Case 7: Respiratory Distress, Newborn

Front 1

List some risk factors factors for neonatal respiratory distress

Back 1

• maternal diabetes
  
• maternal diabetes
  
• prematurity
  
• maternal group b strep infection
  
• C-section delivery
  
• PROM >/= 18 hours
  
• meconium in amniotic fluid
  

Front 2

What is the APGAR score?

Back 2

describes condition of newborn infant immediately after birth

records fetal to neonatal transition

Front 3

What affects APGAR score?

Back 3

gestational age

maternal meds

resuscitation

cardiorespiratory and neurological conditions that may be present in the infant

Front 4

What is poor neurologic outcome associated with?

Back 4

documented asphyxia

Front 5

T/F: APGAR score correlates strongly with future neurological outcome of the term infant?

Back 5

False

Front 6

T/F: Low apgar scores at 1 and 5 minutes are conclusive markers of acute intrapartum hypoxic event?

Back 6

False

Front 7

Three classifications of birth weight?

Back 7

• large for gestational age (LGA)
  
• appropriate for gestational age (AGA)
  
• small for gestational age (SGA)
  

Front 8

Harms of LGA babies?

Back 8

• must be delivered by c-section often, by forceps, or vacuum extraction
  
• birth injuries more common (e.g. fractured clavicle, brachial plexus injury, facial nerve palsy
  
• hypoglycemia common in LGA infants born to diabetic mothers
  

Front 9

SGA babies, harms?

Back 9

• temperature instability (hypothermia)
  
• inadequate glycogen stores (hypoglycemia)
  
• polycthyemia and hyperviscosity
  

Front 10

at birth, these factors allow for a successful transition to extrauterine life?

Back 10

• umbilical cord cut, removes low resistance placental circulation
  
• air breathing by newborn
  
• reduction of pulmonary arterial resistance
  
• closure of PFO and PDA
  

Front 11

TTN?

Back 11

delayed absorption of pulmonary fluid

persistent postnatal pulmonary edema

Front 12

first hour of life

Back 12

resp and heart rates elevated

Front 13

second hour of life

Back 13

heart rate 120-160

resp rate 40-60

Front 14

signs of respiratory distress?

Back 14

• tachypnea
  
• retractions
  
• grunting
  

Front 15

Systems involved in cyanosis of newborn?

Back 15

• Respiratory
  
• Cyanotic congenital heart defects
  
• CNS
  
• Infectious
  
• Other
  

Front 16

Common respiratory causes of cyanosis

Back 16

• TTN
  
• RDS
  

Front 17

Common cyanotic congenital heart defects?

Back 17

• Tetralogy of fallot
  
• Transposition of great arteries
  

Front 18

Transposition of great arteries, what is it?

Back 18

• aorta and pulmonary artery are transposed
  
• cyanosis as ductus closes shortly after bith
  

Front 19

CNS causes of cyanosis?

Back 19

• hypoxic ischemic encephalopathy
  
• intraventricular hemorrhage
  
• sepsis/meningitis
  

Front 20

Infection causes of cyanosis?

Back 20

• Septic shock
  
• Meningitis
  

Front 21

Other causes of cyanosis?

Back 21

• RDS secondary to maternal medications
  
• hypothermia
  
• polycythemia/hyperviscosity syndrome
  

Front 22

What is control of diabetes during pregnancy an indicator of?

Back 22

• Fetal outcome
  
• especially with regard to risk of birth defects
  
• incidence of malformations is directly related to first trimester HbA1c level
  

Front 23

Why breastfeed?

Back 23

• ideal nutrient for newborn human
  
• Provides lower renal solute load than formula
  
• several anti infective and anti allergic properties
  
• fosters mother-infant bonding
  

Front 24

When does tachypnea preclude oral feeding?

Back 24

• not contraindicated
  
• only if RR > 80 and difficulty with oral and nasogastric feeds require IV fluid support
  

Front 25

Difficulties breastfeeding?

Back 25

• tachypnea
  
• import mother pumps breast as soon as possible after delivery initiates milk production and ensures adequate supply
  
• expressed breast milk, supplemented with formula as needed
  

Front 26

When to intervene re: hypoglycemia?

Back 26

administer glucose if:

infant symptomatic

Front 27

Two assessments of gestational age?

Back 27

Dubowitz score

Ballard scord

Front 28

dubowitz system

Back 28

physical characteristics and neuro findings

Front 29

ballard score

Back 29

shortened dubowitz

Front 30

when to perform assessment of gestational age

Back 30

within twelve to twenty four hours of life

Front 31

Clinical features of developmental dysplasia of the hip?

Back 31

partial or complete dislocation

instability of femoral head

Front 32

Risk factors associated with DDH?

Back 32

breech position

gender, female predominance

family history

Front 33

Newborn hospital discharge considerations

Back 33

follow up

feeding

jaundice

vitamin d

car seat

sleep position and co sleeping

Front 34

Follow up

Back 34

follow up arranged in first week after birth

any infant discharged from nursery before forty eight hours of life must be evaluated by health care practitioner within forty eight hours

Front 35

Breastfed infant feed considerations

Back 35

feed on demand every two to four hours, feeding ten to 15 min on each side

Front 36

Jaundice considerations

Back 36

TBR measured prior to discharge

if low, no further tests needed

parents should observe for jaundice over next several days and contact physician if it does appear

Front 37

Car seat considerations

Back 37

specific guidelines, car seat challenge

Front 38

Sleep position and co sleeping considerations

Back 38

SIDS: back to sleep program reduces risk

infants should not bed share during sleep

should be returned to their own bassiness or crib when parent ready to sleep

Front 39

Communicating with parent of ill child, guidelines?

Back 39

be clear about what you know

be clear about next steps in evaluation

Front 40

DDx for tachypnea in a newborn?

Back 40

• RDS
  
• TTN
  
• Pneumothorax
  
• hypoglycemia
  
• CHF
  
• neonatal sepsis
  
• congenital diaphragmatic hernia
  
• severe coarctation of aorta
  
• meconium aspiration
  
• maternal drug exposure
  
• Hypothermia
  

Front 41

Studies to evaluate cyanosis in newborn?

Back 41

• arterial blood gas
  
• CSF cultures
  
• CBC with diff
  
• CXR
  
• echocardiogram
  
• oxygen challenge test
  
• physical exam
  
• pulse oximetry
  

Front 42

How to evaluate tachypnea in newborn?

Back 42

• CBC and diff
  
• serum or plasma glucose level
  
• blood culture CSF for culture
  
• blood gas
  
• pulse oximetry monitoring
  
• chest xray
  

Front 43

TTN

Back 43

wet looking lungs, no consolidation no air bronchograms

Front 44

RDS

Back 44

diffuse

ground glass appearance

air bronchograms

Front 45

Diaphragmatic hernia

Back 45

most often develops on left side

air filled loops of bowel on left side of chest, displacing heart and mediastinum to opposite side

Neonatal pneumonia

Front 46

Neonatal pneumonia

Back 46

Clinical findings much more concerning for sepsis

similar appearance to ttn

Front 47

Testing of hypoglycemia?

Back 47

glucometer is screen

Front 48

treatment for hypoglycemia?

Back 48

depends on presence or absence of symptoms of hypoglycemia

if child cannot intake oral feeds, place nasogastric tube and resume breast milk or formula

if symptomatic, IV infusion of dextrose started immediately

(D5)

Front 49

Monitoring hypoglycemia?

Back 49

monitor closely until levels stable