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
What is difference between
-caput
-cephaehaematoma
-subgaleal haemorrhage
Caput
present at birth
oedema sitting above periosteum (crosses sutures)
generally doesn’t require treatment
cephaehaematoma
develops after birth
bleeding UNDER periosteum
does not cross sutures
subgaleal haemorrhage
bleeding into epicranial space and periosteum
boggy swelling
increases in size, head circumference, signs of shock
risk- vacuum delivery
- TRANSFER- if vital signs normal and HC stable / no ongoing bleeding
- EMERGENCY- if concern about baby’s vitals / bleeding/ HC increasing
what may a bulging fontanelle indicate
hydrocephalus (build up of CSF)
Intracranial haemorrhage
what is ankyloglossia
when is treatment warranted
tongue tie
when lingual frenulum is abnormally short or tight = restricted movement of tongue
“not very BF difficulty is due to tongue tie, and not every tongue tie causes a BF issue”
NOT recommended unless there is clear association with breastfeeding difficulty
MCNZ
* expects MW’s assess BF and make appropriate/timely referral for ankyloglossia
* allows MW ‘s that have competed training to carry out frenotomy
what happens to skin ph after birth
falls (becomes more acidic)
what is lanugo
what does it indicate
fine soft downy hair
more likely to be present if baby is preterm
what is vernix
what are it’s benefits
waxy cheese like substance on baby
antimicrobial + thermoregulation- leave in situ
what is acrocyanosis
transitory
bluish hands / feet
first 2-6hrs post birth
cause- delay for peripheral perfusion to be fully established
superficial capillary naevi
when do they go
stork bites
mainly go in 1st year
hyperpigmented macules
mongolian blue spots
usually fade over 1st year of life- some persist into adulthood
what are strawberry naevus
develop after birth - grow fast in first few months, then stop.
caused by overgrowth of cells
usually shrink over few years
what is erythema toxicum
small red lesions with white centre
rash can be extensive
1st week of life
NOT an infection -clears by itself
milia
exposed sebaceous glands on face - disappear after 4-6wks
p
petechiae
small pinpoint skin lesions- looks a bit bruised
disappear 48-72hrs
how/ when does the cord separate
what is best way to care for cord
cord separation
process of ‘dry gangrene’ Saprophytic action
can become quite sticky around hte base- should gently remove sticy material.
VERY small amount of dark blood may be seen
Any further discharge- blood / serous/ purpulent may indicate infection
redness at base usually infeciton
3-7days
clamp can come off 2-3 days
what is treatment for umbilical hernia
unless very large, closes spontaneously by 2-3yrs
when can you palpate kidneys
1st 24-48hrs
what is polydactyly
extra digits
what is single palmar crease associated with
Downsyndrome T21
What is inguinal hernia / mgmt
rx - consult
when do you consult for no pasage of mec
36hrs post partum
what is rx for undescended testes
primary
what is expected nappy output in 1st wk
day 1: 1 wet nappy / 1+ mec
2: 2 wet nappies / 3+ mec
3: 3 wet nappies /3+ transitional
5-7: 6-8 wet nappies / 3-5 yellow stools
what is traction response
when does baby have this
lifting baby up by hands, head lags behind
>37wks
asymmetric tonic neck reflex
when baby lies on their side- limbs on same side relax, limbs on other side flex
strong / present 30-36wks
moro reflex
(startle reflex)- responding to loud noise/ sudden lowering of head
stepping response
simulated walking
indicates mature extension/flexion mechanisms
Developmental dysplasia of hips
describe barlow and ortalani test
barlow
* test to see joint laxity / capability for joint to dislocate with ease
* procedure- lift leg and ADDUCT - testing whether head of femur slides over rim) -
“PALPABLE clunk
** ortalani
**examines for presence of dislocated hip”
procedure- ABDUCT
testing whether dislocated head can be slid back into acetabulum
palpable and audible CLUNK
what is general attitude to early signs baby is not well
- babies can become unwell very quickly
- they don’t show signs of illness the way adults do
- signs are often subtle- baby that has been feeding well, then stops feeding / persistent low grade jaundice
- LISTEN to mum if she is worried
metabolic screen
-can you use alcohol swab?
no -alcohol can affect accuracy of results
don’t warm foot with warm water/ warmed cloth
when is bed sharing associated with increased SUDI risk
evidence indicates it is the circumstances of bedsharing that lead to SUDI risk, not bed sharing itself
vulnerable baby (not breastfed, maternal smoking, premature, young age <3mths)
impaired mum (refent maternal alcohol / drug consumption / overtired)
physical environment (excess bedding, crowding)
what is management if baby has ‘sticky eyes’ in first week of life
most commonly related to inflamed tear duct
recommend
-regular cleansing of eye
gentle massage
few drops of breastmilk
if infection is suspected
- take swab for cultures + sensitivities BEFORE starting treatment
consider chlamydia if eye is red + inflamed, or infection doesn’t resolve quickly
Persistent pulmonary hypertension of newborn
what is it
signs
risk factors
Fetal circulation persists at birth
signs- cyanosis
Risk factors- antidepressants
asssssment-
monitor colour + breathing
mgmt
give oxygen, check pulse oximetry, call NICU
how do we assess risk of breastfeeding if mum is taking maternal psychotrophic meds
‘relative infant dose’ <10%
% baby receives s mum’s weight
what is ‘poor neonatal adaptation’
collection of symptoms seen in some babies exposed to (AD’s and antipsychotics)
poor feeding, vomiting diarrhoea
tremors, irritability, lethargy
hyper/hypotonia
instable body temp
tachyapnoea
hypoglycaemia
usually mild / self resolve in <72hrs
what are signs of baby exposed to benzodiazepines / opiates in trimester 3
hypotonia
hypothermia
respiratory depression
neonatal abstinence (tremors, feeding difficulty, irritability)
BUT NEVER ASSUME these signs are solely due to maternal medicine, they may also indicate baby is seriously unwell, so you need to investigate
what is FASD
what are signs
Fetal alcohol syndrome disorder
umbrella term for range of lifelong physical, cognitive and beavhiour impairments including Fetal alcohol syndrome)
signs:
- small eye openings
- thin upper lip
- flat midface
- absent/ elongated groover between upper lip and nose
- low birthweight
what is neonatal abstinance syndrome
sudden withdrawal of opiates
symptoms- irritability, hypertonia, tremores, feeding intolerance, respiratory distress
what is plantar reflex
press index under toes and toes curl inwards
what is babinski reflex
place finger on outer edge- toes splay outwards
How do we support baby born to drug dependent mother
expect baby to be normal, except likely SGA
Don’t necessarily need NICU
DON’T GIVE NALOXONE TO BABY AT RISK OF DRUG WITHDRAWAL (MUM HAS BEEN TALKING OPIOIDS)
Assessments
vital obs
wrap snugly
signs of withdrawal
tremors, irritability, hypertonicity + hyperactivity, vomiting, high pitched cry, maybe Resp distress
