Newborn Cases ppt

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Questions and Answers

What is the AAP's recommendation for the duration of exclusive breastfeeding?

4 months

12 months

6 months (correct)

2 years

Which of the following is a benefit of breastfeeding for the mother?

Lower risk of breast cancer (correct)

Reduced risk of insomnia

Decreased risk of stroke

Reduced anxiety

What is a potential risk of unnecessary formula supplementation?

Increased breast milk supply

Enhanced immunity in infants

Overfeeding and weight gain (correct)

Decreased maternal weight

What should be considered before exclusively feeding formula?

The baby has specific medical conditions Signup and view all the answers

Which of the following strategies should be discussed to support exclusive breastfeeding?

Identifying and addressing perceived barriers Signup and view all the answers

What might indicate the need for supplementing with formula in a newborn?

Maternal breast milk volume is low Signup and view all the answers

At what weight loss percentage should a newborn's feeding adequacy be assessed more critically?

5% Signup and view all the answers

What is a primary concern for a mother reporting insufficient breast milk for her exclusively breastfed newborn?

The newborn losing more than 11% of body weight Signup and view all the answers

What condition is indicated by sores, yellow crusts, purulent discharge, poor healing, and/or fever at the circumcision site?

Infection Signup and view all the answers

What is the primary reason for performing gentle retraction of the foreskin after a circumcision?

To prevent adhesions Signup and view all the answers

Which of the following conditions is characterized by erythematous papules and scaliness on the skin surfaces with oil glands?

Cradle cap Signup and view all the answers

In assessing a newborn with circumcision care, what is a normal finding during the healing phase?

Yellow secretions adherent to the glans Signup and view all the answers

What is the correct management for Baby Girl Adams, who presents at her 2-month well visit with risk factors for developmental dysplasia of the hip?

Order a hip ultrasound Signup and view all the answers

What is the recommended age for a child to remain in a rear-facing car safety seat according to the AAP guidelines?

Until 2 years old Signup and view all the answers

What is the significance of a positive Ortolani maneuver during a hip exam in an infant?

Potential developmental dysplasia of the hip Signup and view all the answers

What should parents be advised if their infant has a rectal temperature of 100.4˚F or greater?

Seek immediate medical evaluation Signup and view all the answers

Which of the following is NOT a characteristic of erythema toxicum neonatorum?

Itchy and painful Signup and view all the answers

What is the appropriate weight loss limit for a newborn before it is deemed excessive?

7-10% Signup and view all the answers

Which sign indicates that a newborn is exhibiting hunger cues?

Crying Signup and view all the answers

What is the advised frequency of breastfeeding in a 24-hour period for a newborn?

How much weight should a newborn expect to regain by their second week of life?

By 10-14 days Signup and view all the answers

If a newborn is formula feeding and has lost 11.4% of their birth weight by day four, what is the first step in management?

Assess the correct preparation of the formula Signup and view all the answers

What is a significant risk associated with excessive weight loss in newborns?

Hypoglycemia Signup and view all the answers

What is an important safety recommendation for the sleep environment of newborns?

Firm sleep surface Signup and view all the answers

What screening tool is validated for assessing postpartum depression?

Edinburgh Postpartum Depression Scale Signup and view all the answers

Which of the following is NOT a recognized characteristic of safe sleep for infants?

Using soft bedding Signup and view all the answers

What daily wet diaper output is considered adequate for a breastfeeding newborn?

6+ Signup and view all the answers

What might be a factor in the social determinants of health affecting a family's overall well-being?

Access to medical insurance Signup and view all the answers

Which demographic of women is reported to experience postpartum depression most commonly?

11-18% of all U.S. women Signup and view all the answers

After how many days should transitional stools appear in a breastfeeding newborn?

3-5 days Signup and view all the answers

What should be done if a newborn presents with redness and discharge after a circumcision?

Monitor for additional symptoms Signup and view all the answers

Study Notes

AAP Breastfeeding Guideline

The AAP recommends exclusive breastfeeding for the first 6 months.
The AAP supports continued breastfeeding along with appropriate complementary foods introduced at about 6 months, as long as mutually desired, for 2 years or beyond.

Benefits of Breastfeeding

For mothers: bonding, depression, hemorrhage, weight management, reduces breast/ovarian cancer risk, financial benefits.
For infants: bonding, growth, digestion, immunity, brain development.

Risks of Unnecessary Formula Supplementation

Decreased breast milk supply: Formula may suppress the mother's milk production.
Overfeeding, spitting up, excess weight gain: Formula can lead to these issues if not used appropriately.

Formula Supplementation

Consider formula supplementation if the newborn is experiencing significant weight loss:
- Low maternal breast milk volume
- Increased caloric and nutrient needs due to prematurity, congenital heart disease, etc.
Exclusive formula feeding is indicated for:
- Certain medical conditions requiring soy formula, like galactosemia
- Adoption
- Mother's fully informed decision to solely formula feed

Assessing Feeding Adequacy in Newborns

Objective: Assess feeding adequacy during the newborn visit.
Factors to consider:
- Weight trend since birth
- Number of feedings per day
- Hunger and satiety cues
- Number of stools and wet diapers per day
- Color and consistency of stools

Normal Weight Loss in Newborns

Nadir: Typical weight loss of 7-10% in the first few days.
Weight regain: Birth weight regained by 10-14 days old.
Subsequent weight gain: Gain 15-30 grams (0.5-1 ounce) per day after regaining birth weight.

Reasons for Newborn Weight Loss

Diuresis: Newborns excrete excess extracellular fluid to maintain hydration and electrolyte balance.
Colostrum: Early breast milk is low in water and high in protein, contributing to weight loss.
Mature breast milk: Fully comes in around 48-72 hours after delivery, later for C-sections due to stress.

Excess Weight Loss in Newborns

Definition: Loss of more than 10% of birth weight.
Consequences: Can lead to hypoglycemia, dehydration, hypothermia, jaundice, and lethargy.
Impact: Can lead to feeding difficulty and further weight loss, creating a downward spiral.

Feeding Frequency and Cues

Frequency: Newborns should feed 8-12 times per day (every 2-3 hours).
Duration: 10-15 minutes per breast.
Wake for feedings: Wake the baby on their own for most feedings.
Hunger cues: rooting, lip smacking, sucking on hands, crying (late sign).
Satiety cues: stopping sucking, closing mouth, pulling away, turning head away, falling asleep.

Stools and Wet Diapers

Normal: 6+ wet diapers and 3+ stools per day.
Transitional stools: Expected by 3-5 days old, yellow and seedy, indicating bilirubin excretion.

Managing Excess Weight Loss in Breastfed Infants

Continue breastfeeding: Encourage continued breastfeeding.
Temporary formula supplementation: Supplement with formula to address weight loss.
Donor breast milk: Consider donor breast milk from a bank, but it can be challenging to obtain outpatient.
Lactation consultant: Seek guidance from a certified lactation consultant.
Weight monitoring: Check weight every 2-3 days until weight loss stops and daily weight gain of 0.5-1 ounce resumes.

Managing Excess Weight Loss in Formula-Fed Infants

Assess formula preparation: Ensure correct formula preparation to avoid dilution:
- Ready-to-feed: Do not add water.
- Concentrate: Add equal parts water and concentrate.
- Powder: Add 1 level scoop of powder to 2 ounces of water.
Assess intake volume:
- Approximately 1 ounce per week of life per feeding for the first four weeks
- At least 24 ounces per day by the end of the first month
- Aim for 100 kcal/kg/day (1 ounce of formula = 20 kcal)
Assess formula access: Consider store brands, which are safe and nutritious; if eligible, sign up for WIC.

Postpartum Depression Screening and Management

Screening: Administer a validated postpartum depression screening tool at all well visits through 6 months of age.
Validated screening tools:
- Edinburgh Postpartum Depression Scale
- Patient Health Questionnaire-9 (PHQ-9)
Referral for treatment: Refer mothers who screen positive for treatment.

Definition: Social and economic factors that influence health.
AAP resources: The AAP offers resources for providers.
Assessment: Ask about:
- Medical insurance
- Food security
- Safe and stable housing
- Mother's employment
- Childcare
- Mother's social support system
- Domestic violence

Safe Sleep Recommendations

Key message: Reduce infant deaths from unsafe sleep environments.
Room sharing: Room sharing for the first 6 months of life.
Separate sleep surface: No co-sleeping; infant should sleep on a separate surface within the parents' room.
Sleep surface:
- Flat surface (not inclined)
- Firm surface
Bedding: Avoid soft objects, loose bedding, bumpers.
Sleep position: Back to sleep, tummy to play.
Overheating: Avoid overheating the infant.
Other recommendations:
- Breastfeeding
- Vaccination
- Avoid smoking, alcohol, and drugs
- Consider a pacifier
- Commercial cardiorespiratory monitors do not reduce risk of SIDS

Circumcision Care

Purpose: Elective procedure for most newborns, reducing the risk of urinary tract infections (UTIs) in infancy and penile cancer, HIV, and other sexually transmitted infections (STIs) later in life.
Postoperative care:
- Petroleum gauze dressing for 4 hours post-op
- Petroleum jelly application with each diaper change for 7-10 days until healed
- Gentle foreskin retraction with each diaper change when healed to prevent adhesions
- Sponge baths only until healed
Signs of infection: Sores, yellow crust, purulent discharge, poor healing, and/or fever

Normal Newborn Skin Changes

Peeling skin: Normal for the first 4-6 weeks; self-resolves; not itchy or painful.
Erythema toxicum neonatorum: Normal for the first few weeks; self-resolves; not itchy or painful; appears as flea bites on hair-bearing skin surfaces; papules contain eosinophil-rich infiltrate.
Cradle cap (infant seborrheic dermatitis): Normal between 2 weeks and 12 months of age; self-resolves; not itchy or painful; erythematous papules and scaliness on any skin surface with oil glands; due to the interaction of overactive oil glands and Malessezia furfur* yeast on the skin.

Developmental Dysplasia of the Hip (DDH)

Definition: Congenital malformation where the femoral head subluxates out of the acetabulum.
Spectrum of severity: Mild cases may go undetected and not become symptomatic until adulthood.
Risk factors: Family history, female sex, breech presentation in the third trimester, incorrect swaddling (legs extended).
Consequences of late detection/treatment: Limp, limb length discrepancy, limited hip abduction, premature osteoarthritis.

Examining for DDH

Visual assessment: Observe for asymmetric abduction, asymmetric skin folds, asymmetric prominence of the trochanter, and limb length discrepancy.
Galeazzi sign: Femur on the side with DDH appears shorter, but the femur is not actually shorter.
Barlow maneuver: Attempts to dislocate the hip.
Ortolani maneuver: Attempts to relocate the hip.
Manuever timing: Should not remain positive beyond 6 weeks of age; order imaging if still positive; perform maneuvers at all well visits until the infant is walking.

Diagnosing and Treating DDH

Imaging: Hip ultrasound between 6 weeks and 4 months of age; Hip X-ray (AP and frog leg views) between 4-6 months of age.
Referral: If risk factors or positive/inconclusive exam by 6 weeks, refer to Pediatric Orthopedics.
Treatment:
- Hip abduction brace
- Surgical correction for failed brace

Fevers in Infants Under 60 Days Old

Definition: Rectal temperature ≥ 100.4˚F (≥ 38˚C).
Rectal temperature: Recommended for infants under 60 days old due to better accuracy.
Medical emergency: Fever is considered an emergency in infants < 60 days old.
Reason: Need to rule out serious bacterial infections, such as UTIs, bacteremia, and meningitis.
Parent guidance: Counsel families to call immediately if their infant develops a fever and to avoid giving Tylenol or fever-reducing medications until a medical assessment is performed.

Car Safety Seat Recommendations

Importance: Vehicle crashes are a leading cause of death and disability in children.
AAP recommendation: Use a rear-facing car safety seat until at least 2 years old.
Rear-facing safety: Protects the cervical spine by absorbing the force of a collision.
Forward-facing risks: The head is thrown forward, which poses risks to infants and toddlers with large, heavy heads and weak neck muscles.

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Description

This quiz covers the American Academy of Pediatrics (AAP) guidelines on breastfeeding, focusing on recommendations for duration and supplementation. It highlights the benefits for both mothers and infants and discusses the risks associated with unnecessary formula use. Test your knowledge on the critical information regarding breastfeeding practices.