Healthy term infant Flashcards
Define what a term baby is
- This is a baby born after 37+0 wks & < 41+6 wks
- Considered pre-term if before this and post-term if after this
What is the normal weight range of a newborn ?
- 2.5 - 4kg
- Considered LGA if >4 and SGA if < 2.5
What happens to the weight of a baby during the 3rd trimester ?
Its weight dramatically increases:
- Average male at 28 weeks = 1150g, 3.5% fat
- Average male at term = 3550g, 15% fat
Transplacental transfer of what occurs during the 3rd trimester ?
Iron, vitamins, calcium, phosphate & antibodies
When the baby is born light, tough and temp all help stimulate what?
The change from fetal to newborn circulation
Why should you be wary of hypoxia when carrying out the initial assessment of a baby ?
Because labour is a hypoxic environment
What is used to assess a newborn baby?
APGAR score
When is the APGAR score used and what does it objectively measure ?
Used at min 1&5 following birth as an objective measurement of perinatal adaptation
What do you assess when carrying out the APGAR score and what is a normal score ?
Scored out of 10, with ≥ 8 being normal
After initial assessment of the baby using APGAR score, you want to wrap the baby up to keep them warm & feed them (establish breastfeeding) & establish attachment.
List the important things to be done following APGAR score assessment
- Ensure skin to skin contact - important for emotional development
- Prophylactic IM Vit K given - to prevent haemorrhagic disease of the newborn (caused by Vit K deficiency)
- Mother will have been screened during pregnancy for Heb B, HIV, Syphilis & Hep C - so will know if extra precautions, vaccinations or prophylactic treatment is needed
- Monitor baby with newborn early warning chart (essentially NEWS chart for a newborn)
- Snuggle bundle
- BCG only given if risk of TB exposure
What vaccinations may mothers get given ?
Pertussis & influenza (should already be vaccinated in the UK)
What will babies born to mothers with Hep B recieve at birth ?
Hep B vaccination
What does the 6-in-1 vaccination consist of ?
diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B vaccinations
Routine vaccination protocol - what is the first potential vaccination someone will recieve and when ?
BCG at birth - if risk factors e.g. recent travel or e.g. TB in the family in the past 6 months
Routine vaccination protocol what is the first (sometimes second if BCG) vaccinations someone will recieve and when ?
Done at 2 months:
- 6-1 vaccine
- Oral rotavirus vaccine
- Men B
Routine vaccination protocol what is the second vaccinations someone will recieve and when ?
Done at 3 months:
- 6-1 vaccine
- Oral rotavirus vaccine
- PCV
Routine vaccination protocol what is the third vaccinations someone will recieve and when ?
Done at 4 months:
- 6-1 vaccine
- Men B
Routine vaccination protocol what is the forth vaccinations someone will recieve and when ?
Done at 12-13 months:
- Hib/Men C
- MMR
- PCV
- Men B
Routine vaccination protocol what is the fifth vaccinations someone will recieve and when ?
Done annually between ages 2-8:
- Flu vaccine
Routine vaccination protocol what is the sixth vaccinations someone will recieve and when ?
Done at 3-4 years:
- ‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
- MMR
Routine vaccination protocol what is the seventh vaccinations someone will recieve and when ?
Done at 12-13 years old:
- HPV vaccination
Routine vaccination protocol what is the 8th vaccinations someone will recieve and when ?
Done between ages 13-18:
- ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
- Men ACWY
What screening tests should a newborn undergo?
- Have a universal hearing screening before discharge
- Hip screening - clinical (burlow & ortalani) +/- USS
- Newborn head to toe exammination when born and a formal one around 24hrs
- At about 5 days they have a blood heel spot test to screen for a number of diseases
What is screened for on the blood heel spot test ?
- Cystic fibrosis
- Congenital hypothyroidism
- Sickle cell disease
- 6 metabolic conditions; Phenylketonuria, Medium-chain acetyl CoA dehydrogenase deficiency (MCADD), Maple syrup urine disease (MSUD), Isovaleric acidaemia (IVA), G;utaric aciduria type 1 (GA1), Homocytinuria (HCU)
What are the main components of the newborn exammination which are assessed?
- Head
- Eyes
- Ears
- Mouth
- Face
- Resp
- Cardio
- Abdo
- Genitourinary
- MSK
- Neuro
- Skin
What is checked when assessing the head during the newborn exammination?
- OFC
- Fontanelles (ant & post) & sutures - if bulging its a sign of increased ICP), sunken may be a sign of dehydration
- Checking for signs of trauma e.g. cephalohaematoma
What is checked when assessing the eyes during the newborn exammination?
- Red reflexes (absent in cataracts & retinoblastoma)
- For squints
- Iris abnormalities
- Conjunctiva
- Size of pupils
What is checked when assessing the ears during the newborn exammination?
- Shape, position
- Tags/pits
- External auditory canal
What is checked when assessing the mouth during the newborn exammination?
- Check palate intact - by sticking finger in and feeling roof of mouth
- Sucking/rooting reflex (when finger in mouth)
- Teeth
- Tongue
- Philitrum
- For cleft palates
What is checked when assessing the face during the newborn exammination?
- Any signs of facial nerve palsy (impaired at birth)
- Dysphorphism - signs of congenital disease
What is checked when assessing the Resp system during the newborn exammination?
- Resp exam
What is checked when assessing the cardiovascular system during the newborn exammination?
- Cardio exam
- For pulses simply checking the femoral are both intact
What is checked when assessing the abdomen during the newborn exammination?
- Check for hernias - umbilical most common in infants
- Check if meconium has past (should in the first 24hrs)
- Abdo distension
- Abdo exam
What is checked when assessing the genitourinary system during the newborn exammination?
- Normal passage of urine
- Normal genitalia
- Descended testes
- Hypospadius
What is checked when assessing the neuro system during the newborn exammination?
- Alert, responsiveness
- Cry
- Tone, movement
- Posture
- Primitive reflexes; sucking & rooting (already done), monros, ATNR, stepping, grasp
What is checked when assessing the MSK system during the newborn exammination?
- Movement & posture
- Spine exam (this is when you pick baby up and use fingers to check the spine seen in pic)
- Limbs & digits
- Hip exam (barlow & ortalani)
What is checked when assessing the skin during the newborn exammination?
Check for any deformities
