Chapter 35 - Acquired Problems of the Newborn

Occipital Osteodiastasis

• separation of cartilaginous joint btwn occipital bone

Most common birth fracture is

Clavicular fracture

S/S of Clavicle Fracture

• affected arm movement is decreased/absent

• crying during passive movement

• tender

• crepitus

Brachial Plexus Injury

• paralysis involving muscles of upper extremities

Erb Duchenne Paralysis

• from injury to the upper plexus caused by pulling head away from shoulder

Injury to phrenic nerve is usually…

Unilateral

S/S of Spinal Shock

• flaccid extremities

• paralyzed abdominal movements

• atonic anal sphincter

• distended bladder

The fetal glucose value is

70% to 80% of maternal value

What happens after cord clamping?

Neonates BG lvl decreases

Hypoglycemia S/S

• apnea

• tachyc

• hypotonia

• cyanosis

• seizures

Pathophysiology behind macrosomic babies of diabetic mothers?

• Hyperinsulinemia (GH)

  • accelerates protein sythesis

  • excessive glycogen and fat stores

Macrosomia Characteristics

• enlarged internal organs

• cord is larger

• increased fat around shoulders

Since GDM is associated with congenital anomalies, GDM diagnosed mid to late pregnancy…

Not associated with increased incidence of anomalies

Neonatal Small Left Colon Syndrome

• intestinal disorder when neonate fails to pass meconium and has

  • abdominal distention

  • bile stained vomit

Electrolyte Imbalances in Infants of Diabetic Mothers

• hypocalcemia

• hypomagnesemia

Neonatal Sepsis

Systemic inflammatory response

Early Onset Sepsis

• within 72hrs

• tx:

  • ampicillin

  • aminoglycosides

Late Onset Sepsis

• after 72hrs

• tx:

  • vancomycin

  • aminoglycosides

Parvovirus B19 (Fifth Disease)

• slapped cheek disease

• s/s: fever, malaise, rash

• transmitted vertically btwn mom and infant

• tx; supportive, transfusion

Tobacco use is associated with

LBW

Fetal Alcohol Syndrome (FAS)

• most severe, death possibly

• s/s: short fissures, thin upper lip, smooth philtrum

Alc Related Neurodevelopmental Disorders (ARND)

• have structural CNS and cognitive abnormalities

Alc Related Birth Defects (ARBD)

• congenital abnormalities

• detected until child begins school

Neurobehavioral Disorder Associated with PAE

• CNS damage

• functional impairments of

  • neurocognition

  • self reg.

Neonatal Abstinence Syndrome (NAS)

• associated with opioid withdrawal

Tx program for women who used opioids that permits BF?

• Methadone

• Buprenorphine

Neonatal Abstinence Syndrome (NAS) S/S

• Tremors

• Exaggerated Moro Reflex

• Hyperactivity

• Hypertonia

Ouid use is associated with…

• growth restriction

• preterm birth

• NICU admit

How may cocaine fetal exposure be prolonged?

Amniotic fluid acts as a reservoir for coke

Cocaine Use S/S

• hypoxemia

• IUGR

• LBW

• preterm

• Acute intoxication

T/F: Cocaine is found in breast milk and BF is contraindicated

TRUE

Meth has

Vasoconstrictive effects

Med to manage infant withdrawal of benzos?

Phenobarbital

Poor Neonate Adaptive Syndrome

• from SSRIs

• resembles NAS

• mild & no longer than 2 days

Diag screening to identify substances

• urine screen

• meconium screening

Opidoid Withdrawal Meds

• Methadone*

• Morphine*

• Phenobarbital

• Clonidine

** = most common

NA for NAS

Avoid overstimulation!!