Normal Newborn Management

Question 1

normal NB Hgb

Answer 1

14.0-20.0

Question 2

normal NB Hct

Answer 2

43-63%

Question 3

normal NB WBC

Answer 3

10-30,000

Question 4

normal NB platelet count

Answer 4

150-350,000

Question 5

What is a concerning newborn blood sugar level?

Answer 5

<45-50 mg/dL

Question 6

What can be expected of a NB’s blood glucose in the first 2h PP?

Answer 6

can fall to nadir of ~40 mg/dL

Question 7

normal NB urinalysis

Answer 7

• low specific gravity
• no protein
• no blood

Question 8

direct vs indirect bilirubin

Answer 8

indirect = unconjugated = non-water-soluble –> direct = conjugated = water-soluble - can be excreted through urine and stool

Question 9

What is a normal total bilirubin for a NB at day 1?

Answer 9

<5 mg/dL

Question 10

When do bilirubin levels peak in NBs?

Answer 10

b/w 48-92h PP

average value = 7-9 mg/dL

Question 11

What are the rare metabolic disorders included on the standard NB screen?

Answer 11

1) phenylketonuria (PKU)
2) maple syrup urine disease (MSUD)
3) galactosemia

Question 12

What does the direct antiglobulin test (DAT)/direct Coombs test look for?

Answer 12

antibodies directly bound to NB’s RBCs

Question 13

What does a negative direct Coombs test indicate?

Answer 13

normal!

positive = BAD!

Question 14

What is the expected number of stools for the breastfed NB?

Answer 14

Once lactation is established, 3-4 stools/day

Question 15

When should one be concerned about a NB’s elimination frequency?

Answer 15

If no BM or urine w/in 24-48h, call pediatric provider

Question 16

What is the expected number of stools for the formula-fed NB?

Answer 16

2-4 stools/day in 1st month –> become less frequent (1-3/day) as infant gets older

Question 17

How does breastfeed NB stool look compared to the formula-fed NB?

Answer 17

formula-fed = firmer, darker, smellier

Question 18

How often should a NB urinate?

Answer 18

at least 6x/day

Question 19

How much formula should be given to NBs in the first weeks?

Answer 19

2-3 oz q3-4h

Question 20

How long should the first bath be delayed?

Answer 20

According to WHO, at least 6h

Question 21

How should cords be cared for?

Answer 21

just keep it dry!

Question 22

How should circumcisions be cared for?

Answer 22

• cleanse daily w/ cotton balls dipped in tap water

- apply small amount of petroleum jelly to tip for first 2-3 days w/ each diaper change

Question 23

How long can NBs sleep?

Answer 23

• 16-18h/day for first few days

- 8-20h/day at 4wks PP

Question 24

When is the soonest a NB will likely sleep more at night?

Answer 24

at 12wks

Question 25

true or false: NBs do not know day from night

Answer 25

false-ish NBs are less confused than they are not as governed by circadian rhythms

Question 26

Why do NBs sleep so much during the day?

Answer 26

sleep associated w/ eating

Question 27

What indicates a NB is overheated?

Answer 27

- red skin - irritability - body warmth - lethargy

Question 28

What are danger s/sx in the NB and should be reported?

Answer 28

1) axillary temp > 99.3F or < 97.5F 2) tachypnea (>60 breaths/min) for > 1 min 3) periodic apnea (pauses >20s) 4) abnormal respirations (e.g retractions, wheezing) 5) umbilicus infection 6) eye infection 7) jaundice 8) GI: projectile vomiting, bile-stained vomit, no stools/urination since birth, taut/swollen abdomen 8) diarrhea (>6 stools/24h) 9) general signs of illness

Question 29

How can diaper rash be treated pharmacologically?

Answer 29

topical antifungals (miconazole) or topical steroids (hydrocortisone) applied at every diaper change until rash gone + 1-2 days after

Question 30

How can thrush be treated?

Answer 30

- nystatin suspension PO 4x/day - gentian violet 1-2% aqueous sol'n applied 2x/day until 1-2 days after white patches gone - put sol'n on nipples if breastfeeding

Question 31

What are potential benefits of circumcision?

Answer 31

1) cleaner glans penis 2) lower chance for UTI 3) reduced incidence of penile cancer, phimosis, balanitis, adhesions, and occlusion of urethral meatus