Module 8: Newborn Flashcards
What is the best, preferred method of evaluating an infant?
Evaluations that cause the least disturbance should be done first.
What are two frequently obvious things in an infant?
Microcephaly or cranial enlargement is frequently obvious.
What is one sign typical of hydrocephalus?
If hydrocephalus is present, the forehead is often prominently protrusive (bossing).
What does normal flexion of all extremities indicate?
Good muscle tone! “BUFF BABY” :-) Trying to pull a little Hillary humor in my life here!
What does lack of flexion associate with? Excessive flexion?
Lack of flexion is associated with hypotonicity, whereas excessive flexion usually suggests hypertonicity.
What would you suspect if an infant will only flex one arm and keep the other straight?
If only one arm is consistently straight and the infant does not flex that extremity, brachial plexus injury must be considered.
Is acrocyanosis significant?
NO! It is normal and is usually seen in hands, feet, and circumoral area.
If a baby is having bilaterally identical, repetitive movements, is this normal?
No, Bilaterally identical, repetitive movements of the extremities are suggestive of seizure activity. Facial and eyelid twitches are also suggestive of convulsions.
What are normal movements for an infant?
Sporadic, well-coordinated movements that are not symmetrical.
What happens when a baby isn’t moving a certain extremity?
Absent or diminished movement of one extremity when the others are used normally is indicative of paresis or paralysis.
What are 3 obvious signs of respiratory issues when observing an infant?
Retractions, grunting, and stridor.
What can cause over expanded lungs in an infant?
Increased anteroposterior diameter of the chest (barrel chest) usually indicates an overexpanded lungs, which may be due to meconium aspiration or respiratory distress syndrome type 2.
What is a sign of cardiomegaly?
One side of the chest is larger than the other.
What should happen after the initial inspection?
With the infant supine, the abdomen should be palpated immediately. The examiner’s fingertips must be gently placed and held on the abdomen without exerting any downward pressure. Deep palpation should then proceed gradually.
When should the examination of the mouth and throat be performed?
Examination of the mouth and throat is performed as the last maneuver of the physical evaluation as it is the most agitating to the neonate.
Describe the body of the newborn:
- Cylindrical
- Head circumference slightly exceeds that of the chest. Avg. 33-35 cm with avg. chest 30-33 cm.
- Sitting height: Crown to rump=head circumference.
- In first few days of life, infant’s posture is result of position in utero.
What covers the infants skin at birth?
vernix caseosa, a pasty covering chiefly of dead cells and sebaceous secretions that protect the skin of the fetus (thank you webster dictionary). It gives the skin its blush, red smooth appearance right at birth.
Jaundice in a newborn between the 2nd and 3rd day that disappears by the 5th and 7th day is usually normal, but what about jaundice within 24 hours?
That is not normal and indicates further evaluation.
If a baby who was breech has a edematous and blue buttock, feet or legs, what is it indicative of?
Venous stasis
This is more commonly a sign of acute blood loss, hypoxia, or poor peripheral perfusion due to hypotension.
Pallor; Subcutaneous edema may mimic pallor.
What can cause ecchymoses in a newborn?
Ecchymoses are most frequently due to trauma during difficult labor or to brisk handling of the infant during or after delivery.
If a baby presents with petechia what would you expect?
Petechiae occur in a number of disease states involving thrombocytopenia and should always prompt an investigation including a sepsis workup and evaluation of the infant for TORCH infections.
Irregular areas of blue-gray pigmentation over the sacrum and buttock are what?
Mongolian spots. They are common in black infants and in infants of Asian and southern European lineage. Mongolian spots usually disappear by 4 years of age, or earlier.
Port wine nevi:
- Hemangiomas
- Mass of dilated capillaries in the superficial skin. –Dense concentrations of such dilated capillaries, which may be small and single or multiple and sparse.
- Color varies from pink to deep purple, and they are sharply demarcated.
- Port wine nevi over the face in a trigeminal distribution suggest Sturge-Weber syndrome (cerebral calcification and glaucoma on the same side as the lesions and hemiparesis on the opposite side)
Telangiectatic nevi is also called what?
- Stork bites
- flat, red, localized areas of capillaries that are considerably less dense than those seen in port-wine nevi.
- Easily blanched, they are commonly situated on the back of the neck, the lower occiput, the upper eyelids, and the nasal bridge.
- disappear by 2 years of age, but in many children they reappear evanescently during crying episodes.
When do strawberry hemangiomas appear?
- They first appear during the second or third week of life.
- bright red, flat spots which are 1–3 mm in diameter and blanch easily. Subsequently, they grow in all directions, protruding prominently from the skin surface. They may not reach their full size for 1–3 months. The temptation to remove these lesions should be resisted because they resolve spontaneously several weeks or months after reaching peak growth.
- Resolution is heralded by one or more pale purple or gray spots on the surface of the lesion, indicating spontaneous vascular sclerosis and obliteration.
Cavernous Hemangiomas
- subepidermal layer
- diffuse and less sharply demarcated than capillary hemangiomas.
- Color of the overlying skin may be normal or blue as a result of color transmission from subjacent blood.
- Spongy, but on occasion they are tight cystic masses.
- no other significance.
- resolve spontaneously in a few months to 1–2 years.
- Large cavernous hemangiomas are often associated with serious thrombocytopenia (Kasabach-Merritt syndrome).
What are mixed hemangiomas made of?
Mixed hemangiomas are common and are comprised of a superficial strawberry lesion that is continuous with a deeper cavernous one.
How many types of GBS are there?
TWO. Early onset that occurs the 1st week of life and Late-onset that occurs from the 1st week to 3 months.
What diseases are common with early onset?
Sepsis, Pneumonia, Meningitis.
Although seen with early onset, which disease is more commonly seen with late onset?
Meningitis.
What are the long term effects of an infant with GBS?
Deafness and developmental disabilities.
How many children die in the US from GBS?
4-6%
Which race is GBS higher among?
African Americans
How many infants get early onset GBS a year?
1200
What other complications can GBS cause?
Group B strep can also cause some miscarriages, stillbirths and preterm deliveries.
There are two gold standards in preventing early onset GBS. What are they?
- Testing all pregnant women for group B strep bacteria late in pregnancy (35-37 wks)
- Giving antibiotics during labor to women who test positive for the bacteria.
What happens if a woman tests positive?
To help protect their babies from infection, pregnant women who test positive for group B strep in the current pregnancy should receive antibiotics (medicine) through the vein (IV) during labor.
What do you do if a woman has GBS in their urine during pregnancy or has had a child with GBS disease?
They should receive antibiotics during labor; they do not need to be screened at 35-37 weeks because they should receive antibiotics regardless of the screening result.
What do you do if a woman doesn’t know if she has GBS or not?
When labor starts, they should be given antibiotics if they have:
- labor starting at less than 37 weeks (preterm labor);
- prolonged membrane rupture (water breaking 18 or more hours before delivery); or
- fever during labor.
Can you give antibiotics before labor?
NO, they only work during labor because the bacteria is so fast growing.
Which antibiotic is normally given for GBS?
PCN
Will giving an antibiotic in labor help prevent late-onset GBS?
NO. To date, receiving antibiotics through the vein during labor is the only proven strategy to protect a baby from early-onset group B strep disease. There is no prevention for late onset GBS.
What are the S/S of GBS?
- Fever
- Difficulty feeding
- Irritability, or lethargy (limpness or hard to wake up the baby)
- Difficulty breathing
- Blue-ish color to skin
How is GBS tested and diagnosed?
Group B strep disease is diagnosed when the bacteria are grown from samples of a baby’s sterile body fluids, such as blood or spinal fluid. Cultures can take a few days to grow. For both early-onset and late-onset disease, if the doctors suspect that a baby has group B strep infection, they will take a sample of the baby’s blood and spinal fluid to confirm the diagnosis.
