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High Risk NB
Hypogly, Bili, GBS
| Term | Definition |
|---|---|
| Surgical birth issues (list 4) | 1) Lack of vaginal squeeze, 2) effects of meds, 3) abruptness/handling stresses NB, 4) loss of natural environmental (smell, heartbeat) |
| For a late preterm NB, they have __ the odds of ____ than term NBs in surgical birth | 9; respiratory disease |
| Hypoglycemia is defined as ______ mg/dl | < 45 mg/dl |
| If there is a dip in BG, need stable results for the next __ checks to be considered stable | 3 |
| True or false: most common sx of hypoglycemia in a TERM infant is NO sign | True |
| Other s/sx of hypoglycemia include | Temp =< 36.1C, lethargy, poor feeding/tone, jittery |
| Who is at risk for hypoglycemia? | SGA, LGA, babies of DM mothers, baby of birth injury, late preterm, baby w/ poor thermoregulation |
| Treatment for hypoglycemia | Give supplement (colostrum > formula), prefer protein, do f/u testing |
| What site do you use to check for BG? | Outer region of heel |
| List causes of hyperbilirubinemia | 1) destruction of fetal cells, 2) blood type incompatibility, birth injury, 3) dehydration, 4) infection, 5) immature/abnormal liver |
| What is hyperbilirubinemia? | RBC destruction leading to rise in bili levels |
| Conjugated hyperbilirubinemia is _____-soluble and _____ | Water-soluble; NON-toxic |
| Unconjugated hyperbilirubinemia is ________-soluble and ____ | Fat-soluble; TOXIC to body tissues |
| Bili levels typically rise over first __ days and then resolves in ____ in normal NB | 3-5 days; resolves 10-14 days in normal NB |
| Which type of hyperbilirubinemia causes significant mental retardation? | Unconjugated |
| Therapy for hyperbilirubinemia? | Hydrate babies, put them to breast, let liver process |
| Who is at greater risk for developing hyperbilirubinemia? | Vacuum suction, Mom O+, baby birth injury, poor BF |
| ________ hyperbilirubinemia peaks at 3-4 days and is _______ | Physiologic; expected compensation |
| Pathologic hyperbilirubinemia peaks at ___ days usually in _________ | 2 days; blood incompatibilities |
| Pathologic hyperbilirubinemia peaks at ____ days with _______ and usually passes on its own | 3-5 days; birth injury |
| Which type of jaundice is most associated with ineffective feeding? | Early breast milk jaundice |
| Nursing care for early onset BM jaundice | Promote good BF, offer breast q2-3h or 8-12x/24h, increase fluids through BF/IV |
| ____ onset BF jaundice will have total bili levels of ____ | Late; 12-20 |
| Late onset BF jaundice may be d/t | Hormonal interference w/ liver conjugation |
| When does late onset BF jaundice peak? | 7-10 days |
| True or false: with late BF jaundice you want to stop BF and supplement with formula immediately. | False. Unless bili levels very high, don't want to disrupt BF |
| _____ may contribute to pathologic hyperbilirubinemia | Polycythemia |
| In pathologic jaundice, you will see bili levels > ____ @ day of birth and total bili levels greater than _____ | 5; 17 |
| What is the pH of babies with pathologic jaundice? | Low; babies may have acidosis |
| Bilirubin encephalopathy is as also known as ____ | Kernicterus |
| What are signs of kernictus? | Seizures, hypotonia, lethargy, irritability |
| Kernicterus may be a precursor to _____ and other complications include _______ and ________ | Cerebral palsy, paralysis, auditory dysfunction |
| Care to prevent kernicterus/pathologic jaundice | Give moms Rhogam, good prenatal checks |
| To prevent kernicterus, it's important to keep bili levels BELOW ____ mg/dl | 20 |
| True or false: preemies may develop kernicterus at lower bili levels than term NB | True |
| Jaundice progresses from face ____ | Down |
| Bilimeter is not valid after ___ started and people of ___ will have higher readings | Phototherapy; color |
| Total bili under __ during first 24h is considered okay | 5 |
| Lab tests for jaundiced babies | NB blood type, CBC (to r/u sepsis), total bili, Coombs |
| What is an indirect Coombs test? | Prenatal test to determine if there's issues for mother and if infant at risk for hemolytic disease |
| If an indirect Coombs has a positive result, we do what? | Screen NB later using direct Coombs |
| Direct Coombs test does what? | Tests baby to see if there's any RBCs destroyed (looking for autoimmune hemo |
| If a baby is at ____ level risk on Bhutani's graph, we should just make sure baby is feeding weel | Low intermediate to low risk |
| If baby is at ___ level risk on Bhutani's graph, we would put them under bili lights and fluids | High intermediate |
| List the bili levels you can estimate based on location of jaundice | Face [5]; nipples [8], groin [10-12], thighs [15] |
| How do you prevent hyperbilirubinemia? | Hydration, frequent feeding, early identification |
| Treatment for jaundice | Hydration and phototherapy (to alter bili so it can better bind to protein and be excreted) |
| Care for baby undergoing phototherapy | Hydrae with q2-3 feeds, increase protein, keep temp regulated, stimulate bowel thru feedings, safety |
| How can we avoid burns on baby undergoing phototherapy? | Cover eyes/genitals; no lotions or oils |
| When should we give mom Rhogam? | At 20th week or within 72 hours of pg |
| Iso-immunization indicates severe ____ | Blood incompatibility |
| _______ is a fetal complication of Rh incompatibility | Hydrops fetalis |
| What is hydrops fetalis? | Pathologic changes that develop in fetal organs secondary to anemia |
| S/sx associated with hydrops fetalis | Fetal hypoxia, CHF, hypoproteinuria (r/t hepatic dysfunction), true sinusoidal pattern on FHM |
| True or false: babies can die in utero d/t hydrops fetalis | True |
| What is ABO incompatibility? | Type O mom has baby with A/B/AB blood |
| ABO incompatible babies usually have enlarged _____ | Spleens/liver |
| True or false: hydrops fetalis presents in Rh and ABO incompatibility | False. Only Rh incompatibility |
| Management of ABO incompatible babies | Coombs test on mom; monitor |
| Exchange transfusion is a last resort and can be done by removing whole from through ___ | Umbilical vessel |
| High dose ___ is given during baby's blood transfusion | IV immunoglobulin |
| What is the reason for exchange blood transfusion? | Baby's total bili level remains elevated AFTER phototherapy |
| True or false: maternal postpartum antibiotic prophylaxis has decreased early onset GBS by 80% in last 20 years | FALSE. Maternal INTRAPARTUM antibiotic prophylaxis has decreased early GBS |
| When is GBS screened? | 35-37 weeks |
| True or false: 60% of term infants with GBS disease are born to mothers who were (-) on late 3rd trimester screening | True |
| ALL ____ patients should be screened and treated if positive | Preterm labor |
| Higher doses of ____ prophylaxis in labor | Penicillin |
| For GBS if NB is showing mild signs (remember sx cluster), do lab tests such as | Blood cultures, CBC, LPs |
Created by:
lapio-obgyn
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