Healthy Term Infant Flashcards
post term definition?
> 41 weeks
normal, over and under weight?
normal = 2.5-4kg over = >4kg under = <2.5kg
average weight of male baby at 28 weeks?
how does this change?
1150g, 3.5% fat
will be around 3550g, 15% at term
= 24g weight gain per day (7g fat per day)
why is labour dangerous?
hypoxic environment during contractions
foetal Hb helps release O2
prolonged labour = reduced foetal reserves
placental insufficiency
growth restriction or excess
increased cortisol and adrenaline enhances adaptation
what important changes must occur after birth?
first breath/cry > alveolar expansion > change from foetal to newborn circulation > decreased pulmonary arterial pressure > increased PaO2
apgar score
early/immediate skin to skin and suckling
what is apgar score?
objective measure of perinatal adaptation score out of 10 0, 1 or 2 per component - HR - Resp rate - responsiveness - tone - colour normal = 8+
most important things to consider immediately after birth?
keep warm
feed (skin to skin contact helps establish breast feeding, dramatic change from continuous glucose in utero)
attachment
what is haemorrhagic disease of the newborn?
clotting disorder to do with vit K deficiency
can cause haemorrhage
how is haemorrhagic disease of the newborn managed?
vit K (IM or oral)
what infections are babies at risk of?
hepatitis B (can vaccinate if maternal history)
hepatitis C (dont need to stop breastfeeding if RNA is low)
HIV (can breastfeed if viral load undetectable)
syphilis
TB
group B strep
vaccinations are all mothers given?
maternal pertussis and influenza
baby vaccinations?
routine schedule
hep B at birth if needed
BCG first month?
what are newborns screened for?
CF haemoglobinopathies thyroid function metabolic disease - all via blood spot test hip screening - clinical and US scan universal hearing screening
what metabolic diseases may be picked up on blood spot screening?
PKA medium chain acyl-CoA dehydrogenase deficiency maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria HCU
newborn examination after birth?
midwife does top to toe examination immediately after birth
formal neonatal examination done by higher qualified practitioner at around 24 hrs
what is looked for on head in neonatal examination?
OFC
moulding of head
overlapping sutures
cephalohaematoma (subperiosteal haematoma in periosteum between skull and epicranial aponeurosis)
fontanelles
caput succedaneum (swelling between skin and epicranial aponeurosis)
ventouse/forceps marks
2 main head deformities to know about?
cephalohaematoma
- unnatural buldge on babies head
- within suture lines
caput succedanum
- scalp swelling over under the skin across midline and suture lines in baby;s skull
- not bound by suture lines?
how are cephalohaematoma and caput succedanum managed?
usually self resolve
what is looked for in eyes on neonatal examination?
size red reflex (absence can indicate cataract) conjunctival haemorrhage squints (frequent) iris abnormality
risk of congenital cataract?
blindness
need light hitting the retina is needed to develop visual pathways
what is looked for in ears on neonatal examination?
position (low set ears can indicate edwards syndrome )
external auditory canal
tags/pits
folding
be aware of family history of hearing loss
what is looked for in the mouth on neonatal examination?
shape and thickness of mouth/lips
philtrum (long can indicate foetal alcohol syndrome)
tongue tie
palate (cleft etc)
neonatal teeth
ebsteins pearls (benign white pearly areas at joins of palate, gums etc)
sucking/rooting reflex
what facial features are looked for on neonatal examination?
facial palsy
dysmorphism (foetal alcohol, downs syndrome etc)
signs of resp distress on neonatal examination?
chest shape nasal flaring grunting tachypnoea (>60) in-drawing breath sounds
cardio signs on neonatal examination?
colour/saturation (SaO2) - CHD screening pulses (femoral) apex beat heaves and thrills heart sounds - common to have transient murmur - persistent murmur can indicate tetralogy of fallot (pulmonary stenosis)
abdominal features on neonatal examination?
moves with respiration
distension (acute abdomen eg due to volvulus)
hernia
umbilicus (infection here can be very dangerous)
bile stained vomiting (obstruction)
passage of meconium
anus (ensure patent)
GU features on neonatal examination?
normal passage of urine
normal genitalia
undescended testes
hypospadias
MSK features on neonatal examination?
movement and posture limbs and digits spine - spina bifida hip examination - DDH etc
neurological features on neonatal examination?
alert/responsive crying tone posture movement primitive reflex
what are the primitive reflexes?
suck rooting moro ATNR stepping grasp
skin features on neonatal examination?
port wine stain
haemangioma
mongolian growth spot (looks like a bruise on back/buttocks)
erythema
