CA powerpoint -- Evaluation of a newborn Flashcards
1
Q
- Estimated Gestational Age
- Prenatal Care/Ultrasounds
–Risk factors? Abnormalities?
- Fetal growth, advanced maternal age, polyhydramnios, oligohydramnios, echogenic cardiac focus, echogenic bowel, hydronephrosis
- Maternal Labs
–GBS, Hepatitis B & C, syphilis, rubella, HIV, STIs, blood type and Rh antigen, Glucose tolerance test
•Exposures
–Medications, tobacco, alcohol, illicit drugs
- Family History
- Social History
- Feeding plan
- Duration of ruptured membranes: water broke longer than 18 hours risk of infections
- Maternal fever
- Clear amniotic fluid or meconium?
- Fetal heart rate tracings
- Presentation: vertex or breech?
- Apgars
A
Prenatal history
2
Q
–Tone, Color, Respiratory effort, Heart rate, Reflex Irritability
A
Apgars score
3
Q
normal HR
normal RR
normal temp… rectally?
A
–HR: 120-160
–RR: 40-60
–T: 36.5 – 37.5 rectally
dont forget to look at their tone and color!
4
Q
2 different types of words to describe babies weight
A
Small for gestation (SGA)
Large for gestation (LGA
5
Q
what are you looking at in head exam ((3 things))
A
fontanelles
suture lines
molding/brusiing/scalp probe
6
Q
what is this
A
Caput succadaneum: soft tissue swelling, will corss suture lines
soft and boggy, resolves in 24 hours
7
Q
whats going on here?
A
Cephalohematoma: blood collection underneath the periosteum, DOES NOT cross suture lines
can put at risk for jaundice
localized to one bone at a time
can stick around for a few months
8
Q
and here?
A
Subgaleal hemorrhage: larger potential space where blood can accumulate
medical emergency
extremely rare!! life threatening
9
Q
and here they all are
A
yah gooooo peds!
10
Q
Eye exam what are we looking for?
and if not present or unequal what could be going on
A
•Red reflex
–If not present or unequal: ? Congenital cataracts, optho consultation
should be present in both eyes if not contact eye doctor
11
Q
often no conjugate until ____-____ months
A
4-6 months
12
Q
what is this?
A
Dysconjugate gaze
13
Q
what is going on here?
A
Subconjunctival hemorrhage: non painful, due to birthing trauma
14
Q
whats this?
A
Dacryostenosis: sclera and conjunctiva not injected
15
Q
and this?
A
Gonococcal conjunctivitis: rare!
eryrthromycin given to all babies to prevent this stuff
16
Q
two things we are looking at on nose exam
A
–Patency?
–Deformity?
17
Q
Ear exam…
what is a position of the ear to be looking for?
what can there be an association with?
what type of abnormalities? syndromes?
A
low set, posteriorly rotated ears
association with renal anomalies and hearing loss
chromosonal abnormalities, genetic syndromes
18
Q
how is this ear?
A
normal
19
Q
how is this ear?
A
Preauricular Tag
20
Q
what is going on with this ear?
A
Preauricular Pit
21
Q
Ankyloglossia
A
tongue tied
22
Q
what is this a picture of?
A
•Oral candidiasis (thrush)
cannot brush away
and there is some firability when it is wipped away
23
Q
what is this?
A
Bohn’s nodules: benign
24
Q
whats this?
A
Epstein Pearls: Benign
25
what's going on here?
cleft lip/palate
26
this is
normal jaw position
27
this is...
Micrognathia :
- ? Underlying chromosomal abnormality
- Feeding difficulty
28
4 things you do while examining neck, clavicles, and chest
* Palpate clavicles
* Inspect for symmetry
* Check neck folds
* Breast buds
29
•Fetal circulation
where does shunting happen and
where does oxygenation occur
–Shunting through foramen ovale and ductus arteriosus
–Oxygenation occurs via the placenta
30
what happens during transition to infant with cardio physiology
--\> pulomonary vascular resistance \_\_\_\_\_\_\_, sysetmic pressure \_\_\_\_\_\_\_\_
--\> __________ closes
--\> ______________ constricts when oxygenation increases
–Pulmonary vascular resistance decreases, systemic pressures increase
–Foramen ovale closes
–Ductus arteriosus constricts when oxygenation increases
31
•Auscultation of murmurs
–Continuous “washing-machine” PDA murmur
–Systolic vs. diastolic murmurs
* Observation of skin color
* Assess perfusion
* Assess respiratory effort
* O2 sats (pre and post-ductal)
other things in the cardio PE
32
2 things that we do when examining lungs and the 4 key points under the second bullet point!!!
* Auscultation
* Observe respiratory effort
–Retractions
–Grunting
–Nasal flaring
–Rate
33
* Transient tachypnea of the newborn: within first 6 hours of life until 24 hours... retained lung fluide... to tachypnic to feed.. diffuce source picture and fluid within the fissures
* Neonatal pneumonia
* Meconium aspiration syndrome
* Pneumothorax
* Respiratory distress syndrome (hyaline membrane disease)
more studd we are looking for in lung PE
34
what is this an x-ray of?
transient tachypnea
35
what about this one?
FOcal pneumonia...
i hate x-rays!
36
HOW ABOUT HERE?
PNEMOTHORAX!
great job!
37
and how about here?
hyaline membrane ds.
38
this?
Maconium aspirations
39
3 things to look at during abdominal exam!?
1. \_\_\_\_\_
2. _____ (how many vessels?)
3. ______ (3 things that are chategorized under here)
* Palpate
* Umbilical cord – 3 vessels
* Abdominal wall defects
–Diastasis recti
–Omphalocele, gastroschisis
40
GU exam
Female
what 2 things may be present
•Vernix and discharge may be present
41
GU
male
what do you palpate
and what are you checking
* Palpate testes
* Check urethral meatus position
42
what's this condition?
and how common?
•Hypospadias
–(1/250 males)
Below
43
what's this condition?
epispadias : ontop
44
what is this?
chordee (tethering)
45
what is this?
inguinal hernias
* bowel sounds
* dont illuminate
46
what is this?
hydroceles
47
whats going on here?
•Descending and undescended testes
48
baby should have a stool in the first ____ hours
24
49
what is this?
meconium stool
50
what is this?
transitional stool
51
what is this?
sacral dimple
52
what is this picture showing?
imperforate anus
53
hip exam.
what are the two tests to Screen for Developmental Dysplasia of the Hip
Barlow test
and
ortolani test
54
The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly.[2] If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated).
barlow test
55
It relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver.[citation needed]
It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abductingthe infant's legs using the examiner's thumbs. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum:[2]
Specifically, this tests for posterior dislocation of the hip.[citation needed]
ortolani test
56
GALEAZZI
lay prone..hips flexed.. make sure knees are at symmetric level!
57
WHAT REFLEX IS THIS?
moro reflex:
## Footnote
The Moro reflex is an infantile reflex normally present in all infants/newborns up to 4 or 5 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components:
spreading out the arms (abduction)
unspreading the arms (adduction)
crying (usually)
The primary significance of the Moro reflex is in evaluating integration of the central nervous system.
58
what reflex is this?
rooting reflex:
A reflex that is seen in normal newborn babies, who automatically turn the face toward the stimulus and make sucking (rooting) motions with the mouth when the cheek or lip is touched. The rooting reflexhelps to ensure successful breastfeeding.
59
what reflex is this?
Galant reflex:
## Footnote
It is elicited by holding the newborn in ventral suspension (face down) and stroking along the one side of the spine. The normal reaction is for the newborn tolaterally flex toward the stimulated side.
This is one of the reflexes tested in newborns to help rule out brain damage at birth.
60
What reflex is this?
Grasp reflex
Palmar grasp reflex (sometimes simply called grasp reflex) is a primitive reflex. It appears as early as 16 weeks in utero and persists until five or six months of age. When an object is placed in the infant's hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable; though it may be able to support the child's weight, they may also release their grip suddenly and without warning. The reverse motion can be induced by stroking the back or side of the hand.
all of these relfex summaries are from wiki.... BTW
61
\_\_\_\_\_\_\_ vs \_\_\_\_\_\_\_
normal tone vs. **hypotonia**
62
what is going on here?
Erythema toxicum: common rash, eosinophils in there
normal during 1st week of life
63
whats going on here?
Cutis Marmorata (Mottling): normal baby that is cold-- if gray not well perfused
64
what about here?
peeling
65
and here....
Acroncyanosis
66
what is this?
Linea Nigra
67
and here?
Nevus simplex (salmon patch)
common
68
what about here?
what's this?
Nevus simplex (stork bite)
69
and here?
Slate grey patches (Mongolian spots)
common in darker skin individuals
70
Skin exam
Jaundice
Risk Factors: (5)
Risk Factors:
1. - Prematurity
2. - Breastfeeding
3. - Illness/Sepsis
4. - ABO incompatibility
5. - G6PD deficiency
71
what is one thing we can do if jandice
phototherapy and then feed them because that is how they clear it!
72
Preterm: \< ___ weeks
Late Preterm: \_\_-\_\_\_ weeks
Term: \_\_\_- ___ weeks
Post-term: \> _____ weeks
* Preterm : \< 35 wks
* Late Preterm : 35-36 6/7 wks
* Term : 37- 42 wks
* Post-term : \> 42 week
73
* Skin texture, lanugo, plantar markings
* Joint mobility
* Eyes/ears
* Genitalia & breast development
* Tone and posture
part of the Gestational Age Assessment
74
BALLARD SCORE
Neuromuscular maturity
BALLARD SCORE
physcial maturity
75
6 things that are part of the Newborn Screening!
1. Hearing
2. Hyperbilirubinemia
3. Metabolic state screen
4. Critical Congenital Heart Disease
5. Infection
6. Hypoglycemia (SGA, LGA, prematurity, infant of diabetic mothers, sepsis, maternal beta-blocker use[HTN during pregnancy] )
76
sorry, this card sucks....
## Footnote
**•Biotinidase Deficiency**
**•Cystic Fibrosis**
**•Galactosemia**
**•Endocrine Disorders:**
–Congenital Adrenal Hyperplasia (CAH)
–Congenital Hypothyroidism
**•Hemoglobinopathies**
**•Amino Acid Disorders:**
–PKU (Phenylketurnia)
–MSUD (Maple Syrup Urine Disease)
–HCU (Homocystinuria)
–Tyr I (Tyrosinemia I)
–Tyr II (Tyrosinemia II)
**•Urea Cycle Disorders:**
–ASS (Citrullinemia)
–ASL (Argininosuccinic Aciduria)
–Argininemia
–HHH Syndrome Hyperammonemia Hyperornithinemia Homocitrullinemia
**•Organic Acid Disorders:**
–GA I (Glutaric Acidemia I)
–IVA (Isovaleric Acidemia)
–MMA (Methylmalonic Aciduria)
–PPA (Propionic Acidemia)
–HMG (HMG CoA Lyase Deficiency)
–MCC (B-Methyl Crotonyl Carboxylase)
–B-KT (B-Ketothiolase Deficiency)
–MCD (Multiple Carnitine Deficiency)
**•Fatty Acid Oxidation Disorders:**
–MCAD (Medium-Chain Acyl Co-A Dehydrogenase Deficiency), LCAD, LCHAD, VLCAD, SCAD
–CPT II Carnitine Palmitoyl Transferase deficiency Type II (CPT Deficiency)
–GA II (Glutaric Acidemia II)
–CUD (Carnitine Uptake Deficiency)
–TFP (Tri-functional Protein Deficiency)
Maine Newborn Bloodspot Screening Program
77
what are the billions of things we see with **_sepsis_**... there are 11 thing listed :)
1. Tachycardia
2. Tachypnea
3. Respiratory distress
4. Low tone
5. Poor feeding
6. Hypoglycemia
7. Apnea
8. Lethargy
9. Temperature instability
10. Hyperbilirubinemia
11. Pallor
78
DONE ... GREAT JOB!
now go enjoy spring break!!!!
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