Newborn Flashcards
Purpose of newborn exam
Earliest possible detection of deviations, baseline for subsequent evaluations, parent counseling and assurance
Newborn exam indications
Immediately after birth, before discharge from maternity unit, any concern about infant progress
Newborn first exam
Apgar: Heart rate, respiratory effort, color, tone, reflex irritability – need discharge paperwork from hospital to get the score
Growth measurements
Weight when naked – use same scale each time. Length when straight. Head circumpherence take 3 measurements.
VS Newborn
HR 120-160, RR 40-60, Tem 36.5-37.5, BP
General skin exam
Pink normal. Acrocyanosis normal, cyanosis, bruises look blue, jaundice, erythema toxicum snork bites, mongolian spots collection of malnin, benign pustular melanosis
Erythema Toxicum
erythematous macules firm 1-3mm yellow or white papules or pustules, cause unsure, pustules contain eosinophils, appear first 3-4 days of life, range from birth to 2 weeks, benign self limiting
Impetigo Neonatorum
Vesicular, pustular, or bullous from day 2-2 weeks. Lesions occur in moist or opposing surfaces of skin, unroofed do not form crusts, treat with antibiotics
Mongolian spots
Most common in black infants, slate gray to blue black lesions, lumbosacral or butt, accumulation of melanocytes, fades by 7 years
Causes for a weak cry in infant
sepsis, asphyxia, metabolic, narcotic use
Causes for hoarsness
Hypocalcemia, airway injury
High pitch cry
CNS causes, kernicterus
Examine head and face
Shape of head, check fontanels, sutures, eyes, make sure nose is patent will sound congested from small passages, mouth lips make sure patent do a finger sweep, ears - low set = congitive delay if otic pit order kidney US since kidneys develop same week as ears, examine neck
Caput Succedaneum
2 words, 2 suture lines. Boggy edema across lines disapears in a few days
Cephalhematoma
Subperiosteal, weeks to resolve, does not cross lines
Head exam
Check circumferences, shape: molding, brachycephaly, flat occiput - back to sleep. widening of the suture may indicate thyroid issue, fontanels, auscultate head for bruit
Craniosynostosis
Premature closing of one or more cranial sutures, growth of the skull occurs parallel to the suture involved, early correction optimizese cosmetic appearance, can be part of Crouzon or Apert syndrome
Chest distress signs
Grunting, tachypnea, nasal flaring, asymetric chest rise, suprasternal intercostal retraction. Look for deformities like pectus excavatum or carinatum
Supernumerary Nipples
Males and females, pink or brown papules along the milk line on chest or abdomen. May contain breast tissue risk for neoplasia
Cardiac assessment
110-160, color, perfusion, central cyanosis, murmurs, single s1 split s2
Abdomen assessment
Scaphoid, distention, wall defect (gastroschisis), palpation kidneys are palpable, liver 2-3cm, spleen palpable, 2 artery 1 vein umbilicus, umbilical and inguinal hernias
Genitalia
size, assess for hypospadias, epispadias, testes for crypoorchid or hydrocele, gemale can have prominent clitoris and minora from positioning in utero, skuin tags, discharge/blood, labial fusion Check patency and location of anus
Hip and Extremities
erbs palsy: extended arm and internal rotation with limited movement. humerus fx. digital abnormalities – syndactaly, brachdactaly, polydachtaly, single palmar crease, hip dislocation - female, breach
Feet and back
Check curvature, sinus tract, tuft of hair
CNS
A&3, moving extremities, flexed body posture, minimal head lag, ventral suspension, vertical suspension
Neonatal reflexes
autonomic behaviors that do not require higher level brain function, provides info on lower motor neurons and muscle tone, protective and disapear as higher level functions emerge
Suck
stroke lips and mouth opens and sucking starts
Rooting
stroke cheek, infant moves head towards stimulus and opens mouth
Palmar grasp
place finger in palm, try to remove finger and tightens grasp
Tonic neck
fencing posture. rotate head from midline to one side baby will extend arm where head is turned and flex opposite arm, same w legs
Moro
hold baby so one hand supports head and the other supports buttocks, suddenly drop of the head in hand, response is hands open and extension and abduction of upper arms, then flexion of arms and audible cry
Stepping
touch top of feet to edge of a table while held upright makes stepping movements
Galant
trunk incurvation. Held in ventral suspension with chest in palm of hand, firm pressure applied to the baby side parallel to spine the response is flexion of the pelvis towards the side of stimulus
Babinski
stimulus to outer edge of foot plantar flexion and flexion or extension of toes
