OB Session 7:

 

Vernix (the white stuff covering the skin) is less abundant the longer GA

 

Acrocyanosis – blue periphery and is normal

 

1st period of reactivity is before the baby falls back asleep. Lasts about an hour.

  • do a lot of mother to baby contact and feeding at this time.

 

The next period is the period of inactivity when the baby cannot really be woken up

 

L.A.T.C.H. score 0-10 10 being best.

Latch, Audible swallowing, Type of nipple, Hold

 

Normals: 110-160bpm, 30-60RR, 98-99F

 

Reasons that babies are bad at controlling temp:

  • Large body SA to Mass, thin epidermis, posture flexed, and need a higher ambient temp to keep their body temp up.
  • Can’t shiver
  • give the baby a layer more than you are wearing

 

Brown fat:

  • once depleted it does not come back
  • 2-7% of body weight
  • on chest and back

 

Blood glucose at 1 hour is ordinary

  • <40ish mg/dl is too low.
  • needs some sort of calories if this is the case.
  • syringe, cup feeding, gavage feed – g tube feeding directly into the stomach.
  • lavage is the cleaning out of the stomach
    • this will happen if the baby swallows bloody amniotic fluid.

 

before placing ID bads what should you do

  • double check identities
  • explain that there may be an alarm system associated with baby’s band to make sure that no one takes it.
  • dont take it off if the baby is still at the hospital

 

milia – don’t pick them

  • keratin cysts
  • they go away

 

stork bite

  • reddened area, may go away

 

epstein pearls

  • white round dots in the back of the throat
  • normal and goes away

 

natal tooth

  • painfull for breast feeding and could be a choking hazard

 

sucking blister in utero

 

polydactyly – extra finger

  • check the rest of the baby closely

 

Lanugo

  • body hair, that is fuzzy and falls off

 

Hair tuft at low back or sacral dimple point towards spina bifida

 

reflexes

  • rooting sucking
  • Moro
  • Palmar grasp
  • step
  • tonic neck
  • Galant
  • Plantar grasp
  • Babinski
  • Protective reflex – link to stanford website

 

Signs or effective breastfeeding

  • seisity
  • good latch
  • stool color change
  • stooling after feeds
  • eventual weight gain, after an initial weight loss of no more than 10% of initial body weight.

 

erythema toxicum

  • normal baby rash and goes away

 

before discharge

  • PKU test
  • car seat test
  • Hearing test
    • Hearing test can be failed due to fluid in the ear canal, need to see a pediatrician to fix this
  • education
  • total bilirubin (sometimes)

 

circumcision is an elective procedure

  • plasta bell, the plastic part is left on until it falls off naturally.
  • clamp types need petroleum jelly to prevent adherence to the diaper.

 

danger or warning signs for parents

  • lay baby on back to prevent SIDS

 

Cephalohematoma

  • does not cross suture line

Caput

  • can cross suture lines

 

Pseudo menstruation, from hormonal withdrawal

brick dust, uric acid excretion in boys and should only happen once.

 

syndactyly, webbed toes

 

slate grey spots – ok and go away

 

Nevus Flammeus – do not generally go away

 

Physiologic jaundice – happens after 24 hours and is OK

Pathologic Jaundice – happens before 24 hours and is bad

  • can be caused by ABO incompatibility

 

Hypoglycemia – <40 mg/dl

  • risk factors:
  • Neonate of DM mother

 

We treat HTN with Aldomet 250mg if the mother has bad HTN, not proteinuria if HTN before

  • HTN can cause Nephrotoxic issues

 

Preeclampsia – HTN after 20 week GA w/ proteinuria  

  • Volume overload and leaky vessels
  • HELLP – hemolysis, elevated liver enzymes, and low platelets
  • cause is mostly know, but thought to be from the placenta developing incorrectly, increased inflammatory response, with endothelial response and leaky.
  • only cure is delivering baby.
  • risk factor: 1st time, HTN or vascular Dx, big baby from DM
  • risks: DIC, abruptio
  • Mag sulfate is for the neural maturity of the baby
    • 4-6 gm loading dose
    • 2-3g/hr
    • Lab: 4-7 mEq/mL
    • monitor mag and RR
    • Pulmonary edema, resp depression and arrest,
    • Calcium gluconate IV is the antidote for MAG toxicity
    • should be on this for 24 hours postpartum, and still at risk for at least 6 weeks

 

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