Nelson - The Newborn Infant Flashcards
Initial examination of a newborn infant should be performed when
As soon as possible after delivery
After a stable DR course, a 2nd and more detailed examination should be performed within
24h of birth
Normal pulse in the neonate
120-160bpm
Normal RR in the neonate
30-60bpm
T/F Pulse oximetry is part of the routine screening for newborn infants
T
T/F An O2 sat more than or equal to 95% after 24h of birth in otherwise healthy appearing term infants has >99% sensitivity and specificity to rule out CHD
T
Which part of the PE should be done first in a relaxed quiet infant?
Palpation of the abdomen or auscultation of the heart
T/F Coarse, tremulous movements with ankle or jaw myoclonus is significant in newborns and should be worked up
F, More common and less significant in newborns than at any other age
T/F Convulsive twitching is normal in neonates usually occurring in a quiet state
T
When confined to 1 or more extremities of a female infant, edema may be the initial sign of
Turner syndrome
T/F Acrocyanosis is harmless cyanosis of the hands and feet especially when they are cool
T
Localized cyanosis is differentiated from ecchymosis by
Momentary BLANCHING pallor with cyanosis that occurs after pressure
T/F Postmature infants tend to have paler skin than premature infants
T
Skin finding in neonates that if large may trap platelets and produce DIC or interfere with local organ function
Cavernous hemangiomas
Slate-blue, well-demarcated areas of pigmentation called Mongolian spots are benign and tend to disappear within
1st year of life
T/F Tufts of hair over the lumbosacral spine suggest an underlying abnormality including tumors
T
What is erythema toxicum
Benign white papules on an erythematous base that develop 1-3 days after birth
Erythema toxicum persists for as long as
1 week
Erythema toxicum contain what cells
Eosinophils
A benign lesion predominantly seen in black neonates that contain neutrophils
Pustular melanosis
Pustular melanosis is present when and lasts until when
At birth until 2-3 days
T/F Pustular melanosis and erythema toxicum need to be distinguished from more dangerous vesicular eruptions
T
Normal size of the anterior fontanelle
20±10mm
A third fontanel suggests what chromosomal abnormality
Trisomy 21
T/F A third fontanel may be seen in premature infants
T
T/F Megalencephaly (excessively large head) may be familial
T
T/F Depression of the skull (indentation, fracture, ping pong ball deformity) is usually of prenatal onset
T
Atrophic or alopecia scalp may represent what congenital abnormality
Aplasia cutis congenita
T/F Möbius syndrome is associated with SYMMETRIC facial palsy
T
Absence or hypoplasia of the 7th nerve nucleus
Möbius syndrome
T/F Conjunctival and retinal haemorrhages in neonates are usually benign
T
T/F Retinal haemorrhages are more common in SVD than vacuum- or forceps-assisted deliveries
F, less common in SVD
T/F Retinal haemorrhages are usually bilateral, intraretinal, and in the posterior pole
T
Retinal haemorrhages resolve in most infants by
2 weeks of age
Retinal haemorrhages resolve in all infants by
4 weeks of age
A cornea >___cm in diameter in a term infant (with photophobia and tearing) suggests congenital glaucoma and requires prompt ophthalmologic consultation
1
T/F The presence of bilateral red reflexes warrants an immediate ophthalmologic consultation
F, WHITE reflex warrants an immediate ophthalmologic consultation
T/F the tympanic membrane in the neonate normally appears pearly white
F, dull gray
T/F Precocious dentition usually indicates extraction
F, not usually indicated
Temporary accumulations of epithelial cells on the hard palate on either side of the raphe
Epstein pearls
T/F Clusters of small white or yellow follicles or ulcers on erythematous bases found on the anterior tonsillar pillars warrant empiric treatment
F, clear without treatment in 2-4 days
T/F Neonates do not have active salivation
T
T/F Ankyloglossia is usually an indication for frenulotomy
F, rarely a reason for cutting
T/F Frenotomy may reduce maternal nipple pain and improve breastfeeding scores more rapidly than no treatment but over time neonates not treated with frenotomy also had successful feeding
T
T/F Suckling callus disappear when suckling ceases
T
T/F Throat of a newborn infant is hard to see
T, because of the low arch of the palate
T/F Neonatal tonsils are small
T
Shield-shped chest may be seen in what chromosomal abnormality
Turner syndrome
T/F RR should be counted for a full minute with the infant in the resting state, preferably asleep
T
T/F In premature infants, the RR is higher and fluctuates more widely
T
T/F An RR consistently greater than 60bpm that persists for more than 30 minutes is an indication to rule out pulmonary, cardiac, or metabolic disease etiologies
F, 60 minutes or 1 hour
T/F The breathing of newborn infants at rest is almost entirely nasal
F, diaphragmatic (during inspiration, the soft front of the thorax is usually drawn inward while the abdomen protrudes, producing a paradoxic movement)
T/F Paradoxic/diaphragmatic breathing always signifies insufficient ventilation and should be investigated
F
Expiratory grunting is benign if it resolves between ___ mins after birth
30 and 60 mins
Normally, breath sounds of neonates are vesicular
F, bronchovesicular
T/F Suspicion of pulmonary pathology in neonates should always be verified with a chest radiograph
T
Neonatal pulse is usually ___ bpm at rest, but may vary normally from ___bpm in relaxed sleep to ___bpm during activity
110-140, 90, 180
Pulse rate of SVT
> 220
Preterm infants usually have a higher resting HR up to ___
160bpm
The easiest and most accurate noninvasive method available for BP measurements
Oscillometric method
The normal liver is palpable as much as ___cm below the rib margin
2
T/F At no other period than the neonatal period does the amount of air in the GIT cry so much, nor is it usually so great under normal circumstances
T
T/F The intestinal tract is gases at birth
T
Gas is swallowed soon after birth, and gas should normal be present in the rectum on roentgenogram by
24 hr of age
The cause of most neonatal abdominal masses
Renal pathology
A solid flank mass clinically associated with hematuria, hypertension, and thrombocytopenia
Renal vein thrombosis
Abdominal distension at birth or shortly afterward suggests
Obstruction or perforation of the GIT often as a result of meconium ileus
Abdominal distension later after birth suggests
1) Lower bowel obstruction 2) Sepsis 3) Peritonitis
Abdominal wall defect that occur THROUGH the umbilicus
Omphalocele
Abdominal wall defect that occur lateral to the midline
Gastroschisis
Abdominal defect usually associated with other congenital anomalies and syndromes
Omphalocele
Anomaly of the umbilical cord associated with an increased risk for occult renal anomaly
Single umbilical artery
T/F A normal scrotum at birth is relatively large
T
Most neonates void by
12hr
Approximately 95% of preterm and term infants void within
24hr
99% of term infants and 95% of preterm infants pass meconium within
48hr
T/F Passage of meconium does not rule out an imperforate anus
T, a rectal-vaginal fistula may be present
