Newborn Care and Health Guidelines Quiz

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Questions and Answers

What is one of the Healthy People 2020 objectives aimed at newborn care?

Increasing breastfeeding rates to provide optimal nutrition (correct)

Encouraging infants to sleep on their stomachs

Reducing access to prenatal care services

Increasing the proportion of neonates requiring formula

Which screening is recommended for all newborns before discharge from the nursery?

Screening for metabolic disorders only after a year

Screening for congenital heart defects

Screening for sickle cell disease only if history presents

Screening for phenylketonuria (PKU) (correct)

What is recommended to promote the health of all newborns?

Minimizing pediatric visits in the first month

Delay in screening for developmental hip dysplasia

Allowing all newborns to be formula-fed exclusively

Topical ocular prophylaxis for all newborns (correct)

Which condition is specifically screened for in neonates to prevent educational challenges later on?

Congenital hypothyroidism Signup and view all the answers

What is one of the major focuses of public health efforts regarding newborns?

Increasing the percentage of healthy full-term newborns sleeping on their backs Signup and view all the answers

What is the purpose of administering vitamin K IM to a newborn?

To prevent bleeding disorders Signup and view all the answers

When should the umbilical cord be allowed to air dry after birth?

Immediately after delivery Signup and view all the answers

What is the typical duration of umbilical cord separation in newborns?

10-14 days Signup and view all the answers

Which of the following statements about circumcision is true according to AAP guidelines?

The benefits of circumcision outweigh the risks. Signup and view all the answers

What should parents do if they observe a foul-smelling discharge around the umbilicus?

Evaluate immediately for sepsis Signup and view all the answers

What screening assessments should be completed prior to a newborn's discharge?

Lab data including syphilis and hepatitis B tests Signup and view all the answers

What is the primary reason for prophylaxis against ophthalmia neonatorum?

To prevent eye infections due to maternal bacteria Signup and view all the answers

Which statement regarding newborn temperature management is accurate?

Newborns' heat loss is four times that of adults. Signup and view all the answers

What physiological change occurs when umbilical vessels are clamped and severed?

Initiation of breathing in the newborn Signup and view all the answers

What is the function of the foramen ovale after birth?

Remains open until the age of 6 months to 1 year Signup and view all the answers

Which system in the newborn is responsible for metabolizing and excreting toxins?

Liver Signup and view all the answers

What vital sign changes are expected during the first period after delivery?

Tachycardia and rapid respirations Signup and view all the answers

What aspect of the newborn assessment is indicated by the APGAR score?

Effectiveness of resuscitation efforts Signup and view all the answers

What does meconium passing indicate during the second period post-delivery?

Normal gastrointestinal function Signup and view all the answers

Which history factor is most relevant to assessing potential congenital conditions in the newborn?

Family history of genetic conditions Signup and view all the answers

What occurs in the respiratory system of newborns as pulmonary vascular pressure drops?

Blood flow to the lungs increases Signup and view all the answers

What is the primary benefit of promoting breastfeeding during the neonatal period?

It provides optimal nutrition. Signup and view all the answers

Which screening is included in the recommended universal screening panel for newborns?

Sickle hemoglobinopathies Signup and view all the answers

What is a significant focus of public health efforts regarding healthy full-term newborns?

Ensuring newborns are placed to sleep on their backs. Signup and view all the answers

Which of the following screening assessments is NOT typically recommended for all newborns?

Hypertension Signup and view all the answers

What is the purpose of topical ocular prophylaxis for all newborns?

To protect against infections that can cause blindness. Signup and view all the answers

What is the recommended practice for the care of the umbilical cord after birth?

Leave the cord to air dry and place the diaper below it. Signup and view all the answers

Which intervention is recommended for a newborn to prevent ophthalmia neonatorum?

Provide prophylactic ointment. Signup and view all the answers

What is the advised follow-up for a newborn concerning feeding after discharge?

To follow up in 2-3 days to ensure proper nutrition. Signup and view all the answers

What condition does circumcision primarily aim to reduce the risk of in male newborns?

Penile cancer. Signup and view all the answers

What should parents observe for regarding the umbilical cord after birth?

Foul-smelling discharge indicates a need for evaluation for sepsis. Signup and view all the answers

Which of the following is a common recommendation for the management of a newborn's temperature?

Wrap in warm blankets and cover the head. Signup and view all the answers

What is the significance of administering the first dose of Hepatitis B vaccine to a newborn?

To lower chances of maternal-foetal transmission of the virus. Signup and view all the answers

In terms of newborn care, what is the appropriate action if granuloma occurs on the umbilical cord stump?

Apply silver nitrate for treatment. Signup and view all the answers

What happens to the foramen ovale after birth?

It closes 6 months to 1 year after birth. Signup and view all the answers

Which of the following systems is immature until vaccines are administered?

Immune system Signup and view all the answers

What is the primary metabolic function of the placenta?

Metabolic functions and blood supply Signup and view all the answers

What physiological change occurs in the lungs after the umbilical vessels are clamped?

Increased blood flow for oxygenation Signup and view all the answers

What condition may arise from failing to address significant maternal health factors prior to delivery?

Higher risks for congenital conditions Signup and view all the answers

What is a key indicator of the success of resuscitation efforts in newborns?

APGAR score Signup and view all the answers

During the first period after delivery, which vital sign changes are typically observed?

Tachycardia and rapid respirations Signup and view all the answers

What is the function of the gastrointestinal tract shortly after birth?

To absorb nutrients and expel waste Signup and view all the answers

What is one of the recommendations for preventing infant mortality during the newborn period?

Placing newborns on their backs to sleep Signup and view all the answers

Which screening is emphasized for all newborns to detect metabolic disorders?

Phenylketonuria (PKU) testing Signup and view all the answers

Which of the following is part of the universal screening panel for newborns?

Sickle cell disease screening Signup and view all the answers

What is the recommended approach for managing breastfeeding in the neonatal period?

Promote exclusive breastfeeding for optimal nutrition Signup and view all the answers

Which intervention is recommended for preventing bacterial infections in newborns?

Applying topical ocular prophylaxis Signup and view all the answers

What is the recommended follow-up period for establishing feeding in a newborn?

2-3 days Signup and view all the answers

What prophylactic measure is typically taken to prevent ophthalmia neonatorum?

Topical ointment Signup and view all the answers

When should parents start observing for signs of infection around the umbilical cord?

If foul-smelling discharge occurs Signup and view all the answers

What is the typical time frame for umbilical cord separation in newborns?

10-14 days Signup and view all the answers

What is the primary role of administering vitamin K to a newborn?

To prevent bleeding disorders Signup and view all the answers

What measure should be taken if a granuloma forms on the umbilical cord stump?

Use silver nitrate treatment Signup and view all the answers

Which statement regarding circumcision and its benefits is correct?

Parents make the decision based on benefits exceeding risks. Signup and view all the answers

What is the advised practice regarding the care of a newborn's umbilical cord?

Allow it to air dry while keeping the diaper below it Signup and view all the answers

What role does the placenta play in fetal development?

Metabolizes toxins and maintains blood supply Signup and view all the answers

What is the expected time frame for the closure of the foramen ovale after birth?

6 months to 1 year after birth Signup and view all the answers

How does the renal system function in a newborn after birth?

Excretes waste and maintains chemical balance Signup and view all the answers

What indicates a successful transition to extrauterine life in a newborn?

Newborn begins to breathe and circulatory changes occur Signup and view all the answers

What is measured by the APGAR scoring system?

The effectiveness of resuscitation efforts Signup and view all the answers

Which physiological change is NOT associated with the clamping of umbilical vessels?

Increase in pulmonary blood flow Signup and view all the answers

How does the immunologic system of a newborn change following vaccination?

Develops the ability to fight infections more effectively Signup and view all the answers

What is an expected response of the newborn during the first period after delivery?

Increased respiratory rate and alertness Signup and view all the answers

What is one of the major recommendations to promote optimal nutrition for newborns?

Increasing breastfeeding rates Signup and view all the answers

Which screening is part of the recommended universal screening panel for newborns?

Sickle cell anemia screening Signup and view all the answers

What specific aspect do public health efforts aim to improve for healthy full-term newborns?

Improve rates of back sleeping placements Signup and view all the answers

What is one key strategy recommended for newborn care regarding metabolic disorders?

Routine newborn screening for congenital conditions Signup and view all the answers

What important practice is recommended for all newborns to prevent infections?

Topical ocular prophylaxis Signup and view all the answers

What is the recommended method for treating a granuloma on the umbilical cord stump?

Using silver nitrate Signup and view all the answers

What is the appropriate care for an umbilical cord immediately after birth?

Leave it to air dry and place the diaper below it Signup and view all the answers

What is the advised protocol for administering vitamin K to a newborn?

Intramuscular injection Signup and view all the answers

Which condition should prompt immediate evaluation for sepsis around the umbilicus?

Foul-smelling discharge Signup and view all the answers

Which statement is true about circumcision according to AAP guidelines?

The decision for circumcision rests with the parents. Signup and view all the answers

What is a crucial aspect of initial care regarding the management of newborn temperature?

Using a radiant warmer and wrapping in warm blankets Signup and view all the answers

What should be done before a newborn is discharged regarding routine assessments?

Blood type and metabolic screenings should be conducted Signup and view all the answers

What physiological change occurs in the newborn's blood circulation shortly after umbilical vessels are clamped?

Closure of the ductus arteriosus Signup and view all the answers

Which system transitions to initiating waste excretion soon after the first feed in newborns?

Gastrointestinal tract Signup and view all the answers

During the first period after delivery, which vital sign change is commonly observed?

Increased oral mucus production Signup and view all the answers

What is the typical timeline for the closure of the foramen ovale after birth?

Between 6 months to 1 year Signup and view all the answers

What maternal factor is most relevant for assessing potential risks for congenital conditions in the newborn?

Maternal age Signup and view all the answers

What is one key function of the placenta before birth?

Facilitating metabolic functions and providing blood supply Signup and view all the answers

What change does the newborn experience in response to decreased pulmonary vascular pressure?

Increased blood flow to the lungs Signup and view all the answers

Which aspect of newborn assessment is primarily measured by the APGAR score?

Resuscitation efforts' success Signup and view all the answers

Study Notes

Newborn Standards of Care

Newborn (Neonatal) period: first 28 days of extrauterine life
Healthy People 2020 objectives
Major focus of many public health efforts:
- increasing breastfeeding rates for optimal nutrition
- obtaining recommended universal screening panel (RUSP) for state-mandated diseases
- reducing proportion of children with metabolic disorder requiring special education services
- increasing percentage of healthy full-term newborns placed to sleep on their backs to prevent infant mortality
Guide to Clinical Preventive Services and Advisory Committee on Heritable Disorders in Newborns and Children recommend:
- Prenatal screening
- Promoting breastfeeding
- Screening neonates for sickle hemoglobinopathies
- Screening for congenital hypothyroidism
- Screening for phenylketonuria (PKU) for all newborns before discharge from the nursery
- Topical ocular prophylaxis of all newborns
- Screening for developmental hip dysplasia

Anatomy and Physiology

Intra-to-extrauterine transition
- placenta (responsible for metabolic functions, blood supply to baby)
- Umbilical vessels- clamped and severed and newborn begins to breathe
- Foramen ovale closes 6 mo-1 yr after birth/ductus arteriosus- within a few days after birth
- Pulmonary vascular pressure- drops, allowing blood to flow to lungs for oxygenation
- Gastrointestinal tract- absorbs nutrients and expels waste after first feed
- Renal system- excretes waste and maintains chemical balance
- Liver- metabolizes and excretes toxins
- Immunologic system- immature until vaccines are given
Vital signs: First period (after delivery)- SNS changes (tachycardia, rapid respirations, grunting, flaring, retractions, falling body temp, hypertonus, alertness). PNS changes (bowel sounds initiation, oral mucus production). Second period- oral mucus production more evident, HR more labile, newborn becomes more responsive to endogenous and exogenous stimuli, and meconium is passed.

Assessment

History: Past maternal, past obstetric, family history (three generation pedigree), obstetric history (current maternal health, maternal age, prenatal care, medications, infections, alcohol/drug use, heavy metal exposure, hypertension, glucose intolerance, labor duration, anesthesia, delivery route, polyhydramnios, oligohydramnios), social history (emotional stressors, unplanned pregnancy, financial, emotional support, educational background, anticipated involvement of partner)
Physical examination:
- APGAR- indicated how well the resuscitation efforts succeeded. Determines long-term health outcomes (Activity, Pulse, Grimace, Appearance, Respiration). Scores 0-2 for each.
- Gestational Age- based on physical exam. Done within 2 hours of birth to confirm maternal gestational dates. 90th percentile (LGA), < 10th percentile (SGA). Between 10-90th percentile (AGA)
- Temperature- heat loss rate in newborn is 4x that of an adult. Can fall in cool, drafty environment. Towel dry newborn after birth, skin-to-skin contact, use a radiant warmer, warp in a warm blanket, cover head when being held by parents
- Lungs- Further expulsion of amniotic fluid and high pulmonary vascular resistance ensure with newborn's first breaths. Careful bulb suctioning. With C section, more intervention required to help with respiratory efforts. Newborn lung sounds are bronchovesicular or bronchial sounds. Fine crackles during first few hours of life are normal
- Umbilical cord- has two arteries and one vein.
- After Stabilization- after initial assessment in OR, physical assessment is done (gestational age, age in hours, stage of transition)
- Screening- done before discharge (maternal syphilis/hepatitis B/HIV, newborn blood type, Coombs test, Hearing screening by 1 month old, CHD and bilirubin screening tests, Administer first Hep B dose)

Management Strategies

Initial Care:
- Establishing Feeding: follow up in 2-3 days to ensure nutrition
- Prophylaxis for ophthalmia neonatorum with ointment and vitamin K IM
- Anticipatory Guidance Before Discharge
- Physical Care:
  - Umbilical cord- leave cord to air dry, place diaper below cord until it separates. Separation occurs at 10-14 days, slight blood discharge will be seen for 1-2 days. Avoid bellybands/coins to cover the navel. Foul smelling discharge warrants evaluation for sepsis. Apply silver nitrate for a granuloma
  - Circumcision- decision rests with parents, AAP states no evidence for routine circumcision, but benefits are greater than risks. Lowers chances for UTIs, keeps glans penis cleaner, penile cancer reduction, phimosis, balanitis, adhesions, and urethral meatus occlusion reduction. Gentle cleaning around gential area, don't force foreskin back, cleanse penis daily with cotton swabs dipped in tap water with petroleum jelly for first 2-3 days
  - Bathing, Oils, and Powders- do not require dial baths. Mild cleansing agents are gentle enough. Avoid oils and powders. Use Keri, Eucerin Aveeno or Cetaphil for lotion. Diapers- Frequent changing and proper cleaning

Early Discharge and Follow Up

Guidelines for Early Discharge of Normal, Healthy Newborns:
- Stable vital signs, rectal temp 97.7-99.3 F (36.5-37.4°C) in an open crib, heart rate 100-190 bpm, respiratory rate less than 60 breaths/min, urine and stool passage, two successful feedings, baseline bilirubin, evaluation and monitoring for sepsis based on maternal risk factors, newborn laboratory data
Guidelines for 48- to 72-Hour Follow-Up Visit: Review delivery and discharge summaries, assess newborn's general health, weight, hydration, jaundice, identify new problems, review feeding, stooling, urination, lactation consult if needed, assess bonding, reinforce maternal and family education, review outstanding laboratory data, neonatal screens or other tests if indicated, develop health care maintenance plan, emergency care, preventive care, immunizations, periodic screenings, evaluate mother for postpartum depression, referrals to WIC program eligibility.

Common Neonatal Skin Conditions

Provide a table comparing significant maternal or newborn history, rash descriptions, diagnoses and management/treatments.

Head, Face, and Eye Conditions

Caput Succedaneum- diffuse, superficial swelling of soft tissue on scalp, usually crosses suture lines, originates from trauma, swelling in parietal scalp regions. Differential Diagnosis- cephalohematoma, subgaleal hemorrhage. Management- no treatment, resolves over first few days of birth.
- Cephalohematoma- deep collection of blood in subperiosteal area of scalp, doesn't cross suture lines, results from trauma in a difficult delivery. Clinical Findings- swelling in parietal area, no cross-suture lines, primigravida history or traumatic delivery, rarely associated with skull fracture, coagulopathy, or intercranial hemorrhage. Differential Diagnosis- caput succedaneum, subgaleal hemorrhage, cranial meningocele. Management- no treatment, resolves within few weeks to months
- Craniotabes- thinning bone of the scalp seen in premature. Clinical Findings- ping-pong ball effect when pressing parietal bone. Management- no treatment, resolves spontaneously.

Head, Face, and Eye Conditions: Jaundice

Jaundice- accumulation of bilirubin in skin. Clinical findings- when bilirubin exceeds 5-7 mg/dL, a cephalocaudal pattern. Physiologic jaundice- rise in bilirubin, from 1-3 mg/dL to 5-6 mg/dL on third day, declining to normal adult level of <1.3-1.5 by 10-12 days. Pathologic jaundice- occurs too early, persists too long, too high bilirubin levels (within 24 hours, lasting longer than 10-14 days, risk factors include hemolytic disease/anemia, inborn errors of metabolism, premature [GA 35-36 weeks])
- Physical exam- assess for jaundice within first 24 hours of life and throughout neonatal period. Face usually affected first, then shoulders, chest, and abdomen.

Sudden Unexpected Infant Death

SIDS- sudden death in infancy, explained or unexplained, often during sleep. Non-Hispanic black and American Indian/Alaska Native infants have more than twice the risk of SIDS than their white peers. Ninety percent of SIDS occurs prior to 6 months of age with a peak between 1 and 4 months. "BRUE" events (brief episodes occurring in infants less than a year). Three main pathophysiologic mechanisms contribute to SIDS: Decreased arousal, asphyxia and re-breathing, thermal stress. Possible causes: respiratory obstruction, restrictive clothing, and hyperthermia. Factors associated with SIDS include previous BRUE, poverty, lack of prenatal care, low birth weight, small for gestational age (SGA), preterm birth, young maternal age, high parity, maternal smoking and drug use, and co-sleeping.
Clinical Findings: Bed sharing, maternal cigarette smoking, drug/alcohol use, limited prenatal care, bottle-feeding, low educational attainment, unmarried, multiparity, maternal age < 20 years old, short interval pregnancies, anemia, newborn-premature, low birth weight, twins/multiple births, APGAR, recent URT infection

Measures that Aid in Preventing Sudden Unexplained Infant Death

Breastfeeding is recommended
Infants should be immunized (reduces risk by 50%)
Place infants on their backs to sleep until at least 6 months old.
Use a firm mattress, do not use bumper pads
Avoid overheating, alcohol and drugs, cigarette smoking, bed sharing and co-sleeping, and have stuffed animals in infant's bed.
Separate but proximate caregiver-sleeping environments.
Consider pacifier use.

Discussion Questions

How to assess a newborn with a focus on SIDS prevention
Prepare a presentation on umbilical cord care and circumcision for parents.
Explain the process and importance of 1 and 5 minute APGAR scores to expecting mothers.

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Description

Test your knowledge about the Healthy People 2020 objectives for newborn care, recommended screenings for neonates, and best practices to promote infant health. This quiz covers essential aspects of newborn management, including cord care, circumcision guidelines, and more.