[17] MIDTERMS | PROFILE OF THE NEWBORN Flashcards
1
Q
VITAL STATISTICS
Weight- Average birth weight:
A
2.5 to 3.5 kg (7.7 lbs)
2
Q
VITAL STATISTICS
Length: The average birth length of a mature female neonate is ____. For male, is ____
A
Length: The average birth length of a mature female neonate is 49 cm (19.2 in). For male, is 50 cm (19.6 in)
3
Q
VITAL STATISTICS
Head Circumference
A
34-35 cm (13.5-14 in)
4
Q
VITAL STATISTICS
Chest Circumference
A
About 2cm less than the head circumference
5
Q
VITAL STATISTICS
Abdominal Circumference
A
Same as chest circumference
6
Q
VITAL SIGNS
Temperature
A
37.2 C at birth
Baby is bathed 6 hours after birth (Unang Yakap)
7
Q
VITAL SIGNS
Pulse
A
Average of 120 to 140 bpm or as low as 90 to 110 bpm
8
Q
VITAL SIGNS
Respiration
A
Average of 30-60 breaths per min
9
Q
VITAL SIGNS
Blood Pressure
A
Approximately 80/46 mmHg at birth.
By the 10th day, it rises to about 100/50 mmHg
10
Q
CARDIOVASCULAR SYSTEM
- The peripheral circulation of a newborn remains ____ for at least the first ____ hours after birth
- Cyanosis in the NB’s feet & hands ( ____ )
- Feet feel ____ to touch at this time
- NB’s blood volume is ____ ml per kilogram of bodyweight, or about ____ in total.
A
- The peripheral circulation of a newborn remains sluggish for at least the first 24 hours after birth
- Cyanosis in the NB’s feet & hands (acrocyanosis)
- Feet feel warm to touch at this time
- NB’s blood volume is 80-110 ml per kilogram of bodyweight, or about 300ml in total.
11
Q
CARDIOVASCULAR SYSTEM
- RBC of ____ million cells/cubic millimeter, Hgb level ave. ____ g/100 ml of blood. Hct count ____
- Indirect bilirubin level at birth is ____ mg/100ml.
- WBC count, ____ cells/mm3 at birth
- Lower than normal level of Vit ____
A
- RBC of 6 million cells/cubic millimeter, Hgb level ave. 17-18 g/100 ml of blood. Hct count 45%-50%
- Indirect bilirubin level at birth is 1-4 mg/100ml.
- WBC count, 15,000-30,000 cells/mm3 at birth
- Lower than normal level of Vit K
12
Q
RESPIRATORY SYSTEM
- All NB have ____ in the lungs from intrauterine life
- A baby born by ____ birth does not have as much lung fluid expelled at birth
- Premature babies, whose alveoli collapse each time they exhale (lack ____ ) have difficulty establishing effective ____ & respiration.
A
- All NB have some fluid in the lungs from intrauterine life
- A baby born by caesarean birth does not have as much lung fluid expelled at birth
- Premature babies, whose alveoli collapse each time they exhale (lack lung surfactant) have difficulty establishing effective residual capacity & respiration.
13
Q
GASTROINTESTINAL SYSTEM
- ____ at birth
- Bacterial source may be ____; vaginal secretions during birth, ____, & from contact at the ____.
- Accumulation of bacteria in the GIT is necessary for digestion & ____ synthesis.
- NB stomach holds ____ ml.
A
- Sterile at birth
- Bacterial source may be airborne; vaginal secretions during birth, hospital bedding, & from contact at the breast.
- Accumulation of bacteria in the GIT is necessary for digestion & vit k synthesis.
- NB stomach holds 60-90 ml.
14
Q
GASTROINTESTINAL SYSTEM
- ____ easily
- Immature liver function can lead to a tendency toward lowered ____ and ____ levels.
- ____, first stool usually passed within 24hrs
- ____ stool, green & loose stool on the 2nd or 3rd day of life.
- ____ stools are noticed for babies receiving phototherapy. (Treatment for ____ )
A
- Regurgitates easily
- Immature liver function can lead to a tendency toward lowered glucose and protein serum levels.
- Meconium, first stool usually passed within 24hrs
- Transitional stool, green & loose stool on the 2nd or 3rd day of life.
- Bright green stools are noticed for babies receiving phototherapy. (Treatment for jaundice)
15
Q
URINARY SYSTEM
- Immature - decreased ability to remove waste products from the blood.
- NB voids within 24 hrs after birth, ____ & ____. About ____ ml in single voiding.
- Males should be assessed to void with enough force to produce a small ____; females should produce a ____, not just continuous dribbling.
- The first voiding may be ____ or ____
- Specific gravity ranges from ____ to ____.
- The daily urinary output for the first 1 or 2 days is about ____ to ____ ml total.
- Diapers can be weighed to determine amount & timings of voiding.
A
- Immature - decreased ability to remove waste products from the blood.
- NB voids within 24 hrs after birth, light-colored & odorless. About 15ml in single voiding.
- Males should be assessed to void with enough force to produce a small projected arc; females should produce a steady stream, not just continuous dribbling.
- The first voiding may be pink or dusky
- Specific gravity ranges from 1.008 to 1.010.
- The daily urinary output for the first 1 or 2 days is about 30 to 60 ml total.
- Diapers can be weighed to determine amount & timings of voiding.
16
Q
IMMUNE SYSTEM
- With passive antibodies ( ____ ) from mother that crossed the placenta.
- Difficulty of forming antibodies against invading antigens until about ____ months of age
- ____ is highly advised.
A
- With passive antibodies (Immunoglobulin G) from mother that crossed the placenta.
- Difficulty of forming antibodies against invading antigens until about 2 months of age
- Breastfeeding is highly advised.
17
Q
NEUROMUSCULAR SYSTEM
- Term neonates demonstrate neuromuscular function by moving their extremities attempting to control the ____ movement, exhibiting a strong ____, and demonstrating newborn ____.
- Limpness or total absence of muscular response to manipulation is never normal & suggests ____, ____ or ____
A
- Term neonates demonstrate neuromuscular function by moving their extremities attempting to control the head movement, exhibiting a strong cry, and demonstrating newborn reflexes.
- Limpness or total absence of muscular response to manipulation is never normal & suggests narcosis, shock or cerebral injury
18
Q
REFLEXES SEEN IN NEWBORNS
- R____ reflex
- S____ reflex
- S____ reflex
- E____ reflex
- M____ reflex
- T____ reflex
- P____ reflex
- S____ reflex
- P____ reflex
- B____ reflex
- Other reflexes
A
- Rooting reflex
- Sucking reflex
- Swallowing reflex
- Extrusion reflex
- Moro / Startle reflex
- Tonic neck / Fencing reflex
- Palmar grasp reflex
- Stepping, placing or dancing reflex
- Plantar grasp reflex
- Babinski reflex
- Other reflexes
19
Q
SENSES
The senses in newborn are ____ at birth.
- HEARING
- VISION
- TOUCH
- TASTE
- SMELL
A
The senses in newborn are already developed at birth.
- HEARING
- VISION
- TOUCH
- TASTE
- SMELL
20
Q
PHYSICAL EXAMINATION
SKIN COLOR & LESIONS
- Assess for ____, cyanosis, ____, & jaundice
- General inspection of a newborn’s skin includes the color, ____, and general appearance
A
SKIN COLOR & LESIONS
- Assess for pallor, cyanosis, plethora, & jaundice
- General inspection of a newborn’s skin includes the color, any birthmarks, and general appearance
21
Q
PHYSICAL EXAMINATION
SKIN COLOR & LESIONS - FINDINGS
COLOR
- Normal color: cyanosis, acrocyanosis, ____, ____, ____
BIRTHMARKS: - Hemangioas
1. ____ or Port Wine Stain
2. ____ Hemangiomas
3. ____ Heamangiomas
4. ____
A
SKIN COLOR & LESIONS - FINDINGS
COLOR
- Normal color: cyanosis, acrocyanosis, jaundice, pallor, Harlequin sign
BIRTHMARKS: - Hemangiomas
1. Nevus Flammeus or Port Wine Stain
2. Strawberry Hemangiomas
3. Cavernous Heamangiomas
4. Mongolian Spots
22
Q
PHYSICAL EXAMINATION
SKIN COLOR & LESIONS - FINDINGS
GENERAL APPEARANCE
VERNIX CASEOSA
- White, cream cheese-like substance that serves as a ____. Usually, it is noticeable on a term newborn’s skin.
- Document the color of the vernix because it takes on the color of the ____.
- ____ vernix indicates meconium was present in the amniotic fluid. ____ vernix implies that the amniotic fluid was ____ from bilirubin.
A
SKIN COLOR & LESIONS - FINDINGS
GENERAL APPEARANCE
VERNIX CASEOSA
- White, cream cheese-like substance that serves as a skin lubricant. Usually, it is noticeable on a term newborn’s skin.
- Document the color of the vernix because it takes on the color of the amniotic fluid.
- Green vernix indicates meconium was present in the amniotic fluid. Yellow vernix implies that the amniotic fluid was yellow from bilirubin.
23
Q
PHYSICAL EXAMINATION
LANUGO
- Fine, ____ hair that covers a newborn’s shoulders, back & upper arms.
- A baby born after ____ wks of gestation has more lanugo than ____ wks AOG.
- By ____ wks of age it has disappeared
A
LANUGO
- Fine, downy hair that covers a newborn’s shoulders, back & upper arms.
- A baby born after 37-39 wks of gestation has more lanugo than 40 wks AOG.
- By 2 wks of age it has disappeared
24
Q
PHYSICAL EXAMINATION
DESQUAMATION
- Within ____ hrs after birth, skin of most NB has become extremely dry. Dryness is particularly evident on the ____ & ____.
- Newborns who are ____ and have suffered ____ may have such extremely dry skin that it has a leathery appearance and there are actual cracks in the skin folds.
- This should be differentiated from normal desquamation because it helps to diagnose the newborn as ____
A
DESQUAMATION
- Within 24 hrs after birth, skin of most NB has become extremely dry. Dryness is particularly evident on the palms of the hands & soles of the feet.
- Newborns who are postterm and have suffered intrauterine malnutrition may have such extremely dry skin that it has a leathery appearance and there are actual cracks in the skin folds.
- This should be differentiated from normal desquamation because it helps to diagnose the newborn as postterm
25
# PHYSICAL EXAMINATION
**MILIA**
* All NB sebaceous glands are immature. A ____ can be found on the cheek or across the bridge of the nose.
* Disappear by ____ weeks of age as the sebaceous glands mature and the plugged ones drain.
**MILIA**
* All NB sebaceous glands are immature. **A white pinpoint white papulae** can be found on the cheek or across the bridge of the nose.
* Disappear by **3 to 4 weeks** of age as the sebaceous glands mature and the plugged ones drain.
26
# PHYSICAL EXAMINATION
**ERYTHEMA TOXICUM**
* A newborn rash; usually appears on the ____ day of life, may appear up to ____ weeks of age. Rash has no pattern. It is caused by a NB’s ____ reacting to the environment as the immune system matures.
**ERYTHEMA TOXICUM**
* A newborn rash; usually appears on the **1st to 4th day** of life,may appear up to **2 weeks** of age. Rash has no pattern. It is caused by a NB’s **eosinophils** reacting to the environment as the immune system matures.
27
# PHYSICAL EXAMINATION
**FORCEP MARKS**
* If forceps were used for birth, there maybe a circular or linear contusion matching the rim of the blade of the forceps on the infants’ cheek. Disappear in ____ days, along with the ____ that accompanies it.
**FORCEP MARKS**
* If forceps were used for birth, there maybe a circular or linear contusion matching the rim of the blade of the forceps on the infants’ cheek. Disappear in **1-2 days**, along with the **edema** that accompanies it.
28
# PHYSICAL EXAMINATION
**HEAD**
* Check for ____ sutures, abnormal shape & size of the head, ____ & ____
* Also measure the head ____. Take note that during infancy the head is the largest area in the body, and it remain disproportionate to the body until ____ years old
**HEAD**
* Check for **overriding** sutures, abnormal shape & size of the head, **posterior & anterior fontanel**
* Also measure the **head circumference**. Take note that during infancy the head is the largest area in the body, and it remain disproportionate to the body until **5 years old**
29
# PHYSICAL EXAMINATION
**HEAD - FINDINGS**
* appears ____
* ____ large & prominent
* ____ appears to be receding
**HEAD - FINDINGS**
* appears **disproportionately large**
* **Forehead** large & prominent
* **Chin** appears to be receding
30
# PHYSICAL EXAMINATION
* spaces or openings where the skull bones join.
anterior
posterior
FONTANEL
31
# PHYSICAL EXAMINATION
* separates the line of the skull
SUTURES
32
# PHYSICAL EXAMINATION
* part of the NB’s head that engages the cervix is molded to fit the cervix contours.
* appears to be prominent & asymmetric
MOLDING
33
# PHYSICAL EXAMINATION
* Edema of the scalp at the presenting part of the head.
* Absorbs & disappears about the 3rd day.
CAPUT SUCCEDANEUM
34
# PHYSICAL EXAMINATION
* collection of blood between the periosteum of a skull bone & itself;
* caused by rupture of a periostal capillary due to pressure of birth
CEPHALHEMATOMA
35
# PHYSICAL EXAMINATION
* Localized softening of cranial bones probably caused by pressure of fetal skull against the mother’s pelvic bone in utero.
CRANIOTABES
36
# PHYSICAL EXAMINATION
**EYES**
* Lay the infant in a ____ position and lift the head.
* Inspect the eyes color, size, symmetry, ____ and ____.
## Footnote
Application of **Terramycin Opthalmic Ointment** to avoid **Opthalmia Neonatorum**
**EYES**
* Lay the infant in a **supine** position and lift the head.
* Inspect the eyes color, size, symmetry, **swelling and discharge.**
37
# PHYSICAL EXAMINATION
**EYES - FINDINGS**
* NB cry ____
* ____ hemorrhage
* Irises are usually ____ or ____
**EYES - FINDINGS**
* NB cry **tearlessly**
* **Subconjunctival** hemorrhage
* Irises are usually **gray or blue**
38
# PHYSICAL EXAMINATION
**EYES - FINDINGS**
* Sclera maybe ____ due to its thinness.
* Assume permanent color between ____ & ____ mos of age.
* Edema often present around the ____ or on the ____.
* ____ should appear round & proportionate in size.
* Pupils should be ____
**EYES - FINDINGS**
* Sclera maybe **blue** due to its thinness.
* Assume permanent color between **3 & 12 mos of age**.
* Edema often present around the **orbit** or on the **eyelids**.
* **Cornea** should appear round & proportionate in size.
* Pupils should be **dark**
39
# PHYSICAL EXAMINATION
**EARS - FINDINGS**
* Not completely formed
* ____ tends to bend easily
* level of the top part of external ear should be on a line drawn from the ____ to the ____ of the eye & back across the side of the head.
* Visualization of the ____ of the NB is usually not attempted.
* hearing test is done by ringing a bell held about ____ inches away from each ear
**EARS - FINDINGS**
* Not completely formed
* **Pinna** tends to bend easily
* level of the top part of external ear should be on a line drawn from the **inner canthus to the outer canthus** of the eye & back across the side of the head.
* Visualization of the **tympanic membrane** of the NB is usually not attempted.
* hearing test is done by ringing a bell held about **6 inches** away from each ear
40
# PHYSICAL EXAMINATION
**NOSE**
* Look for flaring of the ____, which is a sign of increased respiratory effort
* Check for ____
* Check for defects such as ____
**NOSE**
* Look for flaring of the **alae nasi**, which is a sign of increased respiratory effort
* Check for **choanal atresia**
* Check for defects such as **cleft lip & palate**
41
# PHYSICAL EXAMINATION
**NOSE - FINDINGS**
* Appear large for the face
* Note for any discomfort or distress with breathing.
* Record presence of ____ on the nose.
* Test for ____ (blockage of the rear of the nose)
* (+) ____
**NOSE - FINDINGS**
* Appear large for the face
* Note for any discomfort or distress with breathing.
* Record presence of **milia** on the nose.
* Test for **choanal atresia** (blockage of the rear of the nose)
* (+) **cleft lip & palate**
42
# PHYSICAL EXAMINATION
**MOUTH**
* Inspect the mouth for size, shape and color
* Note also if there is a ____ present
* Inspect the ____ for intactness.
**MOUTH**
* Inspect the mouth for size, shape and color
* Note also if there is a **tooth/teeth** present
* Inspect the **palate** for intactness.
43
# PHYSICAL EXAMINATION
**MOUTH - FINDINGS**
* Open evenly when NB cries.
* Tongue appears large & prominent in the mouth.
* Tongue is short creating an impression of ____.
* ____ should be intact.
* One or two small round glistening, well circumscribed cysts are present on the palate, ____.
* Sometimes natal teeth will have erupted.
* ____ can also be seen on the tongue and sides of the cheeks as white or gray patches and requires antifungal treatment.
**MOUTH - FINDINGS**
* Open evenly when NB cries.
* Tongue appears large & prominent in the mouth.
* Tongue is short creating an impression of **“tongue tied”**.
* **Palate** should be intact.
* One or two small round glistening, well circumscribed cysts are present on the palate, **Epstein’s pearls**.
* Sometimes natal teeth will have erupted.
* **Thrush** can also be seen on the tongue and sides of the cheeks as white or gray patches and requires antifungal treatment.
44
# PHYSICAL EXAMINATION
**NECK**
* Inspect for symmetry of shape of the neck, its alignment; ____ & possible ____; ____
* Assess infant’s ability to ____
**NECK**
* Inspect for symmetry of shape of the neck, its alignment; **lumps & possible fracture**; **lymph nodes**
* Assess infant’s ability to **control head**
45
# PHYSICAL EXAMINATION
**NECK - FINDINGS**
* Short & often ____, with increased skin folds
* (-) rigidity of neck ( ____ )
* Not strong enough to support total weight of head
**NECK - FINDINGS**
* Short & often **chubby**, with increased skin folds
* (-) rigidity of neck (**Congenital torticollis**)
* Not strong enough to support total weight of head
46
# PHYSICAL EXAMINATION
**CHEST**
* Assess for the ____ and pattern and observe chest movement for symmetry and ____
* Inspect the ____ for appearance and presence of symmetry
* Palpate the ____ for swelling and edema
* Breast may be slightly ____ secondary to presence of maternal hormones
* Auscultate for breath sounds, noting the inspiratory to expiratory ratio and the presence of ____
* ____ is of little clinical benefit and should be avoided especially in low-birth-weight or preterm infants as it may cause injury
**CHEST**
* Assess for the **respiratory rate and pattern** and observe chest movement for symmetry and **retractions**
* Inspect the **clavicles** for appearance and presence of symmetry
* Palpate the **breast** for swelling and edema
* Breast may be slightly **enlarged** secondary to presence of maternal hormones
* Auscultate for breath sounds, noting the inspiratory to expiratory ratio and the presence of **adventitious sounds**
* **Percussion** is of little clinical benefit and should be avoided especially in low-birth-weight or preterm infants as it may cause injury
47
# PHYSICAL EXAMINATION
**CHEST - FINDINGS**
* Breast maybe engorged.
* May appear small
* ____ milk
* Clavicles should be straight, should appear symmetric side by side
* RR: ____ bpm
* (-) chest ____
**CHEST**
* Breast maybe engorged.
* May appear small
* **Witch’s milk**
* Clavicles should be straight, should appear symmetric side by side
* RR: **30-60 bpm**
* (-) chest **retractions**
48
# PHYSICAL EXAMINATION
**ABDOMEN**
* Inspect for the shape; contour & note any abdominal ____, masses, visible peristalsis, ____, & obvious malformations
* Assess umbilical cord & count the ____; auscultate for bowel sounds.
* Inspect anal area for patency & for presence of ____ or ____.
* Palpate for the kidneys
**ABDOMEN**
* Inspect for the shape; contour & note any abdominal **distension**, masses, visible peristalsis, **diastasis recti**, & obvious malformations
* Assess umbilical cord & count the **vessels**; auscultate for bowel sounds.
* Inspect anal area for patency & for presence of **fistulas or skin tags**.
* Palpate for the kidneys
49
# PHYSICAL EXAMINATION
**ABDOMEN - FINDINGS**
* Looks slightly ____
* Bowel sound should be present within ____ hr after birth.
* Edge of the liver should be palpable 1-2 cm below the ____ margin
* Edge of the spleen should be palpable 1-2 cm below the ____ margin
**ABDOMEN - FINDINGS**
* Looks slightly **protuberant**
* Bowel sound should be present within **1hr** after birth.
* Edge of the **liver** should be palpable 1-2 cm below the **right costal margin**
* Edge of the **spleen** should be palpable 1-2 cm below the **left costal margin**
50
# PHYSICAL EXAMINATION
**ABDOMEN -FINDINGS**
* Umbilical cord appears bluish white, gelatinous structure; moist; marked with the red & blue streaks of umbilical vein & 2 arteries during the ____ hr.
* After clamping: begins to dry & appears dull & ____, then turns ____
**ABDOMEN -FINDINGS**
* Umbilical cord appears bluish white, gelatinous structure; moist; marked with the red & blue streaks of umbilical vein & 2 arteries during the **1st hr**.
* After clamping: begins to dry & appears dull & **yellowish brown**, then turns **greenish black**
51
# PHYSICAL EXAMINATION
**ABDOMEN - FINDINGS**
* single artery = ____ or ____
* Hematoma / ____
* Draining & ____ at the base
**ABDOMEN - FINDINGS**
* single artery = **congenital heart or renal abnormality**
* Hematoma / **omphalocele**
* Draining & **erythematous** at the base
52
# PHYSICAL EXAMINATION
**ANOGENITAL AREA**
* ____ anus; not covered by a membrane
* Check for ____ anus
* Note for the time after which the infant first passes ____
**ANOGENITAL AREA**
* **Patent anus**; not covered by a membrane
* Check for **imperforate anus**
* Note for the time after which the infant first passes **meconium**
53
# PHYSICAL EXAMINATION
**ANOGENITAL AREA - FINDINGS**
* ____ - The opening to the anus is missing or blocked.
* ____ may exist wherein stool is evacuated via the vagina, scrotum, or raphe.
**ANOGENITAL AREA - FINDINGS**
* **Imperforate anus** - The opening to the anus is missing or blocked.
* **Fistula** may exist wherein stool is evacuated via the vagina, scrotum, or raphe.
54
# PHYSICAL EXAMINATION
**MALE GENITALIA**
* Assess any malformation, abnormalities or ____.
* Inspect glans, urethral opening, foreskin or the prepuce, & the scrotum; palpate for the testes & ensure that both testicles are descended into ____.
* Elicit ____ reflex by stroking the internal side of the thigh.
**MALE GENITALIA**
* Assess any malformation, abnormalities or **sexual ambiguity**.
* Inspect glans, urethral opening, foreskin or the prepuce, & the scrotum; palpate for the testes & ensure that both testicles are descended into **scrotum**.
* Elicit **cremasteric reflex** by stroking the internal side of the thigh.
55
# PHYSICAL EXAMINATION
**FEMALE GENITALIA**
* Check the labia, clitoris, urethral opening & ____
**FEMALE GENITALIA**
* Check the labia, clitoris, urethral opening & **external vaginal vault**
56
# PHYSICAL EXAMINATION
**MALE GENITALIA - FINDINGS**
* Scrotum edematous & has ____
* Both ____ should be present in the scrotum
* (+) cremasteric reflex, elicited by stroking ____ of thigh
* ____ - penis is absent
* ____ - urethra ends in the upper part of penis
* ____ - urethra ends in the underside of penis
**MALE GENITALIA - FINDINGS**
* Scrotum edematous & has **rugae**
* Both **testes** should be present in the scrotum
* (+) cremasteric reflex, elicited by stroking **internal side** of thigh
* **Agenesis** - penis is absent
* **Epispadias** - urethra ends in the upper part of penis
* **Hypospadias** - urethra ends on the underside of penis
57
# PHYSICAL EXAMINATION
**FEMALE GENITALIA - FINDINGS**
* Vulva may be ____ (effect of maternal hormones)
* Sometimes with mucus vaginal secretion, ____ if blood tinged. This ____ is a manifestation of the abrupt decrease in maternal hormones and usually disappears by ____ weeks of age.
**FEMALE GENITALIA - FINDINGS**
* Vulva may be **swollen** (effect of maternal hormones)
* Sometimes with mucus vaginal secretion, **pseudomenstruation** if blood tinged. This **pseudomenstruation** is a manifestation of the abrupt decrease in maternal hormones and usually disappears by **2 to 4 weeks of age**.
58
# PHYSICAL EXAMINATION
**BACK**
* Inspect the back and base of the newborn’s spine for opening, ____, or ____ in the skin
**BACK**
* Inspect the back and base of the newborn’s spine for opening, **dimpling**, or **sinus tract** in the skin
59
# PHYSICAL EXAMINATION
**BACK - FINDINGS**
* Flat in the ____ & ____ areas.
* (-) dimpling, (-) sinus tract (suggest ____ )
* A ____ anywhere along the spine, but most commonly in the sacral area, indicates some type of spina bifida.
* A ____ may indicate the existence of spina bifida occulta or be a portal of entry into the spinal column.
**BACK - FINDINGS**
* Flat in the **lumbar & sacral areas**.
* (-) dimpling, (-) sinus tract (suggest **spinal bifida**)
* A **protruding sac** anywhere along the spine, but most commonly in the sacral area, indicates some type of spina bifida.
* A **pilonidal cyst** may indicate the existence of spina bifida occulta or be a portal of entry into the spinal column.
60
# PHYSICAL EXAMINATION
**EXTREMITIES**
* Test the upper extremities for ____
* Assess shoulder girdle for injury & clavicles for fracture (shoulder ____ ).
* Assess mobility of the ____ & extension of ____. Inspect ____ for assessment of gestational age & count the fingers.
* Assess the feet & ankles for deformity, mobility & count the toes.
* Test for ____
* Examine the ____ last, using the ____.
* Check for ____
**EXTREMITIES**
* Test the upper extremities for **muscle tone**
* Assess shoulder girdle for injury & clavicles for fracture (**shoulder dystocia**).
* Assess mobility of the **shoulder** & extension of **elbow**. Inspect **palmar creases** for assessment of gestational age & count the fingers.
* Assess the feet & ankles for deformity, mobility & count the toes.
* Test for **capillary refill**
* Examine the **hips** last, using the **Ortolani-Barlow maneuver**.
* Check for **ankle clonus**
61
# PHYSICAL EXAMINATION
**EXTREMITIES - FINDINGS**
* The arms and legs of the newborn appear ____ in proportion to the trunk.
* The hands seem plump and clenched.
* Short arms would signify ____
* ____
* The legs appear ____ and short
* The sole of the foot is ____
* Feet turned in ( ____ deviation).
* A foot does not align readily or will not turn to midline position ( ____ ).
**EXTREMITIES - FINDINGS**
* The arms and legs of the newborn appear **short** in proportion to the trunk.
* The hands seem plump and clenched.
* Short arms would signify **achondroplasia (dwarfism)**
* **Simian crease**
* The legs appear **bowed** and short
* The sole of the foot is **flat**
* Feet turned in (**Varus deviation**).
* A foot does not align readily or will not turn to midline position (**clubfoot**).
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# **BALLARD SCORE**
* Also know as ____
* It allows clinicians to estimate ____
* It is based on the neonate's physical and neuromuscular maturity and can be used up to ____ days after birth
* The ____ components are more consistent over time because the ____ components mature quickly after birth
* Also know as **"Dubowitz"**
* It allows clinicians to estimamate **gestational age**
* It is based on the neonate's physical and neuromuscular maturity and can be used up to **4 days after birth**
* The **neuromusuclar components** are more consistent over time because the **physical components** mature quickly after birth
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# BALLARD SCORE
* Because the Ballard score is accurate only within plus or minus ____ weeks, it should be used to assign gestational age only when there is ____ about the estimated date of confinement or there is a major discrepancy between the obstetrically defined gestational age and the findings on physical examination.
* Scores from neuromuscular and physical domains are added to obtain total score.
* Because the Ballard score is accurate only within plus or minus **2 weeks**, it should be used to assign gestational age only when there is **no reliable obstetrical information** about the estimated date of confinement or there is a major discrepancy between the obstetrically defined gestational age and the findings on physical examination.
* Scores from neuromuscular and physical domains are added to obtain total score.
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# BALLARD SCORE
* **Premature**: < 34 weeks gestation
* **Late pre-term**: 34 to < 37 weeks
* **Early term**: 37 0/7 weeks through 38 6/7 weeks
* **Full term**: 39 0/7 weeks through 40 6/7 weeks
* **Late term**: 41 0/7 weeks through 41 6/7 weeks
* **Post term**: 42 0/7 weeks and beyond
* **Postmature**: > 42 weeks
* **Premature**: < 34 weeks gestation
* **Late pre-term**: 34 to < 37 weeks
* **Early term**: 37 0/7 weeks through 38 6/7 weeks
* **Full term**: 39 0/7 weeks through 40 6/7 weeks
* **Late term**: 41 0/7 weeks through 41 6/7 weeks
* **Post term**: 42 0/7 weeks and beyond
* **Postmature**: > 42 weeks
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* It is used to assess the degree of respiratory distress in neonates
* Evaluates five parameters and assigns a numerical score for each parameter.
-> Chest movement
-> Intercostal retraction
-> Xiphoid retraction
-> Nares dilatation
-> Expiratory grunt
SILVERMAN-ANDERSEN INDEX
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It is a quick test performed on a baby at 1 and 5 minutes after birth
APGAR SCORING
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# APGAR SCORING
* The ____ -minute score determines how well the baby tolerated the birthing process.
* The ____ -minute score tells the health care provider how well the baby is doing outside the mother's womb.
* The newborn is considered to be ____ if the initial scores are 7 and above. If the five-minute score is less than 7, scoring is done every ____ minutes thereafter until the score reaches 7.
* It may be repeated at 10, 15, and 20 minutes if the score is low.
* The **1-minute score** determines how well the baby tolerated the birthing process.
* The **5-minute score** tells the health care provider how well the baby is doing outside the mother's womb.
* The newborn is considered to be **“vigorous”** if the initial scores are 7 and above. If the five-minute score is less than 7, scoring is done every **five minutes** thereafter until the score reaches 7.
* It may be repeated at 10, 15, and 20 minutes if the score is low.
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# APGAR SCORE
* ____ (1909-1974) introduced the Apgar score in 1952.
* It is done by a doctor, midwife, or nurse
* The provider examines the baby's:
-> Respiratory effort
-> Heart rate
-> Muscle tone
-> Reflex Irritability
-> Skin color
* Each category is scored with ____, depending on the observed condition.
* ____ is common in newborns that a score of 1 can be thought as normal.
* **Virginia Apgar, MD** (1909-1974) introduced the Apgar score in 1952.
* It is done by a doctor, midwife, or nurse
* The provider examines the baby's:
-> Respiratory effort
-> Heart rate
-> Muscle tone
-> Reflex Irritability
-> Skin color
* Each category is scored with **0, 1, or 2**, depending on the observed condition.
* **Acrocyanosis** is common in newborns that a score of 1 can be thought as normal.
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* A - ____
* P - ____
* G - ____
* A - ____
* R - ____
* A - **ACTIVITY**
* P - **PULSE**
* G - **GRIMACE**
* A - **APPEARANCE**
* R - **RESPIRATION**
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# APGAR SCORE - INTERPRETATION
* Apgar scores of ____ are critically low, especially in term and late-preterm infants
* Apgar scores of ____ are below normal, and indicate that the baby likely requires medical intervention
* Apgar scores of ____ are considered normal (1, 3)
**A baby with a low Apgar score may need**:
* ____ and clearing out the airway to help with breathing
* ____ to get the heart beating at a healthy rate
* Most of the time, a low score at 1 minute is near-normal by 5 minutes.
* Apgar scores of **0-3** are critically low, especially in term and late-preterm infants
* Apgar scores of **4-6** are below normal, and indicate that the baby likely requires medical intervention
* Apgar scores of **7+** are considered normal (1, 3)
**A baby with a low Apgar score may need**:
* **Oxygen** and clearing out the airway to help with breathing
* **Physical stimulation** to get the heart beating at a healthy rate
* Most of the time, a low score at 1 minute is near-normal by 5 minutes.
