Lecture 3: Newborn Exam Flashcards
What is the purpose of the prenatal visit?
Finding the right pediatrician
What are the 4 general aspects of newborn history?
- Prenatal visits
- Review of Prenatal history
- Review of Delivery history
- Newborn history
What 3 things make up newborn history?
- Maternal and paternal medical Hx
- Maternal past OB Hx
- Current antepartum and intrapartum Hx
Define antepartum, intrapartum, and post-partum.
- Antepartum: occurring prior to delivery
- Intrapartum: occurring during delivery
- Postpartum: occurring up to 6 weeks post delivery
When is the Hep B vaccine indicated for newborns?
All newborns, starting in 1st month
What is the newborn treatment if the mother is HBsAg+?
Baby: HBIG + HBV (opposite legs)
What is the recommendation regarding breastfeeding for HIV+ mothers?
Do not breastfeed
When is APGAR measured?
1 minute and 5 minutes post birth.
What does APGAR stand for?
- Appearance
- Pulse
- Grimace (reflex irritability)
- Activity
- Respiration
0-10, exact same scales as HEART
What is the Dubowitz/Ballard Exam?
Evaluation of newborn physical and neurological characteristics.
6 signs of each, estimating gestational age.
What is generally the best indicator of gestational age?
LMP
When is the Ballard postnatal assessment performed and what does it look at physically?
- Performed 30-42 hours of age.
- Testable on any infant from 20-44 weeks.
- Looks at plantar creases.
When might a newborn/pediatric assessment be performed without any parent present?
Suspicion of abuse
What qualifies as sudden infant death syndrome? (SIDS)
Sudden death of a previously healthy baby prior to age 1, MC during sleep.
Thought to be due to an immature brain forgetting to breathe.
What are the risk factors for SIDS?
- Born with hydrocephalus
- Low birth weight
- Respiratory infections
- Sleeping on stomach/side
- Sleeping on soft surface
- Co-sleeping
- Overheating (term babies have normal temp regulation)
- Males between 2-4m
- Pre-term
- Secondhand smoke
- Sibling who died of SIDS
What is the ideal sleeping situation for a newborn?
- On their back with a firm mattress
- Only a simple blanket, no pillows or blankets or stuffed animals.
- In parent’s room but in crib for the first 6m
- Pacifier
What 3 things are measured for every infant exam for a growth curve?
- Ht
- Wt
- Head circumference
What is normal skin for a newborn?
Pink and uniform
Yellowness = abnormal in first 24h
What parts of an infant are commonly blue?
Extremities. Acrocyanosis is NORMAL, but central cyanosis is ABNORMAL.
When is cutis marmorata/marbled skin commonly seen?
Seen in about half of infants.
More common in Down syndrome.
Rewarming should eliminate it.
What is vernix caseosa?
Waxy/cheesy film present on newborn to protect from infection.
Left on for 24 hours to help!
What is lanugo?
- Light fine hair covering baby.
- Earlier it appears, the hairier they are.
- Disappears over time
What are the 4 normal skin “rashes” in newborns?
- Erythema toxicum
- Newborn acne
- Milia
- Sebaceous gland hyperplasia
What is erythema toxicum?
- Small vesicular rash commonly due to eosinophils that resolves within weeks.
- First appears 2-5 days postbirth.
What is acne neonatorium?
- Newborn acne around 2-4 weeks age
- Closed comedones that resolve on their own.
- Probable etiology: maternal hormones.
What is milia?
- Tiny, white, epidermal cysts made of keratin.
- MC on face, resolving in 2-4 weeks.
- Epstein’s pearl is milia on the roof of the mouth.
What are hemangiomas?
- Large vascular birth marks
- Grow rapidly, but tend to resolve by age 9.
What might prompt us to treat a hemangioma?
- Visual/hearing/rectal/vaginal/nasal/airway obstruction
- If very large, could cause cardiac decompensation.
What is a nevus simplex?
- “Stork bite”
- Light red macule
- MC on neck, upper eyelid, between eyebrows.
What is nevus flammeus/port wine stain?
- Dark red macules on body with thick, dilated vessels.
- If found on ophthalmic branch of Trigeminal, 25% have sturge weber syndrome
What is sturge weber syndrome associated with?
- Vision problems (glaucoma)
- Brain angiomas
What is congenital dermal melanocytosis?
- “Mongolian spot”
- Darkish blue birthmark on lower back/butt
- Found on darker skinned babies
- Lasts for years
What might make cafe au lait spots suspicious?
More than 6 that are > 0.5cm = diagnostic criteria for NF1
What happens to heads in vaginal births vs breech births?
- Vaginal: Elongation of head
- Breech: Narrow face and head
What is hydrocephalus?
Enlargement of ventricles due to increasing ICP.
What are the possible underlying mechanisms for hydrocephalus?
- Malformations
- Dandy walker malformation
- Arnold chiari malformations
- Overproduction of CSF
What might suggest hydrocephalus upon exam?
- Sunsetting eyes
- Enlarged head measurements
What is the tx for hydrocephalus?
VP shunt
Where are the two fontanelles located?
Anterior and posterior
Anterior closes at 9-24m
Posterior closes first at 2-3 months
What does a bulging fontanelle suggest? Depressed?
- Bulging: ICP
- Depressed: Dehydration
What is caput succedaneum?
- Swelling of scalp due to mechanical pressure on head during vaginal birth
- Resolves 2-3 days after usually with a cap.
- Extends past suture lines, presenting as squishy edema
What is cephalohematoma?
- Subperiosteal hemmorhage
- Soft like a cyst, but DOES NOT CROSS SUTURE LINES
- Takes weeks to resolve
Caput vs cephalohematoma
What are craniotabes?
- Abnormal thinning of parietal bones in preterm babies
- MC seen along parietal bones
- Should disappear in a few weeks.
What is a subgaleal hematoma/hemorrhage?
Complication during vacuum assisted delivery that is due to rupture of emissary veins and accumulation of blood in the epicranial aponeurosis.
What is pierre robin syndrome and how is it treated?
- Life-threatening congenital abnormality
- Short jaw, cleft palate, airway obstruction
- Failure of mandible growth
- Treated by lower jaw surgery.
What might suggest facial nerve palsy at birth?
Crying with an asymmetric face
Just observation
What is a common eye finding in newborns that requires no treatment?
Subconjunctival hemorrhage
What is given to all newborns in their eyes and what does it prevent?
Erythromycin ointment in all eyes to prevent chlamydia infection.
Prevent blindness.
What might cataracts at birth suggest?
- Metabolic disease
- Congenital infection
- Thyroid issues
How does glaucoma present in a newborn?
- Tearing
- Tight eyelids
- Photophobia
What is the proper way to check red reflex in a newborn?
- 6 inches away
- every visit for first 3 years
- Lack thereof = immediate referral to oph.
- White reflex = leukoria = referral
What is a retinoblastoma?
- Rapidly developing eye tumor due to immature retinal cells.
- Highly curable if caught early.
- Presence of leukoria = refer to oph IMMEDIATELY.
What is dacryostenosis and management?
- Blocked tear duct
- MCC of tearing and discharge from eye
- Should not cause redness.
- Self-resolving within 6 months.
Redness would suggest dacryocystitis
What is acute dacryocystitis and management?
- Infection of tear duct
- Redness, warmth, swelling of area
- Staph A MCC.
- Can lead to orbital cellulitis!
- Consult oph and probe.
What is choanal atresia and treatment?
- Back of nose is not connected to pharynx, so they can only breathe through their mouth.
- Newborn will suffocate when fed.
- Need surgery to open area.
What are natal teeth and the management?
- Weak teeth with poor rotos that present on birth
- Removable but associated with multiple syndromes.
What is oral thrush and the management?
- White coating inside mouth/tongue that is not scrapable
- Due to yeast infection and requires antifungal
- Boil all nipples and pacifiers while treating.
How is appropriate ear placement determined in a newborn?
Inner canthus to eye perpendicular to vertial axis of head.
canthus = where upper and lower eyelids meet
What are preauricular pits and management?
- Little hole in the front of ear
- Common, but more likely to have permanent hearing loss
- Rarely needs fixing.
- Newborns all get hearing tests.
- Perform a renal US if found with other craniofacial abnormalities
What is normal respiratory rate for a newborn?
30-60 BPM
If a baby has poor LE pulses, what congenital heart defect might this be?
Coarctation of the aorta
If an abdominal mass is felt in a newborn, what is the most probable etiology?
Kidney anomaly
What might an imperforate anus suggest for a newborn?
Missing or blocked.
What abdominal organs can be felt in a newborn easily?
- Liver
- Spleen
- Kidneys
What are the S/S of a diaphragmatic hernia?
- Tachypnea
- Tachycardia
- Cyanosis
Often diagnosed prenatally and fixed surgically.
MC: left side
What is an infected umbilical area called?
Omphalitis
Who is an umbilical hernia MC in?
African Americans
How do we manage an umbilical hernia?
- Self-resolving usually within 3-4 months
- Surgery consult if not resolved by 3 years
What is an umbilical granuloma?
- Friable granulation tissue commonly seen at belly button.
- Silver nitrate used to cauterize area.
What is leukorrhea?
Vaginal discharge in female infants
What is the main thing to check for in male infants?
Presence of both testicles in scrotum.
Cannot retract foreskin so penis cant be checked well.
What is congenital hip dysplasia?
- Head of femur not fitting into hip socket well.
- Due to socket being shallow
- MC in left hip, girls, firstborns, FHx, breech, multiples
Untreated will cause limp and osteoarthritis of hip
Check via US due to lack of bone density
What two maneuvers to check for hip socket fit?
- Barlow: Adduct hip and push
- Ortolani: Abduct hip and pull
What is the management for congenital hip dysplasia?
Pavlick harness
What is the most common fracture in a newborn?
Clavicular fracture
How does a clavicular fx present in a newborn and what is the management?
- Difficult vaginal delivery
- Crepitus, swelling, crying, abnormal bone contour
- Immobilize with a sling if desired.
- No surgery to fix.
What are the risk factors for clavicular fracture in a newborn?
- Shoulder dystocia
- Post-term
- Induced birth
- High birth weight
What are the primitive reflexes?
- Sucking reflex: nipple or pacifier in mouth
- Rooting reflex: turn to side of facial stimulation
- Palmar grasp (by 28 wks)
- Babinski: outward fanning normal under 2yo
- Moro/startle: Head drop will cause baby to abduct arms and extend, then adduct and flex.
What is a tonic neck reflex?
- Turning of head will cause extension of ipsilateral leg and arm.
- Contralateral flexion of leg
- “Fencing position”
- GONE BY 8 MONTHS
What is a traction reflex?
- Pulling a baby from sitting position by the hands will cause it to have lag when moving its head, which goes midline and then flex forward.
- Infant will eventually help.
What nerve plexus is the most commonly injured during delivery?
Brachial plexus
What kind of maneuvers cause brachial plexus injury?
- Pulling on shoulders during head first delivery
- Pressure on baby’s raised arms during feet first delivery
How is brachial plexus injury managed?
- Massage + ROM exercises
- Surgery is rarely needed
- 3-6 months of obs.
What is a sacral dimple?
- Small hole/dimple in the gluteal folds near tailbone.
- Only considered abnormal if large or hair or lumpy
- Associated with spina bifida occulta or tethered cord
