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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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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
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
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
know your patients history
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,
determining gestational age
Determining Gestational Age
  • Neuromuscular
  • Physical
    • skin
    • lanugo
    • plantar surface
    • breast
    • eye/Ear
    • Genitals
  • Score: i.e. 30=36 wks
gestational age and weight
Gestational Age and Weight
  • AGA
  • LGA
  • SGA
  • LBW (<2500 g)
  • VLBW (<1500 g)
  • IUGR (<rate of growth)
newborn screening
Newborn Screening
  • Hypothyroidism (most common)
  • PKU
  • Galactocemia
  • Sickle cell
  • CF
  • Congenital adrenal hyperplasia (CAH)
algo hearing test
Algo hearing test
  • 50% congenital 50% environment
  • OAE: otoacoustic emissions testing
  • ABR: auditory brainstem response
  • They have to be calm and quiet!!!
on a scale of 1 10 rate your pain
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
newborn jaundice
Newborn Jaundice
  • Physiologic (baby on left)
  • Pathophysiologic (baby on right)
  • Breast milk
physiologic jaundice
> 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
pathophysiologic jaundice
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
breast milk jaundice
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???
hyperbilirubinemia treatment
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!
hypothermia prevention
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
hypothermia
Hypothermia
  • Signs: Cyanosis, Temp < 36.5, > RR
  • Control heat loss, Monitor VS, don’t be pushed into bathing a cold baby
hypoglycemia bs 35 mg dl or 40 mg dl plasma
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
circumcision
Circumcision
  • Informed consent from parents
  • Pain medication for patient Before and after)
  • Post op care
  • Check for bleeding, voiding
reasons for circumcision
Reasons for circumcision
  • Religious
  • Cultural
  • HIV Prevention?
  • Cleanliness?