Emergency Care in the Streets Chapter 42 - Neonatal Care

The APGAR score is taken within ____ minute and again at ____ minutes

1 min, 5 mins

The depth of compression is _____ of the antero-posterior diameter of the chest

1/3

Dry mucous membranes, tachycardia, or a sunken fontanelle are clues that the patient needs hydration. NS (_____ mL/kg per bolus) may be required

10 mL/kg

When no signs of life are present after ____ minutes of resuscitation, the chances of success are low

10 minutes

A ____% _____ solution may be given as an IV bolus (____ mL/kg) if the newborn's BGL is less than _____ mg/dL and the infant is symptomatic, with a recheck of the BGL in about _____ mins

10% Dextrose, 2 mL/kg, 40 mg/dL, 30 mins

Fever is defined as a rectal temperature of greater than ______. Oral and axillary temperatures are, respectively, ____ degree and ____ degrees lower than the rectal temperature on average

100.4 degrees, 1 degree, 2 degrees

Pulse (APGAR)

2 - >100 1 - <100 - >0 0 - Absent

Activity (APGAR)

2 - Active motion 1 - Some flexion of extremities 0 - Limp

Appearance (APGAR)

2 - Completely pink 1 - Body pink, extremities blue 0 - Centrally blue/pale

Grimace (APGAR)

2 - Cries, coughs, sneezes 1 - Grimaces 0 - No response

Respiration (APGAR)

2 - Strong cry 1 - Slow and irregular 0 - Absent

Most newborns remain asymptomatic until the BGL falls below ____ mg/dL for a significant period of time

20 mg/dL

Apnea is defined as a respiratory pause of greater than ____ seconds

20 seconds

Pneumothorax decompression in newborn:

2nd intercostal space, mid-clavicular line (over top of 2nd rib) Insert 22-gauge needle attached to extension tubing, 3-way stopcock, and a 20-mL syringe

After ____ seconds has elapsed, evaluate if the second set of interventions is effective

30 seconds

At birth, providers should immediately perform initial interventions of drying, warming, suctioning, and stimulation. Approximately _____ secs after birth, providers should reassess these initial interventions

30 seconds

Reassess for the presence of a pulse after ____ seconds of well-coordinated chest compressions and ventilations

30 seconds

Cord clamping for vigorous infants should occur ____-____ seconds after delivery

30-60 seconds

A newborn delivered at fewer than _____ weeks gestation is considered preterm

37 weeks

A newborn delivered at ____-____ weeks of gestation is considered term

38-42 weeks

In a newborn, provide ventilation at a rate of ____-____ breaths/min or 1 breath every ____ seconds

40-60 breaths/min, every 3 seconds

A newborn delivered at more than _____ weeks of gestation is described as postterm

42 weeks

In full-term or preterm newborns, hypoglycemia is a BGL of less than ____ mg/dL

45 mg/dL

Oxygen flow rate for cyanotic newborns should be set at ____ LPM

5 LPM

A normal number of stools per day for an infant is ____-____, especially if the infant is breastfeeding, when infants produce stool after every feeding

5-6

Newborns weighing less than ____ lbs are considered low birth weight. Most commonly from prematurity

5.5 lbs

In newborns, chest compressions and artificial ventilation should not be delivered simultaneously; rather, they should be coordinated to result in ____ compressions and ____ breaths/min. This rate equals _____ actions per minute

90 compressions, 30 breaths, 120 actions per minute

Hypothermia is a drop in body temperature to less than _____ degrees

95 degrees

For the neonate, the thermoneutral temperature range is _____-_____ degrees

97.9 - 99 degrees

The average normal temperature of a newborn at birth is _____ degrees

99.5 degrees

Many newborns become centrally pink but have blue hands and feet (______). Considered normal

Acrocyanosis

If the newborn is kept above the level of the placenta, reverse blood flow may occur and may cause ______ in the newborn

Anemia

Indications for newborn BVM:

Apnea Inadequate respiratory effort Pulse of <100 after airway is cleared/infant is stimulated

APGAR Score:

Appearance Pulse Grimace Activity Respiration

When _____ _____ _____ is present, an abnormal opening exists in the septum separating the atrial chambers, allowing some of the oxygenated blood from the left atrium (at higher pressure) to flow through the hole to the right atrium (at lower pressure)

Atrial septal defect

If the newborn has a normal breathing pattern and a pulse rate of greater than 100 but maintains central cyanosis of the trunk or mucous membranes, provide supplemental _____-_____ ______

Blow-by O2

_____ _____ injuries typically occur in deliveries complicated by shoulder dystocia

Brachial plexus

_____ in a newborn is most frequently a result of inadequate ventilation and often responds to effective PPV

Bradycardia

_____ _____ is swelling of the soft tissue of the newborn's scalp as it presses against the dilating cervix. Common

Caput succedaneum

A ______ is an area of bleeding between the parietal bone and its covering periosteum

Cephalohematoma

If the newborn's pulse rate is less than 60 beats/min, begin _____ _____ in addition to PPV

Chest compressions

Bilateral ____ ____ is bony or membraneous obstruction of the back of the nose preventing airflow

Choanal atresia

The ______ is the most frequently fracures bone in the newborn

Clavicle

______ seizures may be classified as either a focal seizure if one body part is involved, or a multifocal seizure if multiple body parts are involved

Clonic seizures

_____ ____ ____ _____ is a narrowing of the aorta, the largest oxygen-carrying artery in the human body. Aorta is pinched or constricted in the area of the ductus arteriosus, just beyond the aorta's branching vessels to the head and arms

Coarctation of the Aorta (CoA)

_____ ______ ______ refers to abnormalities of the heart during development

Congenital heart disease (CHD)

All newborns are ______ immediately after birth

Cyanotic

_____ _____ _____ (also called blue defects are congenital abnormalities in which deoxygenated blood from the right (pulmonary) side of the heart mixes with oxygenated blood from the left (systemic) side and enters the systemic circulation, bypassing pulmonary circulation

Cyanotic heart lesions

If the newborn is hypoglycemic, you may administer _____. Warm IV fluids can assist in rewarming the newborn

D10W

Persistent vomiting is a warning sign and can cause excessive loss of fluid, ______, and changes in _____ levels

Dehydration, electrolyte

Congenital _____ _____ is a congenital defect in which abdominal organs herniate through an opening in the diaphragm into the chest cavity

Diaphragmatic herniation

Fetal circulation has 3 major blood flow deviations:

Ductus venosus - bypasses liver Ductus arteriosus - bypasses lungs Foramen ovale - bypasses lungs

Conditions such as bilateral choanal atresia, Pierre Robin sequence, and macroglossia, an ____ ____ can be inserted down a nostril to a level below the base of the tongue (other than choanal atresia)

ET Tube

If ventilation and chest compressions do not improve the bradycardia, administer _______, preferably via IV line

Epinephrine (0.01 mg/kg 1:10,000 or 0.1 mL/kg 1:10,000)

The most common brachial plexus injury is ____ ____ (involvement of C5, C6)

Erb palsy

One possible cause of newborn vomiting is _____ _____ (a failure to develop the distal lumen)

Esophageal atresia

As the fetus is delivered, a rapid series of events need to occur to enable the newborn to breathe. This process is called _____ _____

Fetal transition

Check the BGL in all sick newborns (by _____ stick) and evaluate the newborn's vital signs

Heel stick

Another cause of vomiting is ______ _______. The last segment of the colon fails to relax and causes mechanical obstruction. Infant usually has a history of not passing meconium in the first 24 hours of life

Hirschsprung disease

Neonates may become ______ during a fever

Hypoglycemic

_____ _____ _____ ______ is the complete underdevelopment of the left side of the heart

Hypoplastic left heart syndrome

Newborns may become ______ with infection

Hypothermic

The most common etiology for bradycardia in a newborn is ______, which is readily reversed by effective PPV

Hypoxia

The newborn's first breathe is triggered by mild _____ and _____ related to partial occlusion of the umbilical cord during delivery

Hypoxia, hypercapnia

_____-_____ ______ is damage to cells in the CNS from inadequate oxygen. Usually secondary to perinatal asphyxia (lack of oxygen to tissues). Single most common cause of seizures in newborns

Hypoxic-ischemic encephalopathy

In ______ _____ _____ _____, marked hypertrophy and hyperplasia of the 2 muscular layers of the pylorus occur. The pylorus becomes thickened and obstructs the end of the stomach

Infantile hypertrophic pyloric stenosis (IHPS)

_____ _____ or _____ _____ include congenital conditions where parts of the bowel may not have developed well or may be narrow

Intestinal atresia, intestinal stenosis

______ that persists beyond 2-3 weeks should raise suspicion for biliary obstruction or liver disease

Jaundice

______ in the newborn results from the immaturity of the liver to conjugate and excrete bilirubin from the RBC breakdown in the first week of life. Can also result from _______ (ABO incompatibility, Rh incompatibility)

Jaundice, hemolysis

______ ______ (involvement of C8-T1) is rare and results in the weakness of the intrinsic muscles of the hand

Klumpke paralysis

Newborn chest compressions are indicated if the pulse rate remains less than ____ despite positioning, clearing the airway, drying and stimulation, and 30 seconds of effective PPV

Less than 60

If the 5-minute APGAR score is less than ____, reassess the newborn's condition and assign an additional score every ____ mins until ____ mins after birth

Less than 7, every 5 mins until 20 mins

Loss of spontaneous arm or leg movement is an early sign of _____ _____ _____

Long bone fracture

______ means large tongue size

Macroglossia

______ is a congenital anomaly of rotation of the midgut. The small bowel is found predominantly on the right side of the abdomen; the cecum found in the epigastrium-right hypochondrium. Vomitus is bile stained and may be ______ (like feces/stool)

Malrotation, feculent

Newborn intubation indications:

Meconium fluid and newborn is not vigorous Diaphragmatic herniation Prolonged PPV needed Craniofacial defects

_____ _____ are dark or blue pigmentation over the buttocks and lower lumbar regions in patients of African, Asian, Mediterranean, and Native American ancestry

Mongolian spots

After delivery, keep the newborn at the level of the _____, with the head slightly _____ than the body while you clamp and cut the umbilical cord

Mother, lower

Suction the _____ before the _____ to prevent aspiration

Mouth before the nose

______ seizures are classified as focal, multifocal, and generalized. Jerks are much more rapid and do not have a rhythm, in contrast to clonic seizure activity. Involves twitching of multiple body parts

Myoclonic

______ is not recommended in newborns with respiratory depression secondary to narcotics. Treat ABCs

Narcan

______ suctioning helps clear the secretions and provides a stimulus to breathe

Nasal

A _____ refers to an infant within the first month after birth

Neonate

A _____ refers to an infant within the first few hours after birth

Newborn

_______ congenital heart disease (also called pink defects) include atrial septal defects, ventricular septal defects, patent ductus arteriosus, and coarctation of the aorta. Oxygenated blood is shunted from the left (systemic) side of the heart to the right (pulmonary) side

Noncyanotic

_____ _____, the production of heat by metabolism, is the primary source of heat production in the newborn

Nonshivering thermogenesis

_____ is wandering or shaking eye movements

Nystagmus

______ refers to a decreased volume of amniotic fluid during a pregnancy

Oligohydramnios

If the baby is apneic (has a 20-second or longer respiratory pause) or has a pulse rate of less than 100 after 30 seconds of drying and stimulation, begin _____

PPV

_____ _____ _____ exists when the ductus arteriosus fails to close after birth. Allows blood flow to bypass the right ventricle and lungs due to the fetus's lungs being filled with fluid

Patent ductus arteriosus

Signs of respiratory distress that suggest need for BVM:

Periodic breathing Intercostal retractions Nasal flaring Grunting on expiration

The _____ _____ _____ is a series of developmental anomalies including a small chin and posteriorly positioned tongue that frequently leads to airway obstrucion

Pierre Robin sequence

A delay in clamping the cord and keeping the newborn below the level of the placenta may cause more blood to flow into the newborn, which can lead to ______ (an abnormally high RBC count)

Polycythemia

During a prolapsed umbilical cord (common with _______), the blood supply through the umbilical cord to the fetus may be cut off. Relieve pressure on the cord

Polyhydramnios

_____ refers to excessive amounts of amniotic fluid

Polyhydramnios

To deliver initial breaths to a newborn using a BVM, you may need to manually (cover with finger) the spring-loaded _____-_____ _____

Pop-off valve

_____ is the single most common cause of respiratory distress and cyanosis in a neonate

Prematurity

_____ _____ is a disease in which the pulmonic valve located near the right ventricle becomes damaged. Patient will have a decrease in blood flow to the lungs and will present with JVD, cyanosis, or right ventricular hypertrophy

Pulmonary stenosis

When fever is suspected, examine the newborn for the presence of ______, especially petechiae or pinpoint pink or red skin lesions

Rashes

Do not wait until you have measured the 1-minute APGAR score before you start ______

Resuscitation

Premature newborns are at risk of _____ _____ _____ (abnormal vascular development of the retina) which may be worsened by long-term oxygen exposure

Retinopathy of prematurity

The best pulse oximeter probe locations for obtaining preductal oxygen saturation are the ____ ____ or ____ ____

Right hand or right earlobe

_____ _____ is preferred when resuscitating term infants

Room air

_____ _____ is an indication of diaphragmatic herniation

Scaphoid (concave) abdomen

A ______ is defined as a paroxysmal alteration in neurologic function (behavioral and/or autonomic function). The degree of _______ will affect the manner of seizure presentation and observed clinical signs

Seizure, myelination

Hypoglycemia may result in ______ and severe, permanent _____ _____

Seizures, brain damage

______ are characterized by a single, brief sudden movement resembling a twitch or jerk

Spasms

______ is alternating convergence or divergence, creating a cross-eyed appearance

Strabismus

A _____ seizure is characterized by eye deviations; blinking; chewing; tonguing; rowing, pedaling, swimming, or stepping

Subtle seizure

_____ _____ and ______ ______ also promote early breathing

Tactile stimulation and cold stress

_____ _____ _____ is a combination of 4 heart defects: a ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta (aorta lies directly over the ventricular septal defect)

Tetralogy of Fallot

Most infants with _____ _____ _____ are pink at birth because they have a patent ductus arteriosus that provides additional pulmonary blood flow. However, as the ductus closes in the first hours or days of life, ______ may develop or become severe

Tetralogy of Fallot, cyanosis

When arterial oxygen saturation suddenly decreases, an infant or child may experience a _____ _____

Tetralogy spell

The _____ _____ technique is preferred for 2-rescuer newborn CPR

Thumb encircling

_____ seizures may be classified as focal or generalized. Persisitent posturing of one limb, the neck, or the trunk with horizontal eye deviation (focal)

Tonic seizures

_____ _____ _____ _____ ________ is a rare congenital defect in which the 4 pulmonary veins do not connect to the left atrium

Total anomalous pulmonary venous return

In _____ _____ _____ _____ _____, the positions of the pulmonary artery and the aorta are reversed. Cyanosis usually present soon after birth

Transposition of the great arteries

In _____ ______, the patient lacks the tricuspid valve, which normally separates the right atrium from the right ventricle. Results in an undersized or absent right ventricle

Tricuspid atresia

In _____ ______, the pulmonary artery and the aorta are combined into one vessel. Increase blood flow into the lungs, ultimately causing heart failure

Truncus arteriosus

A newborn's pulse rate can be determined by auscultation or by feeling the base of the _____ _____ at the baby's abdomen

Umbilical cord

In a _____ ______ ______, an abnormal opening exists in the wall separating the right and left ventricles. Allows some of the oxygenated blood to flow from the left ventricle through the hole to the right ventricle and pulmonary artery instead of into the aorta. Stroke volume reduced

Ventricular septal defect

_____ is a white cheesy material that is a common finding on a newborn's skin

Vernix

The most common cause of acute diarrhea in children is _____ _____ (especially rotavirus during winter months)

Viral infection