Evaluation Of The Neonate And Infant Flashcards
What gets a score of 2 for Respiration
Vigorous cry
What are primitive reflexes?
Reflexes that disappear by certain ages
What are abnormal findings with baby’s respiration/breathing patterns?
Nasal flaring
Grunting
Retractions
Audible wheezing/stridor
Do babies breathe through nose or mouth
Obligate nose breathers
Is erythema toxicum bad?
No, no one knows what causes it and it goes away within 1 week
What is meconium staining?
Meconium causes a greenish color on skin, umbilical cord, mucosa, amniotic fluid, placenta
What does jaundice in first 24 hours suggest?
Hemolytic disease
What is the most common life shortening autosomal recessive disease in Caucasian’s?
CF
What is the heel stick for?
Checking for metabolic and genetic disorders based on state requirements
At the one minute APGAR check: arms and legs were flexed, HR was 110, some flexion of extremities to reflex irritability, body is pink, and there is a slow, irregular cry. What is the APGAR score?
7
1, 2, 2, 1, 1
How many arteries and veins are in umbilical cord
2 arteries 1 vein
What gets a score of 1 for Appearance
Body pink, extremities blue
What are the total bilirubin levels in physiologic jaundice?
Over 20mg/dL
Acoustic blink reflex (snapping in ear) tests which cranial nerve
CN VIII
Five minute APGAR score 6 or less indicates?
High risk for CNS/organ dysfunction. Intervention required
When is the heel stick done to check for disorders
1st at 24-48hrs
2nd at first doctors visit/5-10 days
5 components of APGAR score
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
How can we know the anus is is patent and working
The baby passes meconium (usually by 48 hrs)
Preemie age
Birth prior to 37 wks
Is nystagmus immediately after birth normal?
Yes it’s common
What could cause a cephalohematoma (bleeding between periosteum and skull)?
Trauma from birth. Forceps/vacuum use
How often should breastfed babies be fed?
Every 2-3 hours for 10-15min per breast
What might central cyanosis indicate?
Cyanotic congenital heart disease
How do you tell the difference between acrocyanosis and central cyanosis?
Mucous membranes will be pink with acrocyanosis, and blue in central cyanosis
What gestational age is considered full term
37-42 weeks
When does Moro reflex go away
5-6 months
Top 4 diagnoses to come out of newborn screening?
Hearing loss
Congenital hypothyroidism
Cystic fibrosis
Sickle Cell
What is rooting reflex
Stroke skin at corner of mouth and baby turns head to suck
APGAR score range
0-10
What might a large posterior fontanelle indicate
Congenital hypothyroidism
How should babies be lying down for sleep
On their backs “back to bed”
What is meconium ileus?
Meconium is thick and hard to pass which causes an obstruction
What is plantar grasp
Touch base of toes and toes curl
What are fontanelles?
The intersections of major sutures “soft spots”
How big is the anterior fontanelle at birth?
4-6cm
When is jaundice considered pathological?
When it starts in first 24 hours or after 2 weeks
What is the most important diagnostic test for CF?
Sweat chloride testing
What does it mean if nystagmus persists for awhile?
May indicate poor vision or CNS disease
Galeazzi, Ortolani, and Barlow tests all screen for what?
Hip dysplasia
What does miliaria rubra look like
Red bumps/vesicles
What is the asymmetric tonic neck reflex
Turn head to Left and the Left arm/leg extend and Right arm/leg flex (and vice versa)
When does palmar grasp go away
4-6 months
What is leukocoria
White pupillary reflex
Pulse below 100bpm gives what score for Pulse?
1
What is physiologic jaundice?
Jaundice noticed AFTER 24 hours
What does prophylactic erythromycin ointment prevent? (Eye goop)
Gonococcal opthalmia (STD)
What are we looking for in the baby’s opthalmoscopic exam
Bilateral Red light reflex
Rooting/sucking reflex tests which cranial nerve
CN V
What is positive support reflex
Hold baby till his feet touch a flat surface and he’ll kind of stand up
What is the Barlow test
Holding one leg and ADDUCT the other one feeling for clunk/movement of hip joint dislocation
What gestational age is considered late-preterm?
34-36 weeks
What is the term for undescended testicles
Cryptorchidism
What can cause cloudiness of cornea
Cataracts
What causes miliaria rubra
Obstructed sweat glands
What is omphalitis?
Infection of the umbilical stump
what gets a score of 0 for appearance
Baby is blue and pale
What is “heat rash”
Miliaria rubra
What does ABO or Rh incompatibility have to do with jaundice?
No idea but it does
What is it called when bilirubin accumulates in the brain
Kernicterus
Infant age
29 days to 12 months
What is erythema toxicum
Red patches with central vesicles that appear on day 2-3 of life
What gestational age is considered preterm?
<34 weeks
What is torticollis?
Injury to sternocleidomastoid
What supplement do breastfed babies require?
Vitamin D 400 IU/day
What does the Nerborns and Mother’s Health Protection Act say?
Insurance is required to cover up to 48 hours for vaginal deliveries and 4 days for c-sections
What might a bulging fontanelle indicate?
Hydrocephalus/infection causing increased ICP
What is acrocyanosis
Blue extremities with pink mucous membranes that commonly appears shortly after birth and goes away in 1-2 days
What gets a score of 2 for Grimace
Active motions-sneeze, cough, pull away
to reflex irritability
When does the posterior fontanelle close
2 months
What is Ortolani test
Holding leg and ABDUCTING hip feeling for clunk of femoral head entering acetabulum
Is paradoxical breathing normal for a baby
Yes they are “belly breathers”
Abnormalities of any primitive reflexes suggests what
Neurological disease
What is galeazzi test
Place feet together and note any difference in knee heights
One minute APGAR score less than 4 requires?
Immediate resuscitation
What is positional plagiocephaly
Flat spot from laying on back of head
When does positivesupport refelx go away
6 months
What are milia?
Developing sebaceous glands on nose, chin, forehead. Look like whiteheads
What could cause leukocoria?
Retinoblastoma
How does breastfeeding protect baby from infections?
IgA antibodies
What is a normal Heart rate for infant?
120-160bpm
How big is the posterior fontanelle at birth/
1-2cm
What is Moro reflex
Pretend to drop baby and look for baby to startle and extend limbs
How often is baby assessed during transitional period
Every 30 min
When does the anterior fontanelle close for 90% of infants
7-19 months
When are APGAR scores taken
1 and 5 minutes
What is the problem with congenital hairy nevus
Significant malignant potential
What gestational age is considered post term?
> 42 weeks
What does the Ballard Scoring System estimate?
Gestational age to within 2 weeks
What is a normal respiratory rate for infant?
30-60 breaths/min
How do we test for Critical Congenital Heart Disease?
Pulse oximetry
When does the asymmetric Tone reflex go away
2-3 months
What is the palmar grasp
Press finger on baby’s palm and he will grasp your finger
Five minute APGAR score of 7 or higher indicates?
Normal, proceed to more thorough examination
What could torticollis cause?
Plagiocephaly(flat spot on head)
Does crypotorchidism ever solve itself
Yes in 2/3 cases both testes descend by 1 year
80-90% of newborns with meconium ileum have___?
Cystic fibrosis
When does rooting reflex go away
3-4 months
Why is it important to do a hearing screen before baby is discharged>?
Early intervention improves speech development
What is the recommended source of nutrition for infants up to 6 months old
Breastfeeding
What are Epstein pearls
small white benign cysts on roof of mouth (at junction of hard and soft palate)
Is central cyanosis a big deal?
Yes its an emergency
Is acrocyanosis a big deal?
No
What is choanal atresia
One side of nose is blocked
What might a depressed anterior fontanelle indicate?
Dehydration
What is the transitional period
First 4-6 hours outside the womb
What is spina bifida occulta?
Abnormalities within 1cm of midline in baby’s buttcrack? Might allow stool to come in contact with spinal canal
Neonate age
Birth to 28 days
When does plantar grasp go away
6-8 months
What is a normal APGAR score?
7-10
What is hypospadias?
Urethra located in wrong location on penis
Arms and legs flexed gives what score for Activity
1
What are important skin colors to note on infant?
Jaundice, cyanosis, and meconium staining
Do we need to treat a cephalohematoma
No, resolves spontaneously within 3 weeks