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Newborn Care and Concerns Flashcards

(101 cards)

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1
Q

prophylactic care in delivery room

A

1 cm ribbon of erythromycin or tetracycline ointment to eyes to prevent neonatal gonococcal opthalmia, and single IM dose of Vitamin K1 to prevent Vitamin K deficient bleeding

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2
Q

Transitional period

A

first 4-6 hours of newborn life

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3
Q

how often should newborns be checked in transitional period?

A

every 30-60 minutes - temp, HR, RR, color, and tone

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4
Q

most newborns don’t need lab tests in transitional period. what are indications to get them?

A

Glucose testing for infants at risk for hypoglycemia (if <45 mg/dL) and hematocrit testing for infants at risk for or symptoms of polycythemia or anemia (if skin very reddenned or pale)

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5
Q

volume of feedings on day 1-3

A

0.5-1 oz per feed on day 1. Increase to 1.5-2 oz. by day 3

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6
Q

prophylactic procedures for newborns

A

umbilical cord care, hep B first vaccination, newborn circumcision if wanted, monitor for hyperbilirubinemia, and routine screening for hearing loss, metabolic and genetic disorders, and congenitally acquired infectious disorders

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7
Q

gestational age best determined by

A

LMP

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8
Q

If growth of baby symmetric vs. asymmetric-

A

if asymmetric, problem happened later in pregnancy, like placental problem or pregnancy induced HTN. If growth is symmetric, then implies event happened earlier in pregnancy like mom using alcohol or drugs early

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9
Q

5 educational points to focus on to caregiver:

A
  1. importance and benefits of breastfeeding, in first 3-5 days of life, expect 4-8 wet diapers and 3 soiled diapers. In 5-7 days of life, 6 or more wet diapers and 3 soiled diapers. 3. talk to them about cord, skin, and genital care
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10
Q

complications of preterm neonate

A

prone to pulm complications, renal complications, patent ductus arteriosus, inc risk of hypoglycemia, hypocalcemia, and infection, and difficulty w/feeding and maintenance of body temperature

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11
Q

aspiration of meconium most commonly occurs in..

A

utero

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12
Q

normal heart rate

A

90-180 bpm

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13
Q

Normal resp rate for neonates

A

30-60. more than 60 is tachypnea, less than 60 is bradypnea/apnea

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14
Q

fever in neonate

A

over 100 deg F

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15
Q

baby presents with irregular irregular rhythm on 1st day. is this serious?

A

no, usually caused by PAC and resolves within the first dya of life

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16
Q

early onset neonatal sepsis

A

birth to 7 days

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17
Q

neonatal sepsis cause

A

group B beta-hemolytic strep

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18
Q

risk factors for sepsis

A

temp more than or equal to 38 deg c, membrane rupture at 18 or more hours, delivery at less than 37 wks gestation, and chorioamnionitis

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19
Q

neutropenia in newborn often caused by either…

A

preeclampsia in mom or sepsis

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20
Q

characteristics of physiological jaundice

A

onset more than 24 hours of age, peak rise at 3-5 days, total bilirubin rise less than 5 mg/dL/day, total bilirubin less than 15 mg/dL, and visible jaundice should resolve by 1 week in full time infant (2 weeks in preterm infant)

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21
Q

if neonates have risk factors for sepsis,

A

they should be observed for at least 48 hours- do not discharge till resolved!

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22
Q

diagnostic evaluation of hyperbilirubinemia

A

serum bilirubin levels or transcutaneous bilirubin measurement

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23
Q

tx hyperbilirubinemai in neonate

A

phototherapy- conjugates bilirubin and allows more to be excreted

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24
Q

how should extreme indirect hyperbilirubinemia be treated?

A

it’s a medical emergency- treat with exchange transfusion

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25
Hypoglycemia in neonate
blood glucose less than 40 mg/dL at birth to 4 hours or less than 45 mg/dL at 4-24 hrs of life
26
risk factors for hypoglycemia
LGA, SGA, preterm, or stressed infants
27
tx of hypoglycemia
feeding of IV dextrose depending on severity
28
normal derm findings in newborn
vernix caseosa, lanugo, superficial desquamation
29
what is lanugo
fine hair that covers the entire body and is shed within the first weeks - normal dermatologic findings
30
superficial desquamation
normal derm finding often noticeable 24-36 hours postpartum
31
vernix caseosa
cheesy white material - normal derm finding in newborn
32
bruising or petechiae in newborn infant can indicate
birth trauma
33
pallor in newborn can indicate
anemia
34
ruddy or plethoric infant can indicate
polycythemia
35
when is jaundice unusual?
in first 24 hrs of life- almost always pathologic
36
greenish discoloration of skin in newborn can indicate
meconium staining
37
name some common dermatologic concerns in newborns
milia, miliaria crystallina, miliaria rubra, transient pustular melanosis, erythema toxicum, mongolian spots, nevus flammeus, nevus simplex, and cafe au lait spot
38
distinguish presentaion and tx of miliaria crystallina vs. rubra
miliaria crystallina- superficial obstruction of eccrine sweat glands while rubra is a deeper obstruction and erythematous. they rarely progress to pustules. are tiny, grouped vesicles. treated by removal to a cooler environment
39
benign idiopathic generalized eruption of vesicles, superficial pustules, and pigmented macules
transient pustular melanosis
40
prognosis of transient pustular melanosis
vesicles and pustules rupture easily and resolve within 48 hours. pigmented macules may persist for several months
41
prognosis of erythema toxicum
usually resolve in 5-7 days
42
this dermatolic skin reaction in newborns may develop within a few hours of life and persist upto 2 weeks of life
erythema toxicum
43
small, yellow white colored papules surrounded by red skin in newborn that may be present upto 2 weeks of age. NOT on palms or soles, mostly on body not face
erythema toxicum
44
nevus flammeus vs. nevus simplex
pink or red patches, mostly unilateral that enlarge and as child grows, often persists. nevus simplex does not enlarge and does not persist- often disappear by 1 year of age
45
if nevus simplex occurs on lumbosacral region,
check if a/w another lumbosacral abnormality- then consider further evaluation for underlying spinal dysraphism
46
is nevus flammeus a/w developmental defects?
rarely
47
when are cafe au lait spots concerning?
6 or more lesions that are greater than 1.5 cm = major diagnostic criteria for neurofibromatosis type I
48
port wine stain aka
nevus flammeus
49
congenital blue/grey or brown macule , often over buttocks- prognosis
benign, usually fade during 1-2 year of life. mongolian spots
50
tense, bulging fontanelle in a sitting infant NOT cryiing may indicate
increased ICP
51
affect of dehydration on fontanelle
may cause depressed fontanelle
52
effect of congenital hypothyroidism on fontanelle
a/w enlarged posterior fontanelle
53
widely split sutures with full fontanelles may indicate
increased ICP
54
what does asymmetric skull indicate
in first 1-2 days, may have just been from passage through birth canal. if persists longer than 2-3 days, may suggest craniosynostosis (premature fusion of sutures)
55
soft of thinned area of skull, common in newborns
craniotabes
56
may see this abnormality upon HEENT exam in child with rickets or syphilis, or other dz affecting bone growth
craniotabes
57
commonly d/t prolonged engagement of head in birth canal or use of vacuum extraction. benign and resolves in a few days
caput succedaneum- area of edema over presenting part of head
58
commonly d/t birth trauma resulting in rupture of vessels beneath the periosteum: subperiosteal collections of blood
cephalohematomas
59
distinguish between caput succedaneum vs. cephalohematomas vs. subgaleal hemorrhrages
caput and subgaleal hemorrhages- swelling can cross suture lines. cephalohematomas- swelling does NOT cross suture lines because between bone and periosteum
60
subgaleal hemorrhages occur from disruption to..
emissary veins resulting in blood accumulation between aponeurosis and the periosteum of the skull
61
facial palsies may occur in newborns from...
forceps delivery of in prolonged delivery in mothers with a prominent sacral promontory
62
how does facial palsy present
loss of nasiolabial fold, partial closing of eye, and droopy mouth. diminished movement on affeced side of face (mandibular branch of facial n. affected)
63
distinguish asymmetric crying facies vs. facial palsies
facial palsies- 3 signs of droopy mouth, partial closing of eye, and loss of nasiolabial fold. asmmetric crying facies- upper face normal.
64
asymmetric crying facies results from congenital absence or hypoplasia of
depressor anguli oris muscle which leads to asymmetry of the face when crying
65
corneal enlargement in newborn could indicate
glaucoma
66
when might you see blue sclera in newborn
light blue- if premature. dark blue- a/w osteogenesis imperfecta
67
asymmetric eye mmovement common in 1st month, but may also indicate
CN abnormality of with brain
68
nystagmus persistent may indicate
poor vision or CNS disease
69
absence or abnormality in the red reflex -
refer to opthalmologist
70
congenital ptosis
may occur d/t birth trauma, CN III palsy, or mechanical problems
71
purulent nasal discharge at birth suggests
congenital syphilis
72
what are common findings in mouth exam of newborns
epstein's pearls- small, white, benign retension cysts and mucus retention cysts- on gums or floor of the mouth
73
prominent tongue may be a/w
congenital syndromes
74
oral equivalent of milia on skin in the mouth=
Epstein's pearls
75
natal teeth are usually
primary mandibular incisors
76
isolated palpable cervical lymph nodes upto 12 mm in diameter
common in healthy infants
77
pectus excavatum vs. pectus carinatum
excavatum- funnel chest. carinatum- pigeon chest
78
most common cause of neonatal respiratory distress
respiratory distress syndrome
79
what kind of infants is neonatal resp distress syndrome most common in
premature- babies born before 28 weeks gestation
80
neonatal resp distress syndrome caused by
deficiency of surfactant
81
premature neonate presents with cyanosis, apnea, decreased urine output, and signs of respiratory distress. what next?
suspect neonatal resp distress syndrome. get ABG, blood cultures, CBC, sequential CRP levels to evaluate for sepsis. get CXR- may show atelectasis, diffuse ground glass appearance, and low lung volume
82
tx of neonatal resp distress syndrome
neonatal resuscitation including supplemental oxygen, CPAP, or intubation with mechanical ventilation. delivery of exogenous surfactant- best if given 30-60 minutes of life - can only give by ET tube, but want to try CPAP first
83
complication of neonatal resp distress syndrom
bronchopulmonary dysplasia is the main chronic complication of RDS
84
prognosis of neonatal resp distress syndrome
condition often worsens for 2-4 days after birth then slow improvement thereafter.
85
when does death most commonly occur in neonatal RDS
day 2 through 7
86
2 most common presentation of heart disease in the newborn infant are
cyanosis and heart failure w/ abnormalities of pulses and perfusion
87
scaphoid/concave abdomen may indicate
diaphragmatic hernia
88
distended abdomen may indicate
intestinal obstruction, organomegaly, or ascites
89
most palpable abdominal masses are
enlarged kidneys, but may also be d/t tumors
90
small cord may indicate
poor maternal nutritional status or intrauterine compromise
91
single umbilical a a/w
increased rate of chromosomal and other congential abnormalities
92
erythema surrounding stump and/or odorous may indicate
omphalitis- infection of umbilical cord stump
93
decreased amount of wharton's jelly within cord may indicate
poor fetal nutrition
94
whitish vaginal discharge with or w/o blood in female newborn may indicate
if in first days of life- d/t maternal hormones
95
labial adhesions in female neonates
paper thin adhesions that often disappear without tx
96
most common cause of vaginal outflow obstruction
imperforate hymen
97
cryptorchidism
undescended testicle that usually descends by 6 months of age- may be present in male neonate
98
what should you be concerned about if present in sacrococcygeal area?
if tuft of hair, hemangioma, sacral dimple, or discoloration in that area may suggest underlying vertebral/spinal cord defect
99
simean crease a/w
newborns with trisomy 21
100
what are 6 signs of severe neurologic dz?
extreme irritability, persistent asymmetry of posture, constant turning of head to 1 side, marked extension of head, neck, and extremities, severe flaccidity, and limited response to pain
101
when are tremors concerning in newborns?
normal in first 2-3 days. if resting tremor more than 4 days, can indicate CNS disease

Peds/Geriatrics (3 decks)

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