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High Risk NB

Hypogly, Bili, GBS

Surgical birth issues (list 4) 1) Lack of vaginal squeeze, 2) effects of meds, 3) abruptness/handling stresses NB, 4) loss of natural environmental (smell, heartbeat)
For a late preterm NB, they have __ the odds of ____ than term NBs in surgical birth 9; respiratory disease
Hypoglycemia is defined as ______ mg/dl < 45 mg/dl
If there is a dip in BG, need stable results for the next __ checks to be considered stable 3
True or false: most common sx of hypoglycemia in a TERM infant is NO sign True
Other s/sx of hypoglycemia include Temp =< 36.1C, lethargy, poor feeding/tone, jittery
Who is at risk for hypoglycemia? SGA, LGA, babies of DM mothers, baby of birth injury, late preterm, baby w/ poor thermoregulation
Treatment for hypoglycemia Give supplement (colostrum > formula), prefer protein, do f/u testing
What site do you use to check for BG? Outer region of heel
List causes of hyperbilirubinemia 1) destruction of fetal cells, 2) blood type incompatibility, birth injury, 3) dehydration, 4) infection, 5) immature/abnormal liver
What is hyperbilirubinemia? RBC destruction leading to rise in bili levels
Conjugated hyperbilirubinemia is _____-soluble and _____ Water-soluble; NON-toxic
Unconjugated hyperbilirubinemia is ________-soluble and ____ Fat-soluble; TOXIC to body tissues
Bili levels typically rise over first __ days and then resolves in ____ in normal NB 3-5 days; resolves 10-14 days in normal NB
Which type of hyperbilirubinemia causes significant mental retardation? Unconjugated
Therapy for hyperbilirubinemia? Hydrate babies, put them to breast, let liver process
Who is at greater risk for developing hyperbilirubinemia? Vacuum suction, Mom O+, baby birth injury, poor BF
________ hyperbilirubinemia peaks at 3-4 days and is _______ Physiologic; expected compensation
Pathologic hyperbilirubinemia peaks at ___ days usually in _________ 2 days; blood incompatibilities
Pathologic hyperbilirubinemia peaks at ____ days with _______ and usually passes on its own 3-5 days; birth injury
Which type of jaundice is most associated with ineffective feeding? Early breast milk jaundice
Nursing care for early onset BM jaundice Promote good BF, offer breast q2-3h or 8-12x/24h, increase fluids through BF/IV
____ onset BF jaundice will have total bili levels of ____ Late; 12-20
Late onset BF jaundice may be d/t Hormonal interference w/ liver conjugation
When does late onset BF jaundice peak? 7-10 days
True or false: with late BF jaundice you want to stop BF and supplement with formula immediately. False. Unless bili levels very high, don't want to disrupt BF
_____ may contribute to pathologic hyperbilirubinemia Polycythemia
In pathologic jaundice, you will see bili levels > ____ @ day of birth and total bili levels greater than _____ 5; 17
What is the pH of babies with pathologic jaundice? Low; babies may have acidosis
Bilirubin encephalopathy is as also known as ____ Kernicterus
What are signs of kernictus? Seizures, hypotonia, lethargy, irritability
Kernicterus may be a precursor to _____ and other complications include _______ and ________ Cerebral palsy, paralysis, auditory dysfunction
Care to prevent kernicterus/pathologic jaundice Give moms Rhogam, good prenatal checks
To prevent kernicterus, it's important to keep bili levels BELOW ____ mg/dl 20
True or false: preemies may develop kernicterus at lower bili levels than term NB True
Jaundice progresses from face ____ Down
Bilimeter is not valid after ___ started and people of ___ will have higher readings Phototherapy; color
Total bili under __ during first 24h is considered okay 5
Lab tests for jaundiced babies NB blood type, CBC (to r/u sepsis), total bili, Coombs
What is an indirect Coombs test? Prenatal test to determine if there's issues for mother and if infant at risk for hemolytic disease
If an indirect Coombs has a positive result, we do what? Screen NB later using direct Coombs
Direct Coombs test does what? Tests baby to see if there's any RBCs destroyed (looking for autoimmune hemo
If a baby is at ____ level risk on Bhutani's graph, we should just make sure baby is feeding weel Low intermediate to low risk
If baby is at ___ level risk on Bhutani's graph, we would put them under bili lights and fluids High intermediate
List the bili levels you can estimate based on location of jaundice Face [5]; nipples [8], groin [10-12], thighs [15]
How do you prevent hyperbilirubinemia? Hydration, frequent feeding, early identification
Treatment for jaundice Hydration and phototherapy (to alter bili so it can better bind to protein and be excreted)
Care for baby undergoing phototherapy Hydrae with q2-3 feeds, increase protein, keep temp regulated, stimulate bowel thru feedings, safety
How can we avoid burns on baby undergoing phototherapy? Cover eyes/genitals; no lotions or oils
When should we give mom Rhogam? At 20th week or within 72 hours of pg
Iso-immunization indicates severe ____ Blood incompatibility
_______ is a fetal complication of Rh incompatibility Hydrops fetalis
What is hydrops fetalis? Pathologic changes that develop in fetal organs secondary to anemia
S/sx associated with hydrops fetalis Fetal hypoxia, CHF, hypoproteinuria (r/t hepatic dysfunction), true sinusoidal pattern on FHM
True or false: babies can die in utero d/t hydrops fetalis True
What is ABO incompatibility? Type O mom has baby with A/B/AB blood
ABO incompatible babies usually have enlarged _____ Spleens/liver
True or false: hydrops fetalis presents in Rh and ABO incompatibility False. Only Rh incompatibility
Management of ABO incompatible babies Coombs test on mom; monitor
Exchange transfusion is a last resort and can be done by removing whole from through ___ Umbilical vessel
High dose ___ is given during baby's blood transfusion IV immunoglobulin
What is the reason for exchange blood transfusion? Baby's total bili level remains elevated AFTER phototherapy
True or false: maternal postpartum antibiotic prophylaxis has decreased early onset GBS by 80% in last 20 years FALSE. Maternal INTRAPARTUM antibiotic prophylaxis has decreased early GBS
When is GBS screened? 35-37 weeks
True or false: 60% of term infants with GBS disease are born to mothers who were (-) on late 3rd trimester screening True
ALL ____ patients should be screened and treated if positive Preterm labor
Higher doses of ____ prophylaxis in labor Penicillin
For GBS if NB is showing mild signs (remember sx cluster), do lab tests such as Blood cultures, CBC, LPs
Created by: lapio-obgyn