Care of the Newborn Flashcards
What is ‘term’ defined as?
Anything after 37 weeks gestation
What is post term defined as?
Anything after 41 weeks gestation
What is a normal birth weight?
2.5 kg-4.0 kg
What weight is large for gestation?
> 4 kg
What weight is small for gestation?
< 2.5 kg
How much weight is the average weight gain?
24 g
How much weight does a baby gain per day in the last 4 weeks of pregnancy?
7 g
Transplacental transfer of various substances happens in the 3rd trimester. What substances are transferred?
- Iron
- Vitamins
- Calcium
- Phosphate
- Antibodies
What baby will have very little/no SC fat?
Preterm babies
Delivery at term can be __________ or ________
- Spontaneous
2. Induced
If a baby is not cephalic position, what is it?
Breech
What kind of environment is a baby in during contractions?
hypoxic + acidotic
In what type of environment does foetal Hb easily give off O2?
Acidotic
When does perinatal adaptation first start?
When the baby first cries
When does perinatal adaptation first start?
When the baby first breathes and cries
Name the 4 main features of perinatal adaptation.
- Alveolar expansion in the lungs
- Change from foetal to newborn circulation
- Decreased pulmonary arterial pressure
- Increased PaO2
What scoring system measures perinatal adaptation?
Apgar
List the 5 categories of Apgar.
- HR
- Resp rate
- Responsiveness
- Tone
- Colour
** KEEP THE BABY WARM + FEED – this reduces risk of h_____________ and a_______ **
- Hypoglycaemia
2. Acidosis
Babies with lots of skin to skin are more likely to breastfeed
TRUE
What medical condition is there increases rates of in mothers who don’t do skin to skin?
Anxiety and depression
What is haemorrhage disease of the newborn?
Abnormal clotting and baby can bleed anywhere, be aware of bleeding into lungs
What does EVERY baby get given at birth to prevent haemorrhage disease of the newborn?
VITAMIN K !!!!
If a mother has Hep B, give the baby ….
Immunoglobulins + vaccine - do this when the baby is born
What 5 things do all babies get screened for?
- Universal hearing screening
- Hip screening – Developmental Dysplasia of Hip clinical +/- USS
- CF
- Haemoglobinopathies
- Metabolic diseases
If you are testing a child for DDH and they have a risk factor ….
Do an USS !!!
Who carries out the top to toe examination of the newborn immediately following delivery?
Midwifes
What is less likely to happen to children if you pick up hearing problems very early in life?
Speech problems
What 4 features of the HEAD are looked for on newborn exam?
- OFC
- Overlapping sutures
- Fontanelles
- Ventouse/forceps marks
What 3 conditions in the HEAD are looked for on newborn exam?
- Moulding
- Cephalhaematoma
- Caput succedaneum
What 3 conditions in the HEAD are looked for on newborn exam?
- Moulding
- Cephalhaematoma
- Caput succedaneum
What is Cephalhaematoma bounded by?
Aponeurosis - thus it is not seen widespread
What 3 conditions in the HEAD are looked for on newborn exam?
- Moulding
- Cephalhaematoma
- Caput succedaneum
What is Cephalhaematoma bounded by?
Aponeurosis - thus it is not seen widespread
Describe Caput succedaneum.
More generalised swelling of the soft tissues of the head as it is not bounded by aponeurosis/ suture lines
What 5 features of the EYES are looked for on newborn exam?
- Size
- Red reflex.
- Conjunctival haemorrhage
- Squints – frequent
- Iris abnormality
Why is it important to look for the red reflex in newborns?
We want to make sure that the baby doesn’t have a congenital cataract
What 4 features of the EARS are looked at on newborn exam? What should you always ask about?
- Position
- External auditory canal
- Any tags/pits
- Any folding
Family history of hearing loss !!
Describe pre-auricular tags.
Very common and benign but if you have an abnormal ear you may also have renal abnormalities
What 7 features of the MOUTH are looked at on newborn exam?
- 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
What commonly happens to babies delivered with forceps?
Facial palsy
What is important to tell the parents if a baby is born with facial palsy from forceps?
It will improve
How do you tell what side the facial palsy is on?
Can’t close eye, or move corner of mouth on the affected side
What 6 features are looked at on RESP exam of the newborn? What are they all non-specific signs of?
- Chest shape
- Nasal flaring
- Grunting
- Tachypnoea
- In-drawing
- Breath sounds
RDS
What 5 features should be looked at on CVS exam?
- Colour/Saturation (SaO2)
- Pulses - femoral
- Apex
- Thrills/heaves
- Heart sounds
Why is it important to do colour and saturation (SaO2) of a newborn?
Congenital heart disease screening + pre/post ductal saturations
What pulse should always be identified in a newborn?
FEMORAL !!
The _______ pulse should be found in EVERY newborn.
FEMORAL
Outline the 4 main features of Tetralogy of Fallot.
- Displacement of the aorta - connected to both ventricles
- Ventricular septal defect - hole between R and L ventricles
- Narrowing of the pulmonary tract
- Thickening of wall of right ventricle
What 7 features should be looked for on ABDO exam of the newborn?
- Moves with respiration
- Distension
- Hernia
- Umbilicus
- Bile-stained vomiting
- Passage of meconium
- Anus
ALWAYS ask if the baby has passed ________
MECONIUM
What can a delay in the passage of meconium be a sign of?
Obstruction
What must you check for/exclude during a genitourinary exam?
- Normal passage of urine
- Normal genitalia
- Undescended testes – very common
- Hypospadius
What 4 things should be checked on MSK exam?
- Movement and posture
- Limbs and digits
- Spine
- Hip exam
What 6 things must be assessed on NEUROLOGICAL exam?
- Alertness, responsiveness
- Cry
- Tone
- Posture
- Movement
- Primitive reflexes
List the 6 primitive reflexes.
- Suck
- Rooting
- Moro/startle - baby extends all limbs, THEN brings them back in
- ATNR - stretched arm is floppy, other one is stiff
- Stepping
- Grasp
How long do primitive reflexes usually last?
6 months to 1 year
Why should you worry about if primitive reflexes persist past 1 year?
A neurological problem of the baby
What is a port wine stain?
A vascular birthmark/ malformation
What can a haemangioma look like?
A bruise
What will happen to a strawberry naevus before disappearing?
It will get bigger
