8.1b Physiologic Adpatations Flashcards
1
Q
Respiratory System
A
- Establishment of effective respirations is critical once baby is born
- Most newborns breathe spontaneously and are able to maintain adequate oxygenation.
- Preterm infants may have respiratory difficulty due to immature lungs
2
Q
Initiation of Breathing
A
- As a fetus, oxygen was shunted away from the lungs but during birth lungs must be used
- Clamping the umbilical cord causes a rise in BP which increases circulation and lung perfusion
- Initiation of respirations caused by chemical, mechanical, thermal and sensory factors
3
Q
Chemical Factors
A
- Chemoreceptors in carotid arteries and aorta activate due to hypoxia associated with labor
- Each labor contraction has decrease in uterine blood flow which causes the hypoxia and hypercarbia
- This causes decrease in pO2 and increase in pCO2 which lowers blood pH
- This stimulates the respiratory center in the medulla to initiate the first breath
- Clamping the cord can cause a drop in prostaglandin levels which can inhibit respiration
4
Q
Mechanical Factors
A
- Respirations stimulated by changes in intrathoracic pressure, resulting from compression of chest during vaginal birth
- After birth the pressure is relieved off the chest. The negative pressure from pressure being relieved helps draw air into the lungs
- Crying promotes expansion of alveoli
5
Q
Thermal Factors
A
- Low temperature of extrauterine life stimulates respirations
6
Q
Sensory Factors
A
- OB doctors suction a newborns mouth and nose
- Baby is dried by the nurses
- Lights/Sounds/Smells
- These all stimulate respirations
7
Q
Establishing Respirations
A
- At birth lungs hold about 20 mL of fluid per kg
- Days preceding labor there is reduced production of fetal lung fluid
- Shortly before labor, catecholamine surge promotes fluid clearance of lungs
- Lung fluid is brought into interstitial spaces via active transport and drainage goes into pulmonary/lymphatic system
- Retention of lung fluid interferes with infants ability to maintain adequate oxygenation
- This is especially important if baby has aspirated meconium, congenital diaphragmatic hernia, esophageal atresia with fistula, choanal atresia, congenital cardiac disease, and immature alveoli
8
Q
C-Section
A
- Babies can experience lung fluid retention (typically clears without harm)
- More likely to develop transient tachypnea
9
Q
Surfactant
A
- Lung expansion depends largely on chest wall contraction and adequate surfactant secretion
- Surfactant lowers surface tension which decreases pressure required for alveoli to open with inspiration. It also prevents collapse of alveoli on exhalation.
- Absent or decreased surfactant causes more pressure required during inspiration which can in turn tire or exhaust preterm/sick infants.
10
Q
Once Respirations are Established
A
- Breaths are shallow and irregular (30-60 breaths/min)
- There can be periods of paused breathing lasting less than 20 seconds
- Periodic breathing occurs most often during active REM sleep and decreases with age
- Apneic episodes longer than 20 seconds is abnormal
- Infants are nose breathers to help coordinate sucking/swallowing/breathing
- If there is a nasal obstruction, infants will open their mouths to breathe
11
Q
Breathing
A
- Before 3 weeks of age cyanosis and asphyxia (deprivation of oxygen) can occur with nasal blockage
- Breathing is usually noted as diaphragmatic contraction and abdominal breathing
- Abdomen and chest rise simultaneously with breathing
12
Q
Respiratory Distress
A
- Nasal Flaring
- Intercostal/Subcostal retractions (in drawing of tissue between ribs)
- Grunting
- Stridor/Gasping represents upper airway obstruction
- Seesaw/Paradoxical Respirations (exaggerated rise in abdomen with respirations as chest falls) should be reported
- Respirations outside normal range of 30-60 should be evaluated
- Analgesic/Anesthetics during labor can effect newborn breathing
13
Q
Apneic Episode
A
Caused by
- Rapid increase in body temperature
- Hypothermia
- Hypoglycemia
- Sepsis
14
Q
Tachypnea
A
- Results from inadequate clearance of lung fluids which can indicate respiratory distress syndrome (RDS)
CAN BE THE FIRST SIGN OF - Cardiac/Respiratory/Metabolic/Infectious illness
15
Q
Baby Color
A
- Newborn should turn from blue to pink within the first 3-5 minutes
16
Q
Acrocyanosis
A
- Blue color in hands and feet
- Normal for first 24 hours of birth
- Duskiness while crying is also common immediately after birth
17
Q
Central Cyanosis
A
- Hypoxemia
18
Q
Circumoral Cyanosis
A
- Blue lips/mucous membranes RESULTS OF - Inadequate oxygen delivery to alveoli - Poor perfusion of lungs that inhibit gas exchange - Cardiac dysfunction
19
Q
Central Cyanosis
A
- Late sign of respiratory distress and significant hypoxemia
20
Q
Transient Tachypnea (TTN)
A
- Rates up to 100 breaths per minute can be present
- Happens with intermittent grunting, nasal flaring and retractions
- Supplemental oxygen may be needed
- Usually resolves within 48-72 hours
21
Q
Signs of Newborn Stress
A
- RR above `120 breaths/min
- Moderate-Severe retractions
- Grunting
- Pallor
- Central cyanosis
- Hypotension
- Temperature instability
- Hypoglycemia
- Acidosis
- Signs of cardiac problems
22
Q
Congenital Defects
A
- Anomalies of great vessels
- Diaphragmatic hernia
- Chest wall defects
- These can cause respiratory issues
23
Q
Hydrops Fetalis
A
- Fluid buildup causing edema
- Can be caused by blood incompatibilities
24
Q
Cardiovascular System
A
- Increased pulmonary blood flow from left side of heart increases pressure in the left atrium which closes the foramen ovale
- Crying can reverse flow through foramen ovale which leads to cyanosis
- CO doubles after birth increasing blood flow to lungs, heart, kidneys, and GI Tract
- Ductus Arteriosus constricts once PO2 levels reach 50 mmHg
25
Q
Ductus arteriosus
A
- Prostaglandins play an Important role in closing ductus arteriosus
- Functionally closed within first 24 hours (permanent closure in 2-3 months)
- Can re-open in response to low oxygen and heard as a heart murmur
26
Q
Heart Rate and Sounds
A
Term Newborn - 120-160 bpm
Term Newborn During Sleep - 80-100 bpm
Term Newborn When Crying - 180 bpm
- Out of range heart rates above 160 or less than 100 should be re-evaluated in 30-60 minutes or when activity changes
27
Q
Apical Impulse (Pericardial Activity)
A
- 4th intercostal space to the left of midclavicular line
28
Q
Heart Rate
A
- Irregular heart rate or sinus dysrhythmias are common in first few hours of life
- Most heart murmurs during neonatal period is not pathologic and disappear by 6 months of age
- Murmurs with poor feeding, apnea, cyanosis, pallor should be evaluated
29
Q
Blood Pressure
A
- Primary affected by gestational age, postconceptional age, birth weight
- BP rises when these factors rise
At birth - 75-95/37-55
12 hours - 50-70/25-45
96 hours - 60-90/20-60
30
Q
Blood Volume
A
- 80-100 mL/kg
- Preterm is 90-105 mL/kg
- Preterm has more blood volume than term because they have greater plasma volume (not RBC)
31
Q
Delayed Cord Clamping (DCC)
A
- Expands blood volume from “Placental Transfusion” by as much as 100 mL depending on length of time delayed
ASSOCIATED WITH - Increased blood volume
- Increase blood pressure
- Reduced risk of intraventricular hemorrhage and necrotizing enterocolitis
- Benefits are best for pre-term babies
- Polycythemia (blood cancer) that occurs with delayed clamping is not harmful
- Increased risk of hyperbilirubinemia must be treated with phototherapy
32
Q
CVD Problems
A
- Variation in VS can be indicative of Cardio Problems
- Persistent tachycardia can be signs of anemia, hypovolemia, hyperthermia and sepsis
- Persistent bradycardia can be signs of congenital heart block or hypoxemia
- CVD issues are seen as unequal/absent pulses, bounding pulses, decreased/elevated BP
33
Q
Skin Pallor
A
During immediate post-birth period can be caused by
- Anemia
- Marked peripheral vasoconstriction as a result of asphyxia or sepsis
- Cyanosis other than hands and feet
- Presence of jaundice can indicate ABO or rH factor incompatibility
34
Q
Congenital Heart Defects
A
- Most common congenital malformation
- Risk increases if mom has rubella, metabolic diseases (diabetes), and maternal drug ingestions
Serious defects can cause
- Cyanosis
- Dyspnea
- Hypoxia
35
Q
HEMATOLOGIC SYSTEM
A
36
Q
Red Blood Cells
A
- Fetus has more RBC’s for oxygen transport due to less efficient fetal circulation
- RBC, Hgb, Hct higher than adults at birth
- Capillary blood yields higher values than venous blood
- RBC slightly increase after birth than substantially drop
- Blood contains 70% hemoglobin at birth
- 6-12 months nearly no fetal hemoglobin left
- Iron stores from mom is usually enough to last 4 months (when transient anemia can occur)
37
Q
Leukocytes
A
- Leukocytosis (elevated WBC) range from 9000-30000 (normal)
- WBC count is initially very high at birth (24000) then drops rapidly to stable (12000)
- Leukocytes in newborns are limited in ability to recognize foreign protein and localize to fight infections
- Sepsis can cause rise in neutrophils
38
Q
Neutrophilia Causes
A
- Infection
- Prolonged crying
- Asymptomatic hypoglycemia
- Hemolytic disease
- Meconium aspiration syndrome
- Labor induced with oxytocin
- Surgery
- Difficult labor
- High altitude
- Maternal fever
39
Q
Platelets
A
- Range from 150,000 - 300,000
- Essentially same in newborns and adults
- Vitamin K reaches adult levels by 6 months
40
Q
Thermogenic System
A
Thermoregulation - Maintenance of balance between heat loss and production Important due to newborns - Thin subcutaneous fat - Blood vessels close to surface of skin - Larger surface to body weight ratios
41
Q
Heat loss
A
- Neutral Thermal Environment - Allows baby to maintain normal body temperature minimizing oxygen and glucose consumption.
Convection - Heat loss from wind
(wrap newborn and put hat on them)
Radiation - Heat loss from cooler surface in close proximity
(Place baby away from outside windows and avoid direct air drafts)
Evaporation - Loss of heat from evaporation
(Most significant cause of heat loss during first few days. Keep baby dry)
Conduction - Loss of heat from touch with a cold object
(Use pre-warmed bed and covers for scales)
42
Q
Methods to prevent heat loss
A
- Skin to skin contact
- Dry baby directly after birth
- Place baby under radiant warmer
43
Q
Thermogenesis
A
- Neonate generates heat via increased muscle activity
- Thermogenesis leads to increased cellular metabolic activity primarily in brain, heart, liver
- Flexion position helps guard baby against heat loss
- Peripheral blood vessels also constrict to conserve heat
44
Q
Heat Loss
A
- Babies cannot shiver to warm themselves
- Metabolism of brown fat is used to heat baby however baby has limited supply of brown fat
45
Q
Hypothermia/Cold Stress
A
- When temperature drops, vasoconstriction occurs
- Baby can look pale and mottled with cool skin
- Respiration rate increases
- If the infant does not maintain adequate oxygen, vasoconstriction jeopardizes pulmonary perfusion.
- When this happens o2 decreases as well as blood pH causing acidosis
- Decreased pulmonary perfusion and oxygen can re-open ductus arteriosus
46
Q
Cold Stress
A
- BMR increases
- Anaerobic Glycolysis
- Acidosis
- Hyperbilirubinemia
- Hypoglycemia
47
Q
Hyperthermia
A
- Temperature greater than 37.5 (99.5)
- Can result from inappropriate use of heating devices such as phototherapy, sunlight, excessive clothes
Signs
- Dilated skin vessels
- Flushed skin
- Extremities warm to touch
- Extension posture
If Sepsis is cause
- Vessels on skin are constricted
- Color is pale
- Hands and feet are cold
- Caused by immature sweat glands
- Can cause neurological injury, seizures, heatstroke and death
48
Q
Renal System
A
- Excretes 15-60 mL/kg/day
- 2-6 voiding a day for the fist 2 days and increase every 24 hours
- Pale straw color indicates adequate hydration
- If infant has not voided in 24 hours check for fluid intake, bladder distension, restlessness, signs of discomfort
- Uric crystals are normal to appear on diaper
- 5-10% loss of birth weight over 3-5 days
- Weight should be regained in 10-14 days
49
Q
Fluid Electrolyte balance
A
- 75% of weight is water
- Weight loss in first few days is extracellular fluid
Fluid Requirements
Days 1-2 = 60-80 mL/kg
Days 3-7 = 100-150 mL/kg
Days 8-13 = 120-180 mL/kg
- GFR rate is lower, fully mature by 2 years old
- Lack of steady stream can indicate renal issues
50
Q
GI System
A
- Capable of eating simple carbs, fats and protein
- The only digestive enzyme not available is amylase and lipase (digest complex carbs and fats)
- Large amounts of mucus is common in first few hours of birth
51
Q
Epstein Pearls
A
- White areas found on gum margins and hard/soft palates.
52
Q
Labial Tubercles
A
- Calluses on the lips usually disappear at 1 years old
53
Q
Teeth
A
- Begin developing in utero phase
- Continues until around 10 years old
54
Q
Mucosal Barrier
A
- Not fully mature until 4-6 months
- Bacteria can easily cross intestinal wall into system circulation which increases risks of allergies and infection
- Intestinal flora is established within 1st week after birth which helps synthesize vitamin k, folate and biotin.
- Breastfeeding is important to build the normal flora
55
Q
Stomach Sizes
A
Day 1 - Less than 10 mL
Day 3 - 30 mL
Day 7 - 60 mL
- GER is common in infants (GERD)
56
Q
How to Avoid GER
A
- Common in first 3 months of life
Do not overfeed baby
Burp baby
Head should be elevated - Treatment can include antacids, histamine blockers, proton pump inhibitors, if baby develops GERD
57
Q
Stool (meconium)
A
- Fills lower intestines at birth
- Contains amniotic fluid, intestinal secretions (bilirubin), cells
- Looks green/black and contains occult blood
- Usually passed within first 12-24 hours (at most 48 hours)
58
Q
Feeding Behaviors
A
- Hand to mouth movement and sucking on fingers represents hunger
59
Q
Stool Transition
A
Meconium - Occurs 24-48 hours. Can be delayed up to 7 days in LBW. If passed in utero it can indicate fetal distress
Transitional - Occurs by 3rd day of feeding. Green/Yellow, thin and less sticky than meconium. May contain milk curds
Milk Stool - Appears by 4th day
Breastmilk - Yellow/gold, pasty, mixture of mustard/cottage cheese, smells like sour milk
Formula - Pale yellow to light brown, firmer consistency, stronger odor than breastmilk
60
Q
Signs of GI Issues
A
- Failure to pass meconium could be due to obstruction (cystic fibrosis, Hirschsprung disease, imperforated anus)
- Rectal “wink” reflex represents good sphincter tone
- Meconium passed through vagina or urinary meatus can be fistulous tract from rectum
Fullness of abdomen
- Hepatomegaly
- Duodenal atresia
- Distension
61
Q
Abdominal Distension
A
- At birth represents serious disorder such as ruptured viscus or tumor
- Later distension can mean GI disorder
Scaphoid (sunken) abdomen, bowel sounds, respiratory distress indicates diaphragmatic hernia
Fullness below umbilicus is distended bladder
Pyloric Stenosis can be seen with vomiting large amounts (projectile vomit)
Bilious (green) emesis is suggestive of intestinal obstruction or malrotation of bowel
62
Q
Hepatic System
A
- 1-2 cm below right costal margin (enlarged) and occupies 40% of abdominal cavity
- Stores iron, glucose and fatty acid metabolism, bilirubin synthesis, coagulation
- Production of hemoglobin after birth
63
Q
Glucose Homeostasis
A
- Once cord is cut, newborn glucose drops from 70-90 to 55-60
- Glucagon increases and insulin decreases release hepatic glucose
- Initial feeding stabilizes blood glucose
- Blood glucose is not regularly assessed unless risks are present including small/large for gestational age, preterm, and diabetic mother
64
Q
Hypoglycemic Infant Symptoms
A
- Jitteriness
- Lethargy
- Apnea
- Feeding problems
- Seizures
65
Q
Fatty Acid Metabolism
A
- Additional source of energy during initial hours of birth
66
Q
Bilirubin
A
- RBC’s get broken down into hemoglobin
- Hemoglobin gets broken down into heme and globin by macrophages
- Heme is broken by reticuloendothelial cells into bilirubin
- Unconjugated bilirubin binds to albumin and sent to liver to be conjugated
- Free bilirubin can cross BBB and cause neurotoxicity (kernicterus or acute bilirubin encephalopathy)
- Bilirubin needs to be conjugated to be excreted
- Glucuronic acid in the liver conjugates bilirubin
67
Q
Bilirubin
A
- Feeding is important to pass bilirubin because it stimulates peristalsis and produces more rapid passage of meconium
- Feeding also increases bacteria used to reduce bilirubin
- Colostrum is a natural laxative to help pass meconium
- Jaundice appears when there is more bilirubin than the liver is able to conjugate
68
Q
Jaundice
A
- Yellow of skin and sclera
- Total Serum Bilirubin (TSB) - exceeding 6-7 mg/dL will cause jaundice
RISKS FOR JAUNDICE - Higher RBC at birth
- Shorter lifespan of neonatal RBC
- Ability for liver to conjugate bilirubin during first few days of life
- Fewer binding sites due to fewer albumin
69
Q
Physiologic Jaundice
A
- Occurs in 60% of term babies
- Appears after 24 hours of birth and usually resolves without treatment
- TSB increases from 2 mg/dL to 5-6 mg/dL by 72-96 hours
- Reaches normal levels by 2 weeks (2mg/dL)
70
Q
Pathologic Jaundice
A
- Appears before 24 hours of birth
- Increases by more than 0.2 mg/dL an hour
- Greater than 95th percentile for age in hours
- Direct serum bilirubin levels greater than 1.5-2 mg/dL
- Lasts more than 2 weeks
71
Q
Pathologic Jaundice Causes
A
- Most often due to maternal-newborn blood incompatibility (Rh, ABO)
- Enclosed hemorrhage (bruising)
- Polycythemia (blood cancer)
- Delayed passage of meconium
- Delayed feeding
- Glucose-6-phosphate deficiency
- Altered hepatic clearance of bilirubin (immaturity)
- Metabolic disorders (Crigler-Najjar Disease, Sepsis, Asphyxia, Congenital Anomalies)
72
Q
Acute Bilirubin Encephalopathy
A
- Bilirubin toxicity that crosses BBB (acute)
- Lethargy
- Hypotonia
- Irritability
- Seizures
- Coma
- Death
73
Q
Kernicterus
A
- Irreversible long term consequences of bilirubin toxicity
- Hypotonia
- Delayed motor skills
- Hearing loss
- Cerebral palsy (affects ability to move and balance)
- Gaze abnormalities
74
Q
Breastfeeding Associated Jaundice
A
- Begins at 2-5 days
- Lack of effective breast feeding causes jaundice
75
Q
Breastmilk Jaundice
A
- Occurs at 5-10 days of age
- Infants are fed well and gained weight appropriately
- Breastmilk may inhibit conjugation of bilirubin
76
Q
Hyperbilirubinemia Risk
A
- Preterm
- Breastfeeding with excessive weight loss
- Rh and ABO incompatibility or hemolytic disease
- Polycythemia
- Asian/Native American
- Bruising related to birth trauma
- Previous sibling who received phototherapy
77
Q
Coagulation
A
- Coagulation factors are synthesized in the liver and activated by Vitamin K
- Lack of intestinal bacteria causes vitamin K deficiency between 2-5 days of life
- Intramuscular Vitamin K injection prevents vitamin K deficient bleeding
78
Q
Drug Metabolism
A
- Immaturity of lungs and depressed liver enzymes at birth slow biotransformation and metabolism of drugs
- Drug clearance is slow which leads to increased serum levels and longer half-life
79
Q
Hepatic System Problems Signs
A
- Hypoglycemia and Hyperbilirubinemia
- All newborns should be assessed for anemia
- Newborns who are circumcised should be monitored for bleeding
80
Q
Immune System
A
- Immunoglobins are low compared to adults
- IgG is the dominant immunoglobin for newborns (transported from placenta)
- IgG passive immunity is sufficient for the first 3 months of life
- IgM is produced by week 8
- IgA is missing from respiratory, urinary tracts and GI unless breastfed
- Breastfeeding leads to enhanced antibody responses to vaccines and lower risk of immune related disease
81
Q
Risk of Infection
A
- High risk of infection during first few months (leading cause of death) Early Signs of Infection - Temperature instability (hypothermia) - Fever (not typical) - Lethargy - Irritability - Poor feeding - Vomiting - Diarrhea - Decreased reflexes - Pale/mottled skin - Apnea - Tachypnea - Grunting - Retraction - Unusual discharge - Rash
82
Q
Risk Factor for Infection
A
- Greatest is prematurity (immature immune system)
- PROM
- Chorioamnionitis
- Maternal fever
- Antenatal
- Intrapartal asphyxia
- Invasive procedures
- Stress
- Congenital anomalies
83
Q
Integumentary System
A
- Vernix Caseosa (cheese like white substance) baby is covered with after birth
- Protective covering
- Acrocyanosis (7-10 days)
- Healthy baby has plump appearance with large amounts of subcutaneous fat
- Lanugo hair
- Ecchymosis (bruising) or petechiae of face can happen from forceps-assisted birth or vacuum extraction
84
Q
Milia Sweat Glands
A
- Small sebaceous glands noticeable on newborn face
- Term infants do not sweat for the first 24 hours
85
Q
Desquamation
A
- Peeling of skin (usually a few days after birth)
- Large areas of desquamation can mean post-maturity
86
Q
Mongolian Spots
A
- Blue/black spots seen at birth
87
Q
Nevi
A
- Nervus Simplex - Salmon Patches
- Telangiectatic Nevi - Stork Bites (superficial capillary defect, affects 80% of newborns)
(Small flat and pink spots in the upper eyelids, nose, upper lip, and neck) - Requires no treatment
88
Q
Nevus Flammeus
A
- Port-wine stain
- Caused by postcapillary venule malformation
- Pink and flat at birth
- Not blanchable found most commonly on face and neck
89
Q
Infantile Hemangiomas (strawberry hemangiomas)
A
- Associated with tissue hypertrophy
- Raised lesion, sharply demarcated, bright/dark red surface swelling
- Common sites are scalp, face, anterior chest
- Maximum growth by 6 months then involution for 5-10 years
90
Q
Erythema Toxicum
A
- Transient rash, newborn rash, fleabite dermatitis
- Appears 24-72 hours after birth and lasts 3 weeks
91
Q
Integumentary problems
A
- Pallor, Plethora (purple color from increased RBC), petechia, central cyanosis, jaundice should be noted
- Birth injuries such as forceps marks and lesions should be monitored
- Nuchal cord can cause bruising on head, neck, face
- Bruising increases risk for hyperbilirubinemia
- Petechiae can be caused by increased pressure to area
- Skin tags (papilloma’s) are common
92
Q
Female Reproductive System
A
- Increased estrogen during pregnancy then drop after birth cause newborns to have vaginal discharge
- Genitalia are edematous with increased pigmentation
- Tags are common findings with no clinical significance
- Breech position can cause bruised and edema labia (resolves in a few days)
93
Q
Male Reproductive System
A
- Foreskin adheres and is not fully retracted for 3-4 years in uncircumcised
- Hypospadias - Urethral opening, on dorsal side of penis is called epispadias
- Epithelial pearls - small white lesions on tip of prepuce
- Cryptorchidism - Undescended testes caused by preterm birth and LBW
- Blue scrotum (testicular torsion) immediate attention
- Hydrocele - Accumulation of fluid in testes
94
Q
Swelling of Breast Tissue
A
- Caused by hypoestrogenism
- Witches Milk - Thin discharge
- By 36 weeks a breast bud 1-2 mm can be palpated
- Breast bud size is 12mm by 42 weeks
95
Q
Reproductive Issue Signs
A
- Adrenal hyperplasia - Clitoris may be mistaken for penis
- Hymenal Tags - Absence of these can mean vaginal agenesis (underdeveloped vagina)
- Hypospadias - Undescended testes
- Circumcision contraindicated in presence of hypospadias because foreskin is used to repair the anomaly
96
Q
Skull
A
- Cranial size and shape can be distorted by molding (shaping of fetal head by overlapping of cranial bones)
97
Q
Caput Succedaneum
A
- Edematous area of scalp most often occiput
- Developed via vertex presentation where pressure slows venous return causing edema
- Edema extends along the sutures and disappears within 3-4 days
- Can be seen in vacuum extraction as well
98
Q
Cephalhematoma
A
- Collection of blood between skull bone and periosteum
- Does not cross cranial suture line
- Firmer and more defined than caput
- Hemolysis of RBC’s can occur while hematoma resolves causing hyperbilirubinemia
99
Q
Subgaleal Hemorrhage
A
- Bleeding into subgaleal compartment
- Caused by shearing of scalp
- Common with vacuum extraction
- Scalp is pulled away from bony calvarium and vessels are torn
- Can cause hypovolemic shock from blood loss
- Boggy scalp, tachycardia, increasing head circumference
- Monitor LOC and decreased hematocrit is key to recognition
- Increased bilirubin can also be seen
100
Q
Spine
A
- Straight and easily flexed
- Spine can lift head and turn from side to side when prone
101
Q
Pilonidal dimple
A
- Can be associated with spina bifida especially with nevus pilosus
102
Q
Oligodactyty
A
- Missing Digits
103
Q
Polydactyly
A
- Extra digits
104
Q
Syndactyly
A
- Fused fingers/toes
105
Q
Developmental Dysplasia of hips
A
- Happens often in breech babies, female babies, and history of DDH
SIGNS
- Asymmetric gluteal and thigh skinfolds
- Uneven knees
- Positive Ortolani test
- Positive Barlow test
106
Q
Barlow Test and Ortolani Maneuvar
A
- Used to assess hip integrity
107
Q
Neuromuscular System
A
- Completely developed at birth
- Transient tremors are normal (involving mouth, chin, arms, and hands)
- Persistent tremors can be pathologic conditions
POSTURE - Flexion of arms and legs, hips abducted
- Intermittent fisting of hands is common
- Hypotonic shows little resistance and feels like a ragdoll
- Hypertonia is increased resistance to passive movement
108
Q
REFLEXES
A
109
Q
Rooting and Sucking
A
- Touch infants lip, cheek, or corner of mouth
- Infant turns head towards stimulus and opens mouth to suck
- Difficult to elicit after infant is fed.
- Weak/absent reflex is preterm defect
110
Q
Swallowing
A
- Feeding infant
- Sucking and breathing usually occurs without gagging
- Weak responses can be due to preterm birth, analgesics, or illness.
111
Q
Grasp Palmar
A
- Place finger in the palm of infants hand
- Infants fingers curl around examiners fingers
- Response lessens by 3-4 months
112
Q
Grasp Plantar
A
- Place finger at base of toes
- Toe curl downward around examiner fingers
- Lessens by 8 months
113
Q
Grasp Extrusion
A
- Touch or depress lip
- Newborn forces their tongue downwards
- Response dissapears about 4-5 months
114
Q
Glabellar
A
- Tap forehead, bridge of nose, maxilla,
- Newborn blinks for the first 4-5 taps
- Continued blinking with repeated taps is consistent with extrapyramidial signs
115
Q
Tonic Neck and Fencing
A
- With infant in supine position turn head to 1 side
- Opposite arm and leg should flex
- Response disappears by 3-4 months
- After 6 weeks persistent response can mean cerebral palsy
116
Q
Moro
A
- Startle Reflex
- When a loud sound is made, baby will throw back their head, extend their arms/legs and cry then pull their arms and legs back in
- May be accompanied by a cry
- Body jerk motion is only seen at weeks 8-18 and gone by 6 months
- Persistent responses after 6 months indicates neurological abnormality
117
Q
Stepping or Walking
A
- Hold infant vertical and allow feet to touch table
- Infant should simulate walking
- Response present for 3-4 weeks
118
Q
Crawling
A
- Place newborn on abdomen
- Newborn should make crawling movements
- Response dissapears by 6 weeks
119
Q
Deep Tendon
A
- Use finger to percuss patella (newborn must be relaxed)
- Reflex jerk is present
- Usually more difficult to elicit upper extremity than lower
120
Q
Crossed Extension
A
- In supine position, extend 1 leg and press down on the knee
- The other leg flexes and adducts and then extends
- Reflex is present during birth
121
Q
Babinski Reflex
A
- Heel stroke bottom of foot
- All toes hyperextend (positive sign)
- Absence requires neurological evaluation
- Response should disappear after 1 years old.
122
Q
Pull-To-Sit
A
- Pull infant up by wrists from supine position
- Head lags until baby is in upright position then the head is held in the same plane
- Response depends on muscle tone and maturity of infant
123
Q
Truncal Incurvation
A
- Place infant in prone position and run finger down back first on one side than on other
- Trunk should flex and pelvis should swing towards stimulated side
- Response disappears by 4 weeks
- Absences suggests depression of nervous system
124
Q
Magnet Reflex
A
- Place infant in supine and partially flex both lower extremities and apply light pressure
- Both limbs should extend against examiners pressure
- Absence suggests damage to CNS
- Week reflex may be seen in breech babies
- May indicate Sciatic Nerve Stretch Syndrome
