*CPS Statements TD > Newborn > Flashcards

Newborn Flashcards

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1
Q

Risk factors in newborns for potential issues

A
  • Maternal medical and mental health concerns, positive family history
  • Psychosocial and/or socio-economic stressors, domestic violence
  • Maternal medications, smoking, alcohol, or substance use
  • Abnormal prenatal screening and ultrasound findings
  • Birth weight
  • Maternal hepatitis B surface antigen, syphilis, HIV, or rubella status
  • Maternal blood group and antibodies
  • Risk factors for infection, including maternal Group B streptococcal colonization status or intrapartum antibiotic prophylaxis
  • Abnormal glucose homeostasis
    Developmental dysplasia of the hip
  • Birth injury
  • Apgar score, need for stabilization at birth, and/or low umbilical cord pH
  • Risk factors for early-onset neonatal jaundice
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2
Q

What are abnormalities sometimes missed on newborn exam

A

cleft palate and imperforate anus

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3
Q

Term newborn discharge - what is on check list

A

Maternal readiness

  • Mother provides routine infant care, including feeding, in a safe and confident manner
  • Mother demonstrates knowledge of how to recognize illness in her infant and when to seek help
  • Psychosocial and environmental risk-factors have been assessed, with an appropriate follow-up plan

Infant health

  • Physical examination by health care provider
  • Birth weight, length and head circumference measurements obtained
  • Normal, stable temperature, heart rate and respiratory rate
  • Passed urine
  • Passed meconium
  • Weight loss <10%; if approaching or >10%, a follow-up plan has been arranged
  • Minimum of 2 successful feeds
  • Antenatal and perinatal risk factors (e.g., sepsis) have been evaluated
  • Maternal serology reviewed
  • If circumcision performed, no excessive bleeding at site
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4
Q

What tests need to be done before discharge of healthy term infant (4)

A
  • Newborn screen at 24 h (must be repeated within 7 days if administered before 24 h)
  • Hearing assessment completed or arranged
  • Bilirubin screening – results reviewed and follow-up arranged, if required
  • Pulse oximetry screen performed
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5
Q

What parental education needs to be done before discharge of health term infant

A
  • Routine infant care
  • Infant safety and injury prevention (including car seat safety, safe sleep practices, sudden infant death syndrome risk reduction)
  • Feeding
  • When to seek medical help
  • Care of circumcision site, if infant is circumcised
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6
Q

Types of Vit K deficiency B

A 
early onset (first 24 hours): maternal meds that inhibit vitamin K activity, ex antiepileptics
classic (days 2 to 7): associated with low intake of vitamin K
late onset (2-12 w - 6 mo): breastfed babies
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7
Q

Vit K prophylaxis doses

A
  1. 5 mg (≤1,500 g)
  2. 0 mg (>1,500g)

If decline:
2 mg Vit K PO at first feed, repeat at 2 to 4 and 6 to 8 weeks of age.

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8
Q

When to image in HIE

A

DOL 3-5 or when rewarming has taken place

Repeat at DOL 10-14 if clinical uncertainty

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9
Q

HIE/Encephalopathy - areas of brain injury

A

Basal ganglia/thalamic lesions: cognitive and motor disability
High risk CP

Watershed pattern: more associated with cognitive issues

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10
Q

Why do we give IAP for GBS+

A

To decrease risk of early onset sepsis

NOT late onset

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11
Q

What to do - GBS+ no RF:

GBS+ mother w adeq IAP + no other RF
GBS+ mother w inadeq IAP + no other RF

A

GBS+ mother w adeq IAP + no other RF: No investigations or tx

GBS+ mother w inadeq IAP + no other RF: Careful P/E, Vitals q3-4h x24h, no CBC

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12
Q

GBS+ mom w or w/o adeq IAP + other RF:

A

Not clear, Observe 24-48h, consider CBC at 4 h

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13
Q

GBS unknown or negative + other RF

A

If single RF, can be managed same as GBS+ mother w/wo adeq IAP
If multiple RF, mgmt should be individualized

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14
Q

Maternal and neonatal risk factors for early onset bacterial sepsis in term infants

A
  • Maternal intrapartum GBS colonization during the current pregnancy
  • GBS bacteruria at any time during the current pregnancy
  • A previous infant with invasive GBS disease
  • Prolonged rupture of membranes ≥18 h
  • Maternal fever (temperature ≥ 38oC)
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15
Q

Car seat challenge - for who?

A

no one

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16
Q

What threshold should you use for pRBC transfusion in preterm infants

A

No resp support:
1st week of life: 100
2nd week of life: 85
3rd week and older: 75

Resp support:
1st week of life: 115
2nd week of life: 100
3rd week and older: 85

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17
Q

What volume of pRBC for transfusion in preterm infants

A

20ml/kg

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18
Q

Risks of neonatal circumcision

A 
Minor bleeding	
Local infection (minor)	
Severe infection
Death from unrecognized bleeding	
Unsatisfactory cosmetic results	 
Meatal stenosis
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19
Q

Benefits of neonatal circumcision

A 
Prevention of phimosis
Decrease in early UTI	
Decrease in UTI in males with
risk factors (anomaly or
recurrent infection)	
Decreased acquisition of HIV	
Decreased acquisition of HSV	
Decreased acquisition of HPV	
Decreased penile cancer risk	
Decreased cervical cancer risk in female partners
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20
Q

What are risks associated with rbc transfusions

A

Infection (viral, bacterial, etc) – viral risk 1/1 million
CMV: risk for premature infants; risk reduced with leukoreduction

Leukocyte adverse effects (graft-vs-host, TRALI, allo-immunization all rare in neonates)

Volume and electrolyte disturbances

Blood group incompatibility (transfusion errors)

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21
Q

Indications for RBC transfusion in newborns

A

hemorrhagic shock

anemia

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22
Q

Key competencies for discharge of preterm infant

A

Thermoregulation
Control of breathing (5-7days apnea free)
Respiratory stability
Feeding skills and weight gain

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23
Q

Sarnat scoring

A

Sarnat 1
Hyperalert, normal tone, tachycardia

Sarnat 2
Lethargic, mild hypotonia, weak moro, seizures, bradycardia

Sarnat 3
Stuporous, flaccid, no reflexes

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24
Q

Late preterm - at risk for?

A 
Hyperbilirubinemia
Feeding and growth 
Apnea 
SIDS
Sepsis
Hypoglycemia 
Temperature control
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25
What to do w newborn if mom had chorio
individual observe at least 24h vitals q3-4h consider CBC at 4h
26
when should you monitor vitals of a newborn
chorio multiple RF GBS+ and RF
27
Risk factors for hyperbilirubinemia
``` Visible jaundice at younger than 24 hours Visible jaundice before discharge at any age Shorter gestation <38 weeks Previous sibling with severe hyperbili Visible bruising Cephalhematoma Male sex Maternal age >25 years Asian/European background Dehydration Exclusive/partial breastfeeding ```
28
When does TSB peak
DOL 3-5
29
When to check first bili
In 24-72h
30
Side effects of phototherapy
temperature instability, intestinal hypermotility, diarrhea, interference with maternal-infant interaction and, rarely, bronze discolouration of the skin increased anxiety and health care use in parents
31
When to refer brachial plexus injury?
1 month
32
What nerves for Brachial plexus
C5-T1
33
What percent of neonatal brachial plexus injury will have full injury?
75% full recovery
34
Indications for surfactant therapy
Intubated infants with RDS Intubated babies with meconium aspiration syndrome and > 50% FiO2 need Sick newborns with pneumonia and oxygenation index >15 Intubated newborns with pulmonary hemorrhage and clinical deterioration
35
Xray of RDS
ground glass appearance, air bronchograms, ↓ lung vol
36
Who should receive prophylactic surfactant?
<26 WGA | 26-27 WGA If no steroids
37
Risks of surfactant
```  Short term: bradycardia, hypoxemia, block ETT, pulm hemorrhage, hyperventilation secondary to spontaneously increased FRC and lung compliance  Long term: antibody formation against surfactant, possible transmission of infection (prions) ```
38
What systems does NAS affect?
CNS, respiratory and GI effects
39
what % of infants of moms on opioids will require tx for NAS
50-75%
40
When do sx of NAS present?
usually within 48-72 hours, up to 5-7 days can last up to 30 days, with mild symptoms up to 6 months
41
Finnegan score - what are sx - how long/often
CNS: cry, sleep, exaggerated moro, tremors, tone, myoclonus, seizures. Metabolic/Resp: sweating, fever, yawning, mottling, stuffiness, nasal flare, tachypnea GI: excessive sucking, poor feeding, emesis, loose stools
42
Non-Pharm interventions for NAS
Skin-to-skin, swaddling, gentle waking, quiet environment, minimal stimulation, low lighting, music and massage. Encourage breastfeeding
43
Pharm interventions for NAS
Morphine and Methadone Adjuncts: phenobarbitals and clonidine
44
Factors important in Communicating w Families w a Perinatal Loss
Should be guided by honesty and respect Info should be provided in a clear, timely and sensitive way to enhance SDM Both parents should be present if possible If diff language, should have interpreter present Should have enough time for dialogue, questions and emotional expression More than one encounter is usually needed Should occur in quiet, private space Small group > large, conference style “Baby” instead of “fetus” - use name if named
45
Lesions detectable using pulse ox screening
``` HLHS Pulmonary atresia w intact vent septum TOF TGA Tricuspid Atresia TAPVR Truncus arteriosus ```
46
Pulse oximetry screening - who and when
WHO: all term and late preterm For asymptomatic infants in nonacute setting WHEN: recommended 24-36 hours after birth Flexible - can be done during day, with other tests/events **Should be done after 24 hours
47
Pulse ox screening - how - pass/fail
Should test RIGHT HAND and ONE FOOT FAIL: SaO2 < 90% BORDERLINE: SaO2 in any limb of 90-94% or >3% difference btwn limbs
48
Who to screen for ROP and when
Either GA <31 wga OR BW ≤ 1250g at 31 wga or at 4 weeks old, whichever is first
49
Tx for ROP
Tx: retinal ablation (conventional) and intravitreal injection of antivascular endothelial growth factor (anti-VEGF)
50
advantages of kangaroo care
helps stabilize vitals KC increases sleep time and more organized sleep Long term - improved neurodevelopmental outcomes assoc w better Breastfeeding Decreased infections, NEC and improved growth and neurodevel outcomes Decreases incidence of nosocomial infections Improves mother infant bonding b/c NICU separates
51
How prem can you do kangaroo care
26wga
52
complications of iNO
production of NO2 and methemoglobin, decreased platelet aggregation, increased risk of bleeding and surfactant dysfunction.
53
Who to treat with iNO age indications
Infants >35 weeks GA (not as effective in prem) Hypoxemic respiratory failure Echo to rule out cyanotic heart disease, and to assess for Pulm HTN/cardiac function OI > 20-25, or PaO2 < 100 despite ventilation with 100% oxygen
54
What percent of preterm infants born at ≤32+6 weeks gestational age (GA) show an abnormal brain image (IVH or parenchymal lesions) on cranial ultrasound
21%
55
Who should receive steroids
≤34+6 wga with risk of delivery in the next 7 days
56
Who should receive MgSO4
mothers at risk for imminent delivery of an infant ≤33+6 weeks GA in the next 24 hours
57
What to do if PPROM or chorio and infant <33wga
BCx and Abx
58
What gestation to use polyethylene bag
<32 wga
59
Preterm infants - what type of ventilation | Target pCO2
Volume targeted | Target PCO2 of 45-55 mmHg
60
How to reduce risk of brain injury in preterm infant?
``` Treat mother with PPROM or chorio BCx and Abx for infant of mom w chorio Steroids <35wga MgSO4 <32 wga DCC Avoid inotropes Consider indomethacin Target pCO2 45-55 Volume controlled ventilation Head neutral, midline, HOB 30 deg At tertiary centre ```
61
Cut offs for hypoglycaemia
First 72h: <2.6 | >72h: <3.3
62
Infants at risk for hypoglycemia
Weight <10th percentile (SGA) IUGR Weight >90th percentile (LGA) IDM Preterm infants <37 weeks GA Maternal labetalol use Late preterm exposure to antenatal steroids Perinatal asphyxia Metabolic conditions (e.g., CPT-1 deficiency, particularly in Inuit infants) Syndromes associated with hypoglycemia (e.g., Beckwith-Wiedemann)
63
NRP Resusc: | what FiO2 to start with
For the term infant, resuscitation should start with 21% oxygen. For preterm infants <35 wga, recommended initial gas is 21%–30% oxygen
64
NRP: what technique for compressions
two thumb
65
what gestation do you do thermoregulation measures and what are they
maintaining room temperature at 23°C, preheating the radiant warmer, use of a hat, placing a thermal mattress under the radiant warmer and using a polyethylene wrap
66
What do steroids do for neuroprotection
IVH
67
What does MgSO4 do for neuroprotection
CP
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