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Flashcards in Newborn Deck (86):
1

Harlequin color change

dramatic confluent red color change of dependent part of body, the other half is pale. Lasts for 30s-to 20minutes and resolves with increased activity. Up to 10% of infants undergo this color change that occurs between day 2-5 of life. 2/2 autonomic dysregulation. Seen more commonly in LBW infants

2

What is considered the neonatal period?

1st month of life

3

When does myelination of the cortex begin?

starts at 8 months gestation, complete by 2 years.

4

What should rate of growth be during first month?

30g/day. This is the period of fastest postnatal growth

5

By when does birthweight double?

4 months

6

What should 2-4 mo old sleep pattern be?

Needs 14-16 hours of sleep per day, with 9-10 concntrated at night and 2 naps through day.

7

When do babies start to "sleep through night"

70% sleep for 6-8 hours straight by 6 months

8

By when does birthweight triple?

1 year

9

At what age are they expected to sleep through night

Add 2 hours to age in month - expected amount of hours sleep through night.

10

When can start using OTC cold meds

at earliest age 6

11

How much should newborns be eating in the first week

1-2 oz q1-2 hours

12

How much should newborns be eating in first month

3-4oz q2-3 hours

13

Signs of a successful latch

Audible swallowing noises without clicking noises from the infant’s mouth (may not be audible in the very early days, but should be visible)
Infant nose aligned to nipple with head tilted backwards
Full rounded cheeks, no dimpling cheeks
Rhythmic jaw movements

14

Treatment of sore nipples?

An over-the-counter product, lanolin, can also be applied to the affected area and does not need to removed before nursing. This product is 100% natural and comes from the raw wool grease of sheep’s wool.

15

How much should babies gain in first 2-3mos of life

she/he should gain somewhere between 4 to 7 ounces a week

16

When do newborn stooling patterns change?

At around 6 weeks of life, the stools may become less frequent, even as infrequent as every 3 days for breastfed infants.

17

Signs of adequate milk intake?

Bowel movements: 3-4 or more every 24 hrs.
 Urination: 6 or more times every 24 hrs.
 Baby is content between feedings
 Average weight gain: 5-7 ounces/week (100 -
200 gms per week

18

When should nipple shields be used

temporarily if woman has inverted nipple or very sore nipples

19

up to what age is thrush ok in normal baby?

6 months after 6-12 months , raised concern for immunodeficiency. Ask if mom has rash, contaminated vitamin dropper, etc?

20

Similac special care

Premature infant formula (<34 weeks)

21

Enfamil Premature

Premature infant formula (<34 weeks)

22

Good Start Premature

Premature infant formula (<34 weeks) partially hydrolyzed whey

23

Neosure

Transition NICU Discharge; intact proteins

24

Enfacare

Transition NICU Discharge; intact proteins

25

Good Start Nourish

Transitional NICU Discharge formula; partially hydrolyzed whey.

26

Similac Advance

Standard formula whey 18: casein 82

27

Enfamil Premium

Healthy Term Infant whey 100: casein 0

28

Enfamil Gentlease

For mild GI discomfort; partially hydrolyzed proteins

29

Good start Protect

partially hydrolyzed proteins for mild GI discomfort. Has probiotics

30

Good start Gentle

partially hydrolyzed proteins for mild GI discomfort. Has Prebiotics

31

Good Start soothe

partially hydrolyzed proteins for mild GI discomfort. Has probiotics and less lactose.

32

Complete elemental formulas

Neocate Infant, Elecare Infant, Nutramigen AA

33

Nutramigen Enflora

Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.

34

Pregestimil

Entensive hydrolyzed proteins (casein), lactose free. For family hitsory of food allergies or sensitive to casein and soy.

35

Alimentum Advance

Entensive hydrolyzed proteins (casein), lactose free. For family history of food allergies or sensitive to casein and soy.

36

What is included in the biophysical profile?

Non-stress test, fetal movement, reactive HR, Breathing, Tone, AFI - get either 0 or 2 for each. total score of 8-10 is normal.

37

What can cause false negative in newborn screen?

Drawn

38

What can cause false positives in newborn screen?

TPN, antibiotics, hemoglobinopathies

39

Placental Accreta

the uterus lacks normal decidua because of previous trauma ( curettage, myomectomy, or c section

40

Placental percreta

develops when the placenta penetras the scars in placental accreta, resulting in serious hemorrhage

41

Placental abruption

develops when a firm blood clot forms after a retroplacental hemorrhage

42

What is the difference between primary and secondary apnea?

Primary apnea can be reversed with tactile stim, for secondary apnea, oxygen and stim will not work. PPV is needed. Both types can occur in utero and it is difficult to tell the difference, thus when a baby is born and is apneic, you are quick to start PPV in case this is secondary apnea.

43

Causes of increased AFP

Renal (renal agenesis, nephrosis, polycystic kidney disease), abd wall defects, NTD, incorrect dates, multiple gestation

44

When is the quad screen done?

15-20 weeks

45

Causes of decreased AFP

TRisomy 13, 18, 21, incorrect fetal age, IUGR, fetal demise

46

Increased AFP, normal hcg, uE3

NTD

47

Low AFP, increased hcg, low uE3

trisomy 21

48

Low AFP, low hcg, low uE3

trisomy 18

49

What is a non stress test

done in 3rd trimester, 20 minutes of continuous monitoring for fetal HR and movement. Measures autonomic system integrity

50

Contraction stress test

Done at >34 weeks. Mom given oxytocin to cause contractions. Look for decels. Measures uteroplacental insufficiency and tolerance of labor

51

What test is used to test lung maturity?

lecithin:sphingomyelin ratio. If greater that 2, low risk for RDS. This helps decide about giving antenatal steroids. MAternal diabetes can mess up this ratio

52

How does hypermagnesemia present in the newborn?

respiratory depression, failure to pass meconium, lethargy, flaccidity, hyporeflexive, poor feeding. IV Ca and mag will reduce levels

53

How can you remember blood pressure parameters in preemies?

MAP should equal GA

54

What is unique about preemie formula

24kcal/oz, higher ca and phos, more MCT, whey:casein 60:40

55

aplasia cutis

ulcerated, noninflammatory, well demarcated congenital absence of skin that is usually limited to a small area. Associated with Trisomy 13. Self resolves with epithilization and atrophic, hairless scar over a few weeks

56

What are congenital cataracts associated with?

rubella, toxo, CMV congenital infections

57

What percent of hemoglobin is fetal at birth?

50%

58

When do you trewat plycythemia in a newborn

when >70%. Partial exchange transfusion

59

When is the nadir of Hgb in full term vs preemie infants?

Full tern 2-3 months, preemie 1-2 months. Also preemies start with a low hgb

60

What is the Apt test?

tests newborns gastric secretions to determine if it in actual swallowed maternal blood

61

What is a neoanatal side effect of turbutaline?

leads to hyperinsulinism and hypoglycemia

62

Widely spaced nipples with shield chest - associated with which conditions

Turners and noonan

63

Why do infants of diabetic mothers have higher risk of RDS?

bc insulin seems to block the development of enzymes necessary for the synthesis of lecithin, a precursor of surfactant

64

Which heart abnormalities occurs in infants of diabetic mothers (type 1)

hypertrophic CM (however this serlf resolves by 3-6 months. Septal defects, TOGA, Truncus arteriosus, coarctation

65

Who gets prophylactic surfactant at birth

infants 50% FiO@ for PaO2>50mmHg

66

Describe lithium in pregnancy and breastfeeding

Lithium use in pregnancy poses some risks but is not completely contraindicated during pregnancy. It is associated with an increased risk for a few birth defects as well as other problems that may develop in the second trimester, and may also cause transient feeding and respiratory problems at birth. Mothers who require lithium to address a serious psychiatric disorder should not breastfeed while taking this medication

67

Which signs and symptoms suggest persistent pulmonary hypertension of the newborn

tachypnea with cyanosis, hypoxia more severe than imaging suggests, greater O2 sats in upper body (due to R to L ductus shunting), prominant precordial pulse, tricuspid regurg murmur, loud, narrowly split P2

68

What is Wilson-Mikity Syndrome?

Interstitial pulmonary fibrosis syndrome. Seen in infants

69

What workup does a well appearing infant, of any GA who mother had chorio need?

limited eval (CBC and blood cultlure with diff) and need empiric antibiotics until cultures are 48 hours neg

70

Management of a GBS positive mother, well appearing infant, adequate GBS prophy

>48 hours of observation (or 24 if there is experienced observer or prompt access to medical care)

71

If well appearing, > or =37 weeks, inadequate prophy and ROM

needs 48hours obs

72

If infant is well appearing, inadequate prophy, 18 hours,

should undergo limited eval and observe for 48 hours

73

What is postive end pressure ventilation helpful in infants with PDA?

it helps to decrease the amoutn of left to right shunting through the PDA, leading to increased systemic blood flow

74

What are contraindications to indomethacin therapy for closing PDA

Nec, serum Cr>1.6, UOP

75

Whats the highest APGAR a VLBW infant can get

6 (2 for HR, 1 breathing, 1 color, 1 flexion, 1 grimace)

76

How do you define direct hyperbilirubinemia?

direct hyperbilirubinemia, which is defined by a serum direct bilirubin concentration of more than 1.0 mg/dL (17.1 µmol/L) with total bilirubin values of less than 5.0 mg/dL (85.5 µmol/L) or greater than 20% of the total bilirubin for values greater than 5.0 mg/dL (85.5 µmol/L).

77

What is the abnormal enzyme in galactosemia?

galactose-1-phosphate uridyltransferase level

78

What do intraabdominal calcifications suggest

meconium peritonitis

79

which parts of the bowel are most often affected by NEC

distal ileum and proximal colon

80

What are reasonable antibiotic regimens for treating NEC

vancomycin, gentamicin and clinda OR metronidazole OR zosyn

81

What score on a biophysical profile suggests need for urgent delivery

4 or less

82

What conditions is hirschsprungs associated with?

Waardenbergs, Downs, Bardet-Biedl syndrome, multiple endocrine neoplasia type 2, Smith-Lemli-Opitz

83

What is used as the CF newborn screening test?

immunoreactive trypsinogen levels

84

how is hemoglobin nadir different in preterm than term infants?

Preterm start with lower hct, reach nadir sooner and recover slower

85

What is molded baby syndrome?

When have too little amniotic fluid and results in torticollis, metatarsus adductus, and DDH. may include head molding, postural torticollis, congenital scoliosis, pelvic obliquity with altered hip movement, and malposition of the knees and feet.

86

Below what age do most cases of IVH occur?