Eval of Neonate and Infant Flashcards
During what time period is a baby a Neonate
first 28 days of life
When is a child considered an infant
29 days to 12 months
when is a baby considered a preemie
birth prior to 37 weeks
The APGAR score is taken at what time increments after birth
1 minute and 5 minutes
Name the 5 components of the APGAR scoring system. What is the range for the total APGAR score
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin color)
- Respiration
- 0-10
give the 3 catagories for Activity (muscle tone) of APGAR score
- Absent = 0
- Arms and legs flexed = 1
- active movement = 2
give the 3 categories for pulse section of APGAR score
- absent =0
- below 100 bpm = 1
- above 100 bpm = 2
give the 3 categories for grimace (reflex irritability) aspect of APGAR score
- Flaccid = 0
- some flexion of extremities = 1
- active motion (sneeze; cough; pull away) = 2
Give the 3 categories of the Appearance aspect of the APGAR score
- blue, pale = 0
- body pink; extremities blue = 1
- completely pink = 2
give the 3 categories of the Respiration aspect of the APGAR score
- absent = 0
- slow, irregular = 1
- vigorous cry = 2
at the ONE minute APGAR score, what numbers require immediate resuscitation
<4
*scores of 5-7: some nervous system depression
what APGAR scores are considered normal at both the one minute and five minute tests
8-10
at the FIVE minute APGAR test, what score indicates a high risk for CNS/organ system dysfunction
0-7
The Ballard scoring system is used for what
estimate gestational age to within 2 weeks
- assessment of neuromuscular and physical maturity
birth weight classification: what is considered normal
greater than or equal to 2500 g (5.5 lbs)
in a premature baby, which of these three groups are at an increased risk for mortality: SGA, AGA, LGA (small, average, large for gestational age)?
Mortality is highest for SGA and LGA
What are some questions you want to ask a mother who gave birth during the child’s first visit
- family hx
- chronic illness
- medications used during pregnancy
- tobacco, etoh, drug use
- previous pregnancy outcomes
- maternal age (<16; >35)
- pregnancy related complications
what are some questions you want to ask mom about the delivery
- duration of rupture of membranes (ROM)
- fetal presentation/distress
- maternal fever
- meconium stained amniotic fluid
- type of delivery
What 4 preventative treatments are done to neonate at the hospital
- prophylactic erythromycin ointment
- vitamin K - prevent vit k deficient bleeding
- hepatitis B vaccine
- newborn screen (heel stick; pulse ox; hearing screen)
what drug is given to neonates after birth to prevent gonococcal ophthalmia (cause blindness)
prophylactic erythromycin ointment
what is the recommended position for neonates to sleep to prevent SIDS
“back to bed”
When is the newborn screening, heel stick, performed
- 24-48 hrs old
- first doctor’s visit or between 5-10 days of age, whichever comes first
What are the two electrophysiologic techniques that are used to test for hearing in neonates
- auditory brainstem responses (ABR)
- Otoacoustic emissions (OAE)
breastfeeding is the recommended primary source of nutrition for infants up to how many months/years
up to 6 months of age
breastfeeding offers child protection against infection via the passage of what immunoglobin
IgA
Name the 3 phases of breast milk
- colostrum
- transitional milk
- mature milk: higher in fat
* milk comes in 3 days post-partum
how often should breastfed infants be fed
- 8-12 times/24 hrs (every 2-3 hrs) for 10-15 minutes/breast
formula should contain what compound
iron
How many wet diapers should be expected within the first 24 hours? By day 5?
- at least 1 wet diaper in the first 24 hours
- by day 5: 6-8 wet diapers/day of light yellow urine
For the first 24-48 hours after birth, what type of stool should be expected? By day 5, what color stools should be expected?
- first 24-48 hrs: meconium: thick, very dark
- by day 5: 3-4 yellow, seedy stools a day
Insurance is REQUIRED to cover how much hospital time for vaginal deliveries and cesarean deliveries?
- vaginal: 48 hrs
- cesarean: 96 hrs
If mother and baby are discharged prior to 48 hours of hospitalization, when is the well child visit recommended? If discharged after 48 hours?
- < 48: well visit is recommended 48 hrs of discharge
- > 48: well visit is recommended within 3-5 days of discharge
what is a normal pulse and respiratory rate for infants
- pulse: 120-160 beats/min
- RR: 30-60 breaths/min
What 3 main measurements are taken for infants
- head circumference
- Length
- Weight
fine hair that covers newborn
Lanugo
what is the name of this condition? What is caused by? when does it go away?
Milia
- developing sebaceous glands
- disappears over several weeks
scattered vesicles on an erythematous base located on the face and trunk. Name condition. What is it caused by? Treatment?
- Miliaria Rubra
- obstruction of sweat glands
- disappears spontaneously within weeks
erythematous macules with central pinpoint vesicles “flea bites” that are scattered diffusely and usually appears on days 2-3 of life. Name condition. Treamtent?
- erythema toxicum
- disappears within 1 week of birth
small vesiculopustules on a brown macular base that is more common in black infants. Name condition. When does this condition go away?
- pustular melanosis
- can last several months
bluish discoloration that commonly appears shortly after birth on the hands and feet. Note: PINK mucous membranes
Acrocyanosis
If lips, oral mucosa/tongue, and trunk are blueish in color, what is this called? What condition is associated with these findings?
- central cyanosis
- cyanotic congenital heart disease
benign birthmark located on the eyelid
eyelid patch
benign birthmark seen on posterior neck
stork bite
Visible jaundice AFTER 24 hrs of age signifies what?
physiologic jaundice
- common: 65% of all newborns
Visible jaundice within 24 hrs of birth suggests what condition
hemolytic disease, biliary, or liver disease (non-physiologic jaundice)
levels of total biliruben above 20 mg/dl are concerning because?
- accumulates in brain -> kernicterus
- neurotoxic: can cause death
- premature babies are at a higher risk
treatment for neonatal jaundice
phototherapy
jaundice that starts After 2 weeks: physiologic or pathologic?
pathologic
* check for ABO or Rh incompatibility
on a neonatal, infant exam, what are you palpating for on the head
- sutures: seperate the bones from one another: feel like ridges
- fontanelles: where the major sutures intersect: “soft spots”
What are the normal measurements for the anterior and posterior fontanelles at birth
- anterior: 4-6 cm
- posterior: 1-2 cm
when do the anterior and posterior fontanelles close
- anterior: closes between 4-26 months (90% between 7-19 months)
- posterior: closes at 2 months
congenital hypothyroidism can have what clinical sign affecting the fontanelles
larger posterior fontanelle
Depressed anterior fontanelle can signify what condition
dehydration
early closure of cranial sutures and fontanelles is called
craniosynostosis
trauma at birth (associated with foreceps or vacuum delivery) can cause a subperiosteal hemorrhage in neonates. What is this condition referred to as? Treatment?
cephalohematoma
- spontaneously resolves within 3 weeks
flat spot on a babies head caused by pressure on the head before or after birth. May see unleveling of ears
positional plagiocephaly
condition in which head circumference is <2 standard deviations below the mean for age and sex
microcephaly
condition in which head circumference is >2 standard deviations above the mean for age and sex
What would you consider if you saw a neonate with nystagmus immediately following birth? If that nystagmus was persistent?
- common immediately following birth
- persistence may indicate poor vision or CNS disease
what would you consider if you saw a child with intermittent stabismus within the first few months of life?
normal
When should a neonate/infant be able to fixate on an object
1 month
what is the condition when you see a white pupillary reflex on ophthalmoscopic exam? What condition could this represent?
- leukocoria
- retinoblastoma
what main reflex are you looking for with ophthalmoscopic exam of neonate?
bilat red light reflex
How would you test for hearing in a neonate
acoustic blink reflex: snap your finger about 12 inches from the infants ear and see if patient blinks
what is choanal atresia
congenital disorder in which back of nasal is blocked usually by abnormal bony or soft tissue
small, white, benign inclusion cysts commonly seen on gums and palate on neonates
Epithelial (Epstein) pearls
yeast/fungal infection that can seen on oral mucosa in neonates
oral candidiasis (thrush)
what is torticollis
position/injury to the sternocleidomastoid, formed from “position of comfort” for a baby that was constrained in utero; may be a precipitating factor for plagiocephaly
What are 4 things you want to include in your physical exam of the neck of a neonate?
- palpate lymph nodes
- assess for masses
- evaluate for torticollis
- evaluate for clavicular fx
How long do you count respirations for in a neonate?
1 full minute
When assessing a neonates breathing, what are some things that are abnormal
- nasal flaring, grunting, retractions, audible wheezing or stridor
should you refer a neonate if you find sinus dysrhythmia that is associated with respiration ?
no, this is a normal finding
if you detect a murmur in a neonate, what are some other things you should look for?
- assess for noncardiac signs and symptoms: poor feeding, tachypnea, hepatomegaly *functional (benign) heart murmurs are common; you want to make sure the child does not have congestive heart failure
when inspecting the umbilical cord in a neonate, what are you assessing for
- there are 2 arteries and 1 vein present
- evaluate for redness and swelling
if you detect an umbilical hernia in a neonate, what should you tell the parents
most disappear by 1 year
what is the name for a infection of the umbilical stump
omphalitis
when does the umbilical cord usually fall off
- cord dries up and falls off within 2 weeks
what is the vaginal introitus? What should you be on the look out for when examing this area?
- vaginal opening
- imperforate hymen: hymen without an opening which completely obstructs the vagina
- white/blood-tinged discharge - normal
congenital condition in which the opening of the urethra is on the underside of the penis
hypospadias
Name the condition of undescended testicle (s). What will you tell parents regarding treatment
- cryptorchidism
- 2/3 of cases, testes descend by 1 year, after that surgery is necessary
what is a way to test that swelling of the scrotum is due to hydrocele
transillumination
what is the condition of webbed fingers
syndactyly
what is the galeazzi test testing for? how do you perform it?
- dysplasia of hip
- place the feet together and note any differences in knee heights
- unequal knee heights = + sign
what is the Barlow test testing for? How do you perform the test
- hip dysplasia
- stablize one leg with one hand, with the other hand, place the thumb medially over the lesser trochanter and index finger laterally over greater trochanter
- flex and adduct the hip while applying a posterior force
- a palpable clunk or sensation of movement is felt as the femoral head exits the acetabulum posteriorly: + sign
what is the ortolani test testing for? How is it performed?
- tests for presence of a posteriorly dislocated hip
- open up hips, place index fingers over the greater trochanter of each hip, thumbs over lesser trochanters
- abduct hip (one at a time)
- positive if you feel a “clunk” as the femoral head enters the acetabulum
what does the babinski response test for? What is the response? When is this response normal
- deep tendon reflex
- dorsiflexion of big toe and fanning of other toes
- normal until age of 2 months
how can you assess CN V is a neonate. When is this response present?
rooting, sucking reflex
- stroke perioral skin at the corners of mouth; mouth will open and baby will turn head toward the stimulated side and suck
- birth to 3-4 months
How can you assess CN VIII in a neonate
acoustic blink reflex
How can you assess the moro reflex (startle reflex)? At what age is this reflex present
- hold baby supine, supporting the head, back, and legs
- abruptly lower the entire body about 2 feet
- the arms ABDuct and extend; hands open; and legs flex
- birth to 4 months
what is the palmar grasp reflex? At what age is the reflex present
- place fingers into the baby’s hand and press against the palmar surface
- the baby will flex all fingers to grasp your finger
- birth to 3-4 months
What is the plantar grasp reflex? At what age is this reflex present
- touch the sole at the base of toes
- toes curl
- birth to 6-8 months
What is the asymmetric tonic neck reflex? At what age is it present
- with baby supine, turn head to one side, holding jaw over shoulder
- arms/legs on side to which head is turned extend while the opposite arms and legs flex
- birth to 2 months
what is the positive support reflex. At what age is it present
- hold baby around the trunk and lower until feet touch a flat surface
- hips, knees and ankles extend, the baby stands up, partially bearing weight, sags after 20-30 seconds
- birth or 2 months to 6 months
