Newborn Assessment Flashcards
What are the two methods for determining gestational age in newborns?
1) New Ballard
2) Dubowitz Method
When should the New Ballard or Dubowitz method be used to ensure greatest accuracy?
Within 48 hours of life
What are the 2 components examined when using New Ballard/Dubowitz Method?
1) Neuromuscular maturity
2) Physical maturity
T/F: A higher score on the New Ballard or Dubowitz method is indicative of a higher gestational age?
True
What is the normal weight for a newborn?
2500-4000 grams or 5.5-8 pounds
What is considered a low birth weight?
<2500 Grams or 3.3-5.5 pounds
What is considered a very low birthweight?
1000-1500 grams or 2.2-3.3 pounds
What is considered an extremely low birthweight?
<1000 g or 2.2 pounds
Describe Macrocephaly
head circumference that is greater than 2 standard deviations above the mean for given age, gender and gestation
Describe microcephaly
head circumference that is two standard deviations below the mean for given age, gender and gestation
What could pale skin be indicative of in a newborn?
- Hypoxia
- reduced peripheral perfusion
- acute blood loss
- anemia
What is acrocyanosis?
blue discoloration of the hands and feet
What is acrocyanosis indicative of?
peripheral vasoconstriction
Is acrocyanosis normal in neonates?
Yes, it is normal and typically disappears within 72 hours after birth
What does skin mottling look like?
A spider web on the skin
What is can skin mottling be indicative of?
- Hypotension
- Anemia
What is the normal heart rate for a neonate?
100-160 bpm
What is normal respiratory rate for a neonate?
40-60 bpm
What is a normal blood pressure for a neonate?
60-90/30-60 mmHg
What is the normal MAP for a neonate?
gestational age + 5
Where should heart rate be assessed on a neonate?
- Brachial artery
- Femoral artery
What considerations should you make when assessing fetal heart rate?
- Sleep vs awake
- Premature vs mature
What effect should stimulation have on a neonates heart rate?
Should increase with stimulation
What is the correlation between gestational age and respiratory rate?
Lower the gestational age, the higher the respiratory rate
When is a neonate considered tachypneic? Bradypneic?
Tachy > 60
Brady < 30
When assessing a neonates respiration, how long should you do it and why?
Over the course of a minute because neonates can have irregular breathing patterns
What are the components of the respiratory assessment of a neonate?
- examination of the chest
- evaluation of respiratory distress
- auscultation of the chest
- chest radiograph
What findings on a chest examination of a neonate might be indicative of respiratory complications?
- Barrel chest
- rib deformities
- absence of chest muscles
- pectus excavatum or carinatum
What are the clinical sighs of respiratory distress in the neonate?
- Nasal flaring
- Grunting
- Tachypnea
- Retractions
Describe the Silverman Score
Tool used to quantify distress and lung disease
What are the 5 areas examined during when calculating a Silverman score?
- Upper chest
- Lower Chest
- Xiphoid retractions
- Nares dilation
- Expiratory grunting
What score on the Silverman score is indicative of severe respiratory distress?
7 or greater
Describe how a score of 0 would appear clinically
- Synchronized expansion of upper and lower chest
- No lower chest retractions
- No xiphoid retractions
- No nare dilations
- No expiratory grunting
Describe a silverman score of 5 would appear clinically
- Lag on inspiration
- Retractions of lower chest just visible
- Xiphoid retractions just visible
- Minimal nasal flaring
- Grunting audible only to stethoscope
Describe how a silverman score of 10 clinically presents
- Seesaw between upper and lower chest
- Marked lower chest retractions
- Marked xiphoid retractions
- Marked nare dilation
- Grunting audible without stethoscope
What should areas of focus be when performing cardiovascular assessment on a neonate?
- Cardiac murmurs
- peripheral pulses
- capillary refill time
- Preductal and post-ductal oxygen saturation
What can a heart murmur be indicative of in a new born?
congenital heart defects
What method is used to assess cardiac output and peripheral circulation in a neonate
capillary refill
What is a normal capillary refill in a neonate?
fewer than 3 seconds
What congenital disorders are neonates mandated to be screened for at birth?
sickle cell anemia
cystic fibrosis
hemoglobinopathies
phenylketonuria
galactosemia
What is the moro reflex?
startle reflex
infant is startled, arms extend and abduct outward with palms open which is quickly followed by bringing arms inward with hands clenched
What is the grasp reflex?
neonates hand closes around the finger and grasp tightens when the finger is moved within the palm
What is the rooting reflex?
neonate turns head toward the stroked cheek side and begins making sucking motions
