Nb Exam Flashcards
What is objective of red eye reflex exam
What referral for abnormal Rer?
Obj
Confirm clarity of len
Confirm presence of retina
Referral- consult
when is surfactant produced
~32 wks
embryology
state what each layer of embryonic cells becomes
endoderm
mesoderm
ectoderm
trophoblast
epiderus
endoderm- epithelium
mesoderm- muscle
ectoderm - nervous system
trophoblast- placenta
epiderus- nuchal crest
When do fetal structures change during extra uterine transition?
- 1st breath reduces pulmonary resistance. Lung expansion opens lungs. Deoxygenated blood goes to lungs
- Oxygenated blood returns to left atrium- increases pressure = foramen ovale closes
(note closure may be incomplete in first 24-48 hrs- and heart murmurs maybe heard. Anatomically closes1yr
3 ductus arteriosis- triggered to close by increase in oxygen + prostaglandins Functionally closed by 8-10hrs but may not anatomically close for several mths
4) ductus venosus- First to close - closes relative to umbilical blood flow
what are 4 ways to lose heat
conduction (heat loss when having direct contact)
evaporation (when water evaporates from skin)
convection (fan - move air or water molecules across skin
radiation (e.g.heat loss to surrounding colder solid object not directly in contact with skin)
what are urates - what is normal
pink / brick red staining on nappy
common / normal in first few days, but after few days, it may indicate dehydration
What could (unexpectedly) low or raised temp signal?
What is referral
GBS infection
Consult (temperature instability)
Jaundice
What are indicators it may be pathological
Jaundice develops <48hrs old
Baby is sleepy, feeding poorly, reduced urine output
Jaundice persisting 7-10 days (should decline over this period)
Sclera/ blanched gums indicate yellow
What are referrals for jaundice
<24 hrs- transfer
SBR >250 in 48hrs- consult
sBR >300 any time- consult
Prolonged / >150 in first 2 wks - consult
Significant jaundice previous baby- consult
Vitamin k deficiency bleeding
Cause
timing
Risks
Signs
Baby needs vitamin k to produce clotting factors
Vit k synthesised In intestine by bacteria- requires feeding to be established
Types
Early <48hrs
Classic 2-7
Late 1wk- 6mths
Risk factors
Premature
Birth trauma/ asphyxia/ cephaehaematoma/ known hepatic disease
Mum is on anticoagulants, anticonvulsant/ antibiotics / anti turbuculosis
Signs
Bleeding, bruising
Not feeding
Prolonged jaundice
brown fat
describe glucose regulation for nb
NORMAL for BGL’s to fall in first 2-6hrs ( transient period of hypoglycaemia + active ketogeneisis)
then rise slowly / steadily over next 24hrs
Signs of neonatal hypoglycaemia
often vague / non-specific
jitteriness
cyanosis
apnoea
weak cry
lethargy
floppy
refusal to feed
neonatal response to SSRI’s
normal weight loss in nb
<10% normal.
@ 7%, assess feeding
@10-12.5% consult
>12.5% Transfer
regain birth weight by 10-14 days
Signs that baby is full term
- flexed limbs (preterm are extended)
- ear returns to normal when folded
- cartilage / curves of pinna are complete
- there are creases over whole of sole of foot in first 12hrs
- genitalia well developed (testes descended)
- scarf sign (crossing arm across midline)- elbow doesn’t reach midline
- plantar creaes
*
describe normal neonatal breathing patterns
rate
rhythm
chest/abdo movement
nose
sound
colour
rate- 30-60 rpm
rhythm- regular + irregular periods, apnoea <20 sec
chest/abdo movement- SYNCHRONISED diaphram + abdo movements (NOT in-drawing)
nose- breathing through nose - no nasal flaring
sound- silent (no grunting)
colour- pink (not pale / cyanosis)
what are rales + rhonchi ?
what causes these
what do you do?
rales- discontinous clicking / rattling
ronchi- continous rattling (“snoring”)
caused by lung fluid not yet absorbed. Shoud clear after 1 hr.
mgt
if baby is full term / healthy + alert, with normal resp+ HR–> recheck in 15mins, and monitor every 15mins until they go.
CONSULT IF these persist, or other signs of respiratory distress
(pale/ cyanosis, tachycardia, - tachyapnoea, lethargy, poor tone)
What are the 4 listening positions
ALL - aortic
PRACTITIONERS- pulmonic
TAKE -tricuspid
MONEY- mitral
what are heart murmurs?
what is mgmt? (Incl. referrals)
are they a reliable measure of cardiac anomalies
heart murmurs- Sounds that may be heard due to abnormal valves/ defects
most NB’s have soft murmurs that are transient and not associated with anomalies
if you hear a heart murmur at initial exam but no symptoms (colour, poor feeding, resp rate), CONSULT
usually you reassess at 24hrs and it passes within 1st week
if you hear heart murmor WIth Symptoms- TRANSFER
many serious cardiac malformations are silent - observe for general symptoms (colour, resp, feeding behaviour, muscle tone)
what is referral for persistent / recurrent cyanosis
transfer
what is referral for persistent tachycardia
consult
what is referral for absent femoral pulse
consult
what is hypoxaemia?
what is referral
<90% oxygen sat
Consult (may indicate congenital heart defect, or other respiratory / infections that may be causing hypoxaemia)
What are neonatal reasons for emergency
CNS
* convulsions
* unresponsive
* limpness / hypotonic (with abnormal vital signs/ other abnormality)
* severe infant depression at birth (1min Apgar ≤6 and litte improvement at 10mins)
HAEMATOLOGY
* neonatal subgaleal haemorrhage- with concerns about babys vitals/ongoing bleeding/ head circumferance Increasing
RESPIRATORY
* apnoea (stop breathing for >20secs and needs resus)
what is purpose of pulse oximetry
what are referrals
to detect hypoxaemia (low oxygen saturation levels) caused by congenital heart disease in NB before onset of symptoms
note- congenital heart disease is most common group of congenital malformations
≥95% = “PASS”
90-94% = “inconclusive”- repeat 3 times then consult
<90% oxygen sat- CONSULT
what is definition / referral for microcephaly
HC <3rd percentile
CONSULT
