Evaluation of the newborn

Question 1

neonate

Answer 1

first 28 days of life

Question 2

Preemie

Answer 2

born prior to 37 weeks

Question 3

APGAR score

Answer 3

determines newborns neurological recovery after birth
1. Activity(muscle tone), none, flexed, movement
2. Pulse: none, below 100, above 100
3. Grimace(reflex irritability): flacid, some flexion of extremitites, active motion
4. Appearance: blue, body pink with blue ext, all pink
5. Respirations: abscent, slow and irregular, vigorous cry
0-3 depressed
4-6: mod depressed
7-10: excellent condition

Question 4

Normal vitals range for newborn

Answer 4

HR- 120-160 and 85-90 during sleep
Resp: 40-60
Temp: 97.7-99.5

Question 5

What is the ballard test used for?

Answer 5

To calculate the gestational age of a baby

Question 6

Gestational age

Answer 6

Preterm: <34 wks
Late preterm: 34-36wks
Term: 37-42 wks
postterm: >42

Question 7

What is normal birthweight

Answer 7

> or = 2500 g

about 5.5 pounds

Question 8

Maternal Hx

Answer 8

SES, FH, meds, tb/alch/drug use, occupational exposure, ob hx,
Labor: duration of ruptured membranes, length of labor, mode of delivery, mom’s condition at delivery, newborns condition at delivery,
Risk of sepsis: membranes ruptured> 18hrs, < 37wks, maternal strep B infection

Question 9

After birth what happens to a healthy child

Answer 9

1. prophylatic erythromycin opthalmic ointment
   - prevents gonnococal opthalemia
2. Vit K injection
   - prevents vit K bleeding
3. Hep B vaccine
4. Umbillical cord care
5. Monitor for hyperbillirubinemia and hypoglycemia
6. Newborn screen: heel stick, hearing test, and pulse ox

Question 10

Congenital Hypothyrodism

Answer 10

Most common preventable cause of mental retardation

Question 11

Adrenal Hyperplasia

Answer 11

Females : ambiguous genetalia with clitoral enlargment and a urethral vaginal orifice
- may have fusion of labial folds but normal interal organs
Males: no overt signs , may have phallic enlargment or scrotal hyperpigmentation
1. Salt losing crisis: off electrolites and FTT
2. Non salt losing: show signs of puberty as a todler

Question 12

Cystic Fibrosis

Answer 12

most common life shortening autosomal recessive disease amoung caucasians

• most newborns with meconium ileus have CF
• *sweat chloride test is the most important diagnostic test and should be done if screening comes back positive.

Question 13

Pulse Ox screens for

Answer 13

• critical congenital heart disease and other causes of hypoxemia
  ex: Meconium aspiration, pneumonia, respiratory distress syndrome

Question 14

Milia

Answer 14

smooth white rased areas- pinpoint papules with no surrounding erythema

• cuased by the retention of keratin
• will disappear over several weeks

Question 15

Neonatal acne

Answer 15

papules and pustules
- usually forehead cheeks and upper chest
begins 2-3wks and goes away 4-6 months

Question 16

Milaria Rubra

Answer 16

scattered vesicles on an erythematous base

• caused by the obstruction of sweat glands “heat rash”
• will dissappear spont in a couple weeks

Question 17

Erythema toxicum

Answer 17

usu. within 2-3 days of life
unknown cause
erythemous macules with pinpoint vessicle» progress to pustules
- will dissapear 1 wk after birth

Question 18

Pustular Melanosis

Answer 18

more common in black infants
3 stages: superficial white pustules> erythematous macules with surrounding scale> hyperpigmented macules
- can last several months

Question 19

Acrocyanosis

Answer 19

bluish discoloration commonly after birth

• hands feet BUT have pink mucus membranes
• ** in central cyanosis the muscus membranes would not be pink***
• returns to normal 24-48hrs

Question 20

Neonatal jaundice “physiologic”

Answer 20

appears after 24hrs and usually resolves after 2wks
- before 24hrs or after 2wks suggests a different disease
- want to watch for sever neonatal hyperbillirubinemia
>25mg/dl, this puts the baby at risk for billirubin indiced neurological disfunction
ex: Kernicterus
Tx: phototherapy

Question 21

Anterior and posterior fontanelles

Answer 21

Ant: 4-6cm at bir and close bt 4-26 months after birth
- usually 7-19 mo
Post: 1-2 cm, and closes at 2 months
* worrsome if you have buldging ant font, or depressed , early closure (craniosynostosis), or delayed closure

Question 22

Eye Visual Milestones

Answer 22

Birth- blinks and regards a face

1mo: fixes on an object

Question 23

How to test for hip dysplasia

Answer 23

or ortolani and Barlow test

Question 24

Galeazzi test

Answer 24

tests for femoral shortening

• baby on back put fee flat on the mat and note any difference in knee hieght
• positive test if yes

Question 25

Barlow test

Answer 25

flex and adduct the hip while applying posterior force

- if there is a paplable clunk or sensation of movement is felt then the sign is positive

Question 26

Ortolani Test

Answer 26

flex legas to right angle and abduct the hip 1 at a time and if there is a clunk then it is positive

Question 27

rooting relfex

Answer 27

will go away 3-4 mo

stroke side of mouth and the infant will turn towards and suck

Question 28

Moro reflex

Answer 28

go away 5-6 months
hold suppine supporting head and neck and back
let baby lower abruptly and check is limbs extend and fingers open

Question 29

Palmar grasp

Answer 29

6- 8 mon

touch soul and the toes should curl

Question 30

Asymmetric tonic reflex

Answer 30

2-3 mon

- with baby supine turn head to one side and the arm away should flex in the other should extend out

Question 31

Positive support reflex

Answer 31

6mon

- hold baby around trunk and see if they can be [artially weight bearing