Care of the Newborn

Question 1

What is ‘term’ defined as?

Answer 1

Anything after 37 weeks gestation

Question 2

What is post term defined as?

Answer 2

Anything after 41 weeks gestation

Question 3

What is a normal birth weight?

Answer 3

2.5 kg-4.0 kg

Question 4

What weight is large for gestation?

Answer 4

> 4 kg

Question 5

What weight is small for gestation?

Answer 5

< 2.5 kg

Question 6

How much weight is the average weight gain?

Answer 6

24 g

Question 7

How much weight does a baby gain per day in the last 4 weeks of pregnancy?

Answer 7

7 g

Question 8

Transplacental transfer of various substances happens in the 3rd trimester. What substances are transferred?

Answer 8

• Iron
• Vitamins
• Calcium
• Phosphate
• Antibodies

Question 9

What baby will have very little/no SC fat?

Answer 9

Preterm babies

Question 10

Delivery at term can be __________ or ________

Answer 10

1. Spontaneous

2. Induced

Question 11

If a baby is not cephalic position, what is it?

Answer 11

Breech

Question 12

What kind of environment is a baby in during contractions?

Answer 12

hypoxic + acidotic

Question 13

In what type of environment does foetal Hb easily give off O2?

Answer 13

Acidotic

Question 14

When does perinatal adaptation first start?

Answer 14

When the baby first cries

Question 15

When does perinatal adaptation first start?

Answer 15

When the baby first breathes and cries

Question 16

Name the 4 main features of perinatal adaptation.

Answer 16

• Alveolar expansion in the lungs
• Change from foetal to newborn circulation
• Decreased pulmonary arterial pressure
• Increased PaO2

Question 17

What scoring system measures perinatal adaptation?

Answer 17

Apgar

Question 18

List the 5 categories of Apgar.

Answer 18

• HR
• Resp rate
• Responsiveness
• Tone
• Colour

Question 19

** KEEP THE BABY WARM + FEED – this reduces risk of h_____________ and a_______ **

Answer 19

1. Hypoglycaemia

2. Acidosis

Question 20

Babies with lots of skin to skin are more likely to breastfeed

Answer 20

TRUE

Question 21

What medical condition is there increases rates of in mothers who don’t do skin to skin?

Answer 21

Anxiety and depression

Question 22

What is haemorrhage disease of the newborn?

Answer 22

Abnormal clotting and baby can bleed anywhere, be aware of bleeding into lungs

Question 23

What does EVERY baby get given at birth to prevent haemorrhage disease of the newborn?

Answer 23

VITAMIN K !!!!

Question 24

If a mother has Hep B, give the baby ….

Answer 24

Immunoglobulins + vaccine - do this when the baby is born

Question 25

What 5 things do all babies get screened for?

Answer 25

* Universal hearing screening * Hip screening – Developmental Dysplasia of Hip  clinical +/- USS * CF * Haemoglobinopathies * Metabolic diseases

Question 26

If you are testing a child for DDH and they have a risk factor ....

Answer 26

Do an USS !!!

Question 27

Who carries out the top to toe examination of the newborn immediately following delivery?

Answer 27

Midwifes

Question 28

What is less likely to happen to children if you pick up hearing problems very early in life?

Answer 28

Speech problems

Question 29

What 4 features of the HEAD are looked for on newborn exam?

Answer 29

* OFC * Overlapping sutures * Fontanelles * Ventouse/forceps marks

Question 30

What 3 conditions in the HEAD are looked for on newborn exam?

Answer 30

* Moulding * Cephalhaematoma * Caput succedaneum

Question 31

What 3 conditions in the HEAD are looked for on newborn exam?

Answer 31

* Moulding * Cephalhaematoma * Caput succedaneum

Question 32

What is Cephalhaematoma bounded by?

Answer 32

Aponeurosis - thus it is not seen widespread

Question 33

What 3 conditions in the HEAD are looked for on newborn exam?

Answer 33

* Moulding * Cephalhaematoma * Caput succedaneum

Question 34

What is Cephalhaematoma bounded by?

Answer 34

Aponeurosis - thus it is not seen widespread

Question 35

Describe Caput succedaneum.

Answer 35

More generalised swelling of the soft tissues of the head as it is not bounded by aponeurosis/ suture lines

Question 36

What 5 features of the EYES are looked for on newborn exam?

Answer 36

* Size * Red reflex. * Conjunctival haemorrhage * Squints – frequent * Iris abnormality

Question 37

Why is it important to look for the red reflex in newborns?

Answer 37

We want to make sure that the baby doesn't have a congenital cataract

Question 38

What 4 features of the EARS are looked at on newborn exam? What should you always ask about?

Answer 38

* Position * External auditory canal * Any tags/pits * Any folding Family history of hearing loss !!

Question 39

Describe pre-auricular tags.

Answer 39

Very common and benign but if you have an abnormal ear you may also have renal abnormalities

Question 40

What 7 features of the MOUTH are looked at on newborn exam?

Answer 40

* Shape * Philtrum (gap between nose and upper lip – affected by fetal alcohol syndrome) * Tongue tie (not usually a surgical issue, unless it interferes with feeding) * Palate * Neonatal teeth * Ebsteins pearls (occlusion cyst on roof of mouth) * Sucking/rooting reflex

Question 41

What commonly happens to babies delivered with forceps?

Answer 41

Facial palsy

Question 42

What is important to tell the parents if a baby is born with facial palsy from forceps?

Answer 42

It will improve

Question 43

How do you tell what side the facial palsy is on?

Answer 43

Can’t close eye, or move corner of mouth on the affected side

Question 44

What 6 features are looked at on RESP exam of the newborn? What are they all non-specific signs of?

Answer 44

* Chest shape * Nasal flaring * Grunting * Tachypnoea * In-drawing * Breath sounds RDS

Question 45

What 5 features should be looked at on CVS exam?

Answer 45

* Colour/Saturation (SaO2) * Pulses - femoral * Apex * Thrills/heaves * Heart sounds

Question 46

Why is it important to do colour and saturation (SaO2) of a newborn?

Answer 46

Congenital heart disease screening + pre/post ductal saturations

Question 47

What pulse should always be identified in a newborn?

Answer 47

FEMORAL !!

Question 48

The _______ pulse should be found in EVERY newborn.

Answer 48

FEMORAL

Question 49

Outline the 4 main features of Tetralogy of Fallot.

Answer 49

1. Displacement of the aorta - connected to both ventricles 2. Ventricular septal defect - hole between R and L ventricles 3. Narrowing of the pulmonary tract 4. Thickening of wall of right ventricle

Question 50

What 7 features should be looked for on ABDO exam of the newborn?

Answer 50

* Moves with respiration * Distension * Hernia * Umbilicus * Bile-stained vomiting * Passage of meconium * Anus

Question 51

ALWAYS ask if the baby has passed ________

Answer 51

MECONIUM

Question 52

What can a delay in the passage of meconium be a sign of?

Answer 52

Obstruction

Question 53

What must you check for/exclude during a genitourinary exam?

Answer 53

* Normal passage of urine * Normal genitalia * Undescended testes – very common * Hypospadius

Question 54

What 4 things should be checked on MSK exam?

Answer 54

* Movement and posture * Limbs and digits * Spine * Hip exam

Question 55

What 6 things must be assessed on NEUROLOGICAL exam?

Answer 55

* Alertness, responsiveness * Cry * Tone * Posture * Movement * Primitive reflexes

Question 56

List the 6 primitive reflexes.

Answer 56

* Suck * Rooting * Moro/startle - baby extends all limbs, THEN brings them back in * ATNR - stretched arm is floppy, other one is stiff * Stepping * Grasp

Question 57

How long do primitive reflexes usually last?

Answer 57

6 months to 1 year

Question 58

Why should you worry about if primitive reflexes persist past 1 year?

Answer 58

A neurological problem of the baby

Question 59

What is a port wine stain?

Answer 59

A vascular birthmark/ malformation

Question 60

What can a haemangioma look like?

Answer 60

A bruise

Question 61

What will happen to a strawberry naevus before disappearing?

Answer 61

It will get bigger