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70 Cards in this Set
- Front
- Back
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When should the ductus arteriosous close? |
By 72 hours of life
the connection between the pulmonary artery and aorta should close |
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What causes the foramen ovale to close?
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when the systemic blood presessure rises, and the pressure inside the left atria is greater than the pressure in the right atria.
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Describe how a neonate thermoregulates by "non-shivering"
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heat is produced by stimulating increased cellular respiration
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Who has brown fat, where is it, and why is it important?
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Brown fat is found in term infants, superfically deposited around the scapulae, neck, axillae, and around the kidneys. Has a higher capacity for heat production via metabolism
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Neonatal Blood Volume?
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80-85 cc/kg
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How much water is the neonate?
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75% water
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What are the two high electrolytes in neonates?
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Na and Cl
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Why do babies have a greater risk for acid bluid up?
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Have a higher metabolic rate that is twice as great in relation to their body size - also their renal system is immature and cannot concentrate urine well - setting the baby up for overhydration/dehydration/ and acidocis
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How much can a neonatal stomach hold?
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90 ml
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When should the passage of meconium occur?
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24-48 hours
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T or F
Neonates have high stores of glycogen |
faluse
Low stores of glycogen, making them more prone to hypoglycemia |
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Why do you see physiologic jaundice?
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the liver is immature, and there are lower levels of glucronyl transference which is required for bilirubin conjugation
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When do digestive enzymes mature
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3-6 mths
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When should a neonate void
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24 hours
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What causes milia
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blocked sebaceous glands
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What is vernix caseosa?
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in utero coat produced by the sebacsous glands of the baby, that protect it against the acidic amniotic fluid
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T or F
A baby has more cartilage at birth |
True, grows into bones by oslification
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What purpose does hypertrophy cause
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encourages muscle growth and development
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When can a baby produce their own immunioglobulins?
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at 2 mths of age
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T or F
The autonomatic nervous system is critical to the sucessful transition towards extrauterine life |
Ture
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What direction does myelination proceed?
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cephalocaudaul-proximodistal - this is why children mater gross moter skils b4 fine motor skils
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If a baby is discharged from the hospital less than 48 hours of birth when do they need to see a PCP
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With in 48 hours
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What are the three normal newborn issues
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bonding
breast/bottle feeding bilirubin |
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What is the acceptiable weight loss for babies
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10% of their body weight by the first five days and then regain it during the next five days
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How much weight does a baby gain
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2/3 oz a day
20-30 gms a day |
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How long with the baby grow in the first month?
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Length will incrse between 1-1.5 inches (2.5 - 4 cm) in the first month
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What is the head circumference in the first moth
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1 inch (2.54 cm) in the first month
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What is the formula intake for babies
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2-3 oz per lb of weight per day
about 4-6 oz a feed |
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How often should bf occur?
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2-3 hours for 10-15 min per brest
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Average wet diapers per day
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6 diapers per day
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A baby is brought to you with spit ups, no weigh gain, irritability - what should you think?
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GERD refleux
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why do spit ups occur
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cuz the musclar valve between the stomach and esophagus is immature
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How do motor movements change over the first weeks
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The babies movements are jerky and become much smoother by the end of the first months
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How far can a baby see
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8 - 15 inches in front - in 1 month can view 3 feet
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When should hearing aids be introduced
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b4 3 months, no later than 6 mths
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Are hearing screen test 100% fool proof in identifying children with hearing problems
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No - only about 50% of significant congenital hearing loss
at a minimum can spot hearing loss with sigificant bilateral hearing |
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What is the ABR - aiditory brain response?
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an electral waveform generated by neuronal activity in the auditory nerve and breainstem pathway following clicking sounds
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T or F
The ABR can differentiate between conductive and sensorineural hearing loss |
True
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Biliribin is only from degradation of hemoglobin
T or F |
False
20-30% is from nonerythroid tissue |
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In utero what eliminates the bilirubin
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Placenta -
but also stool and amniotic fluid |
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What is the underling cause of kernicterus
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Unbound bili to the albuim sites - the bilirubin circulates freely in the plasma and migrates into the brain cells
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When does bilirublins metabloism peak
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Term baby day 2- 4
preterm baby 5-7 |
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Why are y, and z proteins (ligands) important?
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They combine with the biliruin once it is transferred across the cell membrane - and is stored or removed from the proteins and conjugated in the hepatic ER
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what is glucuronic acid?
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A chemical that bilirubin attaches to inorder to become bilirubin glucuronide
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What is bilirubin glucronide
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the form of bilirubin that can be excreeted into the bile and into the intensine
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What is urobilirubin
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the inconjugated form of bilirubin that in formed after intestinal flora reduces it
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What does bilirubin glucuronidase do
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breaks down conjugated bilirubin and then the intestines reabsord it
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When does jaundice occur
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when the production of bilirubin exceeds the newborns liver's ability to conjugate and elimate it
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What is the treatment of hyperbilirubeinmia dependent upon
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Gestational age
Birth weight Clinical Course Rate of rise of level (.5mg/dl/h) Rate of hemolysis |
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What are the two ways to treat hyperbilirubinemia
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Phototherapy
Exchange transfusion |
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How quickly does the phototherpy work
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1-2 mg/dl
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What is an abnormal rise in bilirubin
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.5mg/gl/h
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What is the amount of bilirubin that is removed from double volume exchange transfusion
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25%
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what is photo-oxidation
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oxidation of bilirubin pigment deposited in the skin and its conversion into colorless produces excreted in the urine
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What is photoisomerization
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conversion of bilirubin plymers in skin to excretable isomers that converts from lipid souluble substance to two water-solubel isomers
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What happens to the two water soluble isomers
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one isomer stays conjungeted and is excreted in the bile, one isomer (liibilirubin) is elimanates throuigh urine and bile
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What is the goal of exchange transfusion?
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Remove biliribin, antibody coated RBC's, circulation maternal antibodies, Rh positive fetal cells and hemolyzed cells from the newborn circulation
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What happens with rebound levels within one hous of exhange transfusion?
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are as high as 55% of preexchange level
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Whats the blood volume in the exchange transfusion?
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80cc/kg
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A pt has polycethemia, what type of exchange transfusion is needed
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Partical exchange transfusion
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What type of blood is needed for exchange transfusions?
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whole cross - matched blood
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What lab values need to be monitored for exchange transfusion
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CBC, electolytes, Ca, glucose, bilirubin levels before, during, and after the procedure
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Mother is Hep. B positive, how do you treat the baby
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the baby should recieve both the vaccination and IVIG
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The mother is hep. B is unkown, what is the treatment?
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you have 12 hours to obtain and give the vaccination and IVG for pretems - term babies can be given with int the first week of life
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The mothers hep b status is negative, what is the tx?
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the vaccine should be given with parental consent
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What is the criteria for early discharge?
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Vag delivery, AGA single birth, 38-42 weeks, VSS for 12 hours, baby has urinated and passes stool, 2 successful feeding with documentation
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What lab values must be looked at b4 early discharge
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maternal syphillis
hep B antigen Infant blood type direct coombs |
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If a family does not want hep B what must occur?
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PCP visit within one week
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How long must a baby be supine to sleep
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fisrt 6 mths
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A baby is discharged 12 hours post delivery, when should a PCP appointment be made
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at 48 hours of life
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