Neonatology Flashcards
(71 cards)
1
Q
What is a neonate?
A
An infant from the time of birth to one month of age.
2
Q
What is a newborn?
A
A baby in the first few hours of its life, also known as a newly born infant.
3
Q
What percentage of field deliveries require life support?
A
6% of field deliveries require life support
4
Q
What is the correlation between birth weight and the need for resuscitation?
A
Need increases as the birth weight decreases.
5
Q
What percentage of newborns weighing 1500 g at birth require resuscitation?
A
80% of newborns weighing 1500 g (3 lbs, 5 oz) at birth require resuscitation.
6
Q
What factors should be considered when determining at-risk newborns?
A
Known factors provided by mother, congenital defects, gestational age, multiple births, mother’s health, prenatal care and habits
Complications may be caused before or during labor
7
Q
What are antepartum (before the onset of labor) factors that may cause complications?
A
Multiple gestation, inadequate prenatal care, mother’s age (<16 or >35), history of perinatal morbidity, post-term gestation, drugs / medications, toxemia, hypertension, diabetes
8
Q
What are intrapartum (occurring during childbirth) factors that may cause complications?
A
Premature labor, meconium-staining, rupture of membranes >24 hours prior to delivery, use of narcotics within four hours of delivery, abnormal presentation, prolonged labor or precipitous delivery, prolapsed cord or bleeding
9
Q
What kind of blood does the umbilical vein carry?
A
Carries oxygenated blood
10
Q
What are the components of fetal circulation?
A
- Umbilical vein
- Portal circulation - ductus venosus
- Pulmonary circulation - foramen ovale, ductus arteriosus
- Umbilical arteries
11
Q
What dramatic changes occur at birth to prepare the neonate for extrauterine life?
A
- Transition from fetal to neonatal circulation
- Respiratory system must suddenly initiate and maintain oxygenation
A. Infants are very sensitive to hypoxia
B. Permanent brain damage will occur with hypoxemia
C. Persistent fetal circulation - Fluid in the fetal lungs will be forced out of the lungs
A. During delivery by compression of the chest
B. Entry of air into the lungs
12
Q
What hemodynamic changes occur at birth?
A
- Following birth, lungs expand as they fill with air. Fetal lung fluid gradually leaves alveoli
- Decreased pulmonary fluids increase PaO2. Pulmonary pressure decreases allow arteries to open and promote blood flow
- Decreased pulmonary pressure and increased PaO2 allow blood to pass by ductus arteriosus and foramen ovale
13
Q
What factors stimulate breathing in newborns?
A
Mild acidosis, initiation of stretch reflexes in lungs, hypoxia, hypothermia
14
Q
What is the assessment for newborns?
A
- Assess newborn immediately after birth
- One paramedic attends the newborn
A. Other attends mother
B. Document newborn on a SEPARATE run report (second patient) - Newborns will be slippery and require both hands
- Follow standard initial assessment
- General impression
- Level of consciousness
- Airway and ventilation
A. Easy, non-labored, non-gasping - Circulation
A. Evaluate skin color/mucus membranes
B. Acrocyanosis - blue extremities (normal finding initially)
15
Q
What are the normal vitals for newborns?
A
- Respirations - normal respiratory rate 40-60 per minute
- Heart rate - normal heart rate 150-180 per minute
A. Slowing to 130-140 after - Blood pressure - 60-90 systolic
- Temperature - 36.6C to 37.7C (98F to 100F)
16
Q
What pulse rate in newborns indicates distress and requires resuscitation?
A
< 100 per minute
17
Q
What is the APGAR scale used for?
A
Assists in initial assessment
Initial APGAR at 1 min, repeat at 5 min
NOT used to determine need for resuscitation (a way to document and trend)
18
Q
What are the five components of the APGAR scale?
A
- Appearance
A. 0 - blue, pale (central cyanosis)
B. 1 - body pink, extremities blue (acrocyanosis)
C. 2 - completely pink - Pulse rate
A. 0 - absent
B. 1 - < 100
C. 2 - > 100 - Grimace
A. 0 - limp
B. 1 - grimace
C. 2 - cries - Activity
A. 0 - no response
B. 1 - some flexion of extremities
C. 2 - active motion - Respiratory effort
A. 0 - absent
B. 1 - slow and irregular
C. 2 - strong cry
19
Q
What is the initial process for a newborn immediately after delivery?
A
- During delivery, head presents
A. Have mother pant and hold (don’t push)
B. Have mother push on each contraction - Following delivery
A. Cut cord first is an option; position, dry and warm, suction (maybe), stimulate; or cut cord last is another option - Cutting the cord
A. Cut cord soon after delivery, allows newborn to be treated as an individual, place two clamps, cut between clamps, do not “milk” or strip cord (polycythemia) - Positioning
A. Position newborn to allow drainage of fluids from pharynx
B. Should be slightly head down
C. Keep level with vagina until cord is clamped - Drying and warming
A. Dry infant of amniotic fluid - don’t try to remove all vernix
B. Wrap baby in blanket
C. Keep head warm - hypothermia is life-threatening, most heat loss from evaporation, core temp can quickly drop 1C - Suction
A. Not routinely performed - consider need
B. Keep patient in head down position
C. Suction mouth first, nose second - aids in prevention of aspiration
D. Expel air before inserting into mouth or nose
E. Expel air before inserting into mouth or nose
F. Equipment - build syringe - Stimulate
A. Drying and suctioning may have created sufficient stimulation
B. If not - flick feet or rub back (DO NOT slap)
C. If unsuccessful - begin resuscitation
20
Q
What occurs during the process of fetal-maternal bonding if initial assessment finds a stable newborn?
A
- Allow mother to hold baby
A. Baby may desire to nurse
B. Initial fluid colostrum
C. Stimulates release of oxytocin - stimulates uterine contractions to reduce size and placental birth - Keep baby on his or her side if possible
A. Facilitates drainage
21
Q
What is the temperature range for a normal newborn?
A
36.6°C to 37.7°C (98°F to 100°F).
22
Q
What is meconium?
A
Fetal intrauterine bowel movement; seen as pea green discoloration of amniotic fluid
23
Q
What are some congenital heart problems?
A
Patent foramen ovale, patent ductus arteriosus, great vessel transposition, tetralogy of fallot, truncus arteriosus,
24
Q
What is the epidemiology of bradycardia in newborns?
A
- Incidence
A. Most commonly caused by hypoxia
B. Increased intracranial pressure
C. Hypothyroidism
D. Acidosis - Risk factors
A. Treatment via pharmacological measures alone
B. Prolonged suction or airway instrumentation - Treatment
A. Oxygenation and ventilation
B. Assure circulation
C. Epinephrine
25
What is the significance of hypoglycemia in newborns?
1. Normal blood glucose concentration
A. Infants: 40-150 mg/dL
B. Premature infants: 30-150 mg/dL
2. Should be determined on all sick infants
A. Hypoglycemia if < 35 mg/dL in first 24 hrs or < 45 mg/dL after first 24 hours
3. May be due to inadequate glucose intake or increased utilization of glucose
26
1. Failure of normal hole in diaphragm to close
2. Allows organs to move into chest
3. Lungs fail to grow to full size
4. Heart development can be affected
5. Assessment findings
A. Little to severe distress
B. May have cyanosis unresponsive to ventilations
C. Scaphoid (flat) abdomen
D. Bowel sounds heard in chest
E. Heart sounds displaced to right
6. Rare (1 in every 2200 births); survival rate is 50%; position on a slant, head up; do not use BVM (if necessary, provide positive-pressure ventilation via ET tube)
Diaphragmatic hernia
27
1. Fourth most common birth defect in US
2. One in 700 newborns affected by one of both
3. Can affect nursing, eating, speaking
Cleft palate/cleft lip
28
What is the incidence of pyloric stenosis?
Narrowing of stomach at pyloric valve causing frequent vomiting
Greatly diminishes passage of chyme
Frequent vomiting, usually with every feeding
29
What are the risk factors for neonatal cardiac arrest?
Bradycardia, intrauterine asphyxia, prematurity, maternal drug use, congenital diseases
30
Fill in the blank: The APGAR scale is assessed at _______ and _______.
[1 min], [5 min].
31
1. Occurs in approx. 10-15% of deliveries
2. Thin meconium may not require treatment
3. Thick meconium should be intubated immediately
4. ET tube becomes suction catheter - consider meconium aspirator
Meconium aspiration
32
1. Meningomyelocele
2. Neural tube defect
3. Suggested by a elevated maternal serum alpha-fetoprotein
4. 1 in every 1000 births
5. Often has associated hydrocephalus
Spina bífida
33
What are some congenital anomalies in newborns that alter effectiveness of respiration or circulation?
Congenital heart problems, diaphragmatic hernia, meningomyelocele, omphalocele, choanal atresia, cleft palate/lip, Pierre robin syndrome, pyloric stenosis
34
What is the correct rate for chest compressions in newborns?
120 per minute.
35
What is retinopathy of prematurity?
A condition resulting from long-term oxygen use that can lead to blindness.
36
What is a significant cause of hypoxemia in neonates?
Irreparable brain damage.
37
What are common causes of apnea in neonates?
Hypoxia, hypothermia, narcotic or CNS depressants, weakness of respiratory muscles, septicemia, metabolic disorders, CNS disorders
38
What are the non-congenital complications of newborns?
Premature infants, apnea, bradycardia, jaundice, seizures, fever, hypothermia, hypoglycemia
39
What heart defects occur together to become the Tetralogy of Fallot?
Ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
40
What is hyperbilirubinemia?
An orange colored pigment associated with bile.
41
What management is required for jaundice in neonates?
Transport for light therapy (natural light en route)
42
What are subtle seizure symptoms in neonates?
Eye deviation, blinking, sucking, swimming movements of the arms, pedaling movements of the legs, apnea
43
What types of seizures can occur in neonates?
Tonic seizure, multi-focal seizure, focal-clonic seizure, myoclonic seizure
44
What is a common rectal temperature indicating fever in neonates?
> 38.0°C (100.4°F)
45
What are assessment findings associated with fever in neonates?
1. Dehydration may contribute to hyperthermia
2. Assessment findings
A. Mental status changes (irritability/somnolence)
B. Feels warm
C. Observe patient for rashes, petechia
D. Term newborns will produce beads of sweat on their brow but not over the rest of their body
E. Premature infants will have no visible sweat
46
What temperature indicates hypothermia in infants?
1. Body temperature drops below 35°C (95°F)
2. Infants may die of cold exposure at temperatures adults find comfortable
3. Increased surface-to-volume relation makes newborns extremely sensitive to environmental conditions, especially when they are wet after delivery
4. Can be an indicator of sepsis in the neonate
47
What are some signs of hypothermia in neonates?
1. Pale color
2. Cool to touch, particularly in extremities
3. Acrocyanosis
4. Respiratory distress or Apnea
5. Bradycardia
6. Central cyanosis
7. Irritability initially, Lethargy in late stage
8. Generally do not shiver (reflex not developed)
48
What environmental conditions are recommended for managing hypothermia in neonates?
24 to 26.5°C (75 to 80°F)
Warms hands prior to touching patient
49
What is the normal blood glucose concentration for infants?
40-150 mg/dL.
50
What indicates hypoglycemia in neonates within the first 24 hours?
Less than 35 mg/dL.
51
What are risk factors and assessment findings for hypoglycemia?
1. Risk factors
A. Asphyxia, toxemia, smaller twin, CNS hemorrhage, sepsis
2. Assessment findings
A. Blood glucose screening test < 45 mg/dL, twitching or seizures, limpness, lethargy, eye-rolling, high pitched cry, apnea, irregular respirations, possible cyanosis
52
What is a management consideration for hypoglycemia?
Administer D10W IV, UVC.
53
What occurs during persistent vomiting in a neonate?
1. Persistent vomiting is a warning sign
2. Vomiting mucous, occasionally blood streaked, in the first few hours of life is not uncommon
A. Vomiting in the first 24 hours of life suggests obstruction in the upper digestive tract or increased intracranial pressure
B. Vomitus containing dark blood is usually a sign of a life-threatening illness
54
What does vomiting in the first 24 hours of life suggest?
Obstruction in the upper digestive tract or increased intracranial pressure.
55
What can diarrhea in neonates lead to?
Dehydration.
56
What are common pathophysiological causes of diarrhea in neonates?
Gastroenteritis, phototherapy, thyrotoxicosis, lactose intolerance, neonatal abstinence syndrome, cystic fibrosis
57
What indicates dehydration in a neonate?
Loose stools, excessive vomiting or diarrhea, decreased urinary output, sunken fontanelle
58
What is the recommended fluid therapy for severe diarrhea in neonates?
10 mL/kg IV bolus.
59
What determines the need for neonatal resuscitation?
1. Distressed newborn may be full term or premature
2. Most common problem is airway
3. Heart rate is most important indicator
A. HR < 100 require ventilations
B. HR < 60 require chest compressions
4. Success based on training, on-going practice, proper equipment
60
Epinephrine (1:10,000 - 0.1 mg/mL) indications and dosage
1. Indications - heart rate < 60 (sometimes higher) and cardiac arrest
2. Dosage - 0.01-0.03 mg/kg UVC/IV/IO repeated every 3-5 minutes
61
Naloxone (0.4-1.0 mg/mL) indications, dosage, and notes
1. Indications - effects of narcotic pain control for laboring mother
2. Dosage - 0.1 mg/kg UVC/IV/IO
3. Used to reverse in-hospital use of narcotics for pain relief in the mother
4. Should not be used for OOH illicit drug use
A. Infants may demonstrate withdrawal symptoms, such as tremors, startles, decreased alertness, and respiratory distress
62
Sodium bicarbonate (0.5 mEq/mL) indications and dosage
1. Indications - used after restoring vital signs and prolonged cardiac arrest (only if effective ventilations before administration)
2. Dosage - 1 (to 2) mEq/kg UVC/IV/IO, slow minimum of 2 minutes
63
Dextrose 10% in Water indications and dosage
1. Indications - hypoglycemia
2. Dosage - 0.2 g/kg followed by 5 mL/kg per hour D10 infusion
64
Dopamine dosage
Initial dose 5-10 mcg/kg/min IV, IO, or IUV, titrated to effect
Typically infusion dose 2-20 mcg/kg/min IV, IO, or IUV
65
What is a cleft palate?
Fissure between sides of palate
66
What is cleft lip?
1. Separation of two sides of lip
2. Often includes bones of upper jaw and/or upper gum
3. Can create difficulty in ventilation and mask seal
67
What are the assessment findings and management of neonates with congenital heart problems?
1. Assessment - persistent central cyanosis, cyanosis worsening with activity
2. Management - keep baby still, administer oxygen by blow by
68
What is an omphalocele?
Malformation involving abdominal contents protruding into umbilical cord
Normally intestines return to abdomen by eleventh week
Over half of infants have other birth defects
69
What is a choanal atresia? What are the signs in a newborn?
1. Posterior hare obstruction
2. Pathophysiology - infants are obligate nose breathers until 4 months
3. Signs
A. Bilateral choanal atresia - cyanosis that is relieved with crying
B. Unilateral choanal atresia - diagnosis usually delayed by years
70
1. A group of abnormalities
2. Marked primarily by a very small jaw with tongue that falls back and downward; may include high arched palate or cleft palate
3. Symptoms
A. Very small jaw with marked receding chin
B. Tongue “appears” large and is placed unusually far back in the oropharynx
C. High arched palate
4. Management - careful attention to mask seal
Pierre robin syndrome
71
What is pyloric stenosis?
Narrowing of stomach at pyloric valve
Greatly diminishes passage of chyme
Frequent vomiting, usually with every feeding
