Evaluation of the newborn Flashcards
neonate
first 28 days of life
Preemie
born prior to 37 weeks
APGAR score
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
Normal vitals range for newborn
HR- 120-160 and 85-90 during sleep
Resp: 40-60
Temp: 97.7-99.5
What is the ballard test used for?
To calculate the gestational age of a baby
Gestational age
Preterm: <34 wks
Late preterm: 34-36wks
Term: 37-42 wks
postterm: >42
What is normal birthweight
> or = 2500 g
about 5.5 pounds
Maternal Hx
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
After birth what happens to a healthy child
- prophylatic erythromycin opthalmic ointment
- prevents gonnococal opthalemia - Vit K injection
- prevents vit K bleeding - Hep B vaccine
- Umbillical cord care
- Monitor for hyperbillirubinemia and hypoglycemia
- Newborn screen: heel stick, hearing test, and pulse ox
Congenital Hypothyrodism
Most common preventable cause of mental retardation
Adrenal Hyperplasia
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
Cystic Fibrosis
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.
Pulse Ox screens for
- critical congenital heart disease and other causes of hypoxemia
ex: Meconium aspiration, pneumonia, respiratory distress syndrome
Milia
smooth white rased areas- pinpoint papules with no surrounding erythema
- cuased by the retention of keratin
- will disappear over several weeks
Neonatal acne
papules and pustules
- usually forehead cheeks and upper chest
begins 2-3wks and goes away 4-6 months
Milaria Rubra
scattered vesicles on an erythematous base
- caused by the obstruction of sweat glands “heat rash”
- will dissappear spont in a couple weeks
Erythema toxicum
usu. within 2-3 days of life
unknown cause
erythemous macules with pinpoint vessicle» progress to pustules
- will dissapear 1 wk after birth
Pustular Melanosis
more common in black infants
3 stages: superficial white pustules> erythematous macules with surrounding scale> hyperpigmented macules
- can last several months
Acrocyanosis
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
Neonatal jaundice “physiologic”
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
Anterior and posterior fontanelles
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
Eye Visual Milestones
Birth- blinks and regards a face
1mo: fixes on an object
How to test for hip dysplasia
or ortolani and Barlow test
Galeazzi test
tests for femoral shortening
- baby on back put fee flat on the mat and note any difference in knee hieght
- positive test if yes
Barlow test
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
Ortolani Test
flex legas to right angle and abduct the hip 1 at a time and if there is a clunk then it is positive
rooting relfex
will go away 3-4 mo
stroke side of mouth and the infant will turn towards and suck
Moro reflex
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
Palmar grasp
6- 8 mon
touch soul and the toes should curl
Asymmetric tonic reflex
2-3 mon
- with baby supine turn head to one side and the arm away should flex in the other should extend out
Positive support reflex
6mon
- hold baby around trunk and see if they can be [artially weight bearing
