Exam and Management of the Neonate

Question 1

Components of routine delivery room care of healthy, term infants

Answer 1

Warming, drying, clearing of airways

Comprehensive review of maternal history and complete physical exam

Prophylactic care to prevent serious disorders

Family education

Discharge care/evlaution

Question 2

5 clinical components of the APGAR score

Answer 2

Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Color

Question 3

Why is vitamin K injected immediately after birth?

Answer 3

Prevents excessive bleeding of newborn (helps babies clot)

Question 4

Why is topical erythromycin ophthalmologic ointment applied immediately after birth?

Answer 4

Prevention of GC (ophthalmia neonatorum)— less against chlamydia

Question 5

Age at which majority of newborns regain their birth weight

Answer 5

10-14 days

Question 6

Expected daily weight gain after the first week for healthy term infant

Answer 6

15-30g/day

Question 7

Maximum acceptable weight loss in the week following birth for healthy term infant

Answer 7

Up to 10% loss is acceptable in most situations

[7% loss or greater demands close follow-up]

Question 8

Blue discoloration of the perioral area (seen with sucking/feeding), feet, and hands; normal for the first 24 hours and closely associated with cool surroundings

Answer 8

Acrocyanosis

Question 9

Bluish discoloration of tongue/mucous membranes persisting after first 10 minutes of life is always abnormal — think cardiac disease/pulmonary disease

Answer 9

Central cyanosis

Question 10

Importance of looking for the “red reflex” in newborns

Answer 10

Ensures lack of opacity of the lens and cornea and to look for intraocular mass (retinoblastoma)

[note: in whites the reflex is red, in darker skinned infants may be more pearly gray; finding a “white” red reflex indicates pathology in need of URGENT referral]

Question 11

Pierre-Robin sequence is associated with _______

Answer 11

Micrognathia

Question 12

Choanal atresia is associate with ________ ______

Answer 12

CHARGE syndrome

Question 13

PE finding indicative of soft palate cleft

Answer 13

Bifid uvula

Question 14

What are epstein pearls?

Answer 14

Inclusion cysts on the back of the hard palate — normal PE finding

Question 15

Describe supernumery nipples

Answer 15

May develop inferior to true nipples, anywhere along the mammary line

Seen in 1% of normal population, more commonly in African-Americans

Question 16

What are supernumery nipples associated with in the white population?

Answer 16

Renal anomalies (hydronephrosis, hypoplasia, etc)

Question 17

What is the difference between omphalocele and gastroschisis?

Answer 17

Omphalocele = abdominal wall defect in which contents protrude through umbilical cord (covered with peritoneum)

Gastroschisis = abdominal wall defect in which contents are exposed at site just to the right of umbilicus

Question 18

Normal number of arteries and veins in an umbilical cord

Answer 18

3 vessels total (2 arteries, 1 vein)

Question 19

Compare and contrast cephalohematomas and caput succedaneums

Answer 19

Cephalohematoma —(subperiosteal blood) may be bilateral and DO NOT CROSS SUTURE LINES. Increase in size after delivery, can be tense or fluctuant, late can mimic a fracture on x-ray, take weeks to months for resolution

Caput succedaneum — boggy area of edema and/or bruising, CROSSES SUTURE LINES, gone in days, present at birth (generally does not enlarge)

Question 20

Define “molding”

Answer 20

Change in fetal head shape as permitted by sutures + fontanelles as it passes through the birth canal

Question 21

Importance of examining lumbosacral spine in every infant

Answer 21

Look for presence of the following:

Hair tuft

Dimples separate from gluteal crease (suggests possible spinal dysraphism/tethered cord)

Skin tags or pits

Lipoma, hemangioma

Question 22

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

Answer 22

Ortolani

Barlow

Question 23

External urethral meatus on ventral shaft of penis

Answer 23

Hypospadias

Question 24

White cheesy skin stuff that babies have all over (especially inguinal/axillary), appears at about 35 weeks and may be gone at 41 weeks

Answer 24

Vernix

Question 25

Benign rash of the newborn that usually appears the second to third day of life (gone in 7-14 days) with erythematous base with 1-2 mm pustules or papules, sparing the palms and soles. Pustule/vesicles contain debris and eosinophils

Answer 25

Erythema toxicum neonatorum (flea-bite syndrome)

Question 26

1-2 mm white firm papules on the face and bridge of nose (and sometimes scalp); resolve spontaneously by a few months — appear at 36 weeks gestation

Answer 26

Milia

Question 27

Slate blue/grey or black spots that are macular to patch size; more common in darker skinned races but affects all; they are benign and tend to resolve over several years

Answer 27

Dermal melanosis