Newborn Care I Flashcards
(108 cards)
1
Q
Terms (4)
A
- Extremely premature: less than 32 weeks gestation
- Late preterm: 34-36 weeks gestation
- Early term: 37-38 6/7th weeks gestation
- Full term: 39-40 6/7th weeks gestation
* Bigger is better! A baby’s brain at 35 weeks weights 2/3 of what it will weigh at 40 weeks; each day makes a huge impact on brain development
2
Q
Birth Weights (3)
A
- LBW: less than 2500gm
- VLBW: less than 1500gm
- Chronological Age/birth age: time since birth
3
Q
Gestational Age
A
Estimated time since conception, can be measured by
- LMP
- Early ultrasound
- Dubowitz/Ballard - done w/i first 48 hours
4
Q
Corrected Age (4)
A
Age corrected for prematurity
- Actual age - weeks premature = corrected age
- Corrected for degree of prematurity for 2 years
* Correct pre-mature baby’s age for first 2years of life when assessing milestones and developments - Age correction most meaningful in first year of life
- Helps anticipate complications and expectations
5
Q
Naegele’s Rule
A
Take first day of LMP and add one year, subtract three months, and add 7 days
6
Q
Catch Up’s (4)
A
- Head circumference - early catch up within first few months post term (unless ELBW/VLBW)
Weight and length
- Catch up by first year if over 30 weeks
- By 2 years of less than 30 weeks
- Use preterm growth charts
* Sometimes weight surpasses if they get extra calories initially
7
Q
Leading Causes of Infant Death (6)
A
- Prematurity
- Birth defects
- LBW
- Maternal complications of pregnancy
- Respiratory distress syndrome (RDS)
- SIDS
8
Q
Contributing Factors to Prematurity (9)
A
- Advanced maternal age
- Hypertension
- IUGR
- Chromosomal abnormalities
- Gestational disorders
- Chronic Health disorders (DM, HTN)
- Assisted reproductive technologies
- Multiple births
- Cesarean sections
9
Q
Four U’s of Late Preterm and Early Term Infants
A
- Unrecognized as premature
- Underestimated for morbidity and mortality
* 3x higher then full term infants
* 19% risk of admission to NICU - Unpredictable
* Hypothermia, hypoglycemia, respiratory support, antibiotics - Understudied
10
Q
Key Pregnancy History Pieces with New Baby (10)
A
- ART (anti-retroviral therapy)
- Complications
- Overall health
- Screening tests
- Amniocentesis
- Use of folic acid / prenatal vitamins
- GBS status (and previous history)
Chronic Health Conditions - DM
- Lupus
- Thyroid disease
11
Q
Labs to Send out for Newborn (5)
A
- Blood type - establishes ABO incompatibility
- Screening glucose
* Hypoglycemia - decreased glycogen stores in preterm infants - Bilirubin
* Elevated in first 24-48 hours = pathological - get total and direct bilirubin levels to check what the cause of the jaundice is - CBC
* Anemia - blood loss or hemolytic - Coombs test
* Positive test indicates fetal RBCs coated with antibodies; diagnostic of Rh incompatibility
12
Q
ABO incompatibility
A
Mother O and Baby is A, B, or AB
13
Q
Rh incompatibility
A
Mother gives birth to Rh+ baby - mixing antibodies attack lysing of the baby’s RBCs
(woman is Rh(-) and gives birth to Rh(+) baby)
Rhogram given at 28-30 weeks and 72 hours after delivery
14
Q
First Visit (8)
A
- Premature infants should be seen within 48 hours of d/c (ideally 24)
Topics to review:
- Adaptation to home environment
- Parental adjustment
- Establish relationship with parent
- Reassurance
- Get to know the infant well
- Review thorough history and NICU discharge summary
- Discuss plans for HCM, immunizations and referrals
15
Q
Maternal Depression (3)
A
- Higher rate with pre-term infants
- Depressed mother more likely to have an infant with poor growth and development; monitor closely with frequent visits or calls
- Edinburgh PP depression scale
* Max score of 30-10 or greater possible depression needs follow up
16
Q
Main reasons for hospital readmission (3)
A
- dehydration
- respiratory issues
- feeding issues
17
Q
PA of throat and respiratory tract (2)
A
- Throat – evaluate suck-swallow, tongue thrust, oralaversion, uvula movement, gag reflex
* Oral aversion could occur if baby was in NICU and intubated
* Premature babies have exaggerated tongue thrusts that keep them from feeding normally and exhausts them/burns calories - Respiratory tract rate and retractions, stridor, wheezing (RSV)
18
Q
PA of neck and shoulder, trunk, and extremities (3)
A
- Neck and shoulder - evaluate poor head control, tight scarf sign, difficulty breathing
- Trunk - evaluate arching, decreased ROM, hypotonia
- Extremities - hypo or hyper tone, hyperreflexia, clonus, babinski testing
19
Q
Landau reflex (2)
A
Postural reflex
- Hold infant in the air horizontally and infant will lift head and extend the neck and trunk
- Present by 5-6 months
20
Q
Parachute reflex (3)
A
Postural reflex
- Present by 6-8 months
- Look for symmetrical response
- The child is held upright and the baby’s body is rotated quickly to face forward (as in falling). The baby will extend his arms forward as if to break a fall
21
Q
Propping Reflex (2)
A
Postural reflex
- Anterior propping when sitting
- Lateral propping to maintain balance
22
Q
postural reflexes
A
a more mature-support control of balance, posture and movement - presence indicates infant’s increasing ability to control body
*replaces primitive reflexes in a sequential manner
23
Q
Pre-term Immunizations (3)
A
- Recommended according to chronological age
- Hepatitis B only after 2 kg (unless mother is Hep B positive)
- Palivizumab (Synagis) for preterm infants born at or before 28 weeks and 6 days gestation (so before 29 weeks)
* 15mg/kg 5 doses maximum
* No more 2nd year of life unless still on oxygen
* Stop if breakthrough RSV occurs with hospitalization
24
Q
Daily weight gains of premature infants
A
15-20gm/day
25
Length gains of premature infants (3)
1. Length gain by 1.1 cm per week until term
2. Then .75cm for 3 months
3. Then .5cm for 3-6 months
26
Head circumference gain in preterm infants
1. 0.5cm/week until 3 months
2. 0.25cm/week for 3-6 months
3. 1.25cm/week or more = hydrocephalus
27
Preterm Nutritional Needs (6)
1. 137-165 calories/kg/day
2. If Chronic Lung Disease (CLD) need a higher caloric intake (b/c they are expending more energy)
3. Multivitamins daily 1ml
4. Vitamin D – 400 IU per day; beginning in first few days of life
* Wean when consuming at least 32 oz/day of Vitamin D fortified formula or whole milk
5. Iron supplementation of 2-4 mg/kg/day in breastfed infants preterm
6. Caveat – higher energy and nutrient requirements due to IUGR, Immaturity of the gut, increased body surface area
28
Growth in VLBW Infants (5)
*AGA infants will grow normal or faster rate
VLBW - Take longer to catch-up
1. 24 months for weight
2. 18 months for head circumference
3. Growth spurt at 38-48 weeks
4. Growth spurt again at 6-9 months
5. Most catch up by 2-3 years
29
Feeding problems in pre-term infant (5)
1. Tonic bite reflex
2. Tongue thrust
3. Hyperactive gag reflex
4. Oral hypersensitivity
5. Refer to speech therapist or PT with specialty in oral motor problems/feeding specialist/swallow study
30
Transition to Extrauterine Life (6)
1. Pulmonary capillary bed expands
2. Right atrial and ventricular pressure fall
3. Systemic resistance increases
4. Left atrial and ventricular pressure rise
5. FO closes (left atrial pressure increase)
6. Umbilical arteries, ductusvenosus and ductus arteriosus constrict in response to increase in oxygen tension
*Can take up to 6-12 hours to have normal breathing
31
Normal Newborn Vitals (3)
1. HR: 90-140 (180)
2. RR: 30-60
3. Temp: 97.8-98.6 F or 36.5-37 C
32
Newborn Temperature Control: Heat Loss (4)
1. Radiation: loss to a cold nearby object not in contact (window)
2. Convection: loss by air motion (cool breeze-O2)
3. Evaporation: loss of heat by moisture vaporizing from skin or respiratory
4. Conduction: direct heat loss to surface in contact (cold mattress)
* takes a while to recover from this
33
Brown Fat Metabolism
Non-shivering thermoregulation; a natural method for newborns to produce heat by increasing metabolic rate (generate heat by breaking down brown fat)
*Storage begins at 26-30 weeks in scapula, kidneys, axilla and neck
34
How do term infants conserve heat? (5)
1. Skin to skin
2. Light clothing
3. Avoidance of heat loss elements - environmental cold spot
4. Preemies do not shiver (hypothalamus and limbic system not developed)
5. Posture (curling up)
35
Consequences to heat loss (8)
1. Hypoxia
2. Hypoglycemia
3. Metabolic acidosis
4. Decreased growth
5. Apnea
6. Pulmonary hypertension
7. Use up oxygen
8. Can lead to acidosis and/or death
36
Definition and Symptoms of Cold Stress (8)
1. Defined as a body temperature less than 36.5C or 97.6F rectally with system wide sequelae
2. Cool to touch
3. Central cyanosis
4. Poor feeding
5. Bradycardia
6. Apnea
7. Lethargy
8. Mottling
37
Umbilical Cord Care: Stump (3)
Dry it out!
1. Dry cord care includes keeping the cord clean and leaving it exposed to air or loosely covered by a clean cloth. If it becomes soiled, the remnant of the cord is cleaned with soap and sterile water
2. Typically falls off within 7 days (if not by 2 months look for underlying cause)
3. Observe for infection
* Umphilitis - fowl smelling redness and swelling around umbilical cord; can spread to cellulitis or bacteremia
38
Nursery Penile Care (4)
1. Circumcision care- make sure normal anatomy; no hyposapdias, epispadias (bladder extrophy), chordee, ambiguous
2. Vaseline gauze/petroleum ointment and observe bleeding after circumcision
3. Watch for urinary retention
4. Care of the uncircumcised penis: teach parents, clean, paraphimosis (urologic emergency), balanitis-smegma
39
Sleeping position and pattern (3)
1. BACK TO SLEEP
2. No soft bedding, pillows, quilts or stuffed animals
3. Healthy term newborns sleep 16-17 hours/day
40
Newborn Weight loss vs. Weight Gain (5)
1. Weight loss of 5-8% is typical, but over 10-12% in first week is a concern
2. Healthy for newborns to regain BW by 2 weeks
3. Double BW by 5 months
4. Triple BW by 1 year
5. An ounce a day is ok!
41
Feeding Patterns and Techniques (7)
1. Encourage and support breastfeeding (Q2-3hours)
2. No shame or guilt if not (formula every 3 hours)
3. Healthy full term requires ~120 kcal/kg/day
4. Vitamin D supplementation if breastfed (400 IU daily)
5. Iron - 1mg/kg/day in breastfed full term infants
6. If formula fed –Use iron fortified infant formula (4-12mg)
7. When burping, do not hit, rub
42
Elimination Patterns (2)
1. Urine of 8-10 wet diapers/day is normal
2. Should be soft, yellow stools
* Pooping every feeding is normal
* Blockage could be biliary atresia
43
When can pacifiers begin?
Once adequate feeding is established
44
When do self soothing techniques begin?
Develops w/i first 3 months
45
Car Seat Safety
Rear-facing seat until 2 years old
46
When should families call the HCP? (6)
1. Fever of 100.4 or above
2. Poor feeding
3. Activity change/lethargy
4. Tachypnea
5. Hypothermia
6. Signs of infection
47
Newborn Screenings (3)
1. Hearing screening before d/c of all newborns
* If fail - repeat - if fail again - refer
2. Metabolic Screening of heel stick blood evaluation; identifies neonates at risk for treatable illnesses (not diagnostic)
3. Congenital Heart Disease
48
Timing of Metabolic Screening (4)
1. Before 12 hours = risk for false negatives or false positive hypothyroidism
2. All screened before discharge - btw 24-48 hours of life
3. Prior to transfusion
4. Sick or preterm – birth, 48-72 hrs, 28 days or discharge
49
Metabolic Screening for... (9)
1. Most asymptomatic for first 2 weeks of life
Examples:
2. Cystic Fibrosis
3. Meconium ileus
4. Intestinal obstruction
5. Congenital hypothyroidism
6. Umbilical hernia
7. Enlarged fontanelle
8. Macroglossia
9. Jaundice
50
Critical Congenital Heart Defect Screening (7)
1. Recommended universal screening for CHD for all newborns prior to discharge
2. No more observing for cyanosis – can’t see it at 80-95%
3. Done at 24 hours of life
4. Right hand and right foot
5. Pulse ox over 95% -either extremity or less than 3% difference –normal newborn care
6. Pulse ox 90-94% - or over 4% difference –repeat hourly x2
* 3 abnormal = REFER
7. less than 90% Pulse ox –examine and notify –possible transfer
51
Criteria For Discharge (13)
1. Gestation over 35 weeks
2. Vital signs stable
3. Cleared for dischargeby HCP
4. No abnormal cardiorespiratory findings
5. No jaundice
6. Hearing, Metabolic and CHD screens done
7. Cord clean and drying
8. Suck/swallow coordination (2 successful feeds)
9. Circumcision not bleeding
10. Voided and stooled at least once spontaneously
11. Feeding pattern established
12. Eye and Vitamin K prophylaxis
13. Medical home established - follow up scheduled
52
Psychosocial Development of the Newborn: Attachment (3)
1. Forming a secure and trusting relationship
2. Based on caregiver interaction
3. Influences growth and development
53
Red flags of psychosocial development (4)
1. No comfort seeking from caregiver
2. No checking back with caregiver when exploring new situations
3. No reaching out to caregiver after brief separation
4. Infant Depression?
54
Bilirubin Metabolic Pathway (3)
1. RBC are broken down: HGB-degredaded by heme oxygenases (end product of heme catabolism)
2. Release of iron and formation of carbon monoxide and biliverdin
3. Biliverdin is further reduced to bilirubin
*If there is a blockage in the pathway where the Bili accumulates, it can cross the BBB and cause newborn encephalitis or kernicterus
Signs --> lethargy and sleeping
55
Glucuronyl Transferase
Liver enzyme that changes bilirubin into a form that can be removed from the body through the bile transport and then gets passed in the stool
56
Unconjugated bili pathway (3)
1st: Unconjugated (indirect) bili is bound to serum albumin
2nd: It is transferred to the liver where it is conjugated by glucuronyl transferase
3rd: A fraction of the bili from the stool is reabsorbed into the blood stream via portal circulation
57
Increased Risks of Hyperbili (3)
1. Not enough albumin to bind (low in premies)
2. Displacement from albumin increases unbound in circulation (drugs such as sulfa/acidosis/sepsis - all increased in premies)
3. Preterm risk factor
58
Jaundice (5)
1. First sign of hyperbilirubinemia
2. Deposition of unconjugated bili
3. Skin and mucous membranes
4. Cephalocaudal progression
5. Physiological jaundice is normal in first 3-5 days
* Press finger on baby's nose and if it turns yellow, it's jaundice, if it's pale then it's not
59
When is jaundice considered pathological? (4)
1. If it presents within 1st 24 hrs of life
* not good if baby is born jaundice or if it occurs in first 24 hours
2. Rises by more than 5mg/dl/day
3. Higher than 17mg/dl
4. S/S of serious illness
60
Estimated Hyperbilirubinemia (4)
1. Face: ~5mg/dl
2. Chest: ~10mg/dl
3. Abdomen: ~12mg/dl
4. Palms/soles: ~15mg/dl
* Anything over 15 is worrisome
* These are for FULL TERM infants
61
Causes of unconjugated (indirect) hyperbilirubinemia (3)
1. Physiologic jaundice
2. Breastfeeding jaundice
3. Breast Milk jaundice
62
Causes of Conjugated (direct) hyperbilirubinemia (4)
Think liver!
1. UTI
2. Sepsis
3. Biliary atresia
4. Direct greater than 1mg/dl is abnormal
63
Hyperbilirubinemia (4)
1. Any total serum bili level above 5mg/dl
2. Very common to occur in newborns; most cases are mild, idiopathic and benign
3. Almost every newborn develops an UNCONJUGATED serum bili level of more than 1.8mg/dl during first week of life
4. Rate of rise is the most important thing (Rises by more than 5mg/dl/day = pathological)
64
Risks for Hyperbilirubinemia (6)
1. Hematological: ABO or G6PD enzyme deficiency
2. Males
3. Higher in Asians and American indians, lower in AA
4. Increased risk if living in high altitude or Greece
5. Higher in preterm and LBW
6. Cephalohematoma
65
Maternal Risk Factors for Hyperbilirubinemia (5)
1. Fetal maternal blood group incompatibility
2. Breastfeeding
3. Drugs (sulfa or streptonycin)
4. Gestational diabetes
5. Ethnicity
66
Neonatal Risk Factors for Hyperbilirubinemia (7)
1. Birth trauma
2. Excessive wt. loss
3. TORCH (CMV,Herpes,Toxo)
4. Prematurity
5. Previous sibling with Hyperbilirubinemia
6. Delayed passage of meconium
7. Polycythemia
67
Physiological Jaundice (7)
1. Unconjugated hyperbilirubinemia
2. Peaks at 5 - 6 mg/dl
3. Higher in Asian infants – 10mg/dl
4. Peaks on Day 3-5 of life
5. Declines over first week
6. Not in first 24 hours
7. Normal PE
68
Contributing factors to physiological jaundice (5)
1. Polycythemia
2. Shortened life span (80 days)
3. Immature hepatic uptake – GT key enzyme
4. Increased enterohepatic circulation
5. Decreased excretion in physiologic jaundice
69
Diagnosis of Physiological jaundice (2)
1. Serum bili levels
2. Transcutaneous bili levels (TcB)
* avoid excessive heel sticks
70
Severity of physiological jaundice depends on (4)
1. Race
2. Gestational age
3. Drugs
4. Feeding
71
Physiological Jaundice Treatment (4)
1. No absolute level for treatment
2. Bhatani nomogram– based on hours of life and risk factors
* Tells you risk of hyperbilirubenemia and kernicterus
3. Phototherapy
4. Exchange transfusion
72
Presentation and Duration of Neonatal Jaundice (4)
1. Physiological jaundice is present on the third day of life (nonpathologic)
2. Jaundice that is visible during the first 24 hours – most likely to be nonphysiologic
3. Infants who present with severe jaundice that continues beyond the first 1-2 weeks – think……
A. results of newborn metabolic screen
B. Galactosemia (lack of enzyme- build up of galactose- presents in fist days after milk product introduced)
C. Congenital hypothyroidism
4. Stool color should be assessed- pale, acholic stools – direct hyperbilirubinemia check
73
Who needs further physiological jaundice evaluation? (6)
1. Infants who present with jaundice on day the first day or after the third day of life
2. Infants who are anemic at birth
3. Infants who are ill appearing
4. Infants in whom significant jaundice persists beyond the first 2 weeks of life
5. Infant with family history of jaundice requiring treatment or G6PD
6. Infants in whom PE reveals findings not explained by physiologic hyperbilirubinemia
74
Labs to Order for Physiological Jaundice (7)
1. Blood type and Rh
2. Direct coombs test
3. Hemoglobin and hematocrit
4. Nomogram for hour-specific bilirubin levels
5. Bilitool – useful tool for predicting either before or at the time of hospital discharge which infants are likely to develop hyperbilirubinemia
6. Peripheral blood film for erythrocyte morphology
7. Conjugated bilirubin levels (at least once in every case of jaundice)
75
Breastfeeding Jaundice (7)
1. Early onset
2. Exaggerated physiologic jaundice
3. Caloric deprivation
4. Dehydration
5. Decreased volume
6. Delayed passage of meconium
7. Moderate jaundice (12mg/dl)
76
Treatment of breastfeeding jaundice (3)
1. Increase feeds
* increase milk production and hydration of the baby b/c this occurs if mother does not have enough milk leading to dehydration and lack of adequate calories
* Pumping and/or increased feeding
2. Formula supplementation
3. NO water or Sugar water
77
Breast Milk Jaundice (7)
1. Later in newborn period
2. Peaks at 6-14th days of life; ~1/3rd of all healthy BF infants
3. Newborn BF well and adequate amount with no signs of liver abnormality
4. Nonpathologic
5. Substances in maternal milk may inhibit normal bilirubin metabolism
* Not entirely understood
6. Can persist several months
7. Greater elevation for longer duration is the typical presentation
* Baby can look jaundice for up to two weeks but there are no other problems
78
How to test breast milk jaundice (2)
1. Interrupt breast feeding for short period of time and follow up with bili levels; if bili level dips then the cause is the breast milk
2. Dx: serum bili level
79
Treatment for breast milk jaundice (5)
1. Temporarily interrupt
2. Formula supplementation
3. Bili declines over next 48 hours
4. Confirms dx
5. Resume breastfeeding
80
Pathological Jaundice (3)
1. Jaundice within first 24 hours
2. Rapidly rising bilirubin
3. Total serum bilirubin over 17mg/dl
81
Causes of pathological jaundice (5)
1. Sepsis
2. Rubella
3. Toxoplasmosis
4. Occult hemorrhage
5. Erythroblastosis fetalis
82
Physical exam of pathological jaundice (4)
1. Petechiae
2. Brusing
3. Hepatosplenomegaly
4. Can lead to extravasations - cephalohematomas, bruising, hemorrhage
83
Phototherapy Treatment (6)
1. Converts unconjugated bilirubin to be excreted in the bile and urine
2. For full term, do when bili is over 15mg/dl
3. For older infant, do when bili is over 18mg/dl
4. Initiated based on age and TSB level (nomogram)
5. Protect eyes and genital areas
6. No phototherapy with conjugated bili; bronze baby syndrome
84
Exchange Transfusion (4)
1. Most rapid lowering
2. Removes partially hemolyzed and antibody coated erythrocytes and replaces them with uncoated RBCs
3. Prevents kernicterus and corrects anemia
4. Transfer to NICU for procedure
85
Kernicterus
1. Yellow staining of basal ganglia
| 2. Occurs more with exclusively breastfed infants and home births
86
Neonatal Jaundice Time Periods Summary (2A, 7B, 4C)
A. In first 24 hours -- Hemolytic disorder or TORCH
B. 2nd day - 3rd week --
1. Physiological
2. Breastmilk
3. Sepsis
4. Polycythemia
5. Cephalhematoma
6. Crigler-Najjar syndrome
7. Hemolytic disorders
C. After 3rd week
1. Breast milk
2. Hypothyroidism
3. Pyloric stenosis
4. Cholestasis
87
Dacryostenosis (8)
1. Congenital nasolacrimal duct obstruction
2. Obstruction due to imperforate valve of Hasner --> of the nasolacrimal duct --> membrane at birth that covers the NLD fails to break down
3. Occurs in ~ 73% of all term infants
4. Onset in first few days to weeks of life
5. Intermittent to constant tearing or visible drainage
6. Unilateral or bilateral
7. Spontaneous resolution in 65% by 6 months of age
8. Dacryocystitis: Inflammation of the involved duct – infection can develop
88
PE of Dacryostenosis (2)
1. Firm blue gray swelling in the nasolacrimal area
| 2. Unilateral or bilateral
89
Tx of Dacryostenosis (4)
1. Moist warm soaks, massage
2. 95% will resolve spontaneously by 1 year old
3. Treat if infection occurs
4. If unresolved by 12 months, refer to opthomology
90
Differential Dx of Dacryostenosis (6)
1. Excessive tearing
2. Foreign body
3. Corneal abrasion
4. Glaucoma
5. Rhinorrhea with tearing
6. Chlamydia conjunctivitis
91
Thrush (5)
1. White curd-like plaques – on palate and tongue
2. Inflamed buccal mucosa
3. May be associated with cutaneous candidiasis in the diaper area
4. Symptom of HIV disease or immune deficiency if recurrent or severe – does not resolve
5. Oral candida albicans
92
Thrush history (3)
1. Fussy - can be asymptomatic
2. Maternal HIV infection
3. Recent antibiotic use
93
What to look for with thrush (3)
1. White curd like plaque; have to scrape off - may bleed
2. check diaper area
3. check mother's nipples if BF
94
Thrush Tx (2)
1. Mycostatin (Nystatin) suspension of 100,000u/mL
2mL QID for 14 days (swish and swallow)
OR
2. Fluconazole (Diflucan) suspension 10mg/mL
6mg/kg/day for day 1
3mg/jg/day for days 2-14
95
Causes of noisy breathing
1. Congenital stridor
2. Stuffy nose
3. URI
96
Congenital Stridor
1. High-pitched upper airway crowing
2. Common cause of noisy breathing in infancy (up to 1-3 years of age)
3. Laryngomalacia (ENT) = most common cause
4. Subglottic Stenosis
97
Laryngomalacia (5)
1. A congenital abnormality of the laryngeal cartilage
2. It is a dynamic lesion resulting in collapse of the supraglottic structures during inspiration
3. Leads to airway obstruction
4. Delay of maturation of the supporting structures of the larynx
5. Laryngomalacia is the most common cause of congenital stridor
98
Subglottic Stenosis
Trauma below cord/above trachea; intubation is most common in preterm
99
Physical Exam of congenital stridor (6)
1. Retractions
2. Cyanosis
3. Apnea
4. Poor feedings – FTT
5. Cough, choking with feeds, cyanosis
6. Identify site of the lesion
100
Tx of stuffy nose or URI
1. Normal saline nose drops/spray
2. Nasal aspirator
3. Nose Frida
4. Humidifier (lab or intensive) - discuss cleaning
101
Red flags with respiratory disorders (5)
1. Tachypnea (over 60-65bpm)
2. Retractions
3. Grunting
4. Cyanosis in room air
5. Noisy or decreased on auscultation
102
Transient Tachypnea of Newborn (6)
1. Rapid breathing, caused by alveolar retention of amniotic fluid
2. More common in GDM or C-section delivery
3. Gets better over time
4. Need for oxygen is minimal
5. Can be precipitated by cold stress
6. CXR is streaky with fluid in fissures
103
Chlamydia (2)
1. Causes conjuncitivitis, trachoma, pneumonia in young infants and genital infections
* Respiratory presentation as well as in eyes
2. C trachomatis is most frequent cause
104
Chlamydia Conjunctivitis (9)
1. Neonatal conjunctivitis
2. Typically develops 5 to 14 days after birth
3. Lasts up to 2 weeks
4. Conjunctival edema
5. Conjunctival injection
6. Watery to mucopurulenteye discharge
7. Pseudomembrane with bloody discharge
8. Routine prophylactic ophthalmic drops of silver nitrate, erythromycin not effective
9. Erythromycin 50mg/kg divided qid x 2 weeks po
105
Chlamydia pneumonia (10)
1. 2 to 19 weeks of age
2. Preceding signs include rhinorrhea, congestion and 3. conjunctivitis
4. Tachypnea with a persistent “Staccato” cough
5. Congestion
6. Rales and rare wheezing
7. Preterm infants can have apnea
8. Erythromycin tx
9. CXR- hyperinflation and infiltrates
10. Gold standard is culture (must contain epithelial cells)
106
Pneumothorax of Newborn (7)
1. Can be spontaneous or associated with meconium aspiration
2. Bacterial pneumonia, sepsis, respiratory distress syndrome, resuscitative measures
3. Can be Tension or NonTension
Clinical Features
1. Can be a Non distressed tachypnea
2. Decreased breath sounds with or without mediastinal shift (on one side)
3. Clear area with distinct margin and absent lung sounds
4. Retractions
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Tx of pneumothorax (2)
1. NonTension --- can be watched
| 2. Tension -- may require a chest tube
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Diagnostic Eval of Pneumothorax
1. Pass catheter into nares to rule out choanalatresia
2. Look at oropharynx
3. Look at neck
4. Chest- special attention to uneven breath sounds
5. Abdomen- rule out scaphoid
6. Chest Xray
