Onal 4-21-08 Post-Natal Considerations

Front 1

Initial 5 Questions- ask Simultaneously after birth

Back 1

Term Gestation?
Clear of Meconium?
Breathing or Crying?
Color Pink?
Good Muscle Tone?

Front 2

Is apgar score used to determine NEED for resuscitation?

Back 2

NOT USED TO DETERMINE NEED FOR RESUSCITATION

Apgar is "Snapshot” of newborn's condition and response to resuscitation

Front 3

Apgar:
Assigned at 1 and 5 minutes
If 5 Minute score <7, what do you do?

Back 3

assign additional scores every 5 minutes for up to 20 minutes

Front 4

Apgar parameters

Back 4

Heart Rate
Respirations
Muscle Tone
Reflex irritability
Color

Front 5

Heart Rate score

Back 5

absent <100 >100

Front 6

Respirations score

Back 6

absent slow,irreg good,crying

Front 7

Muscle Tone score

Back 7

flaccid some flexion active

Front 8

Reflex irritability score

Back 8

none grimace cry

Front 9

Color score

Back 9

pale,cyanotic cyanotic extr. Pink

Front 10

Basic procedure immediately after birth

Back 10

Provide Warmth
Avoid hypothermia
Clear Airway
Head neutral, slightly extended
Suction mouth, then nose
Tactile stimulation (rub firmly on back of spine)
If ineffective, begin Positive Pressure Ventilation(PPV)

Front 11

MOST IMPORTANT AND MOST EFFECTIVE ACTION

Back 11

Ventilation

Front 12

Indications for PPV(40-60 breaths/sec)

Back 12

Apnea or gasping
Heart Rate < 100 (even if breathing)
Persistent central cyanosis despite 100% free flow oxygen
Reassess after 30 seconds

Front 13

What vitamin IM is given For prevention of hemorrhagic disease of the newborn

Back 13

Vitamin K

Front 14

hemorrhagic disease of the newborn
is Secondary to

Back 14

hepatic immaturity, poor placental transport of vitamin K and absence of intestinal flora to produce it, newborns have low levels of active vitamin K-dependent clotting factors(II,VII,IX,X)

Front 15

Infants develop vitamin K deficiency by ___ days of life if supplementation not given at birth

Back 15

Infants develop vitamin K deficiency by 2-3 days of life if supplementation not given at birth

Front 16

Three patterns of hemorrhage

Back 16

1. Classic - occurs in otherwise healthy infants, usually breastfed >24 hours old
Bleeding may be localized(cephalohematoma, GI) or Diffuse ecchymoses
2. Early – occurs in newborns < 24hrs old.
- associated with maternal medications(Phenytoin, Phenobarbital, salicylates,isoniazid,rifampin,warfarin.)
-bleeding may range from moderate skin and umbilical hemorrhage to fatal Intrathoracic, intraabdominal or intracranial hemorrhage
3. LATE – beyond neonatal period
- associated with impaired Vit K absorption
bleeding may be initial sign of underlying problem: Cystic fibrosis, biliary atresia,alpha 1 antitrypsin deficiency, hepatitis, malabsorption syndromes.

Front 17

What is used for eye prophylaxis?

Back 17

Prevention of neonatal gonococcal or Chlamydia infection
1% silver nitrate
Erythromycin 0.5 % ointment or drops

Front 18

Infants born to mothers with known gonococcal infection should receive eye prophylaxis plus ___________ IM

Back 18

Infants born to mothers with known gonococcal infection should receive eye prophylaxis plus Ceftriaxone IM

Front 19

What screening tests are given immediately after birth?

Back 19

Newborn Metabolic Screening(PKU)
Hearing evaluation

Front 20

What vaccine is given immedieately after birth?

Back 20

Hep B

Front 21

What are the Dubowitz and Ballard exams

Back 21

Exams that estimates gestational age vs Ultrasound/dates.

Front 22

Small for Gestational Age (SGA) any infant whose birth weight is below (usually <__th percentile) for a given gestational age

Back 22

Small for Gestational Age (SGA) any infant whose birth weight is below (usually <10th percentile) for a given gestational age

Front 23

IUGR (in utero growth pattern) reduced fetal growth pattern resulting from any of a various adverse effects on the fetus

Back 23

IUGR (in utero growth pattern) reduced fetal growth pattern resulting from any of a various adverse effects on the fetus

Front 24

LGA infant birth weight usually above __th percentile for a given gestational age

Back 24

LGA infant birth weight usually above 90th percentile for a given gestational age

Front 25

Low Birth weight refers to any infant born weighing <____grams

Back 25

Low Birth weight refers to any infant born weighing <2500grams

Front 26

Extremely Low Birth weight <____ grams

Back 26

Extremely Low Birth weight <1500 grams

Front 27

Macrosomia refers to large infants, typically >____g

Back 27

Macrosomia refers to large infants, typically >4000g

Front 28

Risk factors for neonatal sepsis

Back 28

Maternal Group B Strep carrier
Prematurity< 37 weeks
Premature rupture of membranes
Prolonged rupture of membranes(>18hrs)
Maternal fever
Chorioamnionitis
Maternal UTI

Front 29

What's the following?

Vaguely demarcated area of edema above the periosteum
Extends across midline of skull and crosses suture lines
Often ecchymoses of overlying skin
Resolves within several days

Back 29

Caput Succedaneum

Front 30

What's the following?

Subperiosteal collection of blood overlying a cranial bone
Sharply limited by periosteal attachments – Does not cross suture lines
Longer time of resolution(6-8 weeks), May calcify.
Associated complications: anemia, hyperbilirubinemia,skull fracture, intracranial hemorrhage

Back 30

Cephalohematoma

Front 31

What's the following birth trauma?

Associated with shoulder dystocia or breech delivery
Presents with crepitus and tenderness with palpation of clavicle and absent moro reflex on that side, decreased movement of that affected arm

Back 31

Clavicular fracture

Front 32

Tx of clavicular fracture

Back 32

Treatment- minimize pain by immobilizing arm
Callus forms and pain subsides 7-10 days

Front 33

Paralysis involving muscles of upper extremities following trauma to spinal roots C5-T1
What are the 3 types of brachial palsy

Back 33

Erb-Duchenne
Klumpke Palsy
Entire Arm

Front 34

Erb-Duchenne-involves upper arm secondary to injury C_-C_
Position of arm is “Waiters tip”-adduction and internally rotated arm, extension of elbow and pronation of forearm and flexion of wrist
Absent Moro, Grasp reflex intact, some sensory deficit
May have respiratory distress b/l of ipsilateral phrenic nerve injury
Most upper arm paralysis will recover within _-_ months

Back 34

Erb-Duchenne-involves upper arm secondary to injury C5-C6
Position of arm is “Waiters tip”-adduction and internally rotated arm, extension of elbow and pronation of forearm and flexion of wrist
Absent Moro, Grasp reflex intact, some sensory deficit
May have respiratory distress b/l of ipsilateral phrenic nerve injury
Most upper arm paralysis will recover within 3-6 months

Front 35

Klumpke Palsy – rare lower arm paralysis secondary to C_-T_ injury
Paralyzed hand, absent grasp reflex, dependent edema hand/forearm
May be accompanied by Horner’s syndrome-cervical sympathetic nerve injury with miosis,ptosis and anhidrosis of ipsilateral side of face
Poorer Prognosis, claw deformity may develop, partial immobilization, OT/PT, prevent contractures.

Back 35

Klumpke Palsy – rare lower arm paralysis secondary to C8-T1 injury
Paralyzed hand, absent grasp reflex, dependent edema hand/forearm
May be accompanied by Horner’s syndrome-cervical sympathetic nerve injury with miosis,ptosis and anhidrosis of ipsilateral side of face
Poorer Prognosis, claw deformity may develop, partial immobilization, OT/PT, prevent contractures.

Front 36

What's this?

Follows compression of facial nerve with forceps or prolonged pressure
Peripheral paralysis-flaccid, may involve entire side of face, eye on affected side may be persistently open, mouth drawn to normal side during crying, smooth forehead

Back 36

Facial nerve palsy

Front 37

Tx for facial nerve palsy

Back 37

Treatment- protect cornea if complete paralysis, most resolve within several days

Front 38

Differentiate CN78 nerve palsy from WHAT other disorders?

Back 38

Mobius syndrome (CN VII palsy agenesis of facial nerve nucleus with B/L Immobile motionless face as well as congenital absence of orbicular angularis muscle

Front 39

Components of the newborn exam

Back 39

General - dysmorphic?, active, pink, well developed, well nourished, well hydrated
Head - dysmorphic, philtrum, fontanelles, normocephalic, epicanthic folds
Skin - pink, pallor, rashes (erythema toxicum - redness w central clearing, pustular melanosus - usually on extremities), jaundice (latent sign of infection) turgor, hemangioma
Eyes - red reflex (pt opens eyes if sucking on finger), deformities
Oropharynx/Mouth - clefts, mucosal cysts, short frenulum,
Neck - crepitus, masses
Chest/lungs - deformities, lung auscultations, retractions
Heart/cardio - tachypnea, heart sounds, murmurs, S1 S2, 2+ femoral artery pulses, assesse brachial and femoral artery pulses together, RPPS (peripheral pulmonary stenosis), VSD, ASD, PDA
Abdomen - auscult bowel sounds, NEC (necrotizing enterocolitis), 2 vessel cord (= renal anomalies maybe)
GU - normal genitalia, dropped testes, urethral abn, hydrocele,
Hips/Extremities - Hip dysplasia (estrogen causes ligament laxity)
Back/Spine - abn, lanugo, central birthmarks (common: stork's bite, angel kiss on front of head)
Neuro - motor devel, fine devel, crying, finger latching, symmetric tone

Front 40

Transient tachypnea of the newborn?

Back 40

TTN
due to retained lung fluid, and common in 35+ week gestation babies who are delivered by caesarian section without labour. Resolves in 24- 48 hours
Treatment is supportive and may include supplemental oxygen and antibiotics.
The chest X-Ray shows hyperinflation of the lungs including prominent pulmonary vasular markings, flattening of the diaphragm, and fluid in the horizontal fissure

Front 41

Respiratory distress syndrome

Back 41

-look it up

Front 42

sepsis signs

Back 42

respiratory stress
if not latching on

Screen with:
CBC
CXR
blood culture