N136-137 OB - Module 4 - Newborn Care Questions With
Complete Solutions
NB Glucose Homeostasis
in utero 70 - 90 mg/dL (like Mom)
→
55-60 mg/dL w/in 30-60 min post-birth
test question: < 40 mg/dL would not be normal
even with this low result, glucagon hormone rises in the
pancreas and glycogen stores activate in the liver to be
converted to glucose...infant should be able to maintain
homeostasis
Newborn Hypoglycemia
may mimic other newborn complications i.e., sepsis, seizure
activity, neonatal opiate withdrawal- always check blood sugar
first
Jaundice
yellow discoloration of the skin, mucous membranes, sclera, and
various organs
Caused by accumulation of unconjugated bilirubin and
hemolyzed RBCs under the skin
Mild initial s/s:
- Lethargy/hypotonia
,- Poor suck
- ↓ or absent moro reflex
Progressive s/s:
- High pitched cry
- Fever
- Seizures
Use Bilitool
Jaundice R/F
- Rh incompatibility (isoimmunization) – RBC lysis
- ABO and other blood group incompatibility
- Preterm – livers immature
- Ineffective breastfeeding
- Content in mother’s breastmilk
- Hypoxia -Polycythemia
- Birth trauma- bruising/blood swallowed by infant
- Asian or Native American
- G6PD deficiency
Bilitool
determines jaundice risk zones
Not one level that is an abnormal level
,On concept maps – we need to know value, time taken, and
hours of age of NB
Physiologic v. Pathogenic Jaundice
Phys - later after 24 hours pp
Path - earlier w/in first 24 h
Breastfeeding-related Jaundice
2 forms
Breastfeeding-associated jaundice: Related to ineffective
feeding, Early-onset jaundice (2-5 days)
Breast milk jaundice- etiology unk, Late-onset jaundice (5-10
days), r/t factors in breastmilk, Baby is feeding appropriately
Breastfeeding does not cause the jaundice; rather it is a lack of
effective breastfeeding that contributes to the
hyperbilirubinemia
Pathologic Jaundice
Appears within first 24 hours
Serum bili rises > 0.2 mg/dL per hour or 5 mg/dl in 24 hrs
Bili level exceeds 12.9 mg/dl (normal is closer to 5)
Clinical jaundice persists > 2 weeks
pathologic if it appears within the first 24 hours of life, if serum
bilirubin levels increase by more than 6 mg/dL in 24 hours, or if
serum bilirubin exceeds 15 mg/dL at any time.
, Causes: Hemolytic disorders- most common of pathologic
jaundice
Causes: Erythroblastosis Fetalis- Hydrops Fetalis, ABO
incompatibility
Physiologic Jaundice
Appears after 24 hours
Disappears within 14 days
Due to ↑ red cell volume
Common in preterm infants and 60% of term newborns
Kernicterus
chronic and permanent results of bilirubin toxicity
↑ total serum bilirubin left untreated can result in acute
bilirubin encephalopathy (rare)
Jaundice Tx
Phototherapy
Biliblankets
Teach parents:
- Ensure proper feeding/hydration as bilirubin is excreted in
urine and feces- monitor I&O
- Protect eyes from lights
- Monitor temperature
- No ointments, lotions, creams
Complete Solutions
NB Glucose Homeostasis
in utero 70 - 90 mg/dL (like Mom)
→
55-60 mg/dL w/in 30-60 min post-birth
test question: < 40 mg/dL would not be normal
even with this low result, glucagon hormone rises in the
pancreas and glycogen stores activate in the liver to be
converted to glucose...infant should be able to maintain
homeostasis
Newborn Hypoglycemia
may mimic other newborn complications i.e., sepsis, seizure
activity, neonatal opiate withdrawal- always check blood sugar
first
Jaundice
yellow discoloration of the skin, mucous membranes, sclera, and
various organs
Caused by accumulation of unconjugated bilirubin and
hemolyzed RBCs under the skin
Mild initial s/s:
- Lethargy/hypotonia
,- Poor suck
- ↓ or absent moro reflex
Progressive s/s:
- High pitched cry
- Fever
- Seizures
Use Bilitool
Jaundice R/F
- Rh incompatibility (isoimmunization) – RBC lysis
- ABO and other blood group incompatibility
- Preterm – livers immature
- Ineffective breastfeeding
- Content in mother’s breastmilk
- Hypoxia -Polycythemia
- Birth trauma- bruising/blood swallowed by infant
- Asian or Native American
- G6PD deficiency
Bilitool
determines jaundice risk zones
Not one level that is an abnormal level
,On concept maps – we need to know value, time taken, and
hours of age of NB
Physiologic v. Pathogenic Jaundice
Phys - later after 24 hours pp
Path - earlier w/in first 24 h
Breastfeeding-related Jaundice
2 forms
Breastfeeding-associated jaundice: Related to ineffective
feeding, Early-onset jaundice (2-5 days)
Breast milk jaundice- etiology unk, Late-onset jaundice (5-10
days), r/t factors in breastmilk, Baby is feeding appropriately
Breastfeeding does not cause the jaundice; rather it is a lack of
effective breastfeeding that contributes to the
hyperbilirubinemia
Pathologic Jaundice
Appears within first 24 hours
Serum bili rises > 0.2 mg/dL per hour or 5 mg/dl in 24 hrs
Bili level exceeds 12.9 mg/dl (normal is closer to 5)
Clinical jaundice persists > 2 weeks
pathologic if it appears within the first 24 hours of life, if serum
bilirubin levels increase by more than 6 mg/dL in 24 hours, or if
serum bilirubin exceeds 15 mg/dL at any time.
, Causes: Hemolytic disorders- most common of pathologic
jaundice
Causes: Erythroblastosis Fetalis- Hydrops Fetalis, ABO
incompatibility
Physiologic Jaundice
Appears after 24 hours
Disappears within 14 days
Due to ↑ red cell volume
Common in preterm infants and 60% of term newborns
Kernicterus
chronic and permanent results of bilirubin toxicity
↑ total serum bilirubin left untreated can result in acute
bilirubin encephalopathy (rare)
Jaundice Tx
Phototherapy
Biliblankets
Teach parents:
- Ensure proper feeding/hydration as bilirubin is excreted in
urine and feces- monitor I&O
- Protect eyes from lights
- Monitor temperature
- No ointments, lotions, creams
