Examination of The Newborn/Infant (pages 10-20) Flashcards
What does APGAR stand for?
A- appearance/color P- pulse/HR G- grimace/reflex/irritability A- activity/muscle tone R- respiratory effort
What is the most common loss of point for in the appearance/color section of APGAR?
- acrocyanosis
Describe the APGAR scoring system.
8-10= good to excellent condition- usually just need routine post-delivery care
5-7= fair condition- may require some help breathing, such as vigorously rubbing baby’s skin or placing towel with O2 under nose
<5 (NEUROLOGIC SEQUELAE)= poor condition, & require immediate lifesaving measures, such as an O2 mask
Normal vital signs at birth
HR/pulse= 120-140bpm (100 sleeping; 180 crying) Respiration= 30-60bpm Temp= axillary or electronic in ear- 98-99.5 F; rectal 98-100 BP= Systolic= 60-80mmHg Diastolic= 40-50mmHg
Most clinically useful fontanelle?
Anterior fontanelle
When does the anterior fontanelle close?
18-24 months
When does the posterior fontanelle close?
birth-6 weeks
When do sutures typically close?
2-6 months (abnormal= >12 months)
What are some signs of distress with fontanelles?
Bulging or depression, hydrocephalus, macrocephaly, cephalhematoma, closed sutures
What is plagiocephaly? When does it typically disappear?
Craniofacial asymmetry due to sustained pressure usually disappears by 2 years
What is caput succedaneum? When does it typically disappear?
Diffuse edematous swelling of soft tissues over presenting part often extends across suture lines. Usually disappears within the first few days of life.
What is cephalohematoma? When does it typically disappear?
Subperiosteal hemorrhage that never crosses suture lines. There can be visible swelling, but may not be visible for a few hours- 1 week. Swelling usually disappears in an average of 6 weeks.
What type of swelling is a caput succedaneum?
Serous
Which is more severe: cephalhematoma or caput succedaneum?
Cephalhematoma
What is Lanugo?
fine body hair on shoulders, forehead, & back (non-problematic)
What is milia?
small white papules on nose, cheeks, chin (non-problematic)
What is erythema toxicum?
a macular eruption common in light skin newborns; it resolves in 1 week (non-problematic)
What are some birthmarks that might be evaluated on a newborn? (4)
Port wine stain
Stork’s bite
Mongolian spots
Accessory supernumerary nipple(s)
What is a Mongolian spot?
Dark blue or purple bruise-like spots on lower back/buttocks common in darker complexioned infants of all races usually disappear within first four years
Heart murmurs are commonly heard at birth- 1 week? T or F
True- may be due to transitional circulation
What % of heart murmurs is associated with congenital heart disease?
10%
What types of things are you concerned about if a babies femoral, radial, or brachial pulses are weak?
- aortic coarctation or
- left ventricle abnormalities
What is a normal respiration rate for an infant?
40-50/min
What are respiratory distress signs to watch out for in infants?
Tachypnea (>60 rpm- depends on age) Intercostal retractions (visibly see sternum or ribs pop out) Cyanosis Grunting on expirations Nasal flaring
True of False. Swelling & pearly discharge of the genitalia is a red flag for an infant.
False- this is quite common in an infant
True or False. The kidneys are ordinarily palpable in infants.
True
Infants should void within ____ hours of birth.
Meconium within ______ of birth.
Void- 24 hrs
Meconium- 24-48 hrs
What are red flags with the abdominal exam of an infant?
Absent bowel sounds visible peristalsis abdominal distension palpable masses red base of cord cord with only 2 vessels
What are some neurological signs of distress in a newborn?
Hypotonia Quivering Limp extremities spasticity straightening of extremities clonic jerking paralysis
What are some signs of distress in the neck of a newborn?
Torticollis
resistance to flexion
webbing of neck
palpable crepitus in sc/ac jt
Ortolani’s and Barlowe’s tests are tests for what?
Congenital hip dysplasia
Brachial stretch injury of the upper brachial plexus (C5-C7) is known as what?
Erb Duchenne palsy
Brachial stretch injury of the lower brachial plexus (C8-T1) is known as what?
Klumpke’s palsy
What are common findings of lower legs and feet of newborns that usually self resolves?
Bowing of legs
Metatarsus varus
- is often due to birth trauma
When lifting up the baby, if there is a leg length inequality noted, which side is most likely to be congenital hip dysplasia?
Short leg
Congenital hip dysplasia is more common in female or male babies? Which direction of movement will be most limited?
- Female
- Abduction
Describe the Barlow maneuver.
Adduct the hip while applying light pressure on knee directing force posteriorly. If hip dislocates= positive. Next step- use Ortolani maneuver to confirm.
Describe the Ortolani maneuver.
Flex the hip and knees of supine infant to 90 degrees, then with index finger, place anterior pressure to greater trochanters, gently and smoothly abducting the infants legs using your thumbs.
Positive= distinctive clunk (heard & felt) as the femoral head relocates anteriorly into acetabulum
This tests for posterior dislocation of the hip.
Typically becomes negative after 2 months.
What is the trunk incurvature reflex?
stroke the side of the trunk & contraction occurs
What are signs of distress of the back & rectum of an infant?
Limited ROM fusion of vertebrae spina bifida, tuft of hair imperforate anus fissures cyst or masses
What are the 3 versions of spina bifida from least severe to most severe?
occulta
spinosa
manifesta
Moro reflex age?
birth - 4 months
Tonic neck reflex age?
birth- 4-6 months
Palmar grasp reflex age?
birth- 3-4 months
Plantar grasp reflex age?
birth - 8-10 months
Describe the blink reflex in a newborn.
What does absence suggest?
A bright light in the eyes causes infant to squeeze them shut, even when the eyes are closed. This should be symmetrical.
Absence or asymmetry= damage to CN II, VII
Describe the Doll’s eye reflex.
As the head is moved slowly, the eyes do not move. This disappears as fixation develops (3 months).
Describe the rooting reflex?
touching or stroking the cheek along the side of the mouth will cause the head to turn toward that side. May disappear at 3-4 months or persist until up to 12 months.
Describe the suck reflex.
Elicited by placing a nipple or finger in the infants mouth. Sucking motions also occur during sleep. Persists through infancy.
Describe the grasp reflex.
Touching palms or soles of feet near base of digits causes flexion of hands & toes. Lessens by 3 months (palmar) and 8 months (plantar).
Describe the Moro reflex.
AKA- startle or parachute
- sudden jarring or change in equilibrium causes sudden extension & abduction of extremities & fanning of fingers, with index & thumb forming a C shape, followed by flexion & adduction of extremities. Concern if: none <1 months or persists longer than 6 months- may indicate brain damage, or if unilateral then brachial plexus, clavicle, or humerus damage
Describe tonic neck reflex.
When infant’s head is turned to one side, arm, and leg will extend on that side, while opposite arm & leg may flex. Disapperas by 3-4 mos
Describe an infant’s Babinski reflex.
Stroking outer sole of foot causes toes to hyperextend and hallux to dorsiflex. This normally disappears by 12-18 months. Persistance= pyramidal tract lesion
Neonate is what age range?
birth - 28 days
What are some conditions that are tested/screened for right away in newborns?
PKU Sickle Cell Anemia Congenital Hypothyroidism Galactosemia Biotinidase deficiency Congenital adrenal hyperplasia Cystic Fibrosis Hearing Loss
How are newborn screening tests done?
Pin prick baby’s heel
Done before hospital release, but some tests may not give accurate results if done too early after birth
What is PKU?
Phenylketonuria
- inherited when both parents have PKU gene (1 in 4 chance)
- cannot process a part of a protein called phenylalanine (in certain foods)
- without treatment can phenylalanine builds up in the bloodstream & causes brain damage & mental retardation
What are symptoms of PKU?
Cognitive & developmental delays
- behavioral
- decreased IQ
- hyperactive
- seizures
- small head
- failure to thrive
- “maple syrup” urine
How do you treat PKU?
Special formula (free of phy & leucine) & modified diet (avoid high protein)
What is galactosemia?
Inability to convert galactose, a sugar present in milk, into glucose.
- causes blindness (cataracts) & mental retardation, growth & development problems, nursing problems, decreased IQ, seizures
How do you treat Galactosemia?
Should start by 10 days old.
Galactose free formula. Milk & other dairy products must be eliminated from the baby’s diet.
