Neonatal Care Quiz

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Questions and Answers

What is the primary purpose of the Apgar score?

To assess the need for immediate vaccinations

To evaluate the mother's health during pregnancy

To determine if the newborn requires resuscitation (correct)

To measure the baby's weight at birth

How many categories does the Apgar score include for evaluation?

5 (correct)

What is the typical amount of blood that transfuses from the placenta to the neonate during delayed cord clamping?

200-250 ml

80-100 ml (correct)

50-70 ml

120-150 ml

What is a potential benefit of delayed cord clamping (DCC)?

Improved cognitive and motor development Signup and view all the answers

What is the recommended dosage of Vitamin K1 for an infant weighing more than 1.5 kg?

1 mg IMI Signup and view all the answers

What is a common risk associated with delayed cord clamping?

Increased level of bilirubin Signup and view all the answers

When should Hepatitis B immunoglobulin (HBIG) be administered to a newborn?

Within the first 12 hours of life Signup and view all the answers

Which of the following is a expected benefit of delayed cord clamping?

Improved levels of ferritin in infants Signup and view all the answers

What is the purpose of the Apgar Scoring assigned at 1 and 5 minutes after birth?

To evaluate the need for resuscitation Signup and view all the answers

Which of the following is NOT part of the immediate physical assessment after birth?

Evaluating the newborn's feeding ability Signup and view all the answers

Which assessment occurs within the first 24 hours after birth?

Complete physical examination Signup and view all the answers

What adaptation is primarily evaluated immediately after birth?

Thermoregulation ability Signup and view all the answers

What is assessed during the newborn's first hour of life?

Progress of newborn adaptations to extra-uterine life Signup and view all the answers

Which of the following is a factor that can impact thermoregulation in a newborn?

Gestational age Signup and view all the answers

What is the main focus of the nutritional assessment for a neonate within the first 24 hours?

Evaluate the infant's feeding ability Signup and view all the answers

Which of the following assessments helps identify high-risk problems in newborns?

Ongoing assessment within 1 to 4 hours Signup and view all the answers

What is the appropriate weight range for a newborn at birth?

2.5-4 kg Signup and view all the answers

What is the purpose of applying an ID bracelet to a newborn?

To identify the infant’s gender Signup and view all the answers

Which is a sign of respiratory distress in a newborn?

Tachypnea Signup and view all the answers

At what age should breastfeeding ideally begin for a newborn if there are no contraindications?

Within the first hour Signup and view all the answers

What is the normal heart rate range for a healthy newborn?

100-160 bpm Signup and view all the answers

What is the recommended action during skin-to-skin contact with a newborn?

Cover both with a warm blanket Signup and view all the answers

What is considered low birth weight (LBW) for a newborn?

Less than 2.5 kg Signup and view all the answers

What is the primary reason for using a baby hat after birth?

To keep the baby warm Signup and view all the answers

What should be measured to confirm if a newborn is experiencing physiological weight loss?

Weight over the first 3-4 days Signup and view all the answers

What is the normal respiratory rate for a healthy newborn?

30-60 breaths per minute Signup and view all the answers

Which developmental characteristic is typical of a healthy newborn?

Flexed arms and legs Signup and view all the answers

When is the first meconium stool expected in a healthy newborn?

Within 24 hours of birth Signup and view all the answers

What measurement is taken at the nipple line of a newborn for assessment?

Chest circumference Signup and view all the answers

What is the significance of ensuring a newborn's blood pressure is measured with an appropriately sized cuff?

To prevent overestimation of pressure Signup and view all the answers

What is the recommended time frame for a newborn to pass urine after birth?

Within the first 24 hours Signup and view all the answers

How should the umbilical cord be cared for in the initial days after birth?

It should be kept clean and dry. Signup and view all the answers

When might the first bath for a newborn typically occur?

At least 24 hours after birth Signup and view all the answers

What is the primary role of vernix caseosa in newborns?

It acts as a protective barrier and moisturizer. Signup and view all the answers

What is the expected appearance of the umbilical stump by day 2-3?

It should shrivel and blacken Signup and view all the answers

Which practice is recommended to prevent diaper rash?

Keep the buttock air dry when skin is red. Signup and view all the answers

How many stools should a newborn pass from days 3-4 after birth?

3-4 stools Signup and view all the answers

What age are most immunizations given to infants typically started?

After the first 2 months. Signup and view all the answers

Which of the following is crucial for umbilical cord care?

Ensuring hands are washed before handling. Signup and view all the answers

What is a suggested method to clean a newborn's buttock after a bowel movement?

Wash with warm water each time. Signup and view all the answers

What is the caloric intake requirement for a healthy term infant during the first month?

100-115 kcal/kg/day Signup and view all the answers

Which of the following is an aim of nursing care for newborns?

Enhance parental knowledge on newborn care Signup and view all the answers

What is the recommended action regarding breastfeeding after birth?

Initiate breastfeeding within 1/2 hour after birth Signup and view all the answers

Which observation is essential for assessing a newborn's condition?

General appearance and vital signs Signup and view all the answers

How should a newborn be maintained in terms of warmth immediately after delivery?

Dried completely and kept warm Signup and view all the answers

What is the recommended frequency for feeding a newborn on formula?

Every 3 hours Signup and view all the answers

Which sign may indicate a nutritional issue in a newborn?

Lethargy and poor feeding behavior Signup and view all the answers

What is a common sign of neonatal jaundice?

Yellowing of the skin and eyes Signup and view all the answers

What is the primary source of energy for infants between 6-12 months?

Carbohydrates Signup and view all the answers

What is the average daily fluid requirement for infants?

140-160 ml/kg/day Signup and view all the answers

When is it recommended for mothers to begin breastfeeding for optimal benefits?

Within the first hour after birth Signup and view all the answers

What signs may indicate dehydration in a newborn?

Depressed fontanels Signup and view all the answers

What percentage of body weight can breastfed infants lose in the first few days after birth?

Up to 7% Signup and view all the answers

What is the average weight gain for an infant during the first month?

1 oz/day Signup and view all the answers

What is the correct way to express colostrum and breast milk?

By hand expression techniques Signup and view all the answers

What is the composition of the initial milk secreted by mothers during pregnancy?

Colostrum Signup and view all the answers

What is the primary cause of physiological jaundice in newborns?

Massive erythrocyte destruction Signup and view all the answers

Which factor is NOT associated with breastfeeding jaundice in newborns?

Rapid meconium elimination Signup and view all the answers

When does the peak of total serum bilirubin typically occur in term infants?

On day 3-4 Signup and view all the answers

What is a significant characteristic of jaundice in preterm newborns compared to term infants?

Jaundice lasts longer Signup and view all the answers

What is the likely effect of hypoglycemia on bilirubin levels in newborns?

Affects albumin binding capacity Signup and view all the answers

Which type of jaundice is most common during the first week of breastfeeding?

Breastfeeding jaundice Signup and view all the answers

What substance in breast milk may inhibit the conversion of indirect bilirubin to direct bilirubin?

Pregnanediol Signup and view all the answers

How can increased feeding frequency impact jaundice in breastfeeding newborns?

It aids in meconium removal Signup and view all the answers

What is primarily indicated when jaundice appears within the first 24 hours after birth?

Pathological jaundice Signup and view all the answers

Which of the following bilirubin levels indicates the need for phototherapy in a term baby weighing more than 2500g?

340 µmol/L Signup and view all the answers

How often should a baby with physiological jaundice be re-assessed while in the hospital?

Every 8-12 hours Signup and view all the answers

Which condition during the first 24 hours would raise suspicion for pathological jaundice?

Severe jaundice with yellow palms and soles Signup and view all the answers

Which of the following is an important part of managing neonatal jaundice?

Use transcutaneous bilirubin check whenever available Signup and view all the answers

Which statement correctly describes the role of phototherapy in the management of jaundice?

It converts unconjugated bilirubin to a water-soluble form. Signup and view all the answers

What is the main reason for monitoring a newborn's bilirubin levels closely after birth?

To prevent severe jaundice and associated complications Signup and view all the answers

What is a common side effect of phototherapy in newborns?

Dehydration Signup and view all the answers

Which of the following interventions is recommended to facilitate bilirubin reduction in a jaundiced newborn?

Increased glucose supplementation Signup and view all the answers

What action should be taken when a baby presents with recurrent jaundice after initial treatment?

Suspect pathological causes and investigate further Signup and view all the answers

Study Notes

Neonatal Assessment and Care (Part 2)

Nursing care and assessments:
- Immediately after delivery (delivery ward)
- Subsequent assessment (postnatal ward)
Major neonatal adaptations:
- Physiological adaptations
- Neurological/behavioural adaptations
Neonatal nutrition, screening and others:
- Nutritional needs
- Neonatal screening
- Neonatal jaundice

Learning Outcomes

Students will be able to outline the physiological and behavioral adaptations of newborns during transition from intrauterine to extrauterine life.
Students will understand the mechanism of thermoregulation in newborns, and its impacts in hypothermia or hyperthermia.
Students will be able to assess a neonate from head-to-toes, understanding the process and rationale behind it.
Students will recognize newborn reflexes and identify differential abnormal responses.
Students will be able to explain nutritional needs of a neonate.
Students will be able to describe the immunization program and neonatal screening in Hong Kong.
Students will be able to identify cases and describe the management of neonatal jaundice
Students will describe care of neonates at health risk (e.g., infection) and manage risks.

Timing and Types of Newborn Assessments

Immediately after birth:
- Need for resuscitation (using Apgar Scoring at 1 and 5 minutes)
- If stable, place with parents for early attachment/bonding
Within 1 to 4 hours after birth:
- Progress of newborn adaptations to extra-uterine life
- Determination of gestational age
- Ongoing assessment for high-risk problems
Within first 24 hours, or before discharge:
- Complete physical examination according to the protocol
- Nutritional status and feeding abilities (breast, bottle, or cup feeding)
- Behavioral state organization abilities

Apgar Scoring System

A rapid standardized assessment to determine if the newborn is at risk/requires resuscitation.
Assigned at 1 minute and 5 minutes of life, for all infants.
Reflects cardiorespiratory and neurological status.
Scored between 0 and 2 in 5 different categories.
Score of <7 at 5 minutes requires further assessments until the score reaches ≥7.
A 5-minute score of 0-3 is associated with increased mortality for both preterm and full-term infants.

Immediate Physical Assessment After Birth

Apgar Scoring System (1952,1958): a rapid assessment of a newborn's condition, considering five criteria (appearance, pulse, grimace, activity, respiration) at 1 and 5 minutes after birth; scoring system used to rapidly assess a newborn's physiological status; can identify those who require additional care.
Score between 0-2 for each criterion.
Values below 7 warrant additional assessments every 5 minutes until score is over 7, or baby is over 20 minutes of age.

Other Observations

Airway: patency of each naris
Chest wall: movement – pattern of respiration
Abdomen: soft, non-distended, umbilical stump
Skin: acrocyanosis vs. central cyanosis
Genitalia: evaluated before determining baby’s gender.
General: check for birth-related injuries (nerve injuries, fractures).

Immediate Nursing Care at Birth (Part 1)

Maintain airway and respiration, including tactile stimulation, gentle oral suction (only if needed)
Umbilical cord clamping (1-3 minutes after birth).
Prevent hypothermia by pre-warming and wrapping with a warm towel
Support skin-to-skin contact.

Immediate Nursing Care at Birth (Part 2)

Medications:
- Vitamin K1 (1mg IM): to prevent Vitamin K deficiency bleeding.
- IMI: 0.5 mg for infants ≤1.5 kg, 1mg for > 1.5 kg (within first hour).
- Oral vit K1 (2mg P.O): for infants who cannot receive IMI (given within 1 week, 4 week, 8 weeks).
- Hepatitis B immunoglobulin (HBIG) IMI: for infants whose mothers are Hepatitis B positive, within 12 hours.
- Antibiotic eye ointment: to prevent neonatal conjunctivitis
Identify infant (gender): showing the infant to the birthing mother, identification of gender, placing ID bracelet.

Immediate Nursing Care at Birth (Part 3)

Promote bonding:
- Skin-to-skin contact with mothers after delivery and encourage skin-to-skin contact to help with postpartum bonding.
- Postpartum Skin-to-Skin Contact (SSC) can be initiated during the surgical stages, recovery room, and within the first hour to support breastfeeding, if not contraindicated.

Subsequent Assessment (Nursery/Postnatal Ward)

Objectives of complete newborn assessments:
- Check for danger signs and normal adaptations after birth.
- Assess congenital malformations and traumas
- Assess growth and development & manage related factors.
- Provide appropriate care and treatment.
- Provide advice and counselling to the mother and family.
Assessments to be conducted in a warm room (>25°C) avoiding 15-20 min. time limits/excessively naked newborns.
A doctor review within 24 hours.

Assessments of the Newborn

Vital signs
- Pulse (110-160 bpm, 80-100 bpm for deep sleep, >180 bpm when crying)
- Respiration (30-60/min)
- Blood pressure: assessed based on facility policy, and varies based on gestational age and birth weight
- Temperature (rectal 37-38 °C /axillary 36.5-37.5°C)

Characteristics of a Healthy Newborn at Birth

Respiratory rate (RR): 30-60 breaths/min
Heart rate: over 100 bpm
Color: mostly pink
Body Temperature: 36.5°C-37.5°C
Posture: arms and legs flexed
Movements: active
Cries, reacts to light and sound
Moves both legs and arms equally
Able to suck
Passes urine within 24 hrs and 6+ times after day two
First stool (meconium): within 24 hours after birth

Head-to-Toe Assessments of the Newborn

General appearance:
- Head: proportionally large for body size, symmetrical, neck short
- Neck: short, with the chin resting on the chest
- Chest: round with prominent abdomen, soft
- Hips: narrow
- Muscles: flexed position
- Extremities: short
- Hands: usually clenched tight

Newborn Measurements

Weight: 2.5-4 kg (between 37-41 weeks of gestational age)
Head circumference: 32-37 cm
Chest circumference: 30-35 cm
Length: 46-56 cm (approx. 2.5 cm growth per month).

Physical Assessment of Newborn (Head)

Symmetry (large, ¼ of body size)
Head circumference (32–37 cm)
Fontanels (two soft spots; anterior fontanel – 1–4 cm; posterior<1cm).
Abnormalities: hydrocephalus, microcephaly, asymmetry, molding, caput succedaneum, cephalohematoma.

Caput Succedaneum vs. Cephalohematoma

Caput succedaneum: collection of fluid, edematous swelling of the scalp
- Caused by pressure from birth canal.
- Crosses suture lines
- Resolves within 12-48 hours
Cephalohematoma: collection of blood
- Caused by pressure from birth canal or instrumental delivery.
- Does NOT cross suture lines
- Resolves in 2-5 weeks.

Neurological Reflexes in Newborns (Part 1)

Moro (Startle) reflex:
- On sudden head extension (or loud sound of 90 decibels), symmetrical abduction and extension followed by flexion.
- Present at 37 weeks gestation, disappears around 4-6 months.
Palmar & Plantar grasp reflexes:
Flexion of fingers or toes when an object is placed in palm/ball of hand/foot.
Present at 28 weeks' gestation and disappears by 2-3 months.

Neurological Reflexes in Newborns (Part 2)

Rooting reflex: stroking the baby's cheek stimulates head turning towards the stimulation. Established at 34 weeks and disappears at 4 months (when visual cues take over).
Sucking reflex: stimulation of palate or nipple causes sucking. Present at 34 weeks; diminishes with age.
Tonic neck reflex: When the head is turned to one side, the arm and leg on that extended, while the arm and leg on the other side remain flexed.

Neurological reflexes in the newborns (Part 3)

Babinski Reflex: Eliciting a stroking of the sole of the foot from the heel to the toe. Toes flare outward & Big toe dorsiflexes. (Contrast to the adult response). Disappears (~3 months).
Stepping/Pacing reflex: when newborns are held upright, one foot then the other giving the impression they're walking; Present from 36 weeks of gestation, disappears after 3 months.

Assessment of Maturity

Estimation of gestational age.
Neurologic and musculoskeletal development.
External physical characteristics.
Amount of breast tissue.
Amount of lanugo.
Cartilaginous development of ear.
Testicular/labia development.

Assessment of Neuromuscular Maturity

Determine neurological function.
Note presence, strength, and symmetry of reflexes.
Assess common newborn (primitive) reflexes.

Assessment of Scar Sign

No resistance, elbow moves past midline, score 1 (before 30 weeks)
Elbow is at midline, score 2 (36-40 weeks)
Elbow is not at midline, score 4 (over 40 weeks).

Additional Notes

Combining the physical assessment score and neuromuscular scores estimates gestational age.
Scores vary greatly based on maturity from low (less than 26 weeks of gestation) to high (mature or postmature).
For very low birth weight preterm infants (< 1500 gms), the scores may not be as accurate.

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Description

Test your knowledge on neonatal care practices including the Apgar score, delayed cord clamping, and vitamin K administration. This quiz covers essential information needed for neonates' health and wellbeing. Perfect for nursing and medical students.