Neonatal & Newborn

Question 1

What is the average birth weight?

Answer 1

3.5kg

Question 2

What is the minimum birth weight before it is classified as low?

Answer 2

2.5kg

Question 3

When is the neonatal period?

Answer 3

The first 4 weeks (28 days) after birth

Question 4

The APGAR score is carried out as soon as the baby is born.

What does this consist of?

Answer 4

Appearance –> pink, blue extremeties, or completely pink/blue

Pulse –> >100, <100, no response

Grimace –> cries, pulls away, weak cry, no response

Activity

Respiratory effort

Question 5

How does a baby’s weight change in the first 5 days?

Answer 5

Babies lose up to 10% their birthweight in first 5 days due to fluid depletion

Question 6

What is lanugo?

Answer 6

Soft, fine hair covering a fetus while inside the uterus.

Question 7

Give some physical characteristics seen in neonates

Answer 7

● Lanugo
● Umbilical cord will shrivel/fall off within 3 weeks
● Neonatal acne – resolves within 4 months, clean daily
● Milia – resolves within first few weeks
● Erythema toxicum – resolves within a week

Question 8

What is milia?

Answer 8

Milia is a common skin condition that causes small white bumps (cysts) under the surface of your skin.

Question 9

When shouold neonates first pass urine?

Answer 9

Within 12-24 hours

Question 10

In the first few days after birth, you may see orange, pinkish, or chalky urine in a baby’s nappy.

What is this?

Answer 10

Precipitated uric acid crystals (not blood) - this is normal

Question 11

How may a newborn’s genitalia be affected? What is this the result of?

Answer 11

● Maternal hormones can cause large scrotum/breasts or discharge from vagina/breasts
● Settles on its own

Question 12

What is meconium?

Answer 12

Meconium is a newborn’s first poo, within 24-48 hours

Question 13

What may no meconium indicate?

Answer 13

Obstruction - check anus is open

Question 14

What is surface tension?

Answer 14

Surface tension is the attraction of the molecules in a liquid to each other, pulling them together and minimising surface area.

This is why, in zero gravity, water floats around in a ball rather than diffusing into a mist.

Question 15

What are the alveoli?

Answer 15

Alveoli are the small sacs where gas collects and diffuses into the blood during inhalation. These are lined with fluid.

The molecules of this fluid pull together due to surface tension, in turn pulling the walls of the alveoli towards each-other, attempting to collapse the space in the alveoli.

Question 16

What is surfactant?

Answer 16

Surfactant is a fluid produced by type II alveolar cells. It contains proteins and fats.

It sits on top of the water in the lungs. It has a hydrophilic side, that faces the water, and a hydrophobic side, that faces the air.

Question 17

Purpose of surfactant?

Answer 17

1) Increases lung compliance:
- reduces the surface tension of the fluid in the lungs
- this keeps the alveoli inflated and maximises the surface area of the alveoli.
- this reduces the force needed to expand the alveoli and therefore the lungs during inspiration (compliance)

2) Surfactant promotes EQUAL expansion of all alveoli during inspiration.

Question 18

What is surfactant produced by?

Answer 18

Type II alveolar cells.

Question 19

When do Type II alveolar cells become mature enough to start producing surfactant?

Answer 19

Between 24-34 weeks gestation.

Therefore, pre-term babies have problems associated with reduced pulmonary surfactant.

Question 20

What causes closure of foramen ovale at birth?

Answer 20

1) baby takes first breaths and expands the alveoli

2) this decreases the pulmonary vascular resistance

3) the decrease in pulmonary vascular resistance causes a fall in pressure in the right atrium

4) at this point the left atrial pressure is greater than the right atrial pressure, which squashes the atrial septum and causes functional closure of the foramen ovale

Question 21

What does the foramen ovale become after birth?

Answer 21

Fossa ovalis

Question 22

What causes the closure of the ductus arteriosus at birth?

Answer 22

Increased blood oxygenation causes a drop in circulating prostaglandins.

Question 23

What does the ductus arteriosus become after birth?

Answer 23

Ligamentum arteriosum

Question 24

What does the ductus venosus become after birth?

Answer 24

Ligamentum venosum

Question 25

What are the steps immediately after birth?

Answer 25

1) Skin to skin

2) Clamp the umbilical cord

3) Dry the baby

4) Keep the baby warm with a hat and blankets

5) Vitamin K

6) Label the baby

7) Measure the weight and length

Question 26

Why do neonates require vitamin K shortly after birth?

Answer 26

Babies are born with a deficiency of vitamin K. Vitamin K is an important part of normal blood clotting.

Question 27

How is vitamin K given to neonates?

Answer 27

Standard practice is to give all babies an intramuscular injection of vitamin K in the thigh shortly after birth.

Question 28

What is an additional benefit of IM vitamin K in neonates?

Answer 28

This can have the helpful side effect of stimulating the baby to cry, which helps expand the lungs.

Question 29

Vitamin K can also be given orally to neonates. When is it given?

Answer 29

Requires doses at birth, 7 days and 6 weeks.

Question 30

What is skin to skin contact after birth?

Answer 30

Skin to skin contact involves putting the baby against the mothers chest immediately after birth.

Question 31

What are the benefits of skin to skin contact after birth?

Answer 31

1) Helps warm baby
2) Improves mother and baby interaction
3) Calms the baby
4) Improves breast feeding

Question 32

Once mum and the baby are out of the delivery room, what are some things to consider next?

Answer 32

1) Initiate breast feeding or bottle feeding as soon as the baby is alert enough

2) The first bath is usually delayed until this baby is warm and stable. It can wait days without any issues.

3) Newborn examination within 72 hours

4) Blood spot test

5) Newborn hearing test

Question 33

What is the blood spot screening test?

Answer 33

A test for 9 congenital conditions.

This involves a heel prick test to provide drops of blood.

The screening card requires four separate drops.

Question 34

When is the blood spot screening test done?

Answer 34

Day 5 (latest day 8) after consent from the parent.

Question 35

What 9 congenital conditions are screened for in the blood spot screening test?

Answer 35

1) Sickle cell disease

2) Cystic fibrosis

3) Congenital hypothyroidism

4) Phenylketonuria

5) Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)

6) Maple syrup urine disease (MSUD)

7) Isovaleric acidaemia (IVA)

8) Glutaric aciduria type 1 (GA1)

9) Homocystin

Question 36

How long do results from the blood spot screening test take to come back?

Answer 36

6-8 weeks