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A Typical Newborn

A Typical Newborn. Flexed Puffy Molded Nose breathers Irregular HR and RR Acrocyanosis Periods of reactivity . Apgar score: What does it tells us?. HR, Resp. effort, tone, reflexes, color 1 min & 5 min 0-10 Good: 7-10. They do all kinds of weird things. Cross their eyes

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A Typical Newborn

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  1. A Typical Newborn • Flexed • Puffy • Molded • Nose breathers • Irregular HR and RR • Acrocyanosis • Periods of reactivity

  2. Apgar score: What does it tells us? • HR, Resp. effort, tone, reflexes, color • 1 min & 5 min • 0-10 • Good: 7-10

  3. They do all kinds of weird things • Cross their eyes • Holes in their heads • Have dry skin (after the vernix absorbs) • They sneeze • Like being wrapped up tightly • Don’t get spoiled

  4. Know your Patients history! • Prenatal: IDM?, GBS+?, mother’s bld type, significant labs or tests, gen. history • Intrapartum: length of labor, PROM, medications received, anoxia, assisted birth, FSE,

  5. Determining Gestational Age • Neuromuscular • Physical • skin • lanugo • plantar surface • breast • eye/Ear • Genitals • Score: i.e. 30=36 wks

  6. Gestational Age and Weight • AGA • LGA • SGA • LBW (<2500 g) • VLBW (<1500 g) • IUGR (<rate of growth)

  7. Erythromycin, Hep B & and Vitamin K!

  8. Newborn Screening • Hypothyroidism (most common) • PKU • Galactocemia • Sickle cell • CF • Congenital adrenal hyperplasia (CAH)

  9. Algo hearing test • 50% congenital 50% environment • OAE: otoacoustic emissions testing • ABR: auditory brainstem response • They have to be calm and quiet!!!

  10. On a scale of 1-10 rate your pain! • Obvious • Subtle • Grimace, eye squeeze, brow contraction, nasolabial furrows • Flexed and rigid • Really quiet or restless • Pain scales for Infants: CRIES or NIPS

  11. Newborn stools

  12. Newborn Jaundice • Physiologic (baby on left) • Pathophysiologic (baby on right) • Breast milk

  13. > RBCs > breakdown (60-90 days) Liver immature Direct bili binds with globulin & is excreted: Good! Indirect: Unbound so absorbs into skin: Bad!! Day 3-7 < 5/mg/dl/day < peaks < 13 mg/dl. Appears healthy: eating, eliminating Jd to nipple line Physiologic Jaundice

  14. Premature Sepsis Cold stress ABO incompatibility Excessive RBCs or release (i.e. hematoma) Problem with liver NA or Asian Occurs within 24 hrs > 15 mg/dl (10 in premies), > 5 mg/dl/day or > 0.5 in 4 hrs Visible jd > 10 days Lethargic, irritable, poor feeding Pathophysiologic Jaundice

  15. Early Day 2-4 < fluid and protein intake < hepatic clearance Rx: take off Br for 24-48 hrs?? Late Peaks at 2 weeks Can last up to 12 weeks BrM interferes with conjugation or excretion of bili Less stools Acts normal: Thriving Breast Milk Jaundice???

  16. Hyperbilirubinemia Treatment • Transcutaneous Biliometry: for screening only • Bili lights: unconjugated into conjugated • Needs fluids, protein • Eye shields: remove when out of crib & feeding • Goal: avoid kernicterus!

  17. Hypothermia: Prevention • 36.5-37.2 • Remember 4 ways to lose heat • Large surface area for weight • More reptilian and mammalian? • Can use brown fat

  18. Hypothermia • Signs: Cyanosis, Temp < 36.5, > RR • Control heat loss, Monitor VS, don’t be pushed into bathing a cold baby

  19. Cold Stress

  20. Hypoglycemia: BS < 35 mg/dl or <40 mg/dl plasma • Risks: LGA, IDM, preterm, cold stress, asphyxia • Signs: poor feeding, jittery, hypothermia, lethargic, flaccid, shrill cry, diaphoretic…seizures, coma • What to do??? Know risk factors!, monitor signs, keep warm, monitor glucose, feed

  21. Circumcision • Informed consent from parents • Pain medication for patient Before and after) • Post op care • Check for bleeding, voiding

  22. Reasons for circumcision • Religious • Cultural • HIV Prevention? • Cleanliness?

  23. Newborn Reflexes

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