Apgar scores
Apgar score(s) are recorded after how many minutes of life?
1 minute and 5 minutes
This is considered to be a normal respiratory rate for a newborn.
40-60 breaths/min.
These are three types of twin arrangements with regard to placenta(s) and amniotic sac(s).
Dichorionic, diamniotic (separate placentas + amniotic sacs)
Monochorionic, diamniotic (shared placenta, separate amniotic sacs)
Monochorionic, monoamniotic (shared placenta + amniotic sac)
These are two common microbial causes of neonatal conjunctivitis.
Neisseria gonorrhea and Chlamydia trachomatis.
Prophylactic erythromycin ointment is applied to the eyes at birth to prevent neonatal conjunctivitis.
You are updating your pregnant patient's prescriptions for chronic hypertension. They ask if they can take their father's prescription because it works fine for him.
You would clarify this about the presumed prescription before answering your patient's question.
Is the prescription an ARB or ACEi?
These medications are teratogenic, especially in the first trimester.
This is considered a normal Apgar score after 5 minutes.
7-10
A newborn is considered bradycardic if their heart rate drops below this value.
120 bpm.
You cannot give this type of vaccine to someone who is pregnant.
Live attenuated vaccines (MMR, varicella, HPV, live attenuated flu)
As a result of shoulder dystocia, a newborn may have transient or permanent damage to this anatomical structure(s).
Brachial plexus, clavicle, and/or humerus.
Babies exposed to magnesium in utero will display this pattern of muscle tone.
Hypotonia.
May be seen in babies born after (pre)eclampsia treatment.
Acrocyanosis describes this aspect of an Apgar score.
Color.
Acrocyanosis: peripheral extremity cyanosis
Newborns may normally lose up to this much of their initial weight in the first few days post-birth.
Up to 10%.
Normally regained within 1-2 wks of life.
The sequential screening test consists of testing the levels of the following hormones.
Step 1: B-hCG and PPAP-A.
Step 2: B-hCG, MSAFP, estriol, inhibin A.
Name the five major cyanotic congenital heart diseases that begin with T.
Tricuspid atresia
Transposition of the great vessels
Tetralogy of Fallot
Total anomalous pulmonary venous return.
This is the most common cause of preventable intellectual disability in the U.S.
Fetal alcohol syndrome.
If an infant scores <7, the Apgar test is performed at intervals of this length for an additional 20 minutes.
Every 5 minutes for an additional 20 minutes.
This is considered to be a normal weight (range) for a newborn.
5.5-8.8 lbs (2500-4000 g).
Falls within 10th-90th percentiles.
This is the most common fetal (transplacental) infection worldwide.
CMV.
80-90% are initially asymptomatic but may develop SN hearing loss -- check hearing at birth and 2 yrs!
Omphalitis, unlike umbilical hernia, is a neonatal emergency that may be managed in the following ways.
Antibiotics (ampicillin + aminoglycoside).
Surgical debridement (necrotizing fasciitis, drainage).
Your pregnant patient has not received proper management for their diabetes throughout their pregnancy. They deliver a newborn at 40 weeks.
If affected, their newborn might show some of these symptoms.
Hypoglycemia sx (due to fetal hyperinsulinemia):
Jitters/tremors
Respiratory distress
Hypothermia
Listlessness
Apnea
Seizures
At 1 minute of life, a newborn is crying loudly. They have flexed blueish extremities, and cough when the physician removes meconium from their mouth. HR = 120 bpm.
Give this newborn an Apgar score.
9
HR > 100 bpm (2)
Good cry (2)
Well flexed extremities (2)
Cough reflex (2)
Acrocyanotic (1)
This is the average mean arterial pressure (range) for a newborn.
52-65 mmHg, but steeply increases after Day 1!
In adults, MAP > 60 mmHg is necessary for minimum organ perfusion
Twin to twin transfusion syndrome results in the following abnormalities in the recipient twin.
Polycythemia, hypervolemia, and polyhydramnios (in DA pregnancies).
Sofia can't think of anything.
What was Sofia's birth weight?
4.5 lbs!
My twin brother was a whole POUND heavier than me. Rude.
A pregnant patient arrives to the ED unconscious, with pinpoint pupils and RR = 5. EMTs state she was found in a puddle of clear bodily fluids. Emergency cesarean section delivers a infant that is 55th percentile height and weight.
These portions of the infant's Apgar score would be most affected by the presumed diagnosis.
Respiratory rate (high-pitched cry, congestion)
Muscle tone (hypertonicity)
Reflex irritability (hyperreflexia).