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N113 Neonatal
N113 - Neonatal transition
| Question | Answer |
|---|---|
| Why is erythromycin used? | For prevention of opthalmia neonatorum, neisseria gonorrhea & chlamydial infections. Given within 1 hour of birth. |
| Why is a vitamin K injection given? | Promotes liver formation of clotting factors (prevent hemorrhage). Newborn gut does not contain bacteria required to produce vitamin K until several days (bottle fed) to several weeks (breast fed). |
| Which babies are at risk for developing hypoglycemia? | Babies born to diabetic mothers, babies small for gestational age, premature babies. |
| Why is hypoglycemia a concern in newborns? | Brain depends on glucose. Too little glucose can impair function, can lead to seizures or brain injury. |
| What are the symptoms of hypoglycemia? | Symptoms may include: jitteriness, cyanosis, apnea, hypothermia, poor body tone, poor feeding, lethargy, seizures. |
| How is a newborn treated for hypoglycemia? | May be as simple as giving glucose/water mixture or formula. Baby may require a glucose IV. Glucose levels are closely monitored after treatment for recurrence. |
| What is considered a low glucose level in newborns? | In most cases 40 mg/dl, some will go as low as 20 mg/dl. |
| What is APGAR scoring? | It assess 5 characteristics of the newborn: appearance-color, pulse-heart rate, grimace-irritability, activity-muscle tone, and respirations-respiratory effort. |
| How often is APGAR scoring done? | At 1 and 5 minutes. If problems continue, can be done again at 10 minutes. |
| How is the central nervous system assessed in a newborn? | Moves extremities, symmetric features & movements, reflexes intact & appropriate, anterior fontanel soft & flat, spinal column completely closed |
| How is the cardiovascular system assessed in a new born? | Heart rate strong & regular - 120-160, as low as 100 when sleeping, as high as 180 when crying, no murmurs, pulses strong/equal bilaterally, cord with 2 arteries & 1 vein, color overall pink. |
| How is the respiratory system assessed in a newborn? | Lungs clear to auscultation, no retractions or nasal flaring, rate 30-60 breaths per/min, chest expansion symmetric, no upper airway congestion. |
| How is the genital/urinary system assessed in a newborn? | Male - urethral opening at tip of penis, testes descended bilaterally. Female - vaginal opening apparent. |
| How is the GI system assessed in a newborn? | Abdomen is soft, no distention, cord attached & clamped, anus patent - 1st meconium stool |
| How is the ears, nose & throat assessed in a newborn? | Eyes clear, palates intact, nares patent, symmetry, top of ears align with outer canthus of eyes. |
| How is the integument system assessed in a newborn? | Color - pink or acrocyanotic, no lesions or abrasions, no peeling, birthmarks, caput/molding, vacuum 'cap', forceps marks |
| When are the alveolar ducts developed? | Between 20-24 weeks, determines viability and ability for newborn to breathe. |
| At what age do the type 1 & type II cells differentiate? | Between 24-28 weeks, type I - respiratory gas exchange, type II - provide synthesis & storage of surfactant. |
| What is surfactant? | A group of surface-active phospholipids - lecithin & spingomyelin, critical for alveolar stability. |
| What mechanical events take place in the respiratory tract? | 1/3 of fluid is squeezed out by movement through the birth canal by chest compression. Remaining fluid must be suctioned out. All fluid is suctioned with C-section babies. |
| What chemical events take place in the respiratory tract? | First breath is an inspiratory gasp, triggered by the cord being clamped off. CO2 increases which stimulates the aortic & carotid chemoreceptors. |
| What is the ductus venosus? | It is a shunt that bypasses the liver, shunting blood directly to the inferior vena cava. |
| What is the foramen ovale? | It bypasses the lungs, it is an opening between the right & left atrium. |
| What is the ductus arteriosis? | It bypasses the lungs also, it is an opening between the pulmonary artery & aorta. |
| When does the ductus venosus close? | It closes with clamping of cord, permanently fibroses in 1 week. |
| When does the foramen ovale close? | Closes when pressure in LA becomes higher than RA. Permanently closed by 3 months. |
| When does the ductus arteriosis close? | Constricts within minutes of birth, complete closure in 10-15 hours. Permanently closes by 3 weeks. |
| What hematologic differences occur in a newborn? | Infant has increased RBC's and increased H&H which enables cells to receive enough O2. Newborn RBC's have shorter life span and breakdown releases bilirubin causing jaundice. |
| What factor can impact fetal blood volume? | Delayed cord clamping can cause an increase in fetal blood volume. |
| What are the liver functions after birth? | Maintenance of blood glucose levels, production of clotting factors, iron storage, metabolism of drugs. |
| What is conjugated bilirubin? | Conversion of yellow lipid-soluble pigment into water-soluble pigment. |
| What is unconjugated bilirubin? | A breakdown product derived from hemoglobin that is released primarily from destroyed RBC's - NOT an excretable form and potential toxin. |
| What are sources of bilirubin? | Physiologic destruction of RBCs - normal & pathologic destruction of RBCs - abnormal |
| What is physiologic jaundice? | Never present during first 24 hrs of life, appears on 2nd or 3rd day. Considered normal if level doesn't get too high. |
| What is breastfeeding jaundice? | Develops due to insufficient intake during first few days. Meconium not eliminated, which is high in bilirubin. |
| What is pathologic jaundice? | Always abnormal. Occurs during first 24 hours, clinical significance depends on age. Major contributing factor is incompatibilities between mother & infant blood type. |
| How are jaundice levels read? | Jaundice levels increase corresponding to the newborns age. A higher level in a 3 day old is acceptable when the same level would be unacceptable in a 2 day old. |
| What digestive enzyme is a newborn lacking? | Pancreatic lipase, which is used to digest fats. Lipase is found in breast milk. The fats in breast milk are easier to digest than those in formula. |
| What can difficulty coordinating suck/swallow signify? | May indicate cardiac abnormality or tracheoesophageal fistula - may drool. |
| What is conductive heat loss? | Heat transferred from a heat source (neonate) to an object that is colder when the two are in contact. |
| What is convective heat loss? | Loss of heat by air movement - open door, air conditioning vent |
| What is evaporative heat loss? | Heat loss related to moisture on skin, wet linens or clothes. |
| What is radiant heat loss? | Heat loss between a warm surface (neonate) and cold room. |
| How will a newborn combat cold stress? | Metabolic rate will increase. Increased metabolism leads to increased heat produced in body. Oxidation of brown fat, reserves are normally available for several weeks. |
| What position will conserve heat loss in newborn? | Flexed position, arms and legs drawn up under abdomen. |
| What happen during cold stress? | Increased metabolic rate increases demand for O2. O2 & energy are diverted from normal function. If demand for O2 can't be met, respiratory distress syndrome can occur. |
| When does a fetus begin producing urine? | At 12 weeks gestation, by 2nd half of pregnancy - fetal urine is major source of amniotic fluid. |
| When are the kidneys completely developed? | By 35 weeks gestation. Still more difficult for newborn to concentrate urine (high levels of H2O in urine), may lead to dehydration, acidosis & over hydration. |
| What happens during the 1st period of reactivity? | Occurs during 1st 30 minutes after birth. Best time for bonding & breast feeding. Infant is alert, startles easy, cries, exploratory behavior. Respirations are irregular, possible grunting & nasal flaring. |
| How long does the period of inactivity last? | Can last anywhere from 60-100 minutes, decrease in motor activity. Baby will likely sleep. |
| What happens during the 2nd reactivity phase? | Occurs during 4th to 8th hour after birth. Lasts from 10 minutes to several hours. Increase in muscle tone, skin color & mucus production. Meconium is frequently passed at this time. |
| What is deep sleep? | Baby is very quiet with very little movement, no facial or eye movement. Breathing is smooth & regular, very difficult to awaken. |
| What is light sleep? | Active sleep, eye fluttering & body movements. Breathing is shallow & irregular. Baby may make crying or fussing sounds. Baby may console self back to sleep. Babies spend most of their sleep time in this state. Can be aroused easily. |
| What is the quiet alert state? | Time when baby is still and ready for interaction. May smile and follow objects with eyes. Best time for parent interaction - talking, singing, playing |
| What is habituation? | Ability to process and respond to stimuli - neonatal defense mechanism. |
| What is orientation? | Ability to be alert, follow and fixate on visual stimuli. |
| What is IgG? | Only immunoglobulin to cross placenta, active against bacterial toxins. |
| What is IgA? | Does not cross the placenta and not adequate until 4 to 6 weeks of age. Present in colostrum & breast milk. Protects the respiratory & GI systems. This is the reason infants are susceptible to respiratory & GI infections. |
| What is IgM? | Produced by gram negative enteric organisms & some viruses. Does not cross the placenta, produced by fetus at 10-15 weeks gestation. If elevated, may indicate intrauterine exposure to bacteria. |
| What is active acquired immunity? | Formation of antibodies in response to an illness or immunization. |
| What is passive acquired immunity? | Results when IgG antibodies are passed from mother to fetus. Very active against bacterial toxins, passed in 3rd trimester. |
| What antibodies are found in breast milk? | IgA, IgG & IgM are all found in breast milk, the most important one is IgA. |
| What is congenital adrenal hyperplasia (CAH)? | Defect in an important enzyme, can cause dehydration, shock or even death. Early treatment can prevent medical problems. |
| What is congenital hypothyroidism? | Babies lack a thyroid hormone. Can cause poor growth or mental retardation, can be treated medically. |
| What is galactosemia? | Babies cannot digest galactose. Galactose is a simple sugar found in breast milk & many formulas. Can cause eye damage, liver or brain damage. Baby must be given milk-free formula. |
| What is maple syrup urine disease? | Babies cannot digest part of a food protein. Can cause severe mental retardation or even death. Babies require a special formula & diet. |
| What is phenylketonuria? | Babies cannot digest a different part of food protein. Can cause nerve & brain cell damage and lead to mental retardation. Babies get special formula and diet. |
Created by:
jrb265
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