral pulses diminished
- oliguria
27
bronchopulmonary dysplasia (BPD)
treatment complication of artificial respiratory support
- when you give babies O2 it can cause BPD
28
symptoms of BPD
- tachypnea
- retractions
- rales
- wheezing
29
how is bpd related to prematurity?
- baby goes into respiratory failure, mechanically ventilated, has a lot of O2, lead to inflammatory response - has acute lung injury, leading to artery/vascular damage causes emphysema/atelectasis/edema/fibrosis
30
preterm infant : PDA patent ductus arteriosus
- mostly all infants born at term have complete closure by 72 hrs after birth
- preterm may have delayed course
- higher risk for necrotizing enterocolitis (NEC) and intraventricular hemorrhage
- mixing of blood from aorta into pulmonary arteries and back through
31
s/s of PDA depending on degree and include
- systolic murmur
- ventricular dilation
- cyanosis
32
PDA treatment
- cyclooxygenase inhibitors = ibuprofen (via IV treatment of choice) or indomethacin
- if they do not respond to meds need surgery
33
intraventricular hemorrhage (IVH)
- bleeding into lateral ventricles of the brain and is one of the most common and dangerous causes of brain injury
34
risk for developing IVH include
- birth before 30 wks gestation
- preeclampsia
- chorioamnionitis
35
IVH diagnosis
routine ultrasound
36
saltatory manifestations, appearing over hour or days for IVH
- reduced movement
- disturbed respirations
- altered LOC
- hypotonia
37
catastrophic manifestations, appearing over minutes or hours for IVH
- flaccidity
- fixed pupils and other abnormalities of cranial nerves from pressure on cranial nerves
- seizures
- hypoventilation and/or apnea
- coma
- metabolic acidosis from poor oxygen profusion
- decreased hematocrit levels due to bleeding
- hypotension
- bradycardia
- bulging of the anterior fontanelle (increased ICP)
38
ROP caused by...
abnormal vascular growth of the blood vessels of the retina in infants born prematurely
- the abnormal vessels are permeable and leak, leading to edema and hemorrhage causing scarring that pulls on the retina leading to distortion and detachment
39
ROP linked to...
low birth wt, prematurity, and excess O2 after birth
40
s/s of ROP
edema, hemorrhage, scarring of the retina (able to see damage)
41
treatment of ROP
- if doesn't resolve spontaneously = laser photocoagulation and/or anti-vascular endothelial growth factor monoclonal antibodies
42
when is maternal IgG transferred to fetus and how
- 32 wks through placenta
43
signs of sepsis
- respiratory distress
- lethargy
- glucose instability (may give dextrose solution IV)
- tachycardia
- poor perfusion (cyanosis, pallor, poor cap refill)
44
temperature considerations preterm
- do not have the brown fat
- flex to stay warm, preterm babies dont have the muscle tone to flex
- thin skin = vessels close to skin surface so they lose heat more readily
45
treatment of mild hypothermia
gradual rewarming
- radiant warmer and/or warming mattress
skin - to - skin
46
cold stress
- low environment temp
- low body temp
- high HR and RR
- high O2 consumption
- depletion of glucose causing hypoglycemia
- low surfactant
47
risk factors for cold stress
- preterm
- SGA (dont have a lot of brown fat)
- hypoglycemia
- prolonged resuscitation
- sepsis
- neurological, endocrine, or cardiorespiratory problems
48
s/s of cold stress
- axillary temp below 36.5 C (97.7 F)
- cool skin
- lethargy
- pallor
- tachypnea
- grunting
- hypoglycemia
- hypotonia
- jitteriness
- weak suck
49
necrotizing enterocolitis (NEC)
- ischemic necrosis of the intestines and is a gastrointestinal emergency
- high mortality rate
50
NEC first sign
- feeding intolerance
- had at least one oral feed and most have had formula - theory formula feeding relates to this
51
other signs of NEC
- abdominal distention
- vomiting, often bile
- respiratory failure
- hypotension
- temp instability
- baby is in pain - high pitch cry
52
NEC treatment
- antibiotics, labs (CBC, electrolytes, BUN, creatinine, and acid base studies)
- radiographic monitoring every 6-12 hrs (monitors progression)
- bowel resection (may result in malabsorption)
53
symptoms of NEC: abdominal
- gastric retention
- vomiting
- diarrhea
- blood in stool
- hypoactive bowel sounds
- abdominal distention
54
symptoms of NEC: systemic
- lethargy
- apnea
- respiratory failure
- poor feeding
- temp instability
55
nursing care for NEC
monitor for
- presence or absence of vomiting
- presence or absence of abdominal distention tenderness, and increased or diminished bowel sounds
- gastric residual fluid less than half the volume of previous feeding
- presecne of blood in stool
- abdominal mass
56
nutrition for preterm
- breastmilk changes to meet needs of the baby and preterm babies need more colostrum type milk, so mother's body will create this for a longer period of time to accommodate
- formula has higher risk of NEC
- should gain 20-30 g per day
57
bottle feeding
- assess ability to coordinate suck and swallow
- conserve energy
- premature nipple = slower milk flow
- should not take longer than 15-20 min
58
breastfeeding
- should be initiated when baby can coordinate suck and swallow, is gaining wt, and can control temp outside of incubator
- can pump and cup or gavage feed breastmilk
- breastfeeding is the best nutrition for baby, but the act of sucking takes the most energy, so mom may pump and put it in a bottle to feed baby to conserve energy
59
gavage feeding
- nasogastric or orogastric methods
- usually a one time thing, if we want baby NPO we will leave NG or OG tube in place
- continuous drip or intermittent
- used when infant does not have coordinated suck and swallow, to decrease energy expenditure, or when there has been wt loss or no significant wt gain
60
NG tube measurement
- tip of nose to earlobe to xyphoid process
- mark the end and this is where you should insert tube to
- after NG tube is placed, secure it, and check placement
61
NG tube placement check
- x-ray
- may insert a little bit of air and listen for gurgling over belly
- aspirate abdominal contents
62
TPN for premature neonate
- may be administered through a central venous catheter or a peripheral venous catheter (central line preferred)
- should include an inline filter
- TPN is a vesicant that can cuase tissue damage w/ infiltration
- may cause hyperglycemia (monitor glucose)
- used in combination with oral feedings of breast milk
63
late preterm at risk for
- hypothermia (do not have brown fat)
- hypoglycemia
- respiratory distress
- jaundice
- feeding difficulties
- unable to coordinate sucking, swallowing, and breathing
64
post term at risk for
- shoulder dystocia
- cephalopelvic disproportion
- bruising
- brachial plexus injuries
- fractured clavicles
65
after 41 wks placenta declines resulting in....
hypoxia, decreased circulation, and blood flow
66
post term complications
- hypoglycemia
- meconium aspiration = fetal hypoxia
- polycythemia = in response to hypoxia, produce more RBCs but they are immature
- congenital anomalies
- seizures = due to hypoxia
- cold stress = loss of subcutaneous fat
67
meconium aspiration
baby is in state of hypoxia and not getting as much O2 as they need, relaxes sphincter and passes meconium
68
IUGR (Intrauterine growth restriction) symmetric
- IUGR that is global = head, torso, extremities are symmetrically undersized
- also called global growth restriction
- indicates that growth has been slow throughout pregnancy
- associated with a higher incidence of permanent neurologic problems
- baby looks well proportioned, just small
69
IUGR (Intrauterine growth restriction) asymmetric
- IUGR in which the head grows normally but the body grows slowly
- slowed growth of the body typically occurs in the third trimester, after normal growth in the first two
- do not look proportionate, head is normal size, body grows slowly so torso and extremities look small
- occurs in w/ slowed growth later in pregnancy, usually in 3rd trimester
70
SGA
- fall below 10th percentile on growth charts
- may be normal based on ethnicity, ht and wt of parents, or could be due to environmental or pathologic genetic reasons
71
SGA babies at risk for
- hypoglycemia, polycythemia, (resulting from hypoxia in utero), or hypocalcemia (potentially caused by perinatal asphyxia, hypoparathyroidism , or maternal diabetes)
- cold stress
72
LGA
- above 90th percentile for growth
- high risk for birth injury, perinatal asphyxia, and hypoglycemia
- not often at risk for cold stress
- postterm babies can be AGA or LGA, postterm are at risk for hypoglycemia bc they have metabolized their brown fat
- bigger more robust, have a lot of brown fat
73
hyperbilirubinemia
- bilirubin comes from breakdown of RBC
- bilirubin binds to albumin and is transported to liver where it is detached from the bilirubin and conjugated
- conjugated bilirubin is excreted in bile into digestive tract; because it is conjugated it cannot be reabsorbed by the intestine
- because the intestinal system is initially sterile, conjugated bilirubin can be unconjugated and reabsorbed through the intestinal epithelium and deposited back into the circulatory system
- known as physiologic jaundice in newborns
74
physiologic jaundice
- appears after 24 hrs of life
- bilirubin levels peak around 96-120 hrs of life
- diminish by day 14
- normal transition from intra to extrauterine life
- causes = increased destruction of RBCs, slow uptake of bilirubin by liver/impaired conjugation, lack of intestinal bacteria (increased reabsorption of bilirubin in the intestinal tract)
- poorly established hydration
75
pathologic jaundice diagnosis
- exhibit jaundice in the first 24 hrs of life
- total bilirubin increase of greater than 0.2 mg/dl/hour (rising too fast; acute)
- surpass 95% percentile for age in hours (rising too high too fast)
- persistent jaundice after 1 weeks of age for term babies and 2 weeks of age for preterm babies (also probably pathologic)
76
pathologic processes of pathologic jaundice
- hemolytic disease of the newborn = erythroblastosis fetalis
- liver disorders
77
high risk for development or severe hyperbilirubinemia in term and late preterm infants
- high bilirubin levels prior to discharge
- jaundice in first 24 h after birth
- maternal/infant blood group incompatibility w/ positive coombs' test
- known hemolytic disease of the newborn
- birth from 35-36 wk of gestation
- treatment of a sibling for hyperbilirubinemia
- cephalohematoma
- extensive bruising
- poor breastfeeding
- mother of east asian ethnicity
78
moderate risk for development or severe hyperbilirubinemia in term and late preterm infants
- intermediate bilirubin levels prior to discharge
- birth from 37-38 wk of gestation
- jaundice prior to discharge
- sibling w/ a discharge following suspected
- macrosomic infant of a diabetic mother
- maternal age of 25 y or more
- male infant
79
factors that reduce risk for development or severe hyperbilirubinemia in term and late preterm infants
- predischarge bilirubin level in the low-risk zone
- birth at or after 41 wk if gestation
- bottle feeding exclusively
- African ethnicity
- discharge from hospital at or after 72 h postpartum
80
ABO incompatibility
- mother is blood type I and baby is blood type A or B
- may result in mild jaundice
- mom has anti-A and anti_B antibodies naturally occurring in maternal blood
- once pregnant these antibodies cross the placenta and produce hemolysis of fetal RBCs (attack baby's blood)
- one of the causes of pathologic jaundice
81
erythroblastosis fetalis
- Rh-negative mother pregnant with an Rh-positive fetus and maternal antibodies cross the placenta (mother is sensitized)
- maternal antibodies enter fetal circulation and destroy fetal RBCs
- fetal response is to increase RBC production (immature RBCs0
- jauncdice and anemia result
- marked increase in immature RBC
- can be avoided with use of RhoGAM
82
hydrops fetalis
- most severe form of erythroblastosis fetalis
- maternal antibodies attach to Rh site on the fetal RBCs
severe anemia and multiple organ failure can result
- frequent cause of death due to Rh disease in utero
83
give Rhogam
- Rh- mom pregnancy with Rh+ fetus is when they develop antibodies that cross placenta, give Rhogam to prevent sensitization during pregnancy
- if for some reason mom never had Rhogam during pregnancy she could be sensitized so that for the next time she gets pregnant, if she has an Rh+ fetus it can attack them and hemolyze their RBCs
84
kernicterus
- most severe form of hyperbilirubin
- accumulation of unconjugated bilirubin in brain
- result of untreated hyperbilirubinemia
- irreversible bilirubin encephalopathy
- seizures, hearing loss, brain damage, death
85
jaundice assessment
- assess for jaundice every 8-12 hrs (visual)
- jaundice prior to 24 hrs, higher risk for severe hyperbilirubinemia
- many institutions now universally screen infants by transcutaneous bilirubin (TcB) measurements.
86
phototherapy
- used in hospital or at home, exposes the infants skin to a particular wave length of light
- converts bilirubin into a more soluble form that does not need to be conjugated in the liver and can be excreted directly into the bile
- monitor temp, serum bilirubin, hydration status, I&Os, and exposure time during phototherapy
- baby is naked except cover genitalia and eyes
- blankets that provide light, overhead lights
87
exchange fusion for jaundice
- effectively removes bilirubin from circulation
- expensive
- requires clinical expertise, rarely used
- involves the systematic removal and replacement of blood volume
88
persistent pulmonary hypertension of the neonate (PPHN)
- caused by vascular resistance that causes left to right shunting and hypoxia, underdeveloped or abnormal pulmonary vascular, or lung disease
89
symptoms of PPHN
- respiratory distress within 24 hrs of birth
- cyanosis (later sign)
- prominent apical impulse
- split S2 heart sound
- systolic murmur
90
treatment for PPHN
- supportive care, nitric oxide, ECMO, and treatment of the underlying respiratory disease
91
transient tachypnea of the newborn (TTN)
- caused by failure to clear fluid from lungs and is most common in late preterm or postterm infants
- typically resolves within 72 hours
- fluid is squeezed out through mechanical stimulation on delivery & baby loses that fluid
- as alveoli get filled w/ air it pushes fluid out
- with these babies, the air does not clear out right away so they have wet lungs for a day or two
92
TTN symptoms
- tachypnea
- nasal flaring
expiratory grunting
- retractions
- cyanosis (late sign)
93
treatment for TTN
- supportive care, O2 supplementation (usually oxyhood) as needed to keep O2 sat above 90% (titrate)
- do not feed PO
94
meconium aspiration syndrome (MAS)
- caused by aspiration of meconium in the fetal lungs resulting in airway obstruction, inflammation and chemical irritation, infection, and inactivation of surfactant
- baby passed meconium into amniotic fluid in utero and then there is aspiration during first breath when baby is born
- can result in pneumonia infection
95
symptoms of MAS
- meconium-stained amniotic fluid
- respiratory or neurologic depression at birth = may need resuscitation
- prematurity or small for gestational age infant
- respiratory distress
- cyanosis
- rales and rhonchi on lung assessment from blocked passages
- pneumothorax
- PPHN
96
MAS treatment
supportive care, antibiotics, surfactant, nitric oxide, and ECMO
97
meconium stained fluid
- can be as little as green-tinged fluid, or as bad that is think and looks like pea soup
98
neonatal abstinence syndrome (NAS)
- withdrawal symptoms that occur as a result of in utero to opioids
- other substances (such as, alcohol, nicotine, benzodiazepines, and antipsychotics) may cause symptoms that mimic NAS symptoms
99
treatment for NAS
- infants are given opioids for symptoms and then weaned from them after they are stable for 24 hrs
100
general signs of NAS
- irritability
- high-pitched cry
- sleep/wake disturbances
- failure to thrive
101
alterations in movement in NAS
- hypertonia
- hyperactive reflexes
- tremors
- skin excoriation
102
GI signs for NAS
- disorganized feeding
- vomiting
- frequent loose stools
- uncoordinated suck and swallow, look like they are hungry and want to eat but will be losing fluid outside their mouth, not swallowing, vomiting
103
autonomic dysfunction signs in NAS
- sweating (babies usually dont sweat so this is a sign)
- sneezing
- mottled skin
- fever
- nasal stuffiness
- yawning
104
nursing care for NAS
- identify in prenatal period
- drug screening following birth
- assess for congenital anomalies
- assess for signs of withdrawal
- reduce withdrawal symptoms, sometimes with comfort measures or opioids in small amounts to wean the,
- promote adequate nutrition (small, frequent feedings)
- reduce stimuli- quiet, dim room, limit visitors
- swaddle
- provide pacifier
105
neonatal abstinence scale
- scoring begins within 2 hours of birth if known in advance or as soon as symptoms are noticed if did not know
- then at least every 4 hours
- may do more or less often depending on rating
highest score = 44
106
early onset sepsis
first 7 days after birth
107
late onset sepsis
after first week after birth
108
risk factors for sepsis
- chorioamnionitis, maternal temp greater than 100.4 F, delivery prior to 37 wk, or an apgar of 6 or less
109
blood culture for suspected sepsis
- from venipuncture, arterial puncture, or newly inserted venous or arterial catheter
- one or two samples
- min volume of 1 mL per sample
- results in 24-36 h
110
lumbar puncture for suspected sepsis
- infants often asymptomatic with meningitis
- performed prior to antibiotic start
- gram stain, culture, cell count w/ differential, protein, glucose
- over 1/3 on infants w/ meningitis have a negative blood culture
111
CBC w/ differential and platelet count for suspected sepsis
- obtain 6-12 h after birth
- more useful for ruling out sepsis than ruling it in
- normal immature-to-total neutrophil ratio can help rule out sepsis
- a low neutrophil count is ore indicative of sepsis than high
112
GBS (group B streptococcus)
- a significant cause of neonatal sepsis but the transmission from mother to infant at the time of birth has decreased since routine screening and antibiotic administration during labor becoming a standard of care
113
early onset GBS disease may manifest as...
- sepsis, pneumonia, or meningitis w/ most displaying symptoms within 24 hrs after birth
- may not have symptoms for a few days
114
risk factors for early-onset GBS disease include
- delivery less than 37 wks
- premature rupture of membranes 18 or more hrs prior to delivery
- chorioamnioitis
- GBS in urine in current pregnancy
115
late-onset GBS symptoms
- less likely to exhibit signs of shock than early-onset GBS
- fever
- cellulitis
- irritability
- lethargic w/ poor feeding
- grunting
- tachypnea
- apnea
- nuchal rigidity
- seizure
116
GBS + mom going into labor
- they get prophylaxis antibiotics, but sometimes mom is not treated or labor goes very quickly it can put baby at risk
117
congenital syphilis
- transmitted vertically from mother to fetus and can result in stillbirth, prematurity, or hydrops fetalis
118
congenital syphilis treatment
- penicillin G
119
gonorrhea neonatorum
- newborn conjunctivitis
once leading cause of blindness
- routinely treated with an antibiotic eye ointment at time of birth
120
chlamydia how it affects neonates
- can cause conjunctivitis or pneumonia
- transmitted through vaginal birth but may pass membranes or the placenta
121
treatment for chlamydia
oral antibiotics
122
herpes
- most common when vaginally delivered by mother experiencing a herpes outbreak
- may cause sepsis
123
herpes treatment
antiviral medication therapy for 14-21 days
- given acyclovir for the course of their pregnancy to reduce risk of outbreak close to delivery
124
moms tested for .... prepregnancy and before delivery
syphilis, chlamydia, gonorrhea
125
eye ointment
erythromycin at delivery bc risk for newborn conjunctivitis
126
toxoplasmosis
- caused by a common protozoan parasite found in cat feces, contaminated soil, and undercooked meat
- may cause anemia, seizure activity, calcifications in the brain, thrombocytopenia, or jaundice
- diagnosed w/ blood test or CSF evaluation
127
infants born to hep B positive mothers
- treated with HBsAG after birth and receive first doses of hep B vaccine within 12 hours to reduce transmission by 95%
- hep B mothers treated with hepB antigen after birth
128
mother-to-child transmission of HIV
- occurs during the intrapartum period
- women taking ART are at low risk for transmitting the virus during delivery
- prophylactic treatment of infants w/ ART is begun 6-12 hrs after delivery
- breast feeding is contraindicated for HIV-positive mothers
- mother on ART has a very low risk of transmitting virus during delivery so they can have vaginal delivery because it is much more controlled now
- baby is treated 6-12 hrs after delivery
- no breastfeeding
129
congenital heart anomalies risk factors
- family history
- certain genetic syndromes
- prematurity
- certain in utero infections
- use of assisted reproductive technology
130
symptoms of heart disease/defects
- cyanosis
- tachypnea
- pulmonary edema
- cardiogenic shock
- some infants will appear normal at birth and begin to decompensate at the ductus arteriosus closes
131
signs of cardiogenic shock
- inadequate perfusion of tissue (cool extremities, acrocyanosis, pallor, delayed cap refill)
- abnormal HR (tachycardia common, bradycardia (late), bradycardia (early, typically in preterm infants)
- metabolic acidosis
- lethargy, irritability, coma, hypotonia, diminished or absent reflexes
- oliguria
- apnea
- hypotension (late finding)
132
congenital anomalies: heart disease screening
- all infants should be screened for congenital heart disease after 24 hrs of age by pulse ox
- blood o2 sat from right hand and either foot to test difference between circulation before ductus arteriosus
133
diagnostic criteria for a positive screen of congenital heart disease
- SpO2 below 90% in either location
- SpO2 below 95% in both locations in three different readings, each separated by 1 h
- a difference in SpO2 of more than 3% between extremities in three different readings, each separated by 1 h
134
anencephaly
open defect of the cranial neural tube caused by the anterior neural tube failing to close at day 25 post conception
- parts of brain are missing
- pregnancy ends early
135
encephalocele
brain or meninges protrude through a skull defect called a cranium bifidum
- often picked up on in utero
136
spina bifida
incomplete closure of the vertebra surrounding the spinal cord. results from the spinal neural tube failing to close by 28 days after fertilization
- parts of spinal column protrude from neural tube
137
risk factors for neurologic anomalies and what to do to try to prevent
- family history
- obesity
- elevated temperature in first trimester (sauna, fever, hot tube)
- inadequate folic acid
prevent by = adequate levels of folic acid (400 mcg daily)
138
TEF
- tracheoesophageal fistula
- abnormal passage joining the trachea and the esophagus
- at risk for aspiration, usually symptomatic shortly after birth. lots of secretions, choking, drooling, resp distress esp after eating
- almost always occurs with esophageal atresia (EA)
- treatment = surgery, can sometimes be done in utero
139
Hirschsprung disease
- enervation of the colon causing functional obstruction
- occurs between gestational wks 4 and 7
- telescoping colon happens pretty early on
140
Hirschsprung s/s
- abdominal distention
- vomiting of bile, failure to pass meconium within first 48 hrs of life
- newborn vomiting can be common but green substance (bile) is never a good thing
141
Hirschsprung diagnosis
biopsy, barium enema, imaging
142
Hirschsprung treatment
surgical removal of the abnormal section of bow
143
omphalocele
- opening of the abdominal wall at the level of the umbilical cord that contains abdominal contents contained in a membrane
- occurs during the 11th and 12th wk of pregnancy
- will see umbilical content protruding into umbilical cord
- ultrasound likley to pick this up
144
risk for omphalocele
- younger than 20 or older than 40
145
omphalocele method of delivery
spontaneous vaginal delivery
- wrapped in a sterile dressing to prevent head and fluid loss
146
gastroschisis
- abdominal wall defect associated with bowl herniation with no containing membrane
- associated w/ poor maternal nutrition, smoking, maternal immune response, exposure to agricultural chemicals
- warp contents with sterile wet dressing
147
congenital diaphragmatic hernia
- abdominal contents herniate through the diaphragm into the chest
148
congenital diaphragmatic hernia s/s
- development of persistent pulmonary hypertension in the neonate
- breath sounds may be diminished or absent
- classic clue = listen to lungs and there isnt a lot of air being exchanged bc not a lot of room for lungs to expand
- heart sounds may be displaced
- abdomen is flat bc there is nothing in it
149
hydrospadias
- misplacement of the urethera on the ventral aspect of the penis (underneath)
150
epispadias
abnormal placement of urethra on dorsal aspect of the penis (on top)
151
risk factors for congenital anomalies
- maternal diabetes
- advanced maternal age
- placental insufficiency
