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CCFP 3 > Newborn > Flashcards

Newborn Flashcards

1
Q

What is in a Biophysical profile?

A

LAMB
limbs (flexion + extension), amniotic fluid volume, movements, breathing

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2
Q

What to assess in a Newborn exam

A

Measurements: head circ, chest circ, weight, length
Skin: turgor, vernix
Head: fontanelles, sutures palpable
Eyes: red reflex, PEARL
Ears: startle reflex
Nose: nostrils patent bilaterally
Mouth + throat: uvula midline, tongue moves freely, sucking reflex, rooting reflex, gag reflex
Neck: clavicles, head turns easily
Chest: nipples
Abdo: soft, 3 vessel cord, bilat femoral pulses, bowel sounds
Genitalia: palpable tests
Back + rectum: patent anus, intact spine
Extremities: equal movement + tone, full ROM in joints, negative hip click, palm + sole creases present

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3
Q

Down syndrome features

A

Rounded head
Third fontanelle
Brachycephaly
Up slanted palpebral fissures
Epicanthal folds
Large tongue in small mouth
Transverse palmar creasers
Hypotonia
Wide gap between 1st + 2nd toe

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4
Q

Fetal alcohol syndrome features

A

Smooth philtrum
Thin, smooth vermilion border of upper lip
Microcephaly
Hearing loss

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5
Q

DDx of high unconjugated bili

A

Overproduction (hemolysis)
Impaired hepatic uptake (reduced blood flow, drugs)
Impaired conjugated (Gilber or Crigler-Najjar)

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6
Q

What are RF for severe hyperbilirubinemia in babies?

A

Jaundice in first 24h of life (always pathologic)
Positive direct antiglobulin test (DAT/Coombs)
Known hemolytic disease (G6PD)
Premature
Previous sibling with severe hyperbilirubinemia/phototherapy
Bleeding/bruising (cephalohematoma)
East Asian
Exclusive breastfeeding

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7
Q

Managment + ix for hyperbilirubinemia

A

Rule out sepsis
Phototherapy as indicated
Investigations
CBC (hemoglobin)
If no anemia, rule out liver disease
Total bilirubin
If conjugated, requires different work-up
Serum bilirubin q4h until decreasing then q12h until normal
Neonatal blood type
Coombs test (r/o autoimmune hemolysis)
Smear
Consider G6PD in severe hyperbilirubinemia or high risk population/family history

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8
Q

Screening for hyperbilirubinemia

A

TcB (Transcutaneous) screen at 72h of life and prior to discharge
Add TcB to 95% confidence interval to estimate maximum probably TSB concentration
Total serum bilirubin if abnormal TcB or clinical jaundice

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9
Q

What is VACTERL?

A

Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities

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10
Q

What is CHARGE?

A

Coloboma of the eye, heart defects, choanal atresia, retraction of growth and/or development, genital and/or urinary abnormalities, and ear abnormalities and deafness

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11
Q

Standard management at birth

A

0.5% erythromycin ointment (1cm ribbon in each eye)
Vitamin K 0.5mg IM
Universal hearing screen
r/o Hyperbilirubinemia (transcutaneous screen in first 24h)
r/o Hypoglycemia (preterm, postterm, diabetic mothers, LGA)
HBV vaccination, immunoglobulin as indicated

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12
Q

Criteria for d/c of newborn

A

Normal stable vital signs x 12 hours
Urination, stooling
Two successful feedings
No physical abnormalities requiring continued care
No excessive bleeding

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13
Q

Discharge instructions

A

Return to hospital if signs of:
Infection r/o sepsis
Fever <3 months old
Decreased alertness (somnolence)
Irritability unable to console
Vomiting
Skin Changes (eg, jaundice, cyanosis)
Dehydration
Poor feeding
Weight loss or poor weight gain
<3 wet diapers per day or no urinary output x 7h
Decreased tears
Breathing problems
Rapid breathing (>60/min)
Apnea
Using neck, chest, abdo muscle to breathe
Wheezing/noise breathing
Any other concern

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14
Q

Counselling about baby weight

A

May lose up to 10% within the first few days, but return back to birthweight at 14 days
Should gain 20-30g/d for first month

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15
Q

Counselling re feeding newborn

A

Avoid juices/water until solid foods (usually 4-6 months of age)
No honey until 1yo
Feed on demand, max q3-4h
Formula
Avoid heated in microwave (burn risk)
Breastfeeding
Technique
Consult physician before taking new medication
Vitamin D 400 units daily if breastfeeding

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16
Q

How many wet diapers is normal

A

Six+ wet diapers per day

17
Q

Management of umbilical cord

A

Umbilical cord should fall off by 2w
Regular cleaning and dry
Watch for signs of infection (red, purulence)

18
Q

Prevention of SIDS

A

Back to sleep, same room, different bed
Smoking cessation

19
Q

Signs + sx of sepsis in newborn

A

Respiratory distress, respitory failure
Hypotension, poor perfusion
Tachycardia
Temperature instability
Lethargy, hypotonia
Apnea
Feeding intolerance

20
Q

RF for early onset sepsis + what pathogens cause this

A

Early-onset (Mother’s GU: GBS, Ecoli, Coag-neg Staph, H influenzae, L monocytogenes)
Intrapartum maternal fever ≥38°C
Maternal chorioamnionitis (maternal fever, leukocytosis, maternal/fetal tachycardia, uterine tenderness, foul odour of amniotic fluid)
Maternal GBS colonization
Inadequate GBS antibiotic prophylaxis (eg. <4h prior to delivery)
Prolonged ROM ≥ 18h
Premature, LBW, Congenital anomalies, low APGAR (≤6)

21
Q

RF for late onset sepsis + what pathogens cause this

A

Late-onset 4-90d (Caregiving environment: Coag-neg Staph, S aureus, E coli, Klebsiella, Pseudomonas, Enterobacter, Candida, GBS, Serratia, Actineobacter, Anaerobes)
Poor hygiene
Low gestational age, LBW
Indwelling central venous/umbilical catheter
Ventilator treatment

22
Q

Definition of hypoglycemia in babies

A

Gluc <3.3 mmol/L

23
Q

Sx of hypoglycemia

A

Symptoms
Lethargy, hypotonic
Jitter/tremors
Diaphoresis
Tachypnea or apnea
Hypothermia
Seizures
Poor suck/feedings

24
Q

Sleep training advice

A

start at 6mo, take baby to bed when drowsy, leave for 5 mins if crying, reassure then leave again, extend intervals

25
Q

Neonatal resus - first things to look for

A

Tone, tears, term

26
Q

Key points in new NRP guidelines

A

practice PPV, limit suction, skin to skin, use O2 judiciously

27
Q

NRP PPV

A

RR: 20-30 breaths/ min, use rescue airway, naloxone if opioids possible

28
Q

Neonatal hypoglycemia sx

A

jittery, lethargic, hypotonic, sweating, weak cry, tachypnea, sz

29
Q

When to give sugar to neonates

A

<2.6

30
Q

Rx for hypoglycemia

A

hourly D10W if cannot feed, bolus if symptomatic, recheck glucose q30mins

31
Q

Sepsis bugs in newborns

A

LEGS (listeria, e coli, group B strep)

32
Q

Jaundice over 2 weeks, what to order?

A

Serum conjugated bili, Hb, group + screen, coomb’s test

33
Q

Direct vs indirect coombs

A

direct = does baby have mom’s antibodies on their RBCs, and indirect = does mom have antibodies against baby’s RBC?

34
Q

Chance of recurrence of Downs in subsequent pregnancies

A

1%

35
Q

RF for hip dysplasia

A

firstborn, female, fam hx, fluid (oligo), feet (breech)

CCFP 3 (67 decks)

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