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OB/Peds > Gestational Age & Newborn Assessment > Flashcards

Gestational Age & Newborn Assessment Flashcards

1
Q

What does the Dubowitz/Ballard Scoring Tool assess?

A

Estimates Gestational Age* based on physical & neuromuscular maturity

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2
Q

When is the Dubowitz/Ballard Scoring Tool used?

A

o Performed w/in 24 hours after birth, if stable-> not done if micropremie/ intervention needed

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3
Q

What are the physical maturity aspects of the Dubowitz/Ballard Scoring Tool?

A
  • Skin texture
  • Lanugo
  • Plantar creases
  • Breast tissue
  • Eyes and ears
  • Genitals
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4
Q

What can the skin texture be like for the newborn?

A

sticky & transparent to smooth, varying degree of peeling & cracking, to parchment-like or leathery

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5
Q

What is the skin texture like for the preterm & term newborn?

A
  • Preterm = sticky, friable, transparent

* Term = leathery, cracked, wrinkled (less vernix as older)

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6
Q

What is lanugo?

A

Soft downy hair on body (shoulders & upper back)

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7
Q

What is lanugo like for the preterm & term newborn?

A
  • Preterm = none

* Term = mostly bald

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8
Q

What are plantar creases?

A

Creases on soles, range from absent to covering the entire foot

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9
Q

What are plantar creases like for the preterm & term newborn?

A
  • Preterm = heel-toe (40-50 mm) (< 40 mm)

* Term = creases over entire sole

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10
Q

What is breast tissue?

A

Thickness & size of breast tissue and areola, range from being small to full and budding

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11
Q

What is breast tissue like for the preterm & term newborn?

A
  • Preterm = imperceptible

* Term = full areola (5-10 mm) budding

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12
Q

What is the eyes and ears parameters like for the ballard scale?

A

Eyelids can be fused or open and ear cartilage and stiffness determine the degree of maturity

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13
Q

What are the eyes and ears like for the preterm & term newborn?

A
  • 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
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14
Q

What is the genital aspect of the ballard scale for male newborns?

A

Evidence of testicular descent & appearance of scrotum

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15
Q

What is the genitals like for the preterm, term, & post-term males?

A
  • Preterm = smooth, flat scrotum, undescended testes (cryptorchidism)
  • Term = covered with rugae
  • Post = ↑ rugae, descended testes
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16
Q

What is the genital aspect of the ballard like for female newborns?

A

Appearance and size of clitoris and labia majora determine maturity

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17
Q

What is the genitals like for the preterm & term females?

A
  • Premature = prominent clitoris with flat labia

* Term = clitoris covered by labia minora

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18
Q

What are the neuromuscular maturity aspects of the ballard scale?

A
  • Posture
  • Square window
  • Arm recoil
  • Popliteal angle
  • Scarf sign
  • Heel to ear
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19
Q

What is the posture aspect of the ballard scale?

A

How does the newborn hold his or her extremities in relation to the trunk?

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20
Q

What is the posture like for the preterm & term newborn?

A
  • Preterm = limp

* Term = more flexed & resistance to movement

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21
Q

What is the square window aspect of the ballard scale?

A

How far can the newborn’s hands be flexed toward the wrist?

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22
Q

What is the square window like for the preterm & term infant?

A
  • Preterm = not as flexible, > 90

* Term = 0 (flexible)

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23
Q

What is the arm recoil aspect of the ballard scale?

A

Evaluates the degree of arm flexion and the strength of recoil

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24
Q

What is the arm recoil like for the preterm & term infant?

A
  • Preterm = sluggish recoil

* Term = immediate return to position

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25
Q

What is the popliteal aspect of the ballard scale?

A

How far will the newborn’s knees extend?

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26
Q

What is the popliteal angle like for the preterm & term infant?

A
  • Preterm = little resistance, mostly straight

* Term = will resist & bend > 90*

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27
Q

What is the scarf sign aspect of the ballard scale?

A

How far can the elbows be moved across the newborn’s chest?

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28
Q

What is the scarf sign like for the preterm & term infant?

A
  • Preterm = elbow reaches or nears opposite shoulder “scarf around throat”
  • Term = does not cross proximate axillary line (doesn’t reach midline = mature)
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29
Q

What is the heel to ear aspect of the ballard scale?

A

How close can the NB feet be moved to ears? (Assess hip flexibility) less flexible = ↑ maturity

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30
Q

What is the heel to ear like for the preterm & term infant?

A
  • Preterm = foot to ear practically w/ little resistance

* Term = less flexibility & more resistance

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31
Q

What are some physical assessment findings for skin in the newborn?

A
  • Initially deep red/purple, turgor (quick), dry/soft/smooth = good hydration
  • Cracks in hands & feet can be present, desquamation (peeling) = few days after birth
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32
Q

What are some nose & mouth assessment findings?

A

Symmetry, suck, intact soft & hard palate

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33
Q

What are some eye assessment findings?

A

No tears, random/jerky movements, pupillary reflex/red reflex present

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34
Q

What are some ear assessment findings?

A
  • Ears – low set ears (downs syndrome)

* Should respond to voices & other sounds

35
Q

What are some neck & chest assessment findings?

A

ROM & movement, auscultate (HR/breathing), breast nodules, chest smaller than head

36
Q

What are some abdomen assessment findings?

A

Symmetry, rounded/protuberant, auscultate BS, umbilical cord (1 vein, 2 arteries= 3 vessels)

37
Q

What are some assessment findings for the male genitalia?

A

No bulging, edema, discoloration (darkened scrotum)

38
Q

What are some assessment findings for the female genitalia?

A

Engorged, edematous, pseudomenstration (vaginal discharge mucus/blood)

39
Q

What are some abnormal assessment findings for both male & female newborns?

A

Anal fissure or fistulas, no meconium passed w/in 24 hours

40
Q

What are some extremities & back assessment findings in the newborn?

A
  • Hair tuff or dimpling (common problems)

* Palpate down spinal column (lumbar sacral)

41
Q

What are some neurologic status assessment findings for the newborn?

A
  • Muscle tone/reflex reaction (moro)

* Palpate fontanelle & assess for fullness or bulges

42
Q

What are some alertness, posture, and muscle tone assessment findings in the newborn?

A
  • Lying In curled-up position w/ arms & legs in moderate flexion,
  • Resistant to extension of extremities
43
Q

What are some reflex assessment findings of the newborn?

A
  • Primitive Reflexes (involuntary)->disappear before 1 year

* Cough / Gag remain thru adulthood

44
Q

What is Acrocyanosis?

A

o Cyanosis of hands/feet (NORMAL)-> only abnormal if central (mouth, color in general dusky)

45
Q

What is Vernix caseosa?

A

o thick white “cheesy” substance, protects skin in-utero

46
Q

What is Millia?

A

o Multiple white/pale yellow unopened sebaceous glands on nose-> disappear 2-4 weeks

47
Q

What is Epstein’s Pearl’s?

A

o Epstein’s Pearl’s: milia in mouth “pear in gum”-> no intervention for either, do not pop

48
Q

What are Stork bites/salmon patches?

A

o Superficial vascular areas on nape of neck, eyelids or between eyes.
o Fade by 1yr, redder w/ cry (most visible)

49
Q

What is Erythema toxicum?

A

o Benign papular-pustule rash

50
Q

What are Mongolian spots?

A

o Bluish spots on lower back, butt-> document location & presence

51
Q

What is Harlequin sign?

A

o Dilation of vessels on 1 side of body, distinct midline demarcation
o Seen when there is a position change

52
Q

What is Nevus vasculosus?

A

o Strawberry hemangioma: raised, rough, dark red & sharpy demarcated
o May darken, disappear/lighten by 3 years

53
Q

What is Nevus flammeus?

A

o “port-wine stain”. Usually on face or head area. Permanent, flat on skin
o Do not fade, possible association w/ child cancers

54
Q

What are fontanels?

A

Soft membranous gaps between skull bones

55
Q

What are sutures?

A

Fibrous joints occurring only in the skull

56
Q

What is molding?

A

o Elongated head shape d/t birth canal

57
Q

What is Cephalhematoma?

A

o Localized effusion of blood beneath the periosteum of the skull & disruption of vessels

58
Q

What is a cause of Cephalhematoma?

A

Prolonged labor & use of assisted devices

59
Q

What are some characteristics of Cephalhematoma?

A

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)

60
Q

What are some possible side effects with Cephalhematoma?

A

o ↑ RF hyperbiliruemia* (RBC breakdown w/in hematoma), ↑ bilirubin & jaundice

61
Q

What is Caput succedaneum?

A

o Localized soft tissue edema on scalp – serous drainage ( not blood)

62
Q

What is a cause of Caput succedaneum?

A

Prolonged labor

63
Q

What are some characteristics of Caput Succedaneum?

A

o CROSSES SUTURE LINES & NOT below bone
o Pitting edema, overlying petechiae and bruising in area
o Resolves 3-4 days w/o treatment

64
Q

What are some newborn reflexes?

A
  • 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
65
Q

When should the newborn be given the Hepatitis B vaccine IM?

A

Within 12 hours after birth

66
Q

If mom has the HBsAg negative, how long may she defer the vaccine for?

A

1-2 month

67
Q

If mom has the HBsAg positive, when should the vaccine be administered?

A
  • Hep B dose 1 and HBIG (Hepatitis B immunoglobulin) within 12 hours of birth
  • Both given before breastfeeding initiated
68
Q

How many disorders does Florida screen for in newborns?

A

53

69
Q

What are some common disorders that are screened for in newborns?

A

PKU, congenital hypothyroidism, galactosemia, Sickle Cell Anemia

70
Q

When are newborns screened for these common disorders?

A

At least 24 hours after first feeding

71
Q

When are newborns screened for hearing?

A

Before discharge-> (if parents refuse, then its not done)

72
Q

How common is hearing loss for newborns in the US?

A

Hearing loss is the most common birth disorder in US

73
Q

How do we screen for Critical Congenital Heart Defects in newborns?

A

o O2 readings of right hand & either foot-> 5% from each other (< 100% needs consult)-> 2 places

74
Q

When do we screen for CCHDs, and how many disorders does it screen for?

A

Completed after 24 hours, screens for 7 CCHDs

75
Q

What are safety considerations to educate the family on @ discharge?

A
  • Car seat & crib
  • Never leave unattended on bed or sofa (may fall)
  • Choking hazards, toys from other siblings
  • Hot bath water
  • Co-sleeping
76
Q

What are some sleep considerations to educate the family on @ discharge?

A
  • 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
77
Q

What are hygiene considerations to educate the family on @ discharge?

A

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

78
Q

What are nutritional considerations to educate the family on @ discharge?

A 
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
79
Q

What are well-care considerations to educate the family on @ discharge?

A

o Frequency & schedule of pediatric visits-> 2-3 days after discharge
o Immunization schedule-> DTaP, Hib, Hep.B, RV, IPV, PVS

80
Q

What are sick care considerations to educate the family on @ discharge?

A

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)

81
Q

What is PKU?

A

Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of protein

82
Q

What is congenital hypothyroidism?

A

Deficiency of thyroid hormone necessary for normal brain growth, calorie metabolism, and development

83
Q

What is galactosemia?

A

Absence of the enzyme needed for the conversion of the milk sugar galactose to glucose

84
Q

What is sickle cell anemia?

A

Recessively inherited abnormality in hemoglobin structure, most commonly found in African American newborns

OB/Peds (7 decks)

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