Newborn Assessment Flashcards
How much weight loss is acceptable after birth?
10% of birth wt can be lost in first 7d
When does birth weight need to be regained by?
DOL 10 - 14
When does the weight double by?
4 - 5 months
How do you measure height prior to 2y and after 2 y
supine <2y, standing after
how much do term babies gain/day?
20 - 30g
How much do babies grow length wise in cm in first year?
25cm
how much do babies grow in length in their second year ?
12cm
How much does the head circumference grow/month in first year?
2cm
What are the causes of asymmetrical SGA?
late onset and head sparing. Causes are; HTN, drugs, eton, smoking
What are the causes of symmetrical SGA?
Torch, congenital abn. idiopathic/syndrome
What does the mnemonic 4xS means in relation with innocent murmurs?
aSymptomatic, Soft, left Sternal edge, Systolic only
what are the usual features of innocent murmurs? (physiologic, flow murmurs)
Mid systolic, soft in intensity (Gr 1 - 3), localized, poorly conducted, musical or vibratory in character, variable with position and respiration, not associated with other signs of heart disease
What are you worried about with a white red reflex?
Congenital cataract, retinoblastoma
How do you differentiate cong. cataracts and retinoblastoma?
if child has strabismus or esotropia then it is more likely retinoblastoma because tumour is causing shift.
3 yo in ER cold like sx, past 2d with cough, viral sx everything else ok but you hear a murmur?
high output state (increased with fever)
when do children get worsening of innocent (systolic murmur)
high output state
What physical features suggest DDH?
asymmetry in gluteal folds, shortened leg, thigh may be shortened as well
if + ortolani or barlow maneuver what do you do next?
f/u in 2 weeks
If you f/u a + ortolani and barlow removal after 2 weeks at f/u then what do you do?
send to paediatric ortho
What is the best management for a 22mo with DDH?
Femoral osteotomy
RF for DDH?
Frank breech, female, first born, family hx, left hip
When is XR good for DDH?
After 4 months of age because there is no ossification of bone
how do you treat hemangiomas? (best tx)
propranolol
What are the physical signs of sturge weber syndrome?
PWS, macrocephaly, ocular manifestations, soft tissue hypertrophy, hemiparesis, visual loss, hemianopsia
What is sturge weber syndrome?
Sporadic disorder with a haemangiomatous facial lesion (port wine stain) in the distribution of the trigeminal nerve associated with a similar lesion intracranially
how do you investigate sturge weber syndrome
image the head as the hemangioma follows the trigeminal nerve distribution
What procedure do you do for undecscended testes?
orchiopexy
Ddx of unpalatable testes
retractile testes, ectopic testes, cryptochordism
congential adrenal hypoplasia what is the deficiency
21 hydroxylase deficiency
What endocrine deficiency causes high K+?
aldosterone deficiency
What is high in the blood when 21 hydroxylase deficiency is present?
17 oh Progesterone. This happens in CAH
What does the “waiter tip position” of a newborn arm indicate?
Erbs Palsy
What is the presentation of Erbs Palsy
Position in “waiter tip position” (Shoulder; adducted, internally rotated/ Elbow; extended, pronated/ Wrist; flexed)
Wat are the three typical brachial plexus injuries? (nerve roots)
Avulsed c5, Ruptured C6, Stretched c7
What does an adducted, internally rotated shoulder, with an extended, pronated elbow and flexed wrist mean?
Erbs Palsy
Each of the following is an important component in the neuromotor assessment of infants below 3 months of age EXCEPT:
Evaluation for asymmetry of movement Assessment of primitive reflexes Evaluation of abnormalities in tone Evaluation of the forward parachute response Measurement of head circumference
Evaluation of the forward parachute reflexes
Most full term infants regain their birth weight by age:
3 days 5 days 10 days 2 weeks 3 weeks
10d
A mother brings her 4 week old baby to your office for examination. She complains that he does not drink much and that she does not know what to do. His birth weight was 3.5 kg. His present weight is 3.6 kg. Which one of the following is the most appropriate course of action?
Refer mother and child to a social worker for evaluation and give another appointment in 1 week
Order a complete blood count and a sweet chloride test
Reassure the mother that some children do not gain much weight during the first month of life
Evaluate caloric intake and parent interaction
Change the milk formula for an iron enriched formula
Evaluate caloric intake and parent interaction
A newborn girl is noted to have a palpable clunk when the hip is abducted, flexed, and lifted forward Which of the following is the most likely mechanism of disease?
Decreased epiphyseal blood flow resulting in osteonecrosis
Displacement of the capital femoral epiphysis
Failure of osteoid to mineralize
Increased intra-articular pressure
Muscle imbalance resulting from spasticity
Shallow, poorly developed acetabulum
F. Shallow, poorly developed acetabulum
An otherwise healthy 6-month-old girl is brought to the physician because of a hemangioma on her neck that has been enlarging since 6 weeks of age. The lesion was 0.5 cm at 6 weeks of age and is now 2 cm. It is raised, erythematous, and blanches with pressure; there is no ulceration Growth is appropriate for age, and laboratory studies show no abnormalities. Which of the following is the most appropriate next step in management?
Observation Intralesional antiangiogenic factor therapy Intralesional interferon therapy Oral corticosteroid therapy Laser therapy
Observation
You are called to evaluate a full-term infant. The infant’s mother expressed concern about her newborn’s arm shortly after delivery. The mother’s prenatal history is notable for gestational diabetes mellitus that was well-controlled with diet. . The infant’s size was appropriate for gestational age. On physical exam, pupils are equal round and reactive to light. There is limited movement of her right arm. Her upper arm is adducted and internally rotated, her elbow is extended, forearm pronated, and wrist and fingers flexed. Biceps and Moro reflexes were absent on the right side. No sensory loss was noted. There is no crepitus over the collarbones. The other arm was normal and the rest of the physical examination was unremarkable.
This pattern of injury is caused by injury to which structures?
A. C5-C7 B. C5-C6 C. C5-T1 D. C8-T1 E. Radial nerve
C5- C7
What is the nerve root injury associated with Erbs Palsy
C5 - C7
The arm is adducted with the forearm extended, internally rotated, and pronated, generating the classic “waiter’s tip” appearance. The biceps and Moro reflexes are absent on the affected side and sensory function usually is preserved. This infant also has wrist and finger weakness suggesting injury to C7.
