OB Newborn Care lab

What is H&P? important thing to consider?

History and physical assessment. a baby's history is mom's history!

What components are in the physical assessment?

apgar score at birth, VS, Head to toe, pain, gestational age, hearing, CCHD, hyperbilirubinemia, GDS, bloodsugar

how often are head to toe assessments done?

every admission and every shift

NP or peds physicians do head to toe _ x daily when the baby is _

once, hospital

Px assessment usuallt has a baseline with what?

physical assessment or with painful stimuli (hep b vaccine)

What are the factors of doing a gestational age assessment?

hx of little to no prenatal care, uncertain due date, preterm

What components are in the history?

prenatal care, social history, subtance, medical proble, OB complications, labs, GTPAL, EDD, intrapartum hx

What is included in intrapartum hx?

length of labor, fetal distress, maternal analgesia/anesthesia, type of birth

how often is baby's weight checked?

daily

what needle and syringe for newborn IM? but what is one thing to keep out?

25G, 5/8", 1cc (ONLY 0.5mL AT A TIME)

where are IM injections done on a newborn?

vastus lateralis - anterolateral side

What injections are given to newborn?

Vit K and Hepatitis B

What is one key thing about Hep B injections

Need consent signed

Where should IM injections be documented?

MAR, consent (hep b), immunization record, pain score

What is the purpose of heelstick blood collection in newborn?

genetic disease screen, lab (bilirubin, CBC, blood gluc)

Why should you warm the heel with a warm pack for 5-10 min before heelstick?

acrocyanosis in hands and feet

Make sure to __ when collecting blood for blood sugar

wipe off first drop of blood

The __ side of the heel is meatier = more blood

lateral

What are the 5 screenings that newborns go through?

Genetic disease screen (GDS), Critical congenital heart defect (CCHD), Hearing screen, Hyperbilirubinemia screen, Blood Glucose

Usually when do you do these newborn screenings?

at or around 24hr (for hyperbilirubinemia 12 or 24hr, and PRN)

What is critical congenital heart defect screen also known as? Where do you do it and why?

pulse oximetry test, on the RIGHT hand bc preductal

What is the purpose of a hyperbilirubinemia screen?

TSB (total serum bilirubin), for jaundice

What does APGAR test?

Appearance (skin), Pulse, Grimace (reflex reactivity), Activity (muscle tone), Respiration

How often do you test APGAR? How to read?

1 min, 5 min after birth. The higher the score, the better on 0-2 each

Newborns can lose up to __% of birthweight in the first few days, but gain back after __.

10%, 2 weeks

What is the average newborn weight?

7lb 8oz, 3405g

What is the average newborn length?

20 in

What is the average newborn head circumference?

32-37cm - 2cm larger than chest

What is the average newborn chest measurement?

32cm (30-35)

Document newborn weight and length on __

growth charts

Why is checking ID bands important for mom and baby?

to prevent infant abduction (compare aloud)

What is the order for the bulb syringe?

Mouth then nose to prevent aspiration from stimuli (M before N)

Why should pt avoid suctioning nose alot?

can cause nasal swelling

What should parents know about if baby is choking?

they can usually clear their own airway, will gag and cough then be fine.

Some indications when swaddling?

at shoulder, not too high, tight, loose or long

Stop swaddling when babies , around __ months

try to roll over, 2-3 mo

Notify that crying is normal and healthy, some cry up to __/day

3 hours

What is colic?

cry at same time every day, outgrow by 3-4mo

How to handle colic

5S's= swaddle (arm down), side (football hold), sway, shh, suck (pacifier)

What are the ABC's in safe sleep reccomendation?

Alone, Back, Crib

What are big nono's in infant sleep?

bed sharing, crowding bassinet, overheating/dressing, smoke exposure

What things are protective in sleep (decrease risk of SIDS)?

room share (6 mo), pacifier, breastfeeding, immunizations

how often should you do supervised tummy time?

15 min twice a day

What is brick dust?

uric acid crystals due to dehydration

What can be seen in baby girls diapers?

pseudomensturation

What are some cord care implications?

keep clean and dry, watch out for odor, drainage, redness at base, bleeding, fever

How many US male babies are circumsized?

2/3 of them

When does circumsision happen?

after 24hr of life

What are the benefits of circumcision?

less risk of UTI in first year of life and when older, less risk of cancer from penis, prevent foreskin infection and phimosis-contraction, easier hygiene

What are the risks of circumcision?

bleeding, infection, improper healing, cutting too much or not enough foreskin

Parents must __ before circumcision

sign informed consent

what type of anesthesia is given for circumcision?

local anesthesia (dorsal penile nerve block)

a gomco clamp is used to cause __, then foreskin is removed with a __

hemostatis, scalpel

What are some important circumcision aftercare?

Lots of petroleum jelly for at least 24h, Tylenol PO may be given

What to check post circumcision? how often?

bleeding, swelling, voiding. check every 30 min for 2h

What to teach parents for circumcision aftercare?

change diaper and don't apply anything. do not rub off the whitish yellow film that covers penis

What to watch out for parents post circumcision?

bleeding, extreme swelling, foul odor, greenish yellow discharch, no void for 8+hr (24max), redness past 3 days

What is the purpose of the genetic disease screen (GDS)?

To detect genetic, metabolic, and infectious disorders that may not be obvious at birth.

When is the GDS performed and repeated?

Within 24–48 hours of birth; repeated around 5 days of age.

How is the GDS collected?

Heel stick.

What is PKU?

An inborn error of metabolism where phenylalanine cannot be properly metabolized.

What can untreated PKU cause?

Permanent brain damage and death. Early detection and dietary management can prevent serious complications.

What is the purpose of the CCHD screen?

To identify critical congenital heart defects that may not cause symptoms during the first days of life.

When is CCHD screening performed?

After 24 hours of age.

Where are pulse oximetry readings taken for CCHD screening?

Preductal: right hand. Postductal: either foot.

What oxygen saturation is typically considered a passing CCHD result?

95% or greater in either extremity.

What difference between preductal and postductal oxygen saturation is typically considered passing?

3% or less.

What is hyperbilirubinemia?

An elevated level of bilirubin in the blood.

How common is hyperbilirubinemia in term vs. preterm newborns?

Approx 60% of term and 80% of preterm.

Why is hyperbilirubinemia screening important?

Extreme bilirubin levels can cause acute bilirubin encephalopathy or kernicterus, leading to permanent neurological damage.

When should bilirubin screening be completed?

Before hospital discharge.

What two methods are used to screen bilirubin levels?

Transcutaneous bilirubin (TcB) measurement and total serum bilirubin (TSB) measurement.

How are bilirubin levels interpreted in newborns?

According to the infant's age in hours using an established nomogram, such as the Bhutani curve.

Why are visual estimations of jaundice not recommended for screening?

They may be inaccurate, especially in darkly pigmented newborns.

What is the purpose of newborn hearing screening?

To detect hearing loss early so interventions can support language development.

When is hearing screening usually performed?

Before hospital discharge.

What type of measures does the hearing screen use?

Physiological measures, not behavioral responses.

What can interfere with accurate hearing screening?

Wax, blood, and amniotic fluid in the ear.

What is the follow-up after a failed initial hearing screen?

Rescreen at 1 month. If the second screen is failed, diagnostic testing is recommended.

Which newborns receive blood glucose screening?

High-risk or symptomatic infants, including infants of diabetic mothers, SGA, LGA, preterm, and post-term infants.

What is the key difference between GDS and blood glucose screening?

GDS is performed on all newborns; blood glucose screening is for high-risk or symptomatic infants.