1What is the ballard score based on?
physical maturity
neuromuscular maturity
2What is gestation age is considered full term?
born after 37 weeks
3What is small for gestational age?
less than 10th percentile for GA
4What are the risks associated with small for gestational age?
multiple gestion
gestation abnormal
infection
placenta abnormal
medications/smoking
assisted reproduction
uterine malformation
5What are infants born SGA at increased risk of?
morbidity and mortality due to poor temp regulation and hypoglycemia
6What is the definition of large for gestational age?
birth weight greater than 90th percentile for GA
7What are the risks associated with being LGA?
genetic syndromes
gestational or maternal diabetes
advanced maternal age
multiparity
excessive maternal weight gain
8What are the complications of LGA?
birth injury
hypoglycemia
polycythemia
meconium aspiration
9What are LGA infants are increased risk of?
obesity and insulin resistance
10Which two things must be monitored within the first few hours after delivery when a baby is LGA?
blood glucose
hematocrit
11What does apgar stand for?
activity (muscle tone)
pulse
grimace (reflex irritability)
appearance (color)
respiration
12If an infant has an APGAR score between 0-3 they are?
severely depressed
13If an infant has an APGAR score between 4 and 6 they are?
moderately depressed
14What is the period in the first 4-6 hours called and what are you monitoring?
transitional period
HR: 120-160
respiratory rate: 40-60
temperature: 97.7-99.5
color
tone
15What is done within the first 24 hours (in a healthy infant)?
prophylactic eye care
vitamin K injection
hepatitis B vaccine
umbilical cord care
monitor bilirubi/jaunidice
monitor hypoglycemia
16When it comes to feeding what are you monitoring?
8-12 feedings/d
breast milk OR
20 cal/oz formula w/ iron
17What is a common percentage of weight loss in a new born?
can lose up to 7%
start getting concerned if its more than 10%
18When do you do glucose monitoring?
preemies
LGA
SGA
IDM
symptomatic
19What symptoms in a newborn may concern you for hypoglycemia?
lethargy
apnea
poor feeding
hypothermia
20What are the 3 routine new born screenings?
universal hearing screen (BAER)
critical congenital heart disease (CCHD)
metabolic and genetic disorders
21What is considered normal in pulse oximitry?
95% in right hand or foot and less than 3% different between right hand and foot
22What metabolic or genetic disorders are screened?
PKU
congenital hypothyroidism
galactosemia
hypoglobinopathies
23What are the pros of circumcision?
less risk of UTIs and STIs
protection against penile cancer and lower risk of cervical cancer in female partners
prevention of balanitis, balanoposthitis, phimosis, paraphimosis
24What are the cons of circumcision?
bleeding, infection
meatal stenosis/meatitis
risk of injury to penis (cutting foreskin too short)
25When discharging the well NB what should be done?
consider high risk patients
review of maternal labs
parent education
26What are some high risk patients?
first time mom
breastfeeding
PMH of depression or drug abuse
27What parent education should be provided before discharging the well NB?
breastfeeding/support
appropriate feeding/output
cord, skin, genital care
recognition of illness (jaundice; sepsis)
infant safety (sleeping, smoking, hot liquids)
car seat
28Before a NB can be discharged..
VSS; no evidence of sepsis
healing circ
one spontaneous urine and stool in first 24 hours
at least 2 successful feedings
appropriate f if jaundiced
adequate maternal support after d/c
medical home identified: first appt made, communication of pertinent maternalirth/hospital
29What is meconium?
thick, black-green, odorless material in the fetal intestine composed of material ingested in utero
30What is meconium aspiration syndrome?
amniotic fluid that remains in the hypopharynx or trachea after delivery and is aspirated during fetal gasping or in the initial breaths
31What are the risk factors for meconium aspiration syndrome?
depressed infant
post maturity
SGA
32How does meconium aspiration interfere with normal lung function?
it can cause an airway obstruction
its a chemical irritant
it can inactivate surfactant
33How does meconium aspiration syndrome present?
respiratory distress
chest appears barrel-shaped due to overinflation
34How is meconium aspiration diagnosed?
Meconium stained amniotic fluid
respiratroy distress
CXR
35What is characteristic on CXR of meconium aspiration?
patchy densities with areas of hyperexpansion; atelectasis
36What is the management of meconium aspiration?
supportive care
37Aside from meconium aspiration what is another newborn complication?
jaundice
38What is hyperbilirubinemia?
increased turnover of more RBCs
39What are the risk factors for severe jaundice?
lower gestation age
risk increases each addition week over 40 weeks
jaundice in the first 24 hours after birth
predischarge TSB or TcB close to phototherapy threshold
hemolysis from any cause if rapid rate of increase of bilirubin >0.3 mg/dL/hour in the first 24 h or >0.2 mg/dL/hour therafter
phototherapy before discharge
parent/sibling requiring phototherapy or exchange transfusion
exclusive breastfeeding with suboptimal intake
scalp hematoma or significant bruising
down syndrome
40What is unconjugated bilirubin?
billirubin that has not been through the liver yet
41What is conjugated bilirubin?
has been through the liver but problem there
42What testing is done for evaluation of jandice
heel stick or transcutaneous to evaluated total bilirubin and percent conjugated vs unconjugated
43What is physiological jaundice?
benign jaundice which affects nearly all newborns
44When does physiological jaundice develop?
72-96 hours after delivery
45When does physiological jaundice go away?
1-2 weeks after birth
46What is breast milk jaundice?
persistence of physiological jaundice beyond the first week of age
47When does breast milk jaundice usually present?
within the first 3-5 DOL
48When does breast milk jaundice usually disappear?
progressively declines after 3-12 weeks
49What is pathological jaundice?
appears within 25 hours, increases 5 dl/day; TB is greater than 15 mg/dL and direct bilirubin greater than 2 mg/dL
50Why do we care about jaundice?
bilirubin is a potential neurotoxin
infants can develop acute bilirubin encephalopathy or kernicterus
51What is the treatment for jaundice?
phototherapy
IVIG
exchange transfusion
52When is IVIG used?
if the jaundic is due to isoimmune hemolytic disease
53What is coombs' test?
detects antibodies that indicated autoimmune/ ABO incompatibility
54if the coombs' test is positive when will the infant develop jaundice?
within the first 24 hours and it will be more severe
55What are the 4 types of birth injuries?
caput succedaneum
cephalohematoma
clavicle fracture
brachial plexus
56What is the different between caput succedaneum and cephalhematoma?
a cephalohematoma does not cross the suture line while the caput succedaneum crosses the suture line
57Which two ways are prematurity defined?
gestational age and birth weight
58What are the parameters for birth weight?
low birth weight is less than 5.5 lbs
very low birth weight is less than 3.3 lbs
extremely low birth weight is less than 2.2 lbs
59What are risk factors for prematurity?
mother less than 16 or older than 35
maternal health disorders
maternal lifestyle
cervicalterine/placental issues
multiple gestation
fetal factors
60What is the percentage of twins and triplets born premature?
50% of twins
90% of triplets
61What are the 7 short term complications of prematurity?
anemia of prematurity
respiratory distress syndrome
bronchopulmonary dysplasia
apnea of prematurity
intraventricular hemorrhage
necrotizing enterocolitis
retinopathy of prematurity
62When does anemia of prematurity typical occur?
3-12 weeks in infants less than 32 weeks GA
63When does the anemia usually resolve?
3-6 months
64What is given to infants with anemia?
iron supplement
65What is respiratory distress syndrome?
deficiency of pulmonary surfactant in an immature lung
66What are the characteristic CXR seen with respiratory distress syndrome?
ground class appearing-air bronchograms
67What is the treatment for RDS?
antenatal steroids
exogenous surfactant
a/o CPAP
68Prognosis for RDS?
symptoms start resolving within 72 hours and symtom resolution by one week of age
69What is bronchopulmonary dysplasia?
disruption of lung development/vasculatur
70how is bronchopulmonary dysplasia diagnosed?
based on need for O2 supplementation, GA and severity
infants who require o2 for last 28 days are classified as mild/mod/severe depending on extent of O2 supplemenation
71How is CXR defined with bronchopulmonary dysplasia?
sequential
72What is apnea of prematurity?
infants less than 37 weeks with cessation of breathing for greater than 20 seconds or respiratory paus associated with oxygen desat +/- bradycardia
73How is apnea of prematurity found?
cardiorespiratory monitors a/o pulse ox
typically a diagnosis of exclusion
74What is the management of apnea?
supportive
CPAP
caffeine
75How long does is persist?
until 37-43 weeks
76What is intraventricular hemorrhage?
impaired cerebrovascular autoregulation; unable to handle changes in BP
77What is the treatment for intraventricular hemorrhage?
supportive, reduce further injury
78What is retinopathy of prematurity?
vascular proliferative disorder that occurs in completely vascularized retina of preemie
79What is stage 5 of retinopathy?
total detachment
80How is retinopathy usually treated?
often resolves spontaneously
screenings done until then or until treatment is needed
81What are the abdominal signs of necrotizing enterocolitis?
distention
gastric retention
tenderness
vomiting
rectal bleeding
diarrhea
82What is seen on abdominal x ray in an infant with necrotizing enterocolitis?
pneumatosis intestinalis
83What is the treatment for necrotizing enterocolitis?
NPO
supportive care
atbx therapy
surgery (if necrosis)
84What are the long term consequences of prematurity?
recurrent hospitalizations
growth impairment
neurodevelopmental
psychologicalehavior issues
greater risk of poor academic performance
85What are some things involved in the care of a NICU graduate?
hearing screening at d/c then repeat in first year
retinal screening again at 9-12 months
car seat test
neurodevelopmental eval with referral to community resources
evaluation for SIDs risk, GER, anemia
86How are vaccines given in preemies?
based on chronological age
87What vaccine might you consider in a preemie and what does it try to prevent?
synagis for RSV
88What are some maternal risk factors for SIDs?
maternal age less than 20
maternal smoking during pregnancy
late or no prenatal care
89What are some environmental and infant factors associated with increased risk of SIDs?
preterm birth and/or low birth weight
prone sleeping position
sleeping on soft surface
sleeping with bedding accessories like loose pillows and blankets
bed sharing
90Most risk factors for SIDs are _____ and associated with ___ risk factors
modifiable
one or more