Newborn Flashcards
1
Q
Newborn Overview
- M_____ Health History
- F_____ History
- G___ and D_____
- S____ History
- I_____/Newborn/H_____ Screening
- F_____/St____/Sl____
- Ph____ Exam
- Newborn and Maternal S____
- C____
- Anticipatory _____
A
- Maternal
- Family
- Growth, Development
- Social
- Immunizations/Hearing
- Feeding/Stooling/Sleep
- Physical
- Safety
- Colic
- Guidance
2
Q
Maternal Health History
- P___natal, L and D
- OB information such as -a__, gr_____ (# of preg), p____, full/pre-___, spontaneous/elective ____, l____ children, b___ type, R_, G____ age (weeks, days), Estimated date of ____ (EDC), medication use
- Prenatal Care, Complications, Illness, Admit reasons, Health problems (DM, HTN, Depression), Covid exposure
- Serology - Group B Beta ____ (abx tx), Chl____, ___ B surface antigen, H _ _, VDRL (____), R____
- Birth History/Hospital Course, ROM, A_____ scores
- Mother and baby’s ____ tpye, C____ +/-, Umbilical cord has __ arteries and _ veins
A
- Prenatal
- age, Gravida, parity, term, abortion, living, blood, Rh, Gestational age, confinement
- Strep, Chlamydia, Hep B, HIV, Syphilis, Rubella
- APGAR
- blood, Coombs, 2 arteries, 1 vein
3
Q
Additional History
- Immunizations in hospital (1)
- Passed h_____ and c____ screening
- F____ history
- S_____ history (including t____, vaping, marijuana use in home and g___ in home)
A
- Hep B
- hearing, cardiac
- Family
- Social (tobacco, guns)
4
Q
Newborn Screening
- > 40 ______ conditions
- www.wadworth.org/programs/newborn/screening/screened-disorders
A
- metabolic
- State driven, state funded - on diff metabolic conditions babies are tested for*
- Using blood blot testing*
- MYS must be done on day 2*
5
Q
Growth and Development (Bright Futures)
- Developmental milestones: regards face, lifts head when ___, ____ movements of extremities
- Social-emotional: smells breast ____, hears v____, see’s best __-__ inches away, responds to t____
- Communicative: learns to anticipate and trust world through parent’s c____- and pre____ care (feeding, sleeping patterns)
- Physical Development: 1st month-environmental changes, lears to s___, swallow, breath while e___, patterned sleep, control of movements
A
- prone, equal
- milk, voices, 6-8, touch
- consistency, predictable
- sucks, eating
In general, mostly reactive, bilateral movements expected - if not maybe fracture?
6
Q
Erickson’s Psychosocial Development
-
Phase 1: Birth - 1.5 years
-
____ vs _____
- trust through ____ behavior in comfort, feeding, tactile stimulation
-
____ vs _____
A
Trust vs. Mistrust
Consistent
7
Q
Piaget’s
Cognitive/Sensorimotor Development: Birth-18/24m
- Infant’s progress from ____ behaviors (sucking, rooting, grasping, crying) to simple r____ acts to im_____ activity
- Stimuli to the five _____ are the tools through which the baby responds to the environment (ex. crying when hungry, mother places nipple in infants mouth)
- After infants start crawling, standing, and walking, their increased physical mobility leads to increased _____ development
A
- reflex, repetitive acts, imitation
- senses
- cognitive
8
Q
Sigmund Freud:
Psychosoexual Theory
- Freud believed that personality developed through a series of childhood stages in which the p____ seeking energies of the id* become focused on certain er____ areas
- ____ stage: 0-1 yr. Mouth is vital for eating, infant derives pleasure from oral stimulation through tasting and sucking. Bc totally dependent on caretakers for feeding, infant develops sense of trust and comfort through oral stim.
- *Unconscious psychic energy that works to satisfy basic urges, needs, and desires
A
- pleasure, erogenous
- Oral Stage
Focused on the babie’s mouth
9
Q
Parenting Skills
- Need to feel s_____
- Are much happier and more predictable when parents respond q____ and eff_____
- There are c_____ differences in child rearing
- No ____ way to do things, many ways work
- R_____ parenting
A
- secure
- quickly, effectively
- cultural
- one
- Responsive
10
Q
Feeding/Stools/Sleep
- Feeding t___, how m___, how o____
- Breast milk from b____, ex____, or both?
- F_____ type, how pr_____ (# of s____ to water; instruct parent to always add ____ first, then ____ powder)
- E_____ - stools, color, consistency, amount, urination
- S____ - how long (usually __-__ hrs of sleep), what p_____, f___ surface, anything in c___?
A
- type, much, often
- breast, expelled
- Formula, prepared, scoops, water first then formula powder)
- Elimination
- Sleep, ~16-18, position, firm, crib
11
Q
Diapers of the Breastfed Baby
- The baby’s poop should change color from ____ to ____ during the first __ days after birth
- Poop can look s___, w____
- Illness, injury, or allergies can cause ____ in poop. Call doctor
- By day 4, most breastfed babies make around __-__ poopy diapers every day
- On day 1 or 2 some babies have ____ or __ pee
- By day 3-4, breastfed babies should make __-__ wet diapers with pee that looks like ____ (3 tbs)
A
- black to yellow, 5 days
- seedy, watery
- blood is bad
- 3-4
- red/orange pee at first
- 3-4, water like pee
12
Q
Classification of newborn by weight and gestational age
- HBW > _____ gm
- NBW (normal): ___- < ___ kg
- LBW < ______ gm
- VLBW < _____ mg
- ELBW (extra low) < _____ gm <750 gm ILBW
- Females ___-___kg, ave 3.5 kg (7lb 12oz)
- Males ___-___kg ave 3.6 (8lb)
- Term =
- Premature =
- Late Preterm =
A
- >4000
- 2.5-4 kg
- <2500
- <1500
- <1000
- 2.8-4.0
- 2.9-4.2
- 37 - 42 wks
- < 36 wks
- 36 - 38 wks
13
Q
Baby Size
- SGA < ___ percentile
- LGA > ___ percentile
- AGA __-__ percentile
- IUGR (intrauterine growth restriction): describe less than optimal growth over period of time ______. It is possible to be IUGR and NOT ____
A
- <10th
- >90th
- 10-90th
- intrauterine and NOT SGA possible
14
Q
Vital Signs
- (2) weights
- _____ visit weight
- RR
- HR
- HC
- Length
- Temperature
- Instability, overbundling, heater
- TcB =
A
- Birth and Discharge
- Newborn
- 40-60
- 120-160
- 33-37cm
- 19-21”
- 97-100F
- Transcutaneous bilirubin-risk zones
15
Q
Neonatal Hyperbilirubinemia
- A yellow discoloration of skin and eyes caused by hyper bilirubinemia (^ serum bilirubin concentration) =
- Usually becomes visible on the ____ at a level of 2-3 mg/dL and on the ____ about 4-5 mg/dL
- With increasing bilirubin lvls, jaundice seems to advance in a ____-____ direction; peaks DOL 5, may take 3 weeks to ____
- Occurs in greater than ___% of all newborns
A
- Jaundice
- sclera, face
- head to toe, resolve 3 wks
- 50% (common ish)
Too much RBC breakdown, Resolves foot to head direction
16
Q
Unconjugated Hyperbilirubinemia
- ______ hyperbilirubinemia = occurs in almost all neonates, shorter neonatal RBC life span increases bilirubin production, Upper GI tract decreases clearance, and low bacterial lvls in intestine combined with increased hydrolysis of conjugated bilirubin increase enterohepatic circulation
- ______ jaundice = develops in 1/6 breastfed infants during first week of life, Breastfeeding increases enterohepatic circulation of bilirubin in some infants who have decreased milk intake and dehydration/low caloric intake
- ____ ___ jaundice = diff from breastfeeding jaundice, develops after first 5-7 days and peaks at 2 wks. Thought to be increased concentration of B-glucuronidase in breast milk, causing increase in deconjugation and reabsorption of bilirubin.
A
- Physiologic
- Breastfeeding
- Breast milk
17
Q
Pathologic Hyperbilirubinemia
- Pathologic hyper bilirubinemia in term infants diagnosied if
- Jaundice appears in first ___ h, after the first week of life, or lasts > 2wk
- Total serum bilirubin (TSB) rises by > ___ mg/dL/day
- TSB is > ___ mg/dL
- Infant shows __/__ of a serious _____
- Some of the most common pathologic causes are
- Immune and non-immune hemolytic ____
- G____ deficiency
- H_____ re-absorption
- S____
- ____thyroidism
A
- Pathologic
- 24h
- 5
- 18
- S/S of serious illness
- Causes
- anemia
- G6PD
- Hematoma
- Sepsis
- Hypothyroidism
18
Q
Serum Bilirubin Lvl Chart
- Infants at lower risk > __ wk and well
- Infants at medium risk > __ wk + risk factors or __-__ wks
- Infants at higher risk __-__ wks + risk factors
A
- 38
- 38 + RF or 35-37wk
- 35-37wk + RF
19
Q
Physical Exam
- Vital ___, w___, l___, Head ____
- General app_____
- Al___ness
- E___
- Eyes, ___ reflex
- Nose, p____
- M___/Th___/P___
- Ton___, fren___
- Jaw al____
- To___
- CV/R_____
- Ab____, Gen___, Sk___
- Extr____
- MSK - h__, kn___, ank___
- Neuro/ref_____
A
- VS, weight, length, circumference
- appearance
- Alertness
- Ears
- Red reflex
- patent
- Mouth/Throat/Palate
- Tongue/frenulum
- Alignment
- Respiratory
- Abdomen, Genitalia, Skin
- Extremities
- hip, knee, ankle
- reflexes
Delayed closing of fontanel could be due to hypothyroidism
20
Q
Fontanel Anatomy
(2) Fontanels
(4) Sutures
A
Anterior, Posterior Fontanels
Metopic, Coronal, Sagittal, Lambdoid Sutures
Cephaly’s happen when sutures fuse too quickly
22
Q
Erythema Toxicum Neonatum
=
- Usually appears and resolves when?
- Where are the lesions not typically found?
- What is the treatment?
A
Benign, self limiting white-yellow papules or pustules (a few-hundreds)
- 24-48hrs after birth, resolves 5-7 days
- mucous membranes, palms, soles
- None
23
Q
Transient Neonatal Pustular Melanosis
=
- More common in what race of babies?
- Describe the 3 stages of skin eruption?
A
Benign, self limiting skin condition without sequela
- Black
- Non-erythematous pustules with milky fluid
- Ruptured vesicles with scaling
- Hyperpigmented macules
Compared to erythema toxicum, no erythematous base and not in clusters
25
Q
What is this a picture of?
A
Congenital Dermal Melanocytosis
Blueish patches that commonly occur on buttocks/back of mostly asian, latinx, black descent babies
26
Q
What is this Skin Condition?
A
Port Wine Stain
27
Q
What is this Skin Condition?
A
Ash Leaf Macule
28
Q
What is this Skin Condition?
A
Cafe Au-Lait Macules
29
Q
What is this Skin Condition?
A
Capillary/Strawberry Hemangioma
30
Q
What is this Skin Condition?
A
Congenital Melanocytic Nevi
31
Q
Seborrheic Dermatitis AKA Cradle Cap
=
- Can attach to hair _____
- When is it usually present?
- When does it resolve?
- Treatments?
A
Benign, self limiting condition of -Scaling, thick yellow/white, crusty or greasy patches on scalp, face, skin folds or skin rich in oil glands
- follicles
- first 3 months
- within 1 month
- Emollients like Vaseline or fragrant free oil (overnight or w shampoo in morning)
34
Q
Neuro cont.
- Head assessment =
- Palsy’s (3)
- S_____ of mouth and face
- Vigorous cry is?
A
- Ventral, vertical suspesion and head control for tone assessment, Minimal head lag
- Brachial plexus palsy, Erb’s palsy (internally rotated arm “waiter’s tip” occurs when neck is stretched to one side during delivery), Facial nerve palsy (absence of depressor angulis oris muslce- muscle associated with frown)
- Symmetry
- assuring
39
Q
Chordee
=
A
Congenital condition where Penis curves downward
40
Q
Hypospadias
=
(4)
A
Birth defect in which urethra opening is not located at the tip of the penis
Glanular
Coronal
Penile shaft
Perineal
41
Q
Ortolani and Barlow’s
Barlow =
Ortalani =
A
dislocation test (straight down)
reduction test
