Question

Case Study #1: A G3P1011 presented to labor and delivery for induction at 39 2/7 weeks with a positive Group B Strep culture but delivered only two hours after the first dose of Penicillin G had infused. The infant’s temperature at birth and 30 minutes of age was 101 degrees F. The neonatologist ordered the following labs: CBC with manual differential and C Reactive Protein. At one hour of age the CBC and differential results were returned. The total WBC count was 31,000. Is the WBC count a reliable indication of infection in a neonate? Why or why not? Immature neutrophils are an important indicator. The may also be referred to as “bands” or “banded neutrophils”. What is an I/T ratio? What is the significance of a normal I/T ratio? Why might a series of CRP values be ordered? What findings are typically seen in bacterial infection? Case

Study #2: A G3P0020 delivered a 6 lb male at 37 weeks. At birth the newborn was visibly jaundiced. The RN noted the mother’s blood type was O positive. Discuss why the neonatologist ordered a Type/Rh, Direct Coombs test, and Bilirubin Direct, Indirect, and Total Bilirubin on this infant. The samples were obtained at one hour of age and the results were reported to be as follows: Blood Type: A, Rh factor= positive, Direct Coombs= positive, Bilirubin direct= 0.8 mg/dl, Indirect= 6.2 mg/dl and Total=7 mg/dl. Is the newborn’s jaundice pathologic or physiologic (include your rationale)? What is the most likely cause of the positive Direct Coombs test and the newborn’s jaundice and hyperbilirubinemia?

Case Study #3: You are caring for the Large for Gestational Age (LGA) infant of a mother diagnosed with gestational diabetes at 28 weeks during her pregnancy. You know that newborns of diabetic mothers are at risk for hypoglycemia in the neonatal period. Discuss the time frame of greatest risk and how point of care monitoring should be carried out. If the glucose reading is below 40 mg/dl, what interventions does the nurse anticipate?

Answer 1

In a case study 1: there was c reactive protein tet is most important than the cbc test ... because it can indicate the bacterial infections in neonate. It's can not diagnose through complete blood counts that neonate have a bacterial infections so if mothere have a bacterial infection and aftr taking penicillin g dose might be neonate have a chances for bacterial infections so through the culture and c reactive protein can indicate the infection in neonate.

And wbc counts are not reliable to identify infection because normal range is 9000-30000 .

I t ratio is immature to totall neutrophils ratio which can helps to identify tthe sensitivity and sepsis in neonatal infection.

Significant ratio is crp: <0.5 mg /dl and I:T ratio at birth is <0.16

Case study :2

Newborn jaundice is pathological jaundice

This is the test can be done for looking for foreign antibodies that are already adhere to rbcs and it can cause hemolysis

For that type rh incompatibility should be examine if it's positive can leads to homolysis

Case study :3

If glucose reading is less than 40 than prompt treatment should be start..with enteral feeding and infusion up to 12.5% D/w

Nusing intervention is examination of neonate for symptoms of hypoglycemia, keep neonate warm, look for cyanosis, prevention for neonatal hypoglycemia.