exam and management of Neonate

Question 1

describe the routine delivery room care of a healthy, term infant

Answer 1

warming, drying, clearing of airway

Question 2

list the 5 clinical components of the APGAR score

Answer 2

heart rate

respiratory effort

muscle tone

reflex irritability

color

Question 3

explain why vitamin K is injected and topical erythromycin ophthalmologic ointment applied immediately after birth

Answer 3

newborns have low vitamin K level necessary for blood clotting

to prevent pink eye in the first month of life, also called ophthalmia neonatorum (ON)

Question 4

know the age at which the majority of newborns regain their birth weight

Answer 4

birth weight regained by 10-14 days

normal weight gain 15-30 grams/day

most babies will lose up to 10% of their birth weight, more than that should be followed closely.

at 2 wks of age, the birth weight should be regained

Question 5

define (for healthy term infant) the following

• expected daily weight gain after the first week
• maximum acceptable weight loss in the week following birth
• the age at which most regain their birth weight

Question 6

describe arcocyanosis vs central cyanosis

Answer 6

acrocyanosis-blue discoloration of the perioral area, feet, and hands)

1. normal for the first 24 hours
2. closely associated with cool surroundings
3. perioral changes seen with sucking/feedings

central cyansos- blusih discoloration of tongue/muscus membranes

1. persisting after the first 10 minutes of life is always abnormal-think cardiac disease.pulmonary disease

Question 7

describe the importance of looking for the red reflex in newborn infant

Answer 7

red reflex evaluation to ensure lack of opacity of the lens and cornea and to look for intraocular mass (retinoblastoma)

1. in whitesm the reflex is red
2. in darker skinned infants, may be more pearly gray, vessels still present
3. finding a “white” red reflec indicates pathology (tumor, trauma, ROP) need urgent referral

Question 8

remember that

• Pierre-Ribin sequence is associated with micrognathia
• Choanal atresia is associated with CHARGE syndrome (describe on back)
• Bifid uvula can be indicative of the soft palate cleft

Answer 8

CHARGE syndrome- coloboma, heart defect, atresia choanne, retarded growth/development , genital abnormalities, ear abnormalities, may become cyanotic when crying

Question 9

describe

• epstein pearls
• supernumery nipples

Answer 9

for mouth examination use the light , tongue blade, gloved finger

1. check frenulum labialis (connects upper lip with the gingival surface or alveolar ridge of the maxilla) and the frenulum linguae (connects tongue to the floor of the mouth)
2. epstein pearls (epithelial cysts, collagen)
3. bifid uvula (check hard palate)
4. natal neonatal teeth

Question 10

describe the difference between an omphalocele and gastroschisis

Answer 10

abdominal wall defect are obvious and require urgen surgical intervention

Question 11

describe the normal number of arteries and veins in an umbilical cord

Answer 11

normally there 3 vessels (2 arteries and 1 vein)

1. single artery is most often a normal variant
2. single artery accompanied by any other abnormal (minor or major) is of concern

Question 12

compare and contrast cephalohematomas and caput succedaneums

Answer 12

cephalohematoma (subperiosteal blood)

1. may be bilater
2. DO NOT CROSS STURE LINES
3. increase in size after delivery
4. can be tense or fluctuant
5. can be tense or fluctuant
6. late can mimic a fracture on x-ray
7. weeks to months for resolution

Caput succedaneum

1. boggy srea edema and or bruising, crosses the suture lines, gone in days, present at birth (generally does not enlarge)

Question 13

defining molding

Answer 13

When a baby is born in a head-first position, pressure on the head in the birth canal may mold the head into an oblong shape. These spaces between the bones allow the baby’s head to change shape. Depending on the amount and length of pressure, the skull bones may even overlap

Question 14

discuss the importance of examining the lumbosacral spine in every infant (tuft of hair, lipoma, hemangioma, pit or dimple)

the dimples is explained on the back

Answer 14

dimples separate from gluteal crease

1. think possible spinal dysraphism
2. should ultrasound by 3 months

Question 15

name the 2 maneuvers used to examine the hips in a newborn baby

• ortolani
• barlow

that are the test used for?

Answer 15

examination of the hip is crucial in evaluation of developmental dysplasia of the hip (Barlow/Ortholani)

1. more common in females
2. more common if there are CNS abnormalities
3. more common with breech presentation
4. re-examination of the hips before discharge has been shown to be the only consistent portion of the PE to pick up an abnormality not seen prior

Question 16

idenitify

• hypospadias
• vernix
• erythema toxicum
• milia
• dermal melanosis

Answer 16

Hypospadias (meatal opening on ventral aspect)

epispadias (dorsal meatal opening)- much less common and associated with bladder exstrophy

white sebaceous cysts are relatively common on distal forskin and of no consequence

vernix- white cheesy stuff that babies have all over especially inguinal/axillary). appears about 35 weeks and may be gone at 41 weeks

erythema toxicum neonatorum (flea-bite syndrome)

1. benign rash of the newborn
2. usually appears second to third day of life (gone 7-14 days approx)
3. erythematous base with 1-2mm oustules or papules
4. spares palms, soles

5 pustule/vesicles contain debris and Eosinophils

Milia

1. appear on face and scalp
2. 1-2mm white, firm papules on face and bridge of the nose
3. resolve spontaneously by few months
4. appear at 36 weeks gestation

slate grey spots (dermal melanosis)

1. slate blue.grey or black
2. macular to patch size
3. more common in darker skinned races, but affects all
4. benign
5. those on the lower back/buttocks tend to resolve over several years
6. formerly (mongolian spots)