Newborn Care Quiz
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Questions and Answers

What is the recommended room temperature for newborn care?

  • 30-32°C
  • 25-28°C (correct)
  • 22-24°C
  • 20-22°C

    • What is the target temperature range for newborns?

  • 36-37°C
  • 37-38°C
  • 35-36°C
  • 36.5-37.5°C (correct)

    • Which of the following is NOT an effect of early skin-to-skin contact in newborn care?

  • Prevents anemia (correct)
  • Encourages breastfeeding
  • Prevents hypothermia
  • Bonding

    • In newborn care, what is the significance of maintaining a temperature of 25-28°C?

    <p>It helps in thermoregulation (A)</p> Signup and view all the answers

    Which specialty would most likely address issues related to hypothermia in newborns?

    <p>Pediatrics (C)</p> Signup and view all the answers

    Which condition is NOT associated with intrahepatic cholestasis?

    <p>Biliary atresia (D)</p> Signup and view all the answers

    What is a common risk factor that can lead to intrahepatic cholestasis in newborns?

    <p>Prolonged use of TPN (D)</p> Signup and view all the answers

    Which test result is expected for alpha-1-antitrypsin deficiency in the context of intrahepatic cholestasis?

    <p>Coombs test negative with normal Hb (A)</p> Signup and view all the answers

    Which of the following is a feature of extrahepatic cholestasis?

    <p>Increased enterohepatic circulation (B)</p> Signup and view all the answers

    What underlying mechanism might contribute to extrahepatic cholestasis related to biliary atresia?

    <p>Paucity of bile ducts (D)</p> Signup and view all the answers

    What is the duration of the neonatal period?

    <p>Birth up to 1 month old (B)</p> Signup and view all the answers

    Which of the following is included in essential newborn care?

    <p>Immediate drying (A)</p> Signup and view all the answers

    Why is uninterrupted skin-to-skin contact important after birth?

    <p>It prevents hypothermia and promotes breastfeeding (D)</p> Signup and view all the answers

    What is the purpose of delayed cord clamping?

    <p>It reduces the likelihood of anemia in the infant (D)</p> Signup and view all the answers

    What condition in the neonate is most likely associated with jaundice spreading to the mid abdomen?

    <p>Hepatosplenomegaly (C)</p> Signup and view all the answers

    Which factor is NOT commonly examined in a neonate with suspected TORCH infections?

    <p>Bone density (C)</p> Signup and view all the answers

    What is the likely bilirubin level if jaundice is noted in a neonate with hepatosplenomegaly and other symptoms?

    <p>15mg/dL (C)</p> Signup and view all the answers

    What sign of respiratory distress is characterized by the indrawing of the chest wall during breathing?

    <p>Retractions (A)</p> Signup and view all the answers

    Which symptom is associated with severe respiratory distress in neonates?

    <p>Tachypnea (A)</p> Signup and view all the answers

    Which of the following is not a common sign of respiratory distress in newborns?

    <p>Hyperthermia (D)</p> Signup and view all the answers

    Which of the following congenital infections is least likely to cause chorioretinitis?

    <p>Syphilis (B)</p> Signup and view all the answers

    What is a potential complication of hydrocephalus observed in neonates?

    <p>Delayed speech development (A)</p> Signup and view all the answers

    What is the most appropriate reason to administer phenobarbital in this case?

    <p>To reduce bilirubin levels in the infant (C)</p> Signup and view all the answers

    Which diagnostic test is best suited to confirm jaundice related to breastfeeding?

    <p>Indirect Coombs Test (A)</p> Signup and view all the answers

    What symptom is most likely associated with inadequate nursing in this infant?

    <p>Coombs Test Positive (A)</p> Signup and view all the answers

    What condition is likely to occur if the breastfeeding continues without addressing caloric intake?

    <p>Prolonged jaundice (D)</p> Signup and view all the answers

    What is the expected duration of jaundice in infants who are not breastfed?

    <p>3 weeks to 3 months (A)</p> Signup and view all the answers

    Which factor is associated with decreased caloric intake in breastfed infants?

    <p>Infrequent breastfeeding sessions (A)</p> Signup and view all the answers

    What is a likely intervention when improper breastfeeding leads to jaundice?

    <p>Stop breastfeeding for 2 days (D)</p> Signup and view all the answers

    What substance in breastmilk is linked to decreased caloric intake in jaundice cases?

    <p>Glucuronidase (A)</p> Signup and view all the answers

    What is the primary purpose of injecting anti-D gamma globulin (RhoGAM) after the delivery of an Rh+ infant?

    <p>To reduce Rh hemolytic disease (A)</p> Signup and view all the answers

    Which of the following results is typically associated with Rh incompatibility before treatment?

    <p>Positive Direct Coombs test (A)</p> Signup and view all the answers

    In evaluating hyperbilirubinemia, what is the first test to check according to the guide referenced?

    <p>Direct Coombs test (C)</p> Signup and view all the answers

    What condition is indicated by a Direct Coombs test that is negative with an increase in hemoglobin?

    <p>Polycythemia (C)</p> Signup and view all the answers

    What defines direct hyperbilirubinemia in neonates?

    <p>Indicates cholestasis and is considered pathologic (D)</p> Signup and view all the answers

    What is generally the first observation regarding bilirubin levels in the first six hours of life for a newborn?

    <p>B1 rises rapidly (D)</p> Signup and view all the answers

    What clinical finding may suggest physiologic hyperbilirubinemia in a newborn?

    <p>Negative Coombs test with normal hemoglobin and reticulocyte count (D)</p> Signup and view all the answers

    What does an increased reticulocyte count in a newborn indicate?

    <p>Possible hemolytic anemia (B)</p> Signup and view all the answers

    Flashcards

    IMCI

    A medical approach focused on the care of children, including their growth, development, and specific health issues.

    Gastroenterology

    The study of the digestive system in children, including common digestive problems and their management.

    Nephrology

    The study of the kidneys and urinary system in children, particularly focusing on kidney diseases and their treatment.

    Hematology/Oncology

    The study of blood and blood-related disorders in children, encompassing conditions like anemia, leukemia, and other blood cancers.

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    Neurology

    The study of the nervous system in children, focusing on conditions like epilepsy, cerebral palsy, and other neurological disorders.

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    Jaundice

    A condition characterized by yellowing of the skin and whites of the eyes, caused by an elevated bilirubin level in the blood.

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    Hepatomegaly

    Enlargement of the liver.

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    Splenomegaly

    Enlargement of the spleen.

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    Chorioretinitis

    Inflammation of the choroid and retina, often caused by infection or autoimmune disorders.

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    Hydrocephalus

    An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain, which can cause increased pressure and lead to several neurological problems.

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    TORCHes

    A group of infections that can be passed from mother to baby during pregnancy or delivery.

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    Hyperbilirubinemia

    An elevated bilirubin level, which can be caused by various factors, including liver problems, red blood cell breakdown, and certain genetic disorders.

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    Tachypnea

    Rapid breathing, often a sign of respiratory distress in infants.

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    Neonatal Period

    The first month of life, from birth to 30 days old.

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    Essential Newborn Care

    A series of standardized procedures performed immediately after birth to ensure the baby's health and well-being.

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    Immediate Drying

    Drying the newborn's skin thoroughly after birth to prevent heat loss and hypothermia.

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    Uninterrupted Skin-to-Skin Contact

    Holding the baby directly against the parent's skin for extended periods, promoting warmth, bonding, and breastfeeding success.

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    Delayed Cord Clamping

    Delaying the cutting of the umbilical cord for 1 to 3 minutes after birth, allowing for more blood transfer to the baby and reducing anemia.

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    Preventing Hypothermia

    The process of protecting the newborn from heat loss, especially in the first few hours after birth.

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    Colonization with Protective Family Bacteria

    The transfer of beneficial bacteria from the mother to the baby during skin-to-skin contact, aiding in immune system development.

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    Improving Breastfeeding Initiation and Exclusivity

    Beginning and maintaining breastfeeding exclusively, without the introduction of any other liquids or foods.

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    Indirect Coombs Test

    A diagnostic test used to assess the presence of antibodies against red blood cells. Useful in identifying hemolytic disease of the newborn.

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    Triangular Cord Sign

    A common finding in newborns with jaundice, characterized by a triangle shape at the point where the umbilical cord was attached due to excessive bilirubin deposition.

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    Breastfeeding Jaundice

    A type of jaundice that develops within the first 3-4 days of life, often seen in babies who are exclusively breastfed. Typically resolves within a week or two.

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    Glucuronidase

    An enzyme present in breast milk in some mothers. It can contribute to increased bilirubin levels in the baby, potentially prolonging jaundice.

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    Exchange Transfusion

    A treatment for jaundice. The baby's blood is replaced with fresh blood, removing excess bilirubin that can be harmful to the baby's brain.

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    Breast Milk Jaundice

    A type of jaundice developing after the first week, often associated with breast milk. Characterized by high levels of bilirubin and a longer duration.

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    Inadequate Nursing Jaundice

    A type of jaundice characterized by low caloric intake, often due to inadequate breastfeeding. The baby may not be getting enough milk, leading to increased bilirubin levels.

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    Phototherapy

    A treatment for jaundice that uses phototherapy lights to break down bilirubin in the baby's skin.

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    Intrahepatic Cholestasis

    A condition where bile flow is blocked within the liver.

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    Extrahepatic Cholestasis

    This occurs when a blockage prevents bile from leaving the liver.

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    Choledochal Cyst

    A rare condition causing a dilated common bile duct, it can lead to bile flow obstruction.

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    Biliary Atresia

    A serious liver disease in which the bile ducts are blocked, leading to a buildup of bile in the liver.

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    Neonatal Jaundice

    A common symptom of intrahepatic cholestasis in newborns, characterized by yellowing of the skin and whites of the eyes.

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    RhoGAM

    A technique used to prevent Rh sensitization in mothers who are Rh-negative and have an Rh-positive baby. RhoGAM is a concentrated solution of antibodies that destroy Rh+ red blood cells before they trigger an immune response in the mother.

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    Rh Hemolytic Disease

    A condition that occurs in infants when the mother's immune system attacks the baby's red blood cells due to Rh-incompatibility. This can lead to anemia, jaundice, and other complications.

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    Bilirubin

    A test that measures the level of bilirubin in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. High levels can lead to jaundice.

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    Direct Hyperbilirubinemia

    A condition that indicates the liver is not working properly and cannot remove bilirubin from the blood effectively, causing bilirubin levels to rise.

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    Indirect Hyperbilirubinemia

    The most common type of hyperbilirubinemia in newborns. It occurs when the liver is still immature and unable to process bilirubin efficiently.

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    Polycythemia

    A condition characterized by an increased number of red blood cells in the blood. It can sometimes lead to hyperbilirubinemia.

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    Study Notes

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    Instructions

    • Instructions for scanning QR codes are provided for both iOS (iPhone/iPad) and Android devices.

    Approach to Topnotch Pediatrics

    • Use the Topnotch main handout.
    • Purchase Nelson Textbook of Pediatrics (20th/21st ed) and Pedia Platinum.

    Neonatology

    • Neonatal Period: birth to 1 month.
    • Essential Newborn Care: a series of time-bound standard procedures.
    • Immediate drying: prevents hypothermia.
    • Uninterrupted skin-to-skin contact: prevents hypothermia, improves breastfeeding.
    • Delayed cord clamping (1-3 minutes): decreases anemia, prevents brain hemorrhage.
    • Non-separation of mother and baby, breastfeeding within the first hour prevents neonatal deaths.
    • Optimal method for maintaining neonatal temperature: skin-to-skin contact.
    • Room temperature: 25-28°C.
    • Target temperature for newborns: 36.5-37.5°C.
    • Common mechanisms of heat loss in newborns: Convection, conduction, radiation, evaporation.

    Classification of Prematurity

    • Based on birth weight and gestational age.
    • Low birth weight (<2,500 grams).
    • Very low birth weight (<1,500 grams).
    • Extremely low birth weight (<1,000 grams).
    • Late preterm birth (equal/ >34 weeks and <37 weeks).
    • Very preterm birth (<32 weeks).
    • Extremely preterm birth (<28 weeks).
    • Low birth weight: based on weight alone, regardless of gestational age.
    • SGA (small for gestational age): compares birth weight to gestational age.

    Newborn Screening

    • Ideally performed at 48 hours of age.
    • Repeat at 2 weeks old if blood collected <24 hours old.
    • Preterm babies: 5-7 days old.
    • Can be done until 1 month old (sick babies).
    • Expanded NBS covers 28 diseases.
    • Examples of conditions screened include: congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, glucose-6-phosphate dehydrogenase deficiency, and MSUD.

    Congenital Adrenal Hyperplasia

    • Autosomal recessive disorders of cortisol biosynthesis.
    • Deficiency in cortisol biosynthesis.
    • Depending on the deficient enzyme: mineralocorticoid deficiency/excess, or virilization.
    • 90% of cases are due to 21-hydroxylase deficiency.
    • Manifestations may appear in the first 6 months of life, with signs of sexual and somatic precocity.
    • Treatment usually involves glucocorticoid replacement (e.g., hydrocortisone) and sometimes mineralocorticoid replacement (e.g., fludrocortisone).

    Galactosemia

    • Three enzyme deficiencies can result in galactosemia: Galactose-1-phosphate uridyltransferase (GALT), galactokinase (GALK), and galactose-4-epimerase (GALE).
    • GALT deficiency (classic form): In infants, feeding intolerance, vomiting, jaundice, convulsions, lethargy, and hypotonia appear in weeks after birth;
    • GALK deficiency: cataracts
    • GALE deficiency (benign): healthy individuals, but the severe form resembles GALT deficiency.
    • Treatment involves a lactose-free diet.

    G6PD Deficiency

    • Presents with episodic or chronic hemolytic anemia.
    • Symptoms typically develop 1-2 days after exposure to oxidant substances (e.g., certain medications, some foods).

    Phenylketonuria (PKU)

    • Deficiency of phenylalanine hydroxylase leads to hyperphenylalaninemia.
    • Accumulation of phenylalanine can disrupt metabolism and damage the brain.
    • Manifestations include developmental delay & intellectual disability if untreated.
    • Treatment involves a diet low in phenylalanine.

    Maple Syrup Urine Disease (MSUD)

    • Genetic disorder resulting from defective branched-chain α-keto acid dehydrogenase complex activity.
    • Toxic accumulation of branched-chain keto acids in the brain.
    • Signs of irritability, poor feeding, maple syrup odor, and encephalopathy.
    • Treatment involves dietary restriction of leucine, isoleucine, and valine.

    Caput Succedaneum

    • Swelling at the site of contact; crosses sutures.
    • Edematous and pits with gravity.
    • Maximum size & firmness at birth and resolves in 48-72 hours.
    • Minimal blood volume.

    Cephalohematoma

    • Over parietal bones; does not cross the sutures.
    • Initially firm, becomes more fluctuant later.
    • Increases after birth for 12-24 hours; resolves over 2-3 weeks.
    • Significant blood volume.

    Subgaleal Hemorrhage

    • Beneath the epicranial aponeurosis; may extend.
    • Firm to fluctuant; ill-defined borders; may have crepitus or fluid waves.
    • Progressive after birth; resolutions over 2-3 weeks.
    • May be massive if associated with coagulopathy.

    Esophageal Atresia with Tracheoesophageal Fistula (EA with TEF)

    • Congenital anomaly of the esophagus.
    • Associated TEF in most cases.
    • Manifests as frothing at the mouth, regurgitation, and respiratory distress after feeding.
    • Diagnosis might be indicated if the infant is unable to pass an NG tube.

    Congenital Diaphragmatic Hernia

    • Most common type: Bochdalek hernia.
    • Herniated abdominal contents into the chest cavity.
    • Usually compresses the left lung.
    • Presents with respiratory distress shortly after birth
    • Xray: mediastinal shift

    Necrotizing Enterocolitis (NEC)

    • Preterm neonates with a stormy clinical course.
    • Triad of pathophysiology : intestinal ischemia, enteral nutrition, and pathologic organisms (e.g., Clostridium, E. coli).
    • Usually in the first week.

    Omphalocele vs. Gastroschisis

    • Omphalocele:
      • Defect below or at the umbilicus.
      • Covered with a membranous sac.
      • Commonly associated with other congenital anomalies.
    • Gastroschisis:
      • Defect to the left or right of the umbilicus, usually on the right side.
      • Exposed bowel.
      • Less frequently associated with other congenital anomalies.

    Pediatric Nutrition

    • Colostrum - first 2 days of lactation, high protein low fat & lactose; rich in Ig (especially IgA)

    Stages of Lactation

    • First 7 days: Colostrum, watery, high protein, low fat & lactose.
    • Transitional milk: in between colostrum and mature milk, macronutrients increase.
    • Mature milk: contains high fat and lactose.
    • Involuntary milk: reverts to colostrum like composition.
    • Exclusive breastfeeding up to 6 months.
    • Breastfeeding is best for 2 years and beyond.
    • Feeding schedule: self-regulated by infant.

    Integrated Management of Childhood Illnesses (IMCI)

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    Pediatrics Main Handout - March 2023 - Topnotch Medical Board Prep

    Description

    Test your knowledge on essential aspects of newborn care including optimal room temperature, skin-to-skin contact, and conditions like cholestasis. This quiz covers important topics that impact the health and well-being of newborns. Perfect for healthcare students and professionals in pediatrics.

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