Chapter 8: Common Health Problems of the Newborn

Hemolytic disease of the newborn is a concern when elevated bilirubin levels are seen within 24 hours of birth and when serum bilirubin levels increase to greater than _________ mg/dl per day. Use numbers only.

5 When bilirubin levels increase to greater than 5 mg/dl per day, there is concern for hemolytic disease of the newborn.

Which infant is most at risk of being injured during the birthing process?

9 lb infant delivered after pushing for 90 min. Birth injuries are more common in large infants with prolonged deliveries. Most infants born between 37 and 40 weeks weigh between 5 lb, 8 oz and 8 lb, 13 oz. A 9 lb infant delivered after pushing for 90 min would be most at risk for a birth injury.

Which nursing statements are appropriate when educating parents about nutrition and feeding of their high-risk infant? Select all that apply.

"Cheek and jaw support with upward lift of the chin can help with nipple feeding in preterm infants." "Clinical signs of poor feeding tolerance include apnea, bradycardia, and decreased oxygen saturation." "Minimal enteral trophic feeds have been proven to benefit and stimulate the infant's gastrointestinal tract." Cheek and jaw support with upward lift of the chin can help with nipple feeding in preterm infants; this would be important to include in the education process. Clinical signs of poor feeding tolerance include apnea, bradycardia, and decreased oxygen saturation. So, this statement should be important to provide in the education process. Minimal enteral trophic feeds have been proven to benefit and stimulate the infant's gastrointestinal tract, so this would be important to include in the education process.

Which parent statements indicate understanding of the diagnosis of Pierre Robin sequence (PRS) for their infant?

"Due to the large tongue and small jaw, my baby will have respiratory issues." Due to the large tongue and small jaw associated with Pierre Robin sequence (PRS), the child will have respiratory issues. Some babies will need a tracheotomy, but some have success with a tongue-lip adhesion surgery.

Which statement by the nurse best describes appropriate care for an infant who was born at 35 weeks and weighs 6 lb?

"Late-preterm infants can be overlooked as they appear to be more stable than significantly-preterm infants." Late-preterm infants (i.e., 34-36 weeks gestation) often get overlooked as they appear more stable than significantly-preterm infants.

Which statement by the mother indicates understanding of ABO incompatibility and risk of hemolytic disease in her unborn infant?

"My blood type is O+, and my unborn infant's blood type is A+, so my infant is at risk for developing hemolytic disease of the newborn." Blood type O has antibodies in the plasma to both A and B blood types, therefore the baby is at risk of developing hemolytic disease of the newborn. This statement would indicate understanding by the mother.

Which statements by a nurse indicate understanding of possible complications for a newborn infant who experienced a prolonged second stage of labor and a failed vacuum extraction requiring an emergency cesarean section? Select all that apply.

"The infant is at risk for subgaleal hematoma and early identification is critical." "Increasing head circumference measurements can indicate swelling and possibly a subgaleal hematoma." "With a subgaleal hematoma, bleeding extends beyond the bone and into the neck area and can have serious complications." A prolonged second stage labor and a failed vacuum extraction increase the infant's risk for a subgaleal hematoma; early identification is critical. Increasing head circumference can indicate swelling and possible subgaleal hematoma. During a subgaleal hematoma, bleeding extends beyond the bone and into the neck area; this may have serious complications.

Which nursing statement is an appropriate response to the mother of a 3-day-old infant, born at 38 weeks gestation, who is exclusively breast-fed when asked why her infant has a yellow tone to her skin?

"Your baby is showing early-onset breastfeeding jaundice, which is related to the mother's milk supply not being fully established but should improve over the next few days as long as you continue to nurse exclusively." The best statement by the nurse would be to explain that early-onset breastfeeding jaundice begins on day 2 to 4 of life and is related to the mother's milk supply not being fully established.

Microcephaly is defined as occipitofrontal circumference greater than ________ standard deviations below the mean for age and sex. Use numbers only.

3 Microcephaly is defined as occipitofrontal circumference greater than 3 standard deviations below the mean for age and sex.

Which statement related to thermoregulation in the high-risk neonate is true?

A neutral thermal environment is when an infant maintains a normal core temperature with minimal oxygen consumption and minimal calorie expenditure. The goal of thermoregulation is to create a neutral thermal environment where the infant maintains a normal core temperature with minimal oxygen consumption and caloric expenditure.

The nurse caring for a newborn infant notices petechiae on the forehead and around the eyes. Which lab work should be prescribed for an infant with notable petechiae after a difficult delivery? Select all that apply.

Complete blood count Blood culture Even if notable petechia is thought to be caused by trauma during delivery, the infant should also be assessed for possible underlying abnormalities, such as a bleeding disorder or infection. Even if notable petechia is thought to be caused due to trauma during delivery, the infant should also be assessed for possible underlying abnormalities, such as a bleeding disorder or infection. A complete blood count and blood culture would help identify an infant with a bleeding disorder or an infection.

Which abnormalities on the assessment of a newborn are seen when a clavicle is fractured in the birthing process? Select all that apply.

Crepitus Hematoma Localized swelling Common findings on a physical exam of an infant with a fractured clavicle include crepitus, the course crackling sensation felt during palpation. Common findings on a physical exam of an infant with a fractured clavicle include localized hematoma or bruising. Common findings on a physical exam of an infant with a fractured clavicle include localized edema or swelling.

What are the benefits of skin-to-skin contact for high-risk infants? Select all that apply.

Decreased risk of mortality Fewer nosocomial infections Decreased length of hospital stay Maintenance of body temperature Decreased stress level Skin-to-skin contact has been shown to decrease risk of mortality, decrease incidence of nosocomial infections, shorten length of hospital stays, help with maintenance of body temperature, and decrease stress levels of the neonate.

Which classifications are appropriate for high-risk neonates? Select all that apply.

Disease process Gestational age Weight High-risk neonates are usually classified according to weight, gestational age, and main pathophysiological issues. High-risk neonates are usually classified according to weight, gestational age, and main pathophysiological issues. High-risk neonates are usually classified according to weight, gestational age, and main pathophysiological issues.

Which birthmark seen in newborns can be found within the PHACE syndrome mnemonic?

Hemangioma The PHACE syndrome mnemonic is composed of the following: posterior fossa brain malformation, hemangiomas, arterial anomalies, cardiac defects, and eye anomalies.

Using the hour-specific nomogram chart, a 39-week-gestation infant who is 36 hours old with a serum bilirubin level of 8 mg/dl should be in which risk zone for developing hyperbilirubinemia?

Low intermediate-risk zone Using the hour-specific nomogram chart, a 39-week-gestation infant who is 36 hours old with a serum bilirubin level of 8 mg/dl would be in the low intermediate-risk zone for developing hyperbilirubinemia.

Which type of newborn birthmark is seen in the image?

Infantile hemangioma The image depicts infantile hemangioma, which is a bright-red, raised lesion with discrete borders seen on some newborns.

Which clinical signs can be indicative of hypoglycemia or hypocalcemia in a high-risk newborn? Select all that apply.

Jitteriness High-pitched cry Cyanosis Tremors Signs of both hypoglycemia and hypocalcemia are similar and include jitteriness, high-pitched cry, cyanosis, and tremors. Signs of both hypoglycemia and hypocalcemia are similar and include jitteriness, high-pitched cry, cyanosis, and tremors. Signs of both hypoglycemia and hypocalcemia are similar and include jitteriness, high-pitched cry, cyanosis, and tremors. Signs of both hypoglycemia and hypocalcemia are similar and include jitteriness, high-pitched cry, cyanosis, and tremors.

What are the names of the primary sutures of an infant's skull? Select all that apply

Lambdoid Coronal Sagittal The primary sutures of an infant's skull are the coronal, lambdoid, and sagittal sutures.

Which position promotes energy conservation in the high-risk neonate?

Prone Prone positioning has been shown to be the best position to promote energy conservation and rest in the infant.

Match the mode of assisted ventilation in the newborn with respiratory distress with the appropriate description.

Mechanical breaths that are synchronized to coincide with infant's breath. (Synchronized Intermittent Mechanical Ventilation (SIMV) Provide constant airway pressure through nasal prongs, face mask, or endotracheal tube (ETT). Continuous Positive Airway Pressure (CPAP) Provides very fast breaths with a low amount of volume with each breath. High-frequency Oscillatory Ventilation (HFOV) Allows infant independent breaths but also provides cycled measured breaths Intermittent Mandatory Ventilation (IMV)

Which statements are true regarding a cephalohematoma in a newborn? Select all that apply.

Swelling can be absent at birth and increase on day 2 or 3 of life. Boundaries are clear and do not extend beyond suture lines. Blood is usually absorbed between 2 weeks and 3 months of life. With a cephalohematoma, swelling can be absent at birth and increase on day 2 or 3 of life. Unlike caput succedaneum, cephalohematoma boundaries are clear and do not extend beyond suture lines. Blood is usually absorbed between 2 weeks and 3 months of life, so this would be a true statement.

Which specialists will a child with a cleft lip and palate repair need to follow up with over the course of their childhood? Select all that apply.

Orthodontist Plastic surgeon Otolaryngologist Speech pathologist Psychologist A child with a cleft lip and palate repair will need to follow up with a team of specialists over the course of their childhood, including a plastic surgeon, audiologist, orthodontist, otolaryngologist, speech pathologist, and psychologist. A child with a cleft lip and palate repair will need to follow up with a team of specialists over the course of their childhood, including a plastic surgeon, audiologist, orthodontist, otolaryngologist, speech pathologist, and psychologist. A child with a cleft lip and palate repair will need to follow up with a team of specialists over the course of their childhood, including a plastic surgeon, audiologist, orthodontist, otolaryngologist, speech pathologist, and psychologist. A child with a cleft lip and palate repair will need to follow up with a team of specialists over the course of their childhood, including a plastic surgeon, audiologist, orthodontist, otolaryngologist, speech pathologist, and psychologist. A child with a cleft lip and palate repair will need to follow up with a team of specialists over the course of their childhood, including a plastic surgeon, audiologist, orthodontist, otolaryngologist, speech pathologist, and psychologist.

In which form of brachial plexus injury is the Moro reflex absent?

With all forms of brachial palsy injury. The Moro reflex is absent in all forms of brachial palsy, Erb's palsy, Klumpke's palsy, and the third and most severe palsy.