Healthy Term Infant Flashcards
what is normal birth weight
2.5-4 kg
what weight is large for gestational age
over 4 kg
what is small for gestation age weight
under 2.5 kg
when is term
37-41 completed weeks
what is the daily weight gain in the 3rd trimester
24g
7g per day in the last 4 weeks
what is importantly transferred in the 3rd trimester
iron vitamins calcium phosphate antibodies
what is a cephalic presentation
vertex (head first)
what is the fetal environment like during contractions
hypoxic
fetal Hb helps release O2
what hormones enhance fetal adaptation during labour
cortisol and adrenaline
how does prolonged labour affect fetus
reduces fetal reserves (hypoxic environment during contractions)
summarise fetal adaptation
First breath/cry Alveolar expansion Change from foetal to newborn circulation Decreased pulmonary arterial pressure Increased PaO2
what score helps monitor fetal adaptation
apgar
what are the components of apgar
scored out of 10 (0,1 or 2 per component)
- HR
- RR
- responsiveness
- tone
- colour
what is a normal apgar score
> /= 8
do babies eat a lot in the first 24 hours
no have little calorific intake
what is haemorrhagic disease of the newborn
coagulation disorder in new borns due to vitamin K deficiency
what systems can haemorrhagic disease of the newborn cause
GI
lung
CNS- intracranial haemorrhage
what is given to prevent haemorrhagic disease of the newborn
vitamin K either IM or orally
what maternal infections convey a high risk of transmission to fetus
hep B and C HIV syphilis TB group B strep
what vaccinations do mothers get
pertussis and influenza
what is screened for at birth
Universal hearing screening Hip screening - clinical and USS Cystic fibrosis (immunoreactive tryptin screened for) Thyroid function testing (TSH measured) Haemoglobinopathies Metabolic disease (phenylketonuria (PKU) medium-chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU))
what does undiagnosed hypothryroidism in neonates have a direct link to
lowered intellect
when is the newborn exam done
generally around 24hrs of life
what is looked for in the babies head on newborn exam
occipital frontal circumference
overlapping sutures
fontanelles
ventouse/ forceps marks
moulding
cephalhaematoma (bruising between periosteum and spicranial aponeurosis - doesnt cross suture line, often looks like two little horns, can calcify)
caput succedaneum (swelling and oedema in outer layer of skin, often gone/ reduced n 12-14hrs)
what is the difference between caput succedaneum and cephalhaematoma
cephalhaematoma- doesnt cross suture lines, between epicranial aponeurosis and periosteum, can calify, often looks like two little horns
caput- can cross suture lines, beneath skin
what is looked for in the eyes in a neonate exam
size red reflex conjunctival haemorrhage squints iris abnormalities
what is the lack of red reflex in child presumed to be
cataract until proven otherwise
why is it important to screen for bilateral congenital cataracts
if missed until 8 week check up then vision unlikely to develop after Tx
if found at newborn scan and treated the good outcome for vision
what is looked for in ears on neonate exam
position
external auditory exam
tags/ pits
folding
(low set ears/ pits and tags can be sign of syndrome)
very important to ask about family Hx of early hearing loss
what is looked for in the mouth in a neonate exam
shape philtrum tongue tie palate neonatal teeth ebsteins pearls sucking/ rooting reflex
what can a smooth philtrum be a sign of
fetal alcohol syndrome
what can tongue tie affect
breast feeding
what can cleft palate go on to cause
problems for feeding, speech and hearing
what is the risk of neonatal teeth
aspiration- usually get dentist to take them out
what are ebsteins pearls
collections of skin cells which almost always go away
what is look for in the face in a neonate exam
facial palsy
dysmorphism
how do you tell which side of the face has a paly
the side that looks weird is the side that is fine- baby will be screwing eyes up and opening mouth to cry, eye that is open is side affected
what resp signs are looked for on neonate exam
chest shape nasal flaring grunting tachypnoea (>60) in drawing breath sounds
what cardio things are looked for in a neonate exam
colour/ saturation (SaO2) (CHD screening) femoral pulse apex thrills/ heaves heart sounds
what are components of tetralogy of fallot
pulmonary stenosis
large ventricular septal defect
overriding aorta
what is looked for on the abdomen in a neonate exam
does is move with respiration
distention
hernia
umbilicus
bile stained vomiting
passage of meconium - if none at 48 hrs big concern
anus - need to make sure its patent
gastroschisis- bowel comes out of abdo cavity
exomphelus- contents of the abdomen herniate into the umbilical cord through the umbilical ring, are contained within peritoneal membrane
what is looked for in the GU part of a neonate exam
normal passage of urine
normal genitalia
descended testes- if not by 6 months get op
hypospadius
what are the MSK parts of the neonate exam
movement and posture
limbs and digits
spine - spina bifida, sacral dimples
hip exam
what harness for DDH
pavlik for 2-4 weeks, frog leg position
how is DDH diagnosed
clinical exam and USS
what are the neurological component of the neonate exam
alert, responsive cry tone posture movement primitive reflexes
what are the primitive reflexes
sucking and rooting moro (startle) ATNR (fencing) stepping grasp
what skin things are look for in the neonate exam
birth marks
port wine stain (abnormality of blood vessels)
erythema toxicum (50% of babies get get, normal)
what health promotion is done for new parents
smoking, alcohol, drug use, diet social interaction feeding vaccination sleeping position baby box positive feedback and confidence parent child attachment community support
