Term
| assists the diaphragm as it mechanically expands the lung during inspiration. |
|
Definition
|
|
Term
| Results from increased inspiratory pressure; enlarges the nostrils, decreasing nasal resistance to air flow, |
|
Definition
|
|
Term
| Expiration through partially closed vocal cords produces this sound. A noise is produced. elevates the pressure at the end of respirations. The maneuver helps keep the lungs expanded and preserves oxygen |
|
Definition
|
|
Term
| This is the most efficient way to increase ventilation and compensate for hypoxia and hypercarbia |
|
Definition
|
|
Term
| may result from peripheral constriction for any number of reasons - not necessarily hypoxia.) The worse the hypoxia, the more extensive the central affect of this phenomenon |
|
Definition
|
|
Term
| what type of acidosis is present if the baby requires just a little stimulation at birth to start breathing |
|
Definition
|
|
Term
| . Babies with low apgars who require much more rescusitation have what type of compromise? |
|
Definition
|
|
Term
| the lower the _____ the harder it will be to resuscitate the baby and the more severe the _____ |
|
Definition
|
|
Term
| review respiratory acidosis |
|
Definition
| pH<7.2, PCO2 >65, HCO3 WNL, and BE WNL |
|
|
Term
| review metabolic acidosis |
|
Definition
| 1. pH <7.2, PCO2 WNL, HCO3 <17, and BE>13 |
|
|
Term
|
Definition
| Low pH, PCO2 >65, HCO3 <17, and BE >7 |
|
|
Term
| Normal Umbilical artery blood gas values; indication of fetal well being |
|
Definition
pH- 7.19-7.34
PCO2 43-63
HCO3- 18.4-25.6
BE- 1-7 |
|
|
Term
| Normal umbilical venous blood gas values; indication of placental well-being |
|
Definition
pH 7.4-7.43
PO2- 28-32
PCO2- 38-42 |
|
|
Term
| result of a delay in respiratory transition with an increase in diffusion |
|
Definition
|
|
Term
| Most common clinical sign is tachypnea of 120-140 breaths per minute, mild to mod retractions grunting may be exhibited |
|
Definition
|
|
Term
| Radiographic findings demonstrate vascular engorgement with increased pulmonary vascular markings. Moderate cardiomegaly may be evident and air bronchograms can be identified |
|
Definition
|
|
Term
| In _____, pauses are longer and includes changes in heart rate, sometimes to less than 80 beats/minute |
|
Definition
|
|
Term
| What is periodic breathing in the nbn? |
|
Definition
| pauses in respirations up to 20 seconds which alternate with breathing |
|
|
Term
| what are risk factors that can lead to passage of meconium in utero? |
|
Definition
| any type of stress to include including maternal hypertension, maternaldiabetes, or eclampsia |
|
|
Term
| what leads to aspiration of meconium in utero? |
|
Definition
| Chronic fetal hypoxia and acidosis can lead to gasping in utero |
|
|
Term
| MEC aspiration has what effect on surfactant? |
|
Definition
|
|
Term
| What is the treatment for meconium aspiration? |
|
Definition
| Surfactant is the gold standard and iNO can alleviate the pulmonary HTN |
|
|
Term
| What are the five risk associated with intubation? |
|
Definition
| hypoxia, bradycardia/apnea,pneumo,contusions/lacerations, perferation of the trachea/esophagus, infection |
|
|
Term
| what are the four non-pulmonary, causes of respiratory problems? |
|
Definition
| cardiac disease, infection,metabolic disorders, CNS disorders |
|
|
Term
| _____commonly presents with central cyanosis, but the infant also may present with signs of heart failure |
|
Definition
|
|
Term
|
Definition
| (head is over 10%, weight is less than 10%) |
|
|
Term
|
Definition
| both head and wt are less than 10%) |
|
|
Term
|
Definition
| between 10-90% for weight based on gest age |
|
|
Term
|
Definition
| weight that is below the 10th percentile for gestational age |
|
|
Term
|
Definition
| weight > 90th percentile for gestational age |
|
|
Term
|
Definition
| less than 2500g (5#8oz) for babies over 33 weeks gestation |
|
|
Term
| review the risk factors for developing of wasting syndrome |
|
Definition
○ poor placental perfusion r/t maternal chronic HTN and/or preeclampsia
○ nutritional deficits to the fetus during the 3rd trimester r/t insufficient maternal caloric intake
○ chronic fetal distress r/t placental insufficiency |
|
|
Term
| 7. Risk factors for decreased fetal growth |
|
Definition
● Maternal substance use: smoking, drugs, alcohol
● Maternal chronic illness such as diabetes
● Pregnancy complications such as preeclampsia; decreased placental perfusion
● Intrauterine infection
● High altitude
● Multiple births
● Genetic disorders
● Chronic malnutrition
● Hx of growth restriction
● Stress and depression
● Obesity
● Exposure to certain medications
● Abnormal placenta attachment |
|
|
Term
| In____________ the heart is a mirror image of the normal heart and there are no other problems. This condition is rare. When this occurs, the organs of the abdomen and the lungs will often also be arranged in a mirror image |
|
Definition
| dextrocardia with situs inversus |
|
|
Term
| subcortical abilities in the neonate include things like___,___, and ___. |
|
Definition
| like reflexes, tone and states. |
|
|
Term
Cortical function is manifested by rudimentary learning ability and the ability to integrate sensory stimuli, as seen in
_____ and ______. |
|
Definition
| visual tracking or habituation |
|
|
Term
| List seizure symptoms in a nbn |
|
Definition
| grimacing, chewing, repetitive swallowing, staring, altered respiratory rhythm, horizontal deviation of the eyes, repetitive blinking, swimming or rowing movements of the arms, bicycling of the limbs, eye fluttering, eye deviation |
|
|
Term
| ________) is the term describing the pathologic findings that result in a term infant who has experienced a significant episode of antepartum, intrapartum, or postnatal asphyxia |
|
Definition
| ● Hypoxic ischemic encephalopathy (HIE) |
|
|
Term
| what is the major cause of nbn seizures? |
|
Definition
| ● Hypoxic ischemic encephalopathy (HIE) |
|
|
Term
| ● Neonates with severe HIE are usually recognized as ____ and ____. |
|
Definition
|
|
Term
| 5. Review 4 characteristics that can be used to distinguish "jitteriness" from seizure activity |
|
Definition
| include gaze, stimulus sensitivity, type of predominant movement, and whether the activity stops when the limb is flexed. |
|
|
Term
| What are the 3 major components of the immune system? |
|
Definition
| humoral, phagocytic,and cell-mediated |
|
|
Term
| Describe the humoral system |
|
Definition
| (Antibody Mediated Immunity & Complement System) IgA, IgM, & IgG have limited abilities compared to adults. Newborns only have 55 - 80% of the adult amounts of all antibodies. This is the 2nd reason newborns have difficulty in fighting off germs. |
|
|
Term
| recognizes and destroys antigens |
|
Definition
| cell-mediated response (t-lymphocytes). |
|
|
Term
| why does the cell-mediated response not fully protect the nbn? |
|
Definition
| ○ This immature immune system leaves the potential for overwhelming infection characteristics in the newborn period because the nbn system only fx at approx 30% and is slow to respond |
|
|
Term
|
Definition
| they encapsulate the invadors/antigens so that are seperated from the rest of the body and can be destroyed |
|
|
Term
| why do phagocytes not work as well in nbns? |
|
Definition
| PMNs can localize small numbers of bacteria or viruses. If the numbers are too large the PMNs cannot respond fast enough to contain and localize the infection. This can also happen if the neonate is compromised |
|
|
Term
| - crosses the placenta and protects the newborn against an infection mom had while pregnant |
|
Definition
|
|
Term
| - is present in the newborn in very small amounts (1-2% of adult levels) It is passed to the infant in breast milk |
|
Definition
|
|
Term
| Infants cannot produce their own until 6 months old |
|
Definition
|
|
Term
| detects foreign (maternal) antibodies attached to the surface of the newborn’s RBCs |
|
Definition
|
|
Term
| detects presence of foreign antibodies in the plasma (not attached to RBCs) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| review Physiologic juandice |
|
Definition
○ appears day 2-4 after birth
○ total bili rises slowly and peaks at day 3 or 4 of life
○ total bili peaks less than 13 |
|
|
Term
| review patholoigical juandice |
|
Definition
○ visible within 24hrs after birth
○ total bili rises quickly, up to >5mg/dl/24hrs
○ total bili >13mg/dl
○ visible juandice persists after one week of life
○ nbn may have risk factors such as cephalohematoma or ABO or Rh incompatibility, polycythemia |
|
|
Term
| What are the most common causes of hyperbilirubinemia? |
|
Definition
● Hemolytic disorders such as blood group incompatibilities--Rh primarily.
● Extravascular blood--from hematoma or hemorrhage
● Polycythemia |
|
|
Term
| what is the most common cause of hyperbilirubinemia? |
|
Definition
| ABO incompatibility, particularly type O |
|
|
Term
| bili levels are lowest in ifnants breastfed more than |
|
Definition
| eight or nines times in 24hrs during the first 3 days after birth. |
|
|
Term
| Only free bilirubin can cross the blood brain barrier and |
|
Definition
| cause bilirubin encephalopathy |
|
|
Term
| Factors that reduce __________ will increase the amount of free bilirubin and, thus, increase the risk for bilirubin encephalopathy |
|
Definition
|
|
Term
| risk factors for kernicterus include |
|
Definition
| : low albumin levels, G6PD deficiency, prematurity, respiratory distress syndrome, hypoxia, acidosis |
|
|
Term
| Increased incidence of hyperbilirubinemia in neonates of _________ |
|
Definition
|
|
Term
| The primary signs of heart disease include |
|
Definition
Central cyanosis
Murmurs
Other cardiac sounds |
|
|
Term
| A loud murmur may be present at birth or not be heard until |
|
Definition
|
|
Term
| Causes of congenital heart defects include |
|
Definition
Single-gene or chromosomal mechanisms
Exposure to teratogens
Most are caused by multiple factors, both genetic and environmental |
|
|
Term
| The most common type of CHD |
|
Definition
| Ventricular Septal Defects |
|
|
Term
| Ventricular septal defects are more common in |
|
Definition
| More common in males than females |
|
|
Term
| Functional closure of the ductus arteriosus usually occurs |
|
Definition
| soon after birth between 15 hours and 2 weeks of life |
|
|
Term
| With PDA, aortic blood is shunted into the pulmonary artery from |
|
Definition
|
|
Term
| PDA is the most common congenital anomaly associated with |
|
Definition
| maternal rubella infection |
|
|
Term
|
Definition
Prematurity
High altitude
Fetal chromosomal anomalies |
|
|
Term
| Are PDAs cyanotic or acyanotic? |
|
Definition
| Acyanotic, machine-like murmur near left sternal border |
|
|
Term
| The most common form of atrial septal defect (ASD) is |
|
Definition
|
|
Term
| What are 4 clinically significant types of ASD? |
|
Definition
Ostium secundum defect
Endocardial cushion defect with a foramen primum defect
Sinus venous defect
Common atrium |
|
|
Term
| Atrial septal defects are |
|
Definition
|
|
Term
| One of the most common but least severe types of CHD |
|
Definition
|
|
Term
| this type of ASD Occurs near the oval fossa |
|
Definition
|
|
Term
| The septum primum does not fuse with the endocardial cushion, causing a patent foramen primum |
|
Definition
| Endocardial Cushion Defects With Patent Foramen Primum |
|
|
Term
| ______without respiratory distress is usually a cardiac problem |
|
Definition
|
|
Term
| ______without respiratory distress is usually a cardiac problem |
|
Definition
|
|
Term
| Signs of possible cardiac problem include: |
|
Definition
Cyanosis
Tachypnea
Poor feeding
Cyanosis with feeding
Poor weight gain
Edema
Sweating (older infants) |
|
|
Term
| Acyanosis with signs of distress such as tachypnea, retractions, grunting, or flaring usually represents a _______ |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Cord compression can cause respiratory acidosis
Inability to clear CO2 at the placenta
Common in newborns with tight nuchal cord or second stage bradycardia
Infants usually clear CO2 rapidly after birth |
|
|
Term
|
Definition
True deficit of oxygen
Switch to anaerobic metabolism occurs
Lactic acid is generated, lactic acid does not cross placenta quickly
Acidosis progresses quickly to asphyxia if not corrected |
|
|
Term
| Normal Umbilical Artery Cord Gas in Term Newborn is the Best representation of _________ |
|
Definition
|
|
Term
| Normal Umbilical Vein Cord Gas in Term Newborn Best representation of the status of the |
|
Definition
|
|
Term
| CXR will show patchy atelectasis and over-inflation due to air trapping |
|
Definition
|
|
Term
| Infant with Meconium Fluid prognosis |
|
Definition
Usually term or post-term infants
13% of all births complicated by meconium stained fluid
4-5% develop meconium aspiration syndrome
Most have complete recovery of pulmonary function
Severe cases have 50% risk of developing reactive airway disease during first 6 months of life |
|
|
Term
|
Definition
Change in activity: lethargy, irritability
Decreased tone
Color: pale, gray, dusky, cyanotic
Feeding concerns: poor feeding, no interest, poor suck, abdominal distention, vomiting
Jaundice
Grunting, apnea, retractions
Low temperature or temperature instability |
|
|
Term
| For infants born to HBsAg + mothers, HBV vaccine & Hep B immune globulin (HBIG) should be given within |
|
Definition
|
|
Term
| If unknown maternal status at the time of labor/birth, give vaccine within |
|
Definition
| 12 hours & test mother for HBV |
|
|
Term
| What is ESOPHAGEAL ATRESIA? |
|
Definition
Lack of continuity of the esophagus
Incidence: 1/4000 babies born in the U.S. have esophageal atresia; 25th most common birth defect |
|
|
Term
| ____________ and esophageal atresia often occur together |
|
Definition
| Tracheoesophageal fistula |
|
|
Term
| Signs/symptoms: excess salivation (especially frothy secretions), respiratory distress, swallowing problems, abdominal distention, and nonbilious vomiting |
|
Definition
|
|
Term
| how do you minimize aspiration in esophageal atresia? |
|
Definition
| place prone with head elevated and do not feed |
|
|
Term
| what are the two most common neurotubal defects? |
|
Definition
| meningocele and meningomyelocele |
|
|
Term
| ___________ vertebra is defective and the spinal cord and spinal roots are externally located in a sac |
|
Definition
|
|
Term
| what is the immediate midwifery management of meningomyelocele? |
|
Definition
| apply sterile, warm saline dressing with dry sterile overwrap, support thermoregulation and fluid maintenance |
|
|
Term
| ____________ requires that you keep the infant prone and make sure feces do not contaminate sterile dressing |
|
Definition
|
|
Term
| Non-junction of the upper lip or palate (roof of the mouth) |
|
Definition
|
|
Term
| Risk factors include heavy alcohol or tobacco use, obesity |
|
Definition
| ABDOMINAL VENTRAL WALL DEFECTS |
|
|
Term
| management for GASTROSCHISIS |
|
Definition
Midwife role at birth
Call for pediatric assistance
Transport to tertiary peds unit
Place newborn in radiant warmer
Apply sterile warmed saline
Wrap torso in sterile gauze
Do not feed infant |
|
|
Term
|
Definition
| ■ Defect in abdominal wall – herniation of abdominal viscera through umbilical ring |
|
|
Term
■ Sac contains spinal cord and/or nerve roots
■ Spinal cord abnormalities are present
■ 80% of Spina bifida cystica |
|
Definition
|
|
Term
|
Definition
■ sterile warm saline dressing – not too tight – cover with plastic
■ Hydration – IVF (must be kept NPO)
■ Gastric tube to keep gut compressed
■ Surgical repair, usually good prognosis, depends on extent of herniation |
|
|
Term
■ Herniation of abdominal contents into thoracic cavity
■ Displacement of heart and lungs |
|
Definition
|
|
Term
| what are the s/s of diaphragmatic hernia |
|
Definition
■ Respiratory distress – related to compromise of lung space
■ Scaphoid abdomen |
|
|
Term
| tx of diagphragmatic hernia |
|
Definition
■ Emergent treatment
■ Endotracheal intubation
■ »Bag and mask will worsen situation
■ »Feeding tube to low suction to vent stomach air
■ Surgical repair |
|
|
Term
■ Anomalies of external genitalia
■ Can not identify sex of newborn
■ Often associated with internal genital anomalies
■ Sex type determined by chromosome studies |
|
Definition
|
|
Term
■ »Increased head circumference
■ »Separation of sutures
■ »Bulging tense fontanelles
■ »High pitched cry
■ »Downward deviation of eyes |
|
Definition
|
|
Term
| what r causes of Hydrocephaly |
|
Definition
■ Impaired circulation and absorption of CSF
■ Possible increase production of CSF |
|
|
Term
| A Failure of the halves of the vertebral arch to fuse. |
|
Definition
|
|
Term
| what are physical s/s of spina bifida occulta? |
|
Definition
| Occasionally indicated by a tuft of hair |
|
|
Term
|
Definition
| a type of Brachial plexus injury associated with traction on the head during delivery |
|
|
Term
| what are risk factors for cephalohematoma? |
|
Definition
Prolonged vaginal deliveries
Instrumental deliveries |
|
|
Term
Extracranial bleeding beneath periosteum
Swelling demarcated- does NOT cross suture lines
Periosteum impedes rapid enlargement and limits final size
Shearing forces of L&D lacerate veins |
|
Definition
|
|
Term
| Cephalohematoma's are not usually obvious and may take a period of time to rise and ______before it resolves. |
|
Definition
|
|
Term
| when are cephalohematoma's dangerous? |
|
Definition
| when it is present at the base of the skull; can easily hemorrhage. other locations help to contain bleeding in one location |
|
|
Term
| Result of shoulder dystocia or breech delivery with arm extension;rare |
|
Definition
|
|
Term
| most common bony injury, usually w shoulder dystocia ; more common in female gender |
|
Definition
|
|
Term
| reveiw s/s of Erb's palsy |
|
Definition
Involves cervical nerve roots C5 and C6
Symptoms include generalized loss of movement in the affected arm with an adduction of the lower part of the arm
Hallmark “waiter’s tip” sign
Grasp reflex intact
Weak Moro reflex on affected side |
|
|
Term
| Reassure parents that for most cases paralysis disappears in 3-6 months in what condition? |
|
Definition
|
|
Term
| review the information on Klumpke’s Paralysis, a brachial plexus injury |
|
Definition
Involves nerve roots C8 and T1
Extremely rare incidence
Weakness of wrist and finger flexors and of the small muscles of the hand
Symptoms:
Grasp reflex is absent
Infant’s hand in claw like posture
Poorer prognosis than Erb’s Palsy |
|
|
Term
| what is the cause of facial paralysis? |
|
Definition
| Caused by forceps or pressure from the maternal sacrum |
|
|
Term
| what are the s/s of facial palsy? |
|
Definition
Asymmetry of the face
Failure of one side of the mouth to move
Failure of one eyelid to close |
|
|
Term
| what are some causes of Causes of Seizures? |
|
Definition
Asphyxia
Infection (cause unknown)
Intracranial hemorrhage
Hypoglycemia
Drug toxicity or withdrawal
Electrolyte imbalance |
|
|
Term
| ________ occur more frequently in the neonatal period than at any other time during the human lifespan |
|
Definition
|
|
Term
| 80% of seizures occur in the ______ and are often the first sign of _______ |
|
Definition
| first week of life and neurological or metabolic dysfunction |
|
|
Term
| ___________is the gold standard for diagnosing neonatal seizures |
|
Definition
|
|
Term
| ______________are the most frequently used drugs to treat neonatal seizures despite their long-term affects |
|
Definition
| Phenobarbitol and Phenytoin |
|
|
Term
| ____________are excessive, synchronous, electrical discharges of a group of neurons in the CNS. |
|
Definition
|
|
Term
| Believed to be the case because myelination, dendritic outgrowth and formation of synaptic junctions in the cerebral cortex are incomplete, while subcortical and limbic structures are more advanced/developed at birth. |
|
Definition
|
|
Term
| what is the physiology of nbn seizures? |
|
Definition
| GABA receptor activation produces excitation rather than inhibition of neurotransmission |
|
|
Term
Identify this seizure:
Most common type
Term and Preterm |
|
Definition
|
|
Term
Identify this type of seizure:
Primarily in preterm infants
Manifested by: tonic extension of limbs or tonic flexion of arms and extension of leg |
|
Definition
|
|
Term
Identify this type of seizure:
Primarily in term infants
Manifested by: clonic movement which moves from limb to limb in a sporadic pattern |
|
Definition
|
|
Term
Identify this type of seizure:
Most commonly noted in term infants
Characterized by localized clonic jerking motions while in a conscious state |
|
Definition
|
|
Term
Identify this type of seizure:
Both term and preterm
Synchronous jerks of flexion affecting upper limbs more then lower limbs |
|
Definition
|
|
Term
| Behaviors of Subtle Seizures |
|
Definition
Persistent sucking; drooling; thrusting of tongue; chewing
Apnea/Altered respiratory rhythm
Occulomotor phenomenon such as:
Sustained eye opening (staring); Facial grimacing
Excessive eyelid blinking/fluttering
Horizontal eye deviations
Jerky and/or swimming/pedaling/rowing movements with arms. |
|
|
Term
| Clinical Management of nbn seizures |
|
Definition
Support airway, breathing and circulation
Check blood glucose and secure vascular access. If hypoglycemia is present in a convulsing infant, give 2 ml/kg of 10% dextrose intravenously and start maintenance dextrose solution to achieve normal blood glucose levels.
Notify for consult and refer care to neurologis |
|
|
Term
| The pathologic findings that result in a term infant who has experienced a significant episode of antepartum, intrapartum, or postnatal asphyxia. |
|
Definition
| Hypoxic-Ischemic Encephalopathy (HIE) |
|
|
Term
| what is the major cause of nbn seizures? |
|
Definition
| Hypoxic-Ischemic Encephalopathy (HIE) |
|
|
Term
| what is the major consequence of Hypoxic-Ischemic Encephalopathy (HIE)? |
|
Definition
| cerebral palsy, especially in preterm infants |
|
|
Term
| Three major signs of HIE include: |
|
Definition
Seizures
Abnormal states of consciousness
Abnormal tone |
|
|
Term
|
Definition
| irregular respirations, apnea, decreased or absent Moro reflex, abnormal cry, poor suck, and unusual eye movements |
|
|
Term
| how do you differentiate between jitteriness and seizure activity? |
|
Definition
Gaze
Stimulus sensitivity
Type of predominant movement
Whether the activity stops when the limb is flexed. |
|
|
Term
| Alcohol (ethanol) readily crosses placenta and is a |
|
Definition
|
|
Term
| FAS is diagnosed based on a highly specific triad of characteristics: |
|
Definition
characteristic facial features
(2) growth deficiency
(3) evidence of central nervous system abnormality |
|
|
Term
| ____is at one extreme end of the fetal alcohol spectrum |
|
Definition
|
|
Term
| physical appearance of FAS include |
|
Definition
| smooth philtrum, small eye opening, and thin upper lip |
|
|
Term
| ____________-also acts as reservoir → prolonging fetal contact with alcohol |
|
Definition
|
|
Term
| Alcohol disrupts DNA and protein synthesis which leads to |
|
Definition
|
|
Term
| Factors that influence the effects of alcohol include: |
|
Definition
pattern of consumption, dose, and timing of exposure
nutrition
genetics
metabolism |
|
|
Term
| The __________ is vulnerable to the effects of alcohol in all trimesters of pregnancy |
|
Definition
|
|
Term
| review the effects on alcohol consumption through all trimesters |
|
Definition
First trimester: may cause damage to developing organs (e.g., heart, eyes, ears, kidney, and extremities)
Second trimester: may increase the risk of spontaneous abortion.
Third trimester: greatest impact on height/length and weight |
|
|
Term
| those affected by FAS may have what type of neurological abnormalities? |
|
Definition
| microcephaly, seizures, cognitive or learning deficits, behavioral issues |
|
|
Term
| Routine screening for asymptomatic GBS bacteria by urine culture is recommended between |
|
Definition
|
|
Term
| Impact of early onset GBS on neonate |
|
Definition
Pneumonia and respiratory
Illness: (54%)
Newborn sepsis (27%)
Meningitis (15%) |
|
|
Term
| s/s of GBS meningitis in the nbn |
|
Definition
| Irritability, lethargy, poor tone & tremors/seizures |
|
|
Term
| > 60% of newborns who develop early onset GBS disease were born from women with |
|
Definition
| negative GBS screenings during pregnancy |
|
|
Term
| 3. Evaluate the characteristics, dangers, and potential short- and long-term sequelae of polycythemia, including the effect of exchange transfusion |
|
Definition
● Polycythemia = Hct level of greater than 65% (incidence: 0.4-12% of neonates)
● The primary concern with polycythemia = hyperviscosity and its associated complications.
● Only 47% of infants with polycythemia have hyperviscosity, and only 24% of infants with hyperviscosity have a diagnosis of polycythemia
● Risk factors: SGA, LGA, diabetic moms, delayed cord clamping
● Dangers: The central nervous, cardiopulmonary, GI, and renal systems are at risk. Metabolic derangements are common. Coagulation can also be affected. |
|
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Term
| 1. Compare newborn whole blood clotting times to adult clotting time. |
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Definition
● aPTT, PT and TT clotting times are prolonged (compared to adults) and are more prolonged with decreasing gestational age.
● However, whole blood clotting times are slightly *shorter* than adult values (pg. 238 of Blackburn). |
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Term
| ● Clinical features ascribed Polycythemia and Hyperviscosity |
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Definition
Central nervous system
○ Early effects: Hypotonia and sleepiness, irritability and jitteriness
○ Neurodevelopment: motor deficits, lower achievement and IQ scores
Metabolism
○ Hypoglycemia
○ Jaundice
○ Hypocalcemia
Heart and lungs
○ Tachycardia, tachypnea, respiratory distress
○ Cyanosis, plethora
○ Chest radiography: cardiomegaly, pulmonary plethora
○ Echocardiography: increased pulmonary resistance, decreased cardiac output
Gastrointestinal tract
○ Poor suck, vomiting
○ Necrotizing enterocolitis
Kidneys
○ Oliguria (depending on blood volume)
Hematology
○ Mild thrombocytopenia
○ Thrombosis (rare) |
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Term
| what are the three acyanotic cardiac defects? |
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Definition
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Term
| Of the acyanotic cardiac defects, which is the most common? |
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Definition
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Term
| ASD, VSD, and PDA place the infant at risk for ____ and ____. |
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Definition
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Term
| Nurse-midwifery management for any arrhythmia, murmur or cyanosis other than transient peripheral acrocyanosis is: |
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Definition
Immediate referral
Supportive care of the family may include drawing a simple diagram or talking about the heart defect
Assurance in the case of PDA or other benign murmur
Therapeutic listening for more ominous diagnoses |
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Term
| ____________are a relative medical emergency because they usually signal life-threatening disease or damage, and they may destroy neurons. |
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Definition
| Seizures are a relative medical emergency because they usually signal life-threatening disease or damage, and they may destroy neurons. |
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Term
| What two events place the infant at highest risk of seizure development? |
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Definition
| pernatal asphyixia and metabolic disturbances |
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Term
| The cortical regions of the brain are less mature than the subcortical regions, thus the subcortical region is responsible for |
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Definition
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Term
| therapuetic hypothermia for HIE requries that the temmperature be dropped to |
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Definition
| 92.3F within 6hrs of ischemic insult |
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Term
| neonatal cooling for occur for____days |
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Definition
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Term
| protects the newborn against infection the mother experienced during pregnancy |
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Definition
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Term
| respond to antigens in the mother's--and thus the nursing infant's environment |
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Definition
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Term
| also differs from adult type in being less able to respond to specific pathogens, limiting its ability to recognize a germ initially. |
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Definition
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Term
| the nbn uses up it's maternal supply quickly and is not able to produce it's own until 6months of life |
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Definition
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Term
| Analyze how the normal range of WBC change from the time of birth to three days after birth. |
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Definition
| a. WBC counts can only suggest infection because of the wide range of normal for newborns: 9,000-25,000 with average of 15,000/mm. Only if the WBC is <3-4,000 or >25,000 is infection indicated. (Blackburn, 480) In addition, normally the total number of WBCs falls from adult levels at birth to the low at 3 days. |
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Term
| Group Beta strep (GBS) can vary in severity of sequalae in the newborn. Review the relationship of maternal colonization to neonatal GBS disease |
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Definition
• the infant may or may not become colonized.
•Colonization depends on the "load" of bacteria, in the "exposure"
•Vertical transmission is estimated to occur in 40-73% of colonized women.
•1-2 % of infants born to healthy, lightly colonized mothers develop sepsis. So, doing the math, if 40 of 100 women are colonized, 0.4% or <1 in 200 of their newborns will get sick. This sounds like very good odds for infants |
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Term
| Differentiate three ways newborns contract viral infections. |
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Definition
| congenitially, noscomial, and aquired |
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Term
| Review the broad categories of symptoms of viral infection. |
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Definition
a. Often there are none. Many viral infections offer no clues to even a tiptop detective. Hepatitis B is a great example.
b. Non-specific as with bacterial infection, for example influenza.
c. Specific, major findings that derive from congenital infections. CMV for example causes petechiae, hepatosplenomegaly, and microcephaly. |
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Term
| treatment of viral infections consist of |
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Definition
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Term
| Review the factors that influence the vertical transmission of HIV and the current rate of transmission. |
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Definition
| AZT for HIV-exposed neonates, which, along with maternal treatment, decreases the rate of transmission by 66%. Moms on the triple therapies have as low as 1-2% vertical transmission rates. |
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Term
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Definition
2mg/kg q6hrs for 4-7days. the viral load is rechecked at 2d,2w, 6w,12, and every 12 weeks until viral reisistence is no longer dectedted
begin 6-12hrs after birth. May take AZT up to 6wks depending on maternal counts |
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Term
| An absence of PMN (neutrophils) is a sign of |
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Definition
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Term
| Direct bilirubin measures |
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Definition
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Term
| Total Serum Bilirubin (TSB) levels of < or equal to 5 mg/dl with a direct bilirubin of > 1 mg/dl |
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Definition
| is abnormal and a sign of disease |
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Term
| TSB levels > 5 mg/dl with a direct bilirubin equal to 20% or greater of the TSB is considered |
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Definition
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Term
| A positive indirect Coombs reflects the presence of a foreign antibody in plasma, which is far less of a threat as no |
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Definition
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Term
| For CNMs in most practice settings ABO incompatibility jaundice requires |
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Definition
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Term
| The only form of bilirubin that can cause kernicterus is |
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Definition
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Term
| Acidosis also decreases albumin's binding affinity for ______. |
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Definition
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Term
| Viscosity is the problem the problem with polycythemia and causeing |
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Definition
| organ damage and neurological problems |
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Term
| CNMs can help prevent the occurrence of polycythemia by encouraging good______,______, and anticipate _______. |
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Definition
| glycemic control, smoking cessation, and hypoxia |
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Term
| Physiologic anemia of infancy occurs at |
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Definition
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