Week 2 - Maternal And Newborn - Ch 15 - The Neonate

Front 1

What mechanical stimuli for initiate extrauterine respirations?

Back 1

Once the face is delivered, amniotic fluid can be expelled from the lungs. Delivery of chest creates a negative pressure for first breath. amniotic fluid is further expelled via absorption throught the lymphatic system and crying.

Front 2

What is the ductus venous?

Back 2

for fetal circulation, it connects the umbilical vein to the inferior vena cava.

Front 3

When does the ductus venous close?

Back 3

closes by day 3

Front 4

Explain circulatory changes in the neonate.

Back 4

closure of shunts after birth. Ductus venous - btwn umbilical vein and the inf vena cava. Ductus arteriousus - btwn pulm artery and descending aorta. Foraman ovale - btwn L and R atria.

Front 5

What influences the closure of fetal shunts?

Back 5

Changes in pressure leads to changes in directional flow. Unused passages become obsolete and close. Dec Pulm vasc reisistnace, inc of systemic vascular resistance.

Front 6

What stimulates the first breath of neonates, chemically?

Back 6

increase in CO2 is primary driving chemical factor

Front 7

What keeps alveoli open at the end of expiration?

Back 7

Surfactant decreases surface tension of alveoli, keeping them from collapsing (surf tension due to water)

Front 8

What is the function of brown adipose tissue?

Back 8

for nonshivering thermogenesis. for neonates and mammals to generate heat since they can't shiver.

Front 9

What prevents cold stress in neonates?

Back 9

a neutral thermal environment (envir temp to maintain body temp)

Front 10

By what mechanisms can a neonate lose heat?

Back 10

Radiation (indirect), Conduction (direct), Convection (wind), Evaporation

Front 11

What are symptoms of cold stress?

Back 11

generally, there is an increased metabolism to generate heat. as a result, inc O2 consumption and depletion of glucose, and dec surfactant. responses of inc heart and resp rate, and resp distress, hypoglycemia.

Front 12

What is an important risk factor for hypoglycemic neonates?

Back 12

diabetic mothers. High amts of insulin are produced in response to high maternal glucose, and lasts for a few hours after birth. hypoglycemia ensues.

Front 13

Avg neonate hematocrit? significance?

Back 13

60%, much higher than 45% in men, and 37% women.

Front 14

What is bilirubin?

Back 14

product of heme metabolism. excreted in bile and urine.

Front 15

What is direct bilirubin?

Back 15

aka conjugated bilirubin. in the liver, it is conjugated to glucuronic acid, making it water soluble, excreted through the urine.

Front 16

What is indirect bilirubin?

Back 16

unconjugated bilirubin. after hemolysis of RBC in the spleen, breakdown of heme releases a non water solule bilirubin.

Front 17

Why is Vit K administered to newborns?

Back 17

newborns have a risk for bleeding due to high HCT and low levels of coagulation factors. Vit K forsynthesis of coagulation factors

Front 18

where is vit K synthesizsed? significance in neonate?

Back 18

synth by intestinal flora, which is absent in newborns. this causes low levels of Vit K, and coagulation factors.

Front 19

Phytonadione. route, dose?

Back 19

vit K injection, IM 0.5 -1 mg within 1 hour of birth

Front 20

Describe neonatal stool.

Back 20

The first stool is black, thick, sticky and odorless (meconium). As baby starts feeding, stool becomes green black, green brown, then green yellow (transitional). Breastfeeding stool is yellow and semiformed, pasty, and has a sour odor.

Front 21

What does a scaphoind abdomen indicate in a baybayy?

Back 21

scaphoid = concave abdomen. Bowel sounds in chest indicates diaphragmatic hernia.

Front 22

IgG

Back 22

antibody against virus and bacteria. crosses placenta for passive immunity.

Front 23

IgA

Back 23

supplied to neonate via breastmilk. provides protection for respiratory and urinary tracts. (mucosa)

Front 24

Caput succedaneum vs cephalhematoma

Back 24

Caput is edema usually due to pressures of being squeezed through cervix. Lies betweeen scalp and periosteum, able to cross sutures. Cephalohematoma is not able to cross suture lines, lies btwn periosteum and skull.

Front 25

accumulation of fluid outside skull that crosses suture lines.

Back 25

caput succadaneum

Front 26

Accumulation of fluid outside skull not able to cross suture lines

Back 26

cephalohematoma

Front 27

Caput succaneum vs subgaleal hemorrhage

Back 27

both form fluid accumulation within the scalp, and crosses suture lines. no clinical manifestaitons with caput, howver infant may go into shock with subgaleal hemorrhage.

Front 28

Parent notices persistent flat, bluish area on buttocks of infant.

Back 28

mongolion spots. not associated with disease. fades over time (gone by adolescence)

Front 29

Infant presents with rash - red macules with white and yellow papules in center.

Back 29

erythema toxicum. benign, disappears without treatment.

Front 30

mottling

Back 30

benign pink and white blotches. response to cold environment

Front 31

acrocyanosis

Back 31

blue hands or feet. response to cold/immature ciruculation

Front 32

respiratory pattern for neonates

Back 32

30-60 b/min, slightly irregular.

Front 33

fluid accumulation in scrotum

Back 33

hydrocele

Front 34

pilonidal dimple

Back 34

small pit in sacral area at top of yo buttcrack. risk for infection

Front 35

what are signs of congenital hip dislocation?

Back 35

unequal gluteal folds and positive barlow-ortolani maneuver

Front 36

What does the barlow-ortolani test?

Back 36

Tests for congenital hip dislocation.

Front 37

how to perform barlow-ortolani maneuver

Back 37

barlow - push down on knees. click may indicate hip dislocation. ortolani - abduct flexed knees and push from posterior to pop hip back in.

Front 38

what is hypertonia? assoc with?

Back 38

tightly flexed arms and stiffly extended legs, quivering, associa with possible drug withdrawal.

Front 39

name neonatal reflexs

Back 39

moro, startle. Tonic neck, rooting, sucking. palmar grasp, plantar grasp. babiniski, stepping.

Front 40

What is used to assess pain in neonates?

Back 40

NIPS - neonatal infant pain scale. PIPP - premature infant pain profile.

Front 41

erythromycin. indication, route, dose?

Back 41

prophylaxis of chlamydia and gonococcal disease. 1/4 inch of ointment to lower eye.

Front 42

vitamin K injection aka

Back 42

phytonadione

Front 43

used to prevent chlamydia and gonoccal infections of eye

Back 43

erythromycin opthalmic

Front 44

When is jaundice a sign of a pathological process in infants?

Back 44

on first day or >7 days of jaundice.

Front 45

benign pink and white blotches

Back 45

mottling. response to cold environment

Front 46

blue hands or feet.

Back 46

acrocyanosis, response to cold/immature ciruculation

Front 47

hydrocele

Back 47

fluid accumulation in scrotum

Front 48

small pit in sacral area at top of yo buttcrack

Back 48

pilonidal dimple. risk for infection

Front 49

tightly flexed arms and stiffly extended legs, quiverin

Back 49

hypertonia. associa with possible drug withdrawal.

Front 50

white, pearl like epithilial cysts on gum margins and palate

Back 50

- epstein's pearls
- benign, disappears within few weeks

Front 51

natal teeth

Back 51

- benign, assoc with congenital defects
- often loose. remove to decrease risk aspiration

Front 52

asymmetrical moro reflex

Back 52

- may be related to birth injury to clavicle, humerus, brachial plexus

Front 53

startle reflex

Back 53

- loud sound should stimulate same as moro reflex
- abnormal is possible deafness of neurological deficit

Front 54

9 mo. infant performs tonic neck reflex.

Back 54

- usually disappears 6 mo.
- after 6 mo may indicate cerebral palsy

Front 55

how often should neonates be fed

Back 55

- at least q4, but may need to be fed more often (q2-q4)

Front 56

types of neonate stool

Back 56

- meconium - 1st stool. black and sticky. 24-48h.
- transitional - around 3rd day. black to green black, to green brown, to green yellow.

type of feeding influences stool
- breastfed stool - yellow, semiformed, pasty, sour odor.
- formula stool - drier, more formed, pale brown yetllow unpleasant odor.

diarrhea - loose and green

Front 57

who poops more often. breastfed or formula?

Back 57

breastfed poops more

Front 58

where to perform a heel stick

Back 58

- either the lateral or medial aspect of the heel

Front 59

when is hepB vaccine administered

Back 59

- CDC recommends all neonates be vaccinated for HepB before discharge
- 2nd dose - 4w to 4mo after
- 3rd dose - 6 mo to 18mo after 1st dose

Front 60

SS of hpyoglycemia

Back 60

= <40mg/dl in neonate

- jitteriness
- hypotonia
- irritability
- apnea
- lethargy
- temperature instability

Front 61

neonatal apgar score

Back 61

- five measurements - Appearance, Pulse, Grimace, Activity, Respiration

- appearance - color completely pink
- pulse - above 100
- grimace - reflex irritbaility- vigorous cry when stimulated
- activity - muscle tone - active motion, flexed arms resist extension
- respiratory effort - strong cry





- each one mentioned is max score of 2
- so score is from 0-10