Ob Test 3

Front 1

Based on gestational age:
1) Preterm
2) Late Preterm
3)Postterm

Back 1

1) baby born after 20 weeks but before end of 36th week gestation
2) born between 34 and 36 6/7 weeks gestation
3) born after 42 weeks gestation

Front 2

Based on size of baby
1) AGA
2) LGA
3) SGA

Back 2

1) appropriate for gestational age—10-90% on growth chart
2) large for gestational age-- >90% on growth chart
3) small for gestational age-- <10% on growth chart; rate of intrauterine growth is restricted (IUGR). IUGR can be symmetrical—everything is small (head, body, etc). This is the worst kind. IUGR that is asymmetrical—head is normal size but weight is decreased (brain sparing).

Front 3

Risk Factors for NB with problems

Back 3

Decreased socioeconomic status, Lack of prenatal care, Maternal obesity, Hypertensive disorders,(gestational, pre-eclampsia),
Infection (PPROM, maternal infection), Diabetes (gestation, Type I and Type II), HELLP syndrome, Multifetal pregnancy

Front 4

Adaptation to Extrauterine Life

Back 4

Baby must regulate temperature, breathe on his own, establish circulatory status that provides blood to entire body, take in and utilize nutrients, etc., This happens very quickly after birth. If the baby is premature or ill, he/she is ill equipped to adapt to some aspects of extrauterine life.

Front 5

Respiratory-Pathophysiology-

Back 5

preterm babies have decreased number of functional alveoli, low levels of surfactant, smaller airway passages, cartilage poorly formed, etc. (see page 754).

Front 6

Respiratory- Assess for...

Back 6

cardinal signs of RD—nasal flaring, grunting, tachypnea, central cyanosis (always a serious symptom), retractions. Check for apnea, hypothermia, hypoglycemia. Check ABG’s, pulse ox.

Front 7

What are normal ABG values for Neonates:
pH, Pa02, PaCO2, HCO3 and 02 sat

Back 7

pH 7.35—7.45
PaO2 60-80 mm Hg
PaCO2 35-45 mm Hg
HCO3 22-26 mEq/L
O2 sat 92-94%

Front 8

Normal Respiration rate for Neonates

Back 8

Normal Resp Rate
30-60

Front 9

Respiration-Apnea

Back 9

Loss of respirations for greater than 20 sec. Usually associated with bradycardia and cyanosis. APNEA MONITOR, CPR training for parents

Front 10

Respiration-Periodic Breathing

Back 10

cessation of breathing for 5-15 seconds. Usually followed by short period of tachypnea.

Front 11

What babies are at risk for Respiratory Distress Syndrome RDS (used to be called hyaline membrane disease)

Back 11

Premature babies, male infants, Caucasian infants, infants with diabetic mothers, second twin, etc.,

Front 12

RDS-Pathophysiology-surfactant acts to decrease the surface tension in the fetal lungs. Without this (or a deficient amount of this) the lungs become sticky and difficult to

Back 12

reinflate [stick together]alveloar collapseinfant fatigues (trying to breathe harder), hypoxiaanaerobic glycolysisacidosis—impaired surfactant productionVISCIOUS CIRCLE…

Front 13

RDS-If pemature birth anticipated give....

Back 13

Betamethasone 12 mg X2 doses 24 hours apart to increase surfactant.

Front 14

RDS-Diagnosis

Back 14

history, symptoms of respiratory distress, x-ray [looks like ground glass, snow storm].

Front 15

RDS-Treatment is...

Back 15

Supportive till baby "outgrows" problem.

Front 16

RDS Treatment-Respiratory Support

Back 16

• Respiratory Support—warm moist O2 per oxyhood or ventilator. Oxygen is adjusted according to ABG readings. Keep O2 sats 85-95%. Can administer at 100% if needed. Gradually wean off.

Front 17

RDS Treatment-additional

Back 17

•CPAP—continuous positive airway pressure-by nasal pressure—keeps airway open.
•Chest PT with suction
•Artificial Surfactant (Exosurf, Survanta, Surfax) given per nebulizer. Directly down ET tube into lungs.

Front 18

RDS Treatment-additional

Back 18

•VENTILATOR—if PaO2 below 50 on 100% or CO2 above 70. Type and settings needed depend on infant’s condition, cause of distress, etc., HIGH FREQUENCY VENTILATION more common today.
•Inhaled Nitrous Oxide—INO—given blended with oxygen thru ventilator-

Front 19

RDS Treatment-additional

Back 19

•Extracorporeal Membrane Oxygenation—ECMO—lets the lungs rest. Blood shunted to a “membrane lung” where it is oxygenated and returned to baby. Cannot use before 34 weeks because need anticoagulants. [INO and High Frequency Ventilation have decreased need for this].

Front 20

Transient Tachypnea of the Newborn

Back 20

retained fetal lung fluid (80-100 mL fetal lung fluid in utero). In vaginal births, labor helps with the expulsion of fluid from the fetal lungs. C-section patients who do not have LABOR are Most at risk for TTN. S/sx—rapid, non-labored respirations. May hear rales. Treatment—May need short term oxygen. Resolves by itself as fetal lung fluid is reabsorbed.

Front 21

Pneumothorax

Back 21

often seen in infant who has been resuscitated or with meconium aspiration syndrome (MAS). Cause—alveolar rupture that causes escape of air into pleural cavity and causes lung to collapse. S/Sx—shift in PMI, heart sounds heard more clearly on unaffected side, increased RD, CXR—collapse lung and dark air filled area. TX—immediate evacuation of air—can use syringe, needle in emergency. Otherwise—chest tube placed to help reinflate lung.

Front 22

Bronchopulmonary Dysplasia-BPD (this is a chronic lung problem)

Back 22

Seen in premature infants, LBW infants, babies on mechanical ventilation and oxygen supplementation. Due to alveolar rupture which forms scar tissue that the lung cannot use for gas exchange. Have residual problems into childhood until child can “grow” enough healthy lung tissue.

Front 23

What are signs in symptoms of BPD?

Back 23

tachypnea, retractions, nasal flaring, increased WOB, exercise intolerance

Front 24

What is the treatment of BPD?

Back 24

oxygen therapy (prolonged), fluid restriction (to prevent fld overload0, meds such as diuretics, steroids, bronchodilators

Front 25

Temperature and the newborn

Back 25

Remember newborns lose heat thru radiation, evaporation, conduction and convection. Brown fat (used for non-shivering thermogenesis) can produce increase when baby is chilled. But, when brown fat gone—no more is produced.

Front 26

What are the risk factors for hypothermia/cold stress

Back 26

immature thermoregulation, decreased fat stores, increased surface area, increased number of thermoreceptors in head and face

Front 27

Who are most at risk for hypothermia?

Back 27

Preterm and or hypoxic infants. Infant may exhibit respiratory distress solely due to hypothermia.

Front 28

Pathophysiology of Hypothermia/cold stress-if temperature less than 36.5

Back 28

Hypothermiaincreased O2 consumptionincreased glucose metabolism (to produce heat) glucose stores depleted (hypoglycemia)increased metabolism of brown fataccumulation of fatty acidsanaerobic glycolysismetabolic acidosisdecreased surfactant production and causes fetal HgB to lose affinity for O2hypoxia.

Front 29

S/Sx of hypothermia

Back 29

inability to maintain temperature above 36.5

Front 30

Treatment of hypothermia
1. Place baby in ____contact shortly after birth if possible.
2. Preterm babies—put in prewamed incubator or ____.
3. Put ELBW or VLBW infant in ____.polyethylene bag with supplemental heat.

Back 30

1. skin to skin (kangaroo)
2. radiant warmer bed. Will have temperature probe to monitor heat and some method to deliver supplemental heat.
3. polyethylene bag with supplemental heat.

Front 31

Treatment of Hypothermia (additional)
1. Maintain neutral ____environment
2. Cover ___
3. Monitor ____ and _____ levels
4. Bundle and teach parents ____

Back 31

1. thermal
2. head
3. temperature and glucose levels
4. to do bundle.

Front 32

Fluid and Electrolytes-
1. Fluids usually given through ______?
2. Must maintain careful ____?
3. Never give potassium unless _____?
4. UAC can cause ____of toes or kidney due to _____. Call _____

Back 32

1. Umbilical Artery catheter (UAC), you can also get blood sample here for ABG.
2. I & O
3. there is adequate kidney function
4. Necrosis due to vascular occlusion call HCP

Front 33

Nutrition-
1. Usually NPO until _____
2. It is important when NPO to maintain ________

Back 33

1. Off oxygen therapy (use TPN, lipids and/or glucose)
2. suck reflex and swallow reflex with even small amounts of feeding.

Front 34

Gavage feeding

Back 34

measure ear to nose to sternum and insert. Verify placement. Make sure feeding warmed for NG fdg. Bolus feed using gravity or feeding pump (can feed breast milk or commercial formula). Always check gastric aspirate before bolus feeding—also known as decanting. Hold if greater than amount specified by dr (usually if >1/2 amount of feeding) and notify HCP.

Front 35

Necrotizing Enterocolitis-
1. Usually due to ___ at or shortly after birth.
2. Cause-Blood is shunted _____. Seen also with early feeding in high risk____.
3. What are s/sx?
Treatment, take to OR to ______,

Back 35

1. Hypoxia
2. To vital organs such as brain and heart (away from gut). Infant.
3. distended abdomen, vomiting, increased gastric residual when decant (can get ileus because of NEC).
4. remove necrotic portion of bowel,

Front 36

Developmental/Neuro
1. Neuro changes in preterm baby may be _____—making it hard to note
2. Ongoing _____ are very important.

Back 36

1. subtle and nonspecific
2. assessment and documentation

Front 37

Developmental/Neuro
1. Cerebral Palsy- Can be caused by ____.

Back 37

1. hypoxia

Front 38

Developmental/Neuro-Retinopathy of Prematurity
1. Is caused by_____?
2. It is diagnosed by ____?
3. How is it treated _____?

Back 38

1. prematurity or supplemental oxygen with oxygen tensions that are too high.
2. retinal examination
3. prevention (keep PaO2 between 50-80 in very preterm baby) , early detection; laser treatment, vitamin E, etc.