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High Risk NB


SGA is defined as Birth wt. > 2SD BELOW mean or less than 10th percentile
2 types of SGA: Symmetrical, asymmetrical
Which type of SGA is better? Why? Asymmetrical because head has fairly normal growth pattern, meaning brain has been developing at normal pace
SGA babies should be able to feed well if they are ____ and ______ term and stabilized
SGA babies weigh less _______ if term 2500 grams
Symmetrical SGA refers to Brains + body are small and underdeveloped; abnormal brain growth bad sign
What are discordant twins? One twin gets all blood/nutrients while other twin has to fight for it. SGA twins are very hardy.
List causes of symmetrical SGA (4) Intrinsic fetal causes, intrauterine infection (TORCH), severe placental insufficiency, constitutionally small infant
TORCH stands for Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes
There potential for ___, ______ infections for babies Multiple, massive
Want mother to avoid infection by Maintaing good hygiene, updated immunizations, staying away from infectious sources (sushi, litter boxes)
List causes of asymmetric SGA Caused by interference with placental function or maternal health in 3rd trimester
LGA babies weigh > _____ and are ____ of the growth curve 4500 grams (9 lbs 15 oz); top 10% of growth curve (90% above)
LGA babies have increased risk of ADHD, learning difficulties, developing DM later in life, socializing issues
Infant of Diabetic Mother has a primary risk of ____ Hypoglycemiaa
Common cause of macrosomia/LGA is _____ Hyperinsulinemia
IDM have increased ____ issues and potential for ____ injury during birth Respiratory; mechanical injury (shoulder dystocia)
How can we avoid severe hypoglycemia? Tightly maintain mom's BG
Management in labor of IDM Put mom on insulin drip, carefully monitor mom's BG = less complications
IDM babies have a HCT of ___ > 65, polycythemia
Polycythemia leads to _____ and _____ feeding Hypoxia, poor feeding
IDM often look Ruddy
MAS stands for Meconium aspiration syndrome
Mortality of significant MAS is ____ 20%
Thin meconium is a ____ color and indicates Off-color green; baby has been swimming in meconium longer
Terminal meconium refers to Baby pooping as baby is born
Chunky meconium indicates Baby just pooped
Meconium stained Baby's body looks greenish since baby has been swimming in meconium for a while
___ is not better in amniotic fluid. ___ fluid is more easily aspirated. Trace; thinner fluid
Thicker meconium in AF leads to worse _____ Obstruction
How do we prevent MAS? Set up all deliveries with resuscitation equipment, check vocal cords and DO NOT agressively suction. Use bulb syringe.
What happens if we over-suction a baby with MAS? Oral airway overstimulated --> heart rate goes down
MAS monitoring and treatment includes close respiratory assessment for _____ First 48 hours
If baby is sx of MAS, then we manage using CXR, antibiotics, O2, mechnical support, IV hydration, nutrition
Created by: lapio-obgyn