Gestational Age & Newborn Assessment Flashcards
What does the Dubowitz/Ballard Scoring Tool assess?
Estimates Gestational Age* based on physical & neuromuscular maturity
When is the Dubowitz/Ballard Scoring Tool used?
o Performed w/in 24 hours after birth, if stable-> not done if micropremie/ intervention needed
What are the physical maturity aspects of the Dubowitz/Ballard Scoring Tool?
- Skin texture
- Lanugo
- Plantar creases
- Breast tissue
- Eyes and ears
- Genitals
What can the skin texture be like for the newborn?
sticky & transparent to smooth, varying degree of peeling & cracking, to parchment-like or leathery
What is the skin texture like for the preterm & term newborn?
- Preterm = sticky, friable, transparent
* Term = leathery, cracked, wrinkled (less vernix as older)
What is lanugo?
Soft downy hair on body (shoulders & upper back)
What is lanugo like for the preterm & term newborn?
- Preterm = none
* Term = mostly bald
What are plantar creases?
Creases on soles, range from absent to covering the entire foot
What are plantar creases like for the preterm & term newborn?
- Preterm = heel-toe (40-50 mm) (< 40 mm)
* Term = creases over entire sole
What is breast tissue?
Thickness & size of breast tissue and areola, range from being small to full and budding
What is breast tissue like for the preterm & term newborn?
- Preterm = imperceptible
* Term = full areola (5-10 mm) budding
What is the eyes and ears parameters like for the ballard scale?
Eyelids can be fused or open and ear cartilage and stiffness determine the degree of maturity
What are the eyes and ears like for the preterm & term newborn?
- Preterm = lids loosely fused (fused until 26-28 weeks), ears do not fold/recoil as well (stiff)
- Term = more amount of ear cartilage with stiffness
What is the genital aspect of the ballard scale for male newborns?
Evidence of testicular descent & appearance of scrotum
What is the genitals like for the preterm, term, & post-term males?
- Preterm = smooth, flat scrotum, undescended testes (cryptorchidism)
- Term = covered with rugae
- Post = ↑ rugae, descended testes
What is the genital aspect of the ballard like for female newborns?
Appearance and size of clitoris and labia majora determine maturity
What is the genitals like for the preterm & term females?
- Premature = prominent clitoris with flat labia
* Term = clitoris covered by labia minora
What are the neuromuscular maturity aspects of the ballard scale?
- Posture
- Square window
- Arm recoil
- Popliteal angle
- Scarf sign
- Heel to ear
What is the posture aspect of the ballard scale?
How does the newborn hold his or her extremities in relation to the trunk?
What is the posture like for the preterm & term newborn?
- Preterm = limp
* Term = more flexed & resistance to movement
What is the square window aspect of the ballard scale?
How far can the newborn’s hands be flexed toward the wrist?
What is the square window like for the preterm & term infant?
- Preterm = not as flexible, > 90
* Term = 0 (flexible)
What is the arm recoil aspect of the ballard scale?
Evaluates the degree of arm flexion and the strength of recoil
What is the arm recoil like for the preterm & term infant?
- Preterm = sluggish recoil
* Term = immediate return to position
What is the popliteal aspect of the ballard scale?
How far will the newborn’s knees extend?
What is the popliteal angle like for the preterm & term infant?
- Preterm = little resistance, mostly straight
* Term = will resist & bend > 90*
What is the scarf sign aspect of the ballard scale?
How far can the elbows be moved across the newborn’s chest?
What is the scarf sign like for the preterm & term infant?
- Preterm = elbow reaches or nears opposite shoulder “scarf around throat”
- Term = does not cross proximate axillary line (doesn’t reach midline = mature)
What is the heel to ear aspect of the ballard scale?
How close can the NB feet be moved to ears? (Assess hip flexibility) less flexible = ↑ maturity
What is the heel to ear like for the preterm & term infant?
- Preterm = foot to ear practically w/ little resistance
* Term = less flexibility & more resistance
What are some physical assessment findings for skin in the newborn?
- Initially deep red/purple, turgor (quick), dry/soft/smooth = good hydration
- Cracks in hands & feet can be present, desquamation (peeling) = few days after birth
What are some nose & mouth assessment findings?
Symmetry, suck, intact soft & hard palate
What are some eye assessment findings?
No tears, random/jerky movements, pupillary reflex/red reflex present
What are some ear assessment findings?
- Ears – low set ears (downs syndrome)
* Should respond to voices & other sounds
What are some neck & chest assessment findings?
ROM & movement, auscultate (HR/breathing), breast nodules, chest smaller than head
What are some abdomen assessment findings?
Symmetry, rounded/protuberant, auscultate BS, umbilical cord (1 vein, 2 arteries= 3 vessels)
What are some assessment findings for the male genitalia?
No bulging, edema, discoloration (darkened scrotum)
What are some assessment findings for the female genitalia?
Engorged, edematous, pseudomenstration (vaginal discharge mucus/blood)
What are some abnormal assessment findings for both male & female newborns?
Anal fissure or fistulas, no meconium passed w/in 24 hours
What are some extremities & back assessment findings in the newborn?
- Hair tuff or dimpling (common problems)
* Palpate down spinal column (lumbar sacral)
What are some neurologic status assessment findings for the newborn?
- Muscle tone/reflex reaction (moro)
* Palpate fontanelle & assess for fullness or bulges
What are some alertness, posture, and muscle tone assessment findings in the newborn?
- Lying In curled-up position w/ arms & legs in moderate flexion,
- Resistant to extension of extremities
What are some reflex assessment findings of the newborn?
- Primitive Reflexes (involuntary)->disappear before 1 year
* Cough / Gag remain thru adulthood
What is Acrocyanosis?
o Cyanosis of hands/feet (NORMAL)-> only abnormal if central (mouth, color in general dusky)
What is Vernix caseosa?
o thick white “cheesy” substance, protects skin in-utero
What is Millia?
o Multiple white/pale yellow unopened sebaceous glands on nose-> disappear 2-4 weeks
What is Epstein’s Pearl’s?
o Epstein’s Pearl’s: milia in mouth “pear in gum”-> no intervention for either, do not pop
What are Stork bites/salmon patches?
o Superficial vascular areas on nape of neck, eyelids or between eyes.
o Fade by 1yr, redder w/ cry (most visible)
What is Erythema toxicum?
o Benign papular-pustule rash
What are Mongolian spots?
o Bluish spots on lower back, butt-> document location & presence
What is Harlequin sign?
o Dilation of vessels on 1 side of body, distinct midline demarcation
o Seen when there is a position change
What is Nevus vasculosus?
o Strawberry hemangioma: raised, rough, dark red & sharpy demarcated
o May darken, disappear/lighten by 3 years
What is Nevus flammeus?
o “port-wine stain”. Usually on face or head area. Permanent, flat on skin
o Do not fade, possible association w/ child cancers
What are fontanels?
Soft membranous gaps between skull bones
What are sutures?
Fibrous joints occurring only in the skull
What is molding?
o Elongated head shape d/t birth canal
What is Cephalhematoma?
o Localized effusion of blood beneath the periosteum of the skull & disruption of vessels
What is a cause of Cephalhematoma?
Prolonged labor & use of assisted devices
What are some characteristics of Cephalhematoma?
o Firm to touch
o DOES NOT CROSS SUTURE LINES ** – unilateral, doesn’t cross suture line/mid line
o Appears after 2-3rd day & lasts weeks (will be D/C with)
What are some possible side effects with Cephalhematoma?
o ↑ RF hyperbiliruemia* (RBC breakdown w/in hematoma), ↑ bilirubin & jaundice
What is Caput succedaneum?
o Localized soft tissue edema on scalp – serous drainage ( not blood)
What is a cause of Caput succedaneum?
Prolonged labor
What are some characteristics of Caput Succedaneum?
o CROSSES SUTURE LINES & NOT below bone
o Pitting edema, overlying petechiae and bruising in area
o Resolves 3-4 days w/o treatment
What are some newborn reflexes?
- Sucking
- Rooting
- Moro (startle reflex)
- Stepping
- Babinski-> (until 1 year)
- Grasp (palmer & plantar)
- Tonic neck (fencing reflex)
- Truncal incurvation reflex (Galant reflex)
- Gag and cough reflexes
- Remain through adulthood
When should the newborn be given the Hepatitis B vaccine IM?
Within 12 hours after birth
If mom has the HBsAg negative, how long may she defer the vaccine for?
1-2 month
If mom has the HBsAg positive, when should the vaccine be administered?
- Hep B dose 1 and HBIG (Hepatitis B immunoglobulin) within 12 hours of birth
- Both given before breastfeeding initiated
How many disorders does Florida screen for in newborns?
53
What are some common disorders that are screened for in newborns?
PKU, congenital hypothyroidism, galactosemia, Sickle Cell Anemia
When are newborns screened for these common disorders?
At least 24 hours after first feeding
When are newborns screened for hearing?
Before discharge-> (if parents refuse, then its not done)
How common is hearing loss for newborns in the US?
Hearing loss is the most common birth disorder in US
How do we screen for Critical Congenital Heart Defects in newborns?
o O2 readings of right hand & either foot-> 5% from each other (< 100% needs consult)-> 2 places
When do we screen for CCHDs, and how many disorders does it screen for?
Completed after 24 hours, screens for 7 CCHDs
What are safety considerations to educate the family on @ discharge?
- Car seat & crib
- Never leave unattended on bed or sofa (may fall)
- Choking hazards, toys from other siblings
- Hot bath water
- Co-sleeping
What are some sleep considerations to educate the family on @ discharge?
- Up to 15-20 hours per day->2-4 increments & do not sleep through night d/t stomach capacity
- On back for sleep, no pillows or fluffy animals
- No bottles in crib
What are hygiene considerations to educate the family on @ discharge?
Cord care & bathing->no baths until cord has fallen off, sponge bath until healed cord & navel has healed->
Diaper changes->WEAR GLOVES, cleanest area to the dirtiest, expose part being washed then cover
Barrier creams->protect the skin from diaper rashes
What are nutritional considerations to educate the family on @ discharge?
o Feeding (breast or bottle)-> q 2-3 hours, BF 1 st 6 months then introduce iron o How & when to introduce solid foods (refer to textbook) o Elimination patterns (6-12 wet diapers/day) & gaining weight
What are well-care considerations to educate the family on @ discharge?
o Frequency & schedule of pediatric visits-> 2-3 days after discharge
o Immunization schedule-> DTaP, Hib, Hep.B, RV, IPV, PVS
What are sick care considerations to educate the family on @ discharge?
o Recognize signs of illness
• Forceful, persistent vomiting (not just spitting up)
• Refusing feeds
• >2 green/watery diarrheal stools
• Infrequent wet diapers & change in BM from normal (↓ urination, diarrhea, ↓ BM)
• Lethargy or excessive sleepiness
• Inconsolable crying & extreme fussiness
• Abdominal distention
• Difficult/labored breathing (flared nostrils, absent breathing > 15 secs)
• Bleeding / purulent drainage from umbilical cord
• Eye drainage
• Jaundice, cyanosis
• How to take temperature
• When to call the HCP (fever > 100.4°F or 38°C)
What is PKU?
Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of protein
What is congenital hypothyroidism?
Deficiency of thyroid hormone necessary for normal brain growth, calorie metabolism, and development
What is galactosemia?
Absence of the enzyme needed for the conversion of the milk sugar galactose to glucose
What is sickle cell anemia?
Recessively inherited abnormality in hemoglobin structure, most commonly found in African American newborns
