NSNE 7200 Neonatal Theory 2 Exam Questions and Answers Graded A+
What is Critical Congenital Heart Disease (CCHD)? - Answers - the most common congenital
malformation
- Approximately ¼ of these newborns have CCHD, defined as the more severe and often duct-
dependent lesions that require intervention early in life for optimal outcome.
- The primary targets for CCHD screening are hypoplastic heart syndrome, pulmonary atresia
with intact ventricular septum, transposition of the great arteries, truncus arteriosus, tricuspid
atresia, tetralogy of Fallot, and total anomalous pulmonary venous return.
- Screening can sometimes identify other forms of CHD.
Why do we perform CCHD pulse oximetry screening? - Answers - CHD is the leading cause of
infant death in Canada.
- Approximately 25-35% of congenital heart defects are diagnosed after discharge from the
hospital.
- Early diagnosis is crucial for decreasing morbidity, mortality, and disability related to delayed
diagnosis of CHD.
- To decrease the rate of undiagnosed CCHD, nurses are now required to screen all infants prior
to discharge from the hospital or by a midwife in the community when there has been a home
birth.
How do we preform CCHD pulse oximetry screening? - Answers - The Canadian Pediatric
Society (2017) recommends routine pulse oximetry screening for all newborns in Canada to
increase the detection of CHD's.
- Pulse oximetry is safe, non-invasive, easy to perform and widely available.
- Ideally the testing should be done between 24-36 hours of age as testing prior to 24 hours
significantly increases the rate of false positive due to transition from fetal circulation.
- The test includes pulse oximetry measurement of preductal (right hand) and postductal (either
foot) oxygen saturations.
- The baby passes the screening if the oxygen saturation is 95% or greater in the right hand and
foot and the different is three percentage points or less between the right hand and foot.
- The screen is immediately failed if the oxygen saturation is less than 90% in the right hand and
foot.
- If the oxygen saturation is greater than 90% and less than 95% in the right hand and foot, or
there is more than a three percent different between the right hand and foot, then repeat the
,screen in one hour and follow the same process as above.
- Rarely, some babies will require three screens (e.g. the initial and two repeat screens, all
separated by one hour).
- A baby whose oxygen saturation is from 90% to less than 95% in either the right hand or foot,
or who has more than a three percent different between the right hand and foot after the third
screen, will be considered to have failed screening.
What happens if an infant fails the CCHD screening? - Answers - After a failed screen, the infant
should be examined by the most responsible health care provider to make sure the baby is
hemodynamically stable, and evaluate for hypoxemia.
- Depending on the status of the baby, this could involve evaluating for sepsis or pneumonia.
- Any signs or symptoms of congenital heart disease should prompt rapid evaluation, including
potential transfer to a center with advanced care capabilities.
- If a cardiac diagnosis cannot be confidently excluded a cardiologist or neonatologist should be
consulted and an echocardiogram should be performed.
- Newborns should not be discharged home until the underlying reason for hypoxemia has been
identified or the hypoxemia has resolved.
These babies will often appear normal and have no clinical finding other than the low oxygen
saturation, this
What about Premature Infants in CCHD? - Answers - Premature infants usually have pulse-
oximetry measured as a routine part of their management and are observed for longer periods
than asymptomatic term infants.
- Routine care in the NICU typically does not involve pre- and post-ductal oxygen saturation
measurements and the presence of lung disease and other illness make oxygen saturation data
more difficult to interpret.
- Therefore, some forms of CCHD may go undetected even in the NICU.
- CCHD screening at 24 hours after birth is frequently not possible in the NICU as preterm
infants are often given supplemental oxygen.
- The Canadian Pediatric Society (2017) says that pulse oximetry screening has not been
adequately studied in preterm newborns or in the NICU setting relative to cut-off values for
normal and abnormal.
,- While pulse oximetry is an important monitoring tool for newborns with signs of CHD, such as
organic murmurs or other cardiac findings, the pulse oximetry protocol is intended for use of
asymptomatic newborns in nonacute care settings.
- The AAP's (2018) recommendation is that the CCHD screening protocol should be followed
once the infant has been weaned from supplemental oxygen.
- Please follow the guidelines in your health authority.
Breastfeeding benefits to infant - Answers · Enhance lifetime immunity
Reduced risk for:
· Gastrointestinal infections
· Celiac disease
· Asthma
· Eczema
· Respiratory tract infections
· Otis media
· SIDS
· Adolescent and adult obesity
· Type 1 and 2 diabetes
· Acute lymphocytic and myeloid leukemia
Preterm infants:
· Enhances neurodevelopment
· Increased/quicker weight gain
· Decreased incidence of sepsis
Decreased risk of necrotizing enterocolitis
Breastfeeding benefits of the woman - Answers · Decreased postpartum bleeding and more
rapid involution
, Reduced risk for:
· Ovarian and breast cancer
· Type 2 diabetes
· Hypertension
· Cardiovascular disease
· Rheumatoid arthritis
· Increased maternal role attainment
Decreased incidence of postpartum depression
Breastfeeding benefits to families and society - Answers · Convenient (ready anytime, anywhere,
no bottles, plastic nipples, or sterilizing required).
· Less expensive than formula
· Reduce annual health care costs
· Less parental absence from work due to illness
Reduced environmental impact (no packaging, no garbage).
What are the three characteristics of breastmilk? - Answers Colostrum (colostral):
- during the first 3 days.
- clear, yellowing fluid which is low in volume but high in density and rich in protein and
immunoglobulins.
Transitional:
- during 3-10 days.
-colostrum gradually changes to mature milk
-this is referred to as "the milk coming in"
Mature:
- By day 3-5 days after birth.
What is Critical Congenital Heart Disease (CCHD)? - Answers - the most common congenital
malformation
- Approximately ¼ of these newborns have CCHD, defined as the more severe and often duct-
dependent lesions that require intervention early in life for optimal outcome.
- The primary targets for CCHD screening are hypoplastic heart syndrome, pulmonary atresia
with intact ventricular septum, transposition of the great arteries, truncus arteriosus, tricuspid
atresia, tetralogy of Fallot, and total anomalous pulmonary venous return.
- Screening can sometimes identify other forms of CHD.
Why do we perform CCHD pulse oximetry screening? - Answers - CHD is the leading cause of
infant death in Canada.
- Approximately 25-35% of congenital heart defects are diagnosed after discharge from the
hospital.
- Early diagnosis is crucial for decreasing morbidity, mortality, and disability related to delayed
diagnosis of CHD.
- To decrease the rate of undiagnosed CCHD, nurses are now required to screen all infants prior
to discharge from the hospital or by a midwife in the community when there has been a home
birth.
How do we preform CCHD pulse oximetry screening? - Answers - The Canadian Pediatric
Society (2017) recommends routine pulse oximetry screening for all newborns in Canada to
increase the detection of CHD's.
- Pulse oximetry is safe, non-invasive, easy to perform and widely available.
- Ideally the testing should be done between 24-36 hours of age as testing prior to 24 hours
significantly increases the rate of false positive due to transition from fetal circulation.
- The test includes pulse oximetry measurement of preductal (right hand) and postductal (either
foot) oxygen saturations.
- The baby passes the screening if the oxygen saturation is 95% or greater in the right hand and
foot and the different is three percentage points or less between the right hand and foot.
- The screen is immediately failed if the oxygen saturation is less than 90% in the right hand and
foot.
- If the oxygen saturation is greater than 90% and less than 95% in the right hand and foot, or
there is more than a three percent different between the right hand and foot, then repeat the
,screen in one hour and follow the same process as above.
- Rarely, some babies will require three screens (e.g. the initial and two repeat screens, all
separated by one hour).
- A baby whose oxygen saturation is from 90% to less than 95% in either the right hand or foot,
or who has more than a three percent different between the right hand and foot after the third
screen, will be considered to have failed screening.
What happens if an infant fails the CCHD screening? - Answers - After a failed screen, the infant
should be examined by the most responsible health care provider to make sure the baby is
hemodynamically stable, and evaluate for hypoxemia.
- Depending on the status of the baby, this could involve evaluating for sepsis or pneumonia.
- Any signs or symptoms of congenital heart disease should prompt rapid evaluation, including
potential transfer to a center with advanced care capabilities.
- If a cardiac diagnosis cannot be confidently excluded a cardiologist or neonatologist should be
consulted and an echocardiogram should be performed.
- Newborns should not be discharged home until the underlying reason for hypoxemia has been
identified or the hypoxemia has resolved.
These babies will often appear normal and have no clinical finding other than the low oxygen
saturation, this
What about Premature Infants in CCHD? - Answers - Premature infants usually have pulse-
oximetry measured as a routine part of their management and are observed for longer periods
than asymptomatic term infants.
- Routine care in the NICU typically does not involve pre- and post-ductal oxygen saturation
measurements and the presence of lung disease and other illness make oxygen saturation data
more difficult to interpret.
- Therefore, some forms of CCHD may go undetected even in the NICU.
- CCHD screening at 24 hours after birth is frequently not possible in the NICU as preterm
infants are often given supplemental oxygen.
- The Canadian Pediatric Society (2017) says that pulse oximetry screening has not been
adequately studied in preterm newborns or in the NICU setting relative to cut-off values for
normal and abnormal.
,- While pulse oximetry is an important monitoring tool for newborns with signs of CHD, such as
organic murmurs or other cardiac findings, the pulse oximetry protocol is intended for use of
asymptomatic newborns in nonacute care settings.
- The AAP's (2018) recommendation is that the CCHD screening protocol should be followed
once the infant has been weaned from supplemental oxygen.
- Please follow the guidelines in your health authority.
Breastfeeding benefits to infant - Answers · Enhance lifetime immunity
Reduced risk for:
· Gastrointestinal infections
· Celiac disease
· Asthma
· Eczema
· Respiratory tract infections
· Otis media
· SIDS
· Adolescent and adult obesity
· Type 1 and 2 diabetes
· Acute lymphocytic and myeloid leukemia
Preterm infants:
· Enhances neurodevelopment
· Increased/quicker weight gain
· Decreased incidence of sepsis
Decreased risk of necrotizing enterocolitis
Breastfeeding benefits of the woman - Answers · Decreased postpartum bleeding and more
rapid involution
, Reduced risk for:
· Ovarian and breast cancer
· Type 2 diabetes
· Hypertension
· Cardiovascular disease
· Rheumatoid arthritis
· Increased maternal role attainment
Decreased incidence of postpartum depression
Breastfeeding benefits to families and society - Answers · Convenient (ready anytime, anywhere,
no bottles, plastic nipples, or sterilizing required).
· Less expensive than formula
· Reduce annual health care costs
· Less parental absence from work due to illness
Reduced environmental impact (no packaging, no garbage).
What are the three characteristics of breastmilk? - Answers Colostrum (colostral):
- during the first 3 days.
- clear, yellowing fluid which is low in volume but high in density and rich in protein and
immunoglobulins.
Transitional:
- during 3-10 days.
-colostrum gradually changes to mature milk
-this is referred to as "the milk coming in"
Mature:
- By day 3-5 days after birth.
