neonate neuro test 2 Flashcards
what is a APGAR score!
Universal method to assess status of newborn after birth
Used to assess newborn response to transition/resuscitation
what is not do the score APGAR
Not used to predict morbidity and mortality
Not used to make diagnoses
what are the parts of the APGAR score
appearence (pink good +2)
pulse (fast good above 100 = +2)
grimace (cry good +2)
activity (flexed good +2)
respirations (cry good robust +2)
normal axillary temp
36.1°C - 37 °C or (97 °F - 98.6 °F)
normal respiratory rate
30 - 60 /min
Oxygen takes ____ to reach normal levels
10 minutes
heart rate awake?
120-160
fever?
Fever is ≥ 38°C (100.4°F) obtained rectally
heart rate alseep?
80-90
blood pressure?
Blood pressure varies by gestational age, birth weight, chronological age
what is the new ballard score!!!
used to estimate the gestational age of a newborn based on 6 physical and 6 neurologic criteria
how do you add up the score to equal gestational age?
score plus 2! so a score of 40 = 42 weeks
what is the physical criteria of ballard score (maybe to indepth)
skin, lanugo hair, plantar surface of the foot, breast, eyes and ears, and genitalia
What is the new ballard score neuro criteria (maybe to indepth)
posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear
what do you measure with posture?
flexion
what do you measure with square window?
angle between palm of hand and forearm with wrist held in full flexion
what do you measure with arm recoil?
by the angle of flexion at the elbow created by the position that the forearm returns to from full extenstion
what do you measure with popliteal angle?
Flex thigh onto abdomen fully and then extend at knee. The score is determined by the angle of extension at the knee
what do you measure with Scarf sign?
The score is determined by the degree to which the elbow can be easily pulled across the chest toward the opposite shoulder:
what do you measure with heel to ear? (baby contortionist)
With infant supine, bring the anterior surface of the thigh toward the mattress alongside the infant’s trunk. Support the thigh with one hand, while using your other hand to stretch the foot toward the ipsilateral ear.
palpable ridge over a suture line that persists for longer than two to three weeks after birth is concerning for?
craniosynostosis
results from edema of the scalp due to pressure of the presenting part of the head against the cervix. Swelling crosses sutures lines. Resolves in day
Caput succedaneum
this is not associated with caput succedaneum
cranial bleeding
results from bleeding into the potential space between the periosteum and skull. Swelling does not cross suture lines. Resolves in weeks.
Cephalohematoma
what is torticollis
presents as the top of the head tilted toward one shoulder
what does torticollis cause
deformational plagiocephaly (cranial flattening from an infant always laying a particular way on her head)
how is torticollis treated
PT
what new deformity doesTurner Syndrome and Down Syndrome cause
Redundant skin/webbing. like the spitting dinosaur from Jurassic park
what does hemivertebra cause
Congenital scoliosis
what do you look for to indicate possible spinal biffida
sacral dimple, hemangioma, nevus, skin tag, or hair tuft
what is a sacral dimple not associated with if midline, located ≤2.5cm from the anus, visible base, less than 0.5 cm in diameter, no other midline skin lesion present
spina bifida occulta
what is spina bifida occulta
(vertebrae malformed)
what is meningocele
(vertebrae malformed and meningeal sac protruding
what is myelomeningocele
(vertebrae malformed and both the meningeal sac and spinal cord are protruding)
what are normal sacral findings (2 of them)
Lanugo hair and Mongolian spots (pigmented birth mark) are normal sacral skin findings
what are 4 abnormal levels of alertness
Mild stupor (lethargy)
Moderate stupor
Deep stupor
Coma
(diminished reaction to noxious stimuli)
what does to little of resistance to passive stretch indicate?
hypotonia
what does to much resistance to passive stretch indicate?
hypertonia
what do asymmetric movements indicate?
weakness
what movements can be mistaken for seizure?
Non-sustained jitteriness and tremulousness
Choreoathetoid movements of the hands
Migrating myoclonus during sleep
Facial twitching during sleep
how do we test muscle strength?
Ventral suspension
Vertical suspension
Stepping
Stepping
(pelvic girdle strength)
Vertical suspension
(shoulder girdle strength)
Ventral suspension
(neck and back strength)
Newborn can lift and plant her feet on a flat surface when held above it in a standing position
Stepping
describe Ventral suspension
Newborn can lift his head and hip gurdle in line with his trunk for a couple of seconds while suspended ventrally
– Newborn can be held upright by her axilla with no support for her feet without slipping through the examiner’s hands (A = normal strength, B = weakness)
Vertical suspension
how to test CN XI (accessory nerve) – Sternocleidomastoid and trapezius muscle functions
cannot be assessed in newborns
how to test CN VIII (vestibulocochlear nerve) –
Hearing is assessed by startling or blinking to a loud noise. Balance cannot be assessed in newborns
how to test CN III, IV, VI (oculomotor, trochlear, and abducens nerves) –
Observe the spontaneous eye movements.
Assess eye muscle function using the Doll’s Eye Phenomenon (vestibular-ocular reflex).
what is the Doll’s Eye Phenomenon (vestibular-ocular reflex).
Moving head to the right causes both eyes to deviate to the left, and vice versa. Can also be performed in the vertical direction. Eye movements should be conjugated and full
t/f It is normal for newborns to intermittently cross their eyes,
t
how far can they see
about 12 inches, the length needed to breastfeeding successfully.
blind as a bat or a mole, or well a blind person
Successful feeding (sucking and swallowing) requires intact functioning of what CN’s
CN 5, 7, 9, 10, 12
CN V (trigeminal nerve) – Facial sensation is tested how
assessed by the infant turning his head to the side of the face being stroked
CN VII (facial nerve) – Facial motor function is assessed by
sucking ability (dylan has a very prominent facial nerve), symmetry of the nasolabial folds, and being able to tightly close the eyes while crying.
what is CN IX and X (glossopharyngeal and vagus nerves) needed for
Both nerves are needed for normal swallowing, palatal movements and gag reflex.
what is CN X needed for
normal vocalization and crying
what is CN XII (hypoglossal nerve) needed for –
Responsible for normal tongue movements.
Deviation of the tongue to one side indicates what?
ipsilateral CN 12 palsy.
Atrophy and fasciculation of the tongue are seen in what?
Type 1 Spinal Muscular Atrophy
what deep tendon reflexes do we check?
Masseter reflex Biceps reflex Brachioradialis reflex Patellar reflex Ankle clonus – 5 to 10 beats is normal Extensor Babinski is normal
how to test Masseter reflex –
Tapping the mandible just beneath the lower lip causes the open mouth to close
how to test Patellar reflex –
Tapping the quadriceps tendon below the patella causes extension at the knee
how to test Babinski
normally extensor in newborns (upgoing great toe and fanning of the other toes)
how to test Brachioradialis reflex –
Tapping the radial aspect of the forearm causes slight flexion and radial deviation at the wrist and slight supination and flexion at the elbow
how to test ankle clonus
5-10 beats of ankle clonus is normal in a newborn. Elicit ankle clonus by swiftly dorsiflexing the foot
what are newborn reflexes controlled by?
basal ganglia, brainstem and spinal cord (there are so many cards!!!!)
name all the reflexes
Gallant reflex rooting reflex grasp reflex sucking reflex asymmetric tonic neck reflex moro reflex
when do reflexes start and stop
Present at birth and disappear by 4-6 months of age
inhibited by cerebrum
is it normal for these reflexes to go past 6 months?
hellllll no…. not good
describeMoro reflex –
Sudden dropping of the head in relation to the trunk causes abduction and extension of the arms and opening of the hands, followed by flexion
describe Rooting reflex –
Tactile stimulation near the infant’s mouth causes the infant to turn her head and move the mouth in search of food
describe Sucking reflex –
Infant will suck on objects placed in the mouth, including a gloved finger, which can be soothing to the newborn during the exam
describe Asymmetric tonic neck reflex –
When the newborn is supine, turning her head results in ipsilateral extension of her arm and leg and contralateral flexion (a fencing posture
describe Palmer grasp reflex –
Newborn’s hand reflexively closes on an object placed in the palm
describe Gallant reflex –
Stroking the paraspinous muscles causes the infant’s trunk to curve toward the ipsilateral side
what is seen with normal sensory function?
infant moves when lightly touched and withdrawals from painful or noxious stimuli
what are the 5 s’s
Suck Swaddle Shush Swing Side or stomach
what is behavior an indication of?
cortical functioning
how is behavior assessed?
Habituation
Consolability
what is Habituation –
Newborns should stop startling to a loud noise repeated 4 or 5 times
what is Consolability –
Upset newborns should be consoled by sucking, swaddling, shushing, swinging, side-lying or stomach position.
Newborns with neurologic dysfunction are difficult to console
t/f APGAR is done at 1 and 5 minutes of life
true
t/f 10 is the highest APGAR score
true
acrocyanosis is normal?
what is acrocyanosis?
yes it is
blue hands and feet
the next 6 questions are about new ballard:
how is skin ranked from low to high score
decreased translucency and increased wrinkling of the skin
lanugo from low to high score
decreased lanugo
foot from low to high score
more creases and size increases to greater than 50 mm
breast tissue low to high score
larger and more well defined
ear and eye low to high score
loss of fusion of the eyelids and firming of the pinna of the ear
genital male low to high score
increased rugae and pendulousness of the scrotum
genital female low to high score
formation of the labia minora and then the labia majora
what are examples of noxious stimuli
gentle shaking ( but tell the parents no baby shaking) gentle pinching,
perioral stroking,
noise,
shining a light in the eyes (you dick)
what are choreoathetoid movements and are they normal
circling at the wrist (invisible hand job)
yes invisible hand jobs are normal
Biceps reflex
Tapping the biceps tendon causes flexion at the elbow elbow
