management and exam of the healthy neonate Flashcards
90% of apgar scores are between
7-10 and require no further assistance
normal respiratory rate
40-60 if above then troublesome
feeding and early weight loss of neonate
early and often no more than 3 hours apart bc can’t keep BG up on their own
up to 10% weight loss is acceptable in most situations
weight usually regained within 2 weeks
what is the best way to do an initial assessment of the baby
wactch it and listen to it
what kind of breathing does baby do
diaphragmatic see saw respirations
if baby looks okay then probably normal
what would be an abnormal respiratory finding
retractions or singing
what color is good of baby and which are the worst
pink = good
blue
mottling/pallor
and grayish hue
- these 3 bad
acrocyanosis
blue discolor of perioral area, feet and hands
normal within first 24 hours
central cyanosis
when abnormal
blue tongue/mucus membranes
if persists after the first 10 mintues of life then this is abnormal
think cardiac or pulmonary disease
does cyanosis or bruises blanch
cyanosis, turns white when pushed on
jaundice in the first _____ is of concern
24 hours
what does grayish hue/color mean
severe acidosis
poor outcome
seen in infections and cardiac disease
what does a high pitched cry mean
cns head trauma and or substance withdrawal
finding a white red reflex means what
tumor, trauma, rop, need urgent referral
red reflex in darker skinned infants
may be more pearly gray, vessels still present
disconjugate gaze should be gone by why
age 4 months
what do you look for in ears
if they are low set
choanal atresia mnemonic
when can they become cyanotic?
CHARGE
coloboma, heart defect, atresia choanne, retarded growth/development, genital abnormalities, ear abnormalities
may be cyanotic when not crying
micrognathia is part of
pierre-robin sequence
natal/neonatal teeth signifigance
if they are loose then they need to come out
what is an epstein peral
epithelial cysts, collagen in the mouth
excess skin at the base of the neck is common in
down syndrome
normal hr in newbork
100-160
checking pulses
check femoral and branchial simultaneously to see if they are equal
what does absence of murmur during ausculataion mean?
nothing, still can have pathological structural problems
babies and murmors
most have murmurs which is usually innocent
if loud murmur then further investigation
scaphoid abdomen seen with
diaphragmatic hernia
full upper abdomen with a flattened lower abdomen means
proximal obstruction or atretic lesion
which is covered gastroschisis or omphalocele?
gastroschisis
oh shit that is not covered (omphalocele)
extreme distension of the abdomen at birth or shortly after think what?
____ abdomen = bad
pathology, taut
meconium ileus
ascites
volvulus
bowel sounds not there is bad
when palpating baby abdomen what position do you want them in?
legs flexed
umbilical vessels and abnormality
usually 2 arteries and 1 vein
single artery is normal varient but if also have any other abnormal (not really sure bc she didn’t say in lecture) is of concern
cephalohematoma
what is it
where does it spread
how long till goes away?
what can mask it?
subperiosteal blood
do not cross suture lines
weeks to months for resolution
can be hidden under caput succedaneum
caput succedaneum
what is it
location
resolution
boggy area of edema or bruising that crosses suture lines, gone in days, present at birth
what is the least common but most dangerous extracranial injury
lots of blood loss
enlarges after birth
crosses suture lines
fluid wave
can cover entire scalp and extend in to the neck
subgaleal hemorrhage
dimples separate from the gluteal crease
think what
and do what
spinal dysraphism (tethered cord) US by 3 months
extremity important fact
what test done
re examine the hips before discharge bc can pick up new abnormality that was not seen before
barlow and ortolani test
genitalia emergency
if ambiguous genitalia then endocrinologic emergency
CAH
femal with mucous (ocassionally bloody) discharge
common and a parental concern
labial mass or mass in the groin maybe
a hernia
consider ectopic gonad
hymenal tags are rare or common
common
the average penis is about ____
2.5 cm, (hung AF)
epispadias
what and location
dorsal meatal opening
hypospadias
what and location
ventral meatal opening
2% of newborn males are cryptorchid and what usually happens
most resolve by 3 months
if not down by 9-12 months then surgeon eval
absence (imperforate) anus is often associated with what
VATER
verterbral defects, VSD
anal atresia
T-E fistual/esophageal atresia
Radial dysplasia
what is vernix
white cheesy stuff that babies have all over, appears 35 weeks and gone by 41 usually
flea bite syndrome
benign rash of newborn
patches or pustules that move around = normal
1-2 mm white firm papules on face and bridge of nose
what happens
milia
go away on own
benign
dermal melanosis
look like bruises
mainly on dark skin individuals?
what must you always do with these?
slate gray spots
document them
