WK7: Neonatal resuscitation, NST, Neonatal injections Flashcards

Question

What is Congenital Hypothyroidism (CHT)? its incidence? pathophysiology? clinical manifestation? treatment?

Answer 1

= The thyroid gland is absent or has not developed properly in these children Incidence: Affects 1 in 2,200 babies in Victoria Patho= causes of abnormal thyroid development during pregnancy are unclear. It is not inherited but occurs spontaneously. Also occurs in countries with low levels of iodine in the diet Complications: - Low thyroid hormone levels can lead to intellectual disability, growth problems, deafness Treatment= a dose of thyroxine evey day for the rest of babys life. - Early thyroid hormone replacement is very effective treatment in correcting the deficiency and its devastating effects.

Answer 2

Incidence= Affects 1 in 12,000 Victorian babies Patho= Defective enzymes that turn fat into energy Complications= If untreated can result in - muscle problems - poor feeding and digesting - vomiting - seizures - sudden death Treatment: dietary modification= avoiding certain fatty acids in the diet.

Answer 3

- A group of over 20 different conditions that affect the breakdown of amino acids or fats - About 9 babies a year will be detected by the NBST with a rare metabolic condition - Mild conditions and special treatment is needed only when the child has an episode of illness such as a viral infection Treatments: treated with special diets or vitamin supplements, or with special medications - Very rarely, abnormalities detected in the baby that are caused by the mother herself having nutritional deficiencies or one of these conditions

Answer 4

48-72hrs old (regardless of feeding or gestational age) *recommended to be performed in this time frame - Allows time for baby's metabolism to establish itself and avoids delay of diagnosis - Can be collected at the first home visit if discharged early - If taken at an older age, it should be noted down the time of the sample - Taken at the same time to standardise - The early sample may gove false negative as baby's metabolism has not had time to establish itself. - To late, delay of diagnosis and treatment also some metabolites decline with age - A poor quality sample can require a recollection, creating anxiety for parents and distress for babies. In some cases parents may refuse the request for recollection, leaving the baby without a meaningful result.

Answer 5

- poor sample - Preterm babies may require retesting when they reach term equivalent age - palliated infant - Infant receiving blood or blood products

Answer 6

1. consent for the test 2. consent for the sample to be used for medical research purposes

Answer 7

- Gain consent - Card filled out completely before heel prick - Parent education and consent - Explain they have all info - NIPT or amniocentesis may know some of the condition - Correct site for collecting a sample - Shaded area indicates safe puncture site areas - (Draw an imaginary line from middle of big toe, and b/w 4th & 5th toes to the heel then go on the outside of that) 1. If alcohol swab is used to prepare the area, needs to be properly dried before taking sample (dont need to swab the area but does prevent contamination) 2. Do not use petroleum jelly for NST 3. Hold the hell in ok position 4. Press tenderfoot into foot 5. First drop of blood should be wiped away with cotton ball (to reduce contamination) 6. Aim to fill at least 2/3rds of the area of each spot, ensuring blood has soaked through to the back of the card 7. Insufficient blood cannot be tested

Answer 8

- Breastfeeding (works as a natural pain relief) - Help upright by parents (gravity so blood flows ot foot) - Warm feet (with warm towel to get blood to the site) - Consider sucrose (not ideal to bring this into the babys gut)

Answer 9

- Use for procedural pain in neonates, where BF is not possible - Small amounts of sweet-tasting solution on anterior of tongue results in a calming effect on baby - Taste thought to influence endogenous opioid release - Analgesic effect lasts 5-8mins, enhanced by other measures such as non-nutritive sucking, swaddling, cuddling, skin-to-skin - Most effective in the first month of life

Answer 10

- Air dryed for >4hrs (with no heat applied) - Place in an individual envelope or with plain paper between samples - Mailed immediately once dry, not in plastic - Nominate hospital liaison person mails cards directly to newborn screening lab

Answer 11

- Cards not filled out properly - Contamination urine, faeces, petroleum jelly - Blood spots inadequate - Too little or clotted - Cards not air dried - Dried artificially or sent in a plastic bag - Delivery, stockpiling

Answer 12

- within their right - ensure adequate education and understanding of the various consents for different uses. - Document it on the card - Parents must sign written statement of refusal- Still fill out a card just tick the ‘no’ consent box and sent off as normal - Referral to Genetic Health Counsellor (they will go though the history) - Refusal is documented and signed, placed in mother’s/baby’s file - NST card should have information completed, with ‘refusal’ written on it - Card sent as evidence to Newborn Screening Laboratory

Answer 13

- All samples and information are securely stored in accordance with privacy legislation and access to the card is restricted according to agreed protocols - Cards stored in a secure facility of the laboratory for two years and then in an off-site secure storage facility which has been approved by both the Department of Health and Human Services (DHSS) and the Public Records Office. - Samples stored for at least 25 years as recommended by the National Pathology Accreditation Advisory Council of Australia and the Public Records Office. - A minimum period of two years of storage is essential for quality assurance purposes (so they can go back and restest so they can test quality control) e.g. if a few children are diagnosed with a metabolic condition the NST didn't pick up they will restest all those form that time period to ensure they weren't at fault. - Parents can request the transfer of their child's card to their custody once the child is two years of age - Parents can nominate that there is no secondary access to the card without their explicit permission

Answer 14

Quality assurance - Access to the blood spot is essential in case of misdiagnosis, e.g. If a child is diagnosed with a condition that was not identified by newborn screening. E.g. if a child gets to 5 years and is diagnosed with CF all the cards tested at that time need to be reviewed to ensure there was no issue or a problem on that card itself - Access to anonymous newborn screening cards Diagnosis - The newborn screening card is a convenient way of transporting blood samples for special individual testing interstate when a particular test is not available in Victoria. - Retrospective diagnosis for the child. - For the benefit of close blood relatives in a deceased child. Forensic identification - Only by court order at the request of the Coroner's Court, for identification of deceased persons. - E.g. missing persons or coroners court Research - Strict criteria for approval from the research ethics committee

Answer 15

there is a small risk of infection; this is minimised by using gloves and cleaning the heel prior to collection.

Answer 16

- Complete all personal details and check with the parents they are correct. - ensure adequate information is provided - consent for test? - They have to sign and tick for secondary research or not - Making the card available for research use is a personal choice and should not interfere with the decision for screening. - It should be documented in the mother’s file that discussion about the newborn bloodspot screening test has occurred, that consent was provided, and the date and time the sample was collected.

Answer 17

- Not an immunisation, a supplement - to prevent VITK deficiency bleeding Vit K is required for; - bone formation on the fetus - forming the clotting factors VII, IX, X - Forming anti-clotting factors protein C and S in the liver

Answer 18

- Stored= in liver Obtained from: - the diet (green veg, veg oils, eggs, cows milk) (K1) the gut flora (K2) - The fetus stores up Vit K in their last month in utero. However, concentrations are lower than maternal, and the placenta acts as a partial barrier to transfer. - All infants have some form of deficiency at birth - Before gut flora is established in the neonate after birth, the healthy neonate has low intake of Vit K, especially those that BF. - Baby forms microbiome from BF, skin on skin, injecting flora on mothers skin, kissing from mother - Important for influencing immune function, line the intestines, break nutrients, avoid infections, hormone function, produce kit K. - There is a transient decline in Vit K dependent clotting factors and anti-clotting factors in the first few days after birth - Offer vit K for BF babys (not those formula feed), mix fed - Prophylactic administration of Vit K prevents the physiological decline, and decreases the risk of VKDB - Colostrum is high in Vit K compared to breast milk

Answer 19

Diagnosis: - Spontaneous or excessive induced bleeding at any site (e.g. NST) with decreased activity of Vit K dependent coagulation factors yet the normal activity of Vit K independent factors fibrinogen levels and platelet count. Classes of VKDB - Early (in the first 24hrs) (highest risk) - Classical (24-7days) - late (6-8 months) - based on the presentation Incidence for early and classical is approximately 0.25%-1.7%, late onset is approx. 4.4 to 7.2 per 100,000 births (reports from Europe and Asia) - As an example, administering a single oral dose the rate of late onset for exaple decreases to 1.4 to 6.4 per 100,000 births Risk factors for VKDB - Instrumental birth - Prolonged birth - Shoulder distocia - Traumatic birth - Insults from birth - Child abuse + neglect (in later life)

Answer 20

Konakion - IM, IV or oral Oral: 2mg IM/CS: 1mg

Answer 21

- First immunisatino on the regiestary - Up to the parent to make the informed decision - Talk about what is in the injection Hepatitis B= is an infection caused by a virus Transmittion= can be transmitted by contact with bodily fluids (needles, sexual intercourse, babys get it from parents) of an infectious person (perinatal, parenteral, mucosal) What it does: After infection, some people can become chronically infected and it affects the liver. Chronic Hep B is associated with death from cirrhosis or hepatocellular carcinoma (liver cancer) in up to 25% of cases. - Not particulary common in aus. Most common in south easy Asia Women with hep b: - Women who test positive for Hep B surface antigen (HBsAg) will be recommended and prescribed that their baby have a single dose of Hep B immunoglobulin (HBIG) as well as the H-B-Vax II immunisation Hepatitis B immunoglobulin= VF is prepared from human plasma containing high levels of antibody to surface antigen of the hep B virus *** a blood product Must follow procedures for blood product administration

Answer 22

Administration - recommend within 24 hours of birth, then 2, 4, 6 months of age - Given IM - (opposite leg to H-B-Vax II) - Use 25 gauge needle - Must be stored in the fridge - Best used within 5mins of being out of the fridge

Answer 23

Jehavas whitness' *** as it is a blood product

Answer 24

- Anterolateral thigh is the prefered placement for infants under 12 months (the bulkiest part of the vastus lateralis through muscle) - in the upper middle third of the infants thigh.

Answer 25

1. Make sure there is a written medication order on the medication chart. 2. Check the correct drug/dose/time/interval/route/patient. 3. Draw the medication up into the syringe using the large bore needle. 4. Change to the 23 g 25 mm needle or 25 g 16 mm needle. 5. Be aware that a second staff member to help position the infant on his/her back on an appropriate surface may be required. 6. Administer sucrose. 7. Undo the infant’s nappy to locate the junction of the upper and middle thirds of the vastus lateralis thigh muscle. 8. Place your forearm across the infant’s pelvis and secure the thigh between your thumb and forefinger if you are the clinician performing the injection. 9. Position the limb to relax the muscle. 10. Pierce the skin at an angle of 90 degrees to the skin. Provided an injection angle of > 70 per cent is used, the needle should reach the muscle layer. The following figures of the thigh show the recommended injection site.

Answer 26

1. When administering a neonatal IM injection what gauge and length needle should be used? 2. What part of the thigh muscle should be injected? 3. At what angle should the needle pierce the skin? 4. What is the recommendation regarding the use of alcohol swabs? 5. What can be done or used to relieve a baby's distress? 6. As there are no large blood vessels in the recommended sites, aspiration before injection of vaccines (pulling back on the syringe plunger after needle insertion but before injection) is not necessary. 7. Slowly inject the medication for even distribution and to minimise the infant's discomfort. 8. Remove the needle. 9. Check the injection site for bleeding and apply cotton wool ball if necessary. Observe the site for local inflammation. 10. Dispose of the needles and syringe into a labelled puncture proof container to prevent needle stick injury or reuse. 11. Document the administration of the IM injection on the medication chart and/or child health record (where appropriate).

WK7: Neonatal resuscitation, NST, Neonatal injections Flashcards

(50 cards)