Newborn Care II Flashcards
Patent Urachus
Umbilical problem; connection between bladder an the umbilicus remains open
Granuloma of Umbilicus (4)
- Small, firm nodule – red/pink in color that stays after the umbilicus falls off
- Ooze and irritate
- Cauterize with silver nitrate
- Don’t touch it to healthy skin or it will burn
Omphalitis (3)
- Infection of umbilical cord; malodorous, purulent, and erythema present
- May be from staph aureus or gram negative bacteria (E. coli, Klebsiella)
- More common in home deliveries
Umbilical Hernia Resolution (2)
- Self resolving by 3 years
2. If persists beyond 4 years - surgical repair
Clinical Manifestaitons of Omphalitis (3)
- Foul smelling discharge
- Periumbilical erythematous streaking, induration and tenderness to palpation
- Purulent or serosanguineous discharge
Predisposing Factors to Omphalitis (4)
- Prematurity
- Complicated delivery
- Improper severing of the umbilical cord
- Poor hygienic practices during neonatal period
Umbilical Hernia (5)
- Occurs when part of the intestine protrudes
through the umbilical opening in the abdominal muscles - Common in infancy; more common in African American infants
- Evident with crying, straining or coughing
- Disappear when resting on back; Classic sign ( in and out )
- Cultural treatments: Tape, penny, quarter, binders are not helpful may increase strangulation risk
Benefits of Circumcision (6)
- Prevents cancer of the penis (rare)
- Decreased risk of UTI less than 5 years old
- Avoids later circumcision
- Prevents paraphimosis; Emergency, risk of necrosis
- Prevents recurrent balanitis
- Decrease risk of acquiring STDs
Risks of Circumcision (3)
- Operative risks: Bleeding, infection, poor results
- Complications of anesthesia
- Post operative risks
- Fibrous bands
- Meatal stenosis
- Adhesions
- Cysts
Pain control and circumcision (5)
- Dorsal penile nerve block
- EMLA
- Oral sucrose
- Pacifier
- Acetaminophen
Phimosis
A condition in which tight foreskin can’t be pulled back over the head of the penis.
*Physiological until 6 years old
Contraindications to Circmucision (4)
- Hypospadias (may need tissue for later repair)
- Ambiguous genitalia
- Sick newborn
- Excessive oozing after heel stick; needs further evaluation
Developmental Dysplasia of the Hip (5)
- Poor formation of hip joint; may lead to clinical or subclinical instability
- More common in females, oligohydramniois, and breech position
- Musculoskeletal risk factors include torticollis, metatarsus adductus, CP/neuromuscular
- HIGH RISK PATIENTS ARE FEMALE INFANTS IN BREECH POSITION W/ STRONG FAMILY HISTORY
- Some cases of mild dysplasia resolve on their own; may be no detriment in observing for 6 weeks
Effects of DDH (4)
- Hip with DDH may become normal, have residual instability, subluxate or dislocate
- Instability / subluxation leads to abnormal wear
- Estimated to account for 25-50% of adult hip
degenerative joint disease - Significant cause of early arthritis
Barlow Manuever (5)
- Do Barlow before Ortolani; passively dislocate
- “Click of exit”; determines dislocatable hip
- Femur gently ADDUCTED and FLEXED; thumb pushes laterally on the upper inner thigh
* Adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. - Clunk indicates femoral head has slipped over the lateral edge of the acetabulum- demonstrates an unstable hip joint that is dislocatable
- Feel for palpable give or click
Ortolani Maneuver (6)
- Confirms Barlow; femoral head is reduced back
- “click of entry”
- Test of hip reduction- of the dislocated femoral
head into the acetabulum - Maneuver used to place the hip back into a normal
position - Femur gently abducted, trochanter elevated
- Feel for palpable “clunk” as head falls into the
acetabulum
Diagnosis of DDH (4)
- Primarily physical exam; exam performed after birth and all follow up visits up to 12 months
- Ultrasound
- X-Ray after 4 months
- MRI/CT; only pre or post op and ordered by ortho
Other signs of DDH (4)
- Galeazzi sign: Femur appears short with hip flexed
- Skin folds in groin or buttock
- Asymmetric abduction/motion of hip
- Remember- irreducible hip is Barlow/Ortalani negative
DDH Referral (3)
- Refer to ortho if positive exam findings
- Repeat exam at 2-4 day visit if questionable exam – follow up positive refer to ortho
- If exam equivical – refer to ortho and followup
DDH Ultrasound (5)
- Used for evaluation/treatment for exam positive hips
- May also be used for very high-risk patients (breech, family history)
- Not for general screening
- Do after 3-4 weeks of age
- If family history or risk factors (female/breech) use at 6 weeks
Pavlik Harness
Treatment of DDH
- Complications with incorrect positioning
- Too much flexion can lead to femoral nerve palsy
- Too much abduction can lead to possible avascular necrosis
Operative Treatments of DDH (5)
- Closed reduction
- Open reduction
- Spica casting
- Pelvic Osteotomy
- Femoral Osteotomy
**Diagnosis and appropriate treatment can
minimize operative treatments*
Newborn Period: Infection Checks (6)
- Fever is an emergency! Esp 100.4 and above in first 30 days of life (rectal temp.)
* Must receive full sepsis work up if 0-30 days old - Chest X-Ray w/ symptoms of respiratory distress
- Blood culture and CBC with differential
- CRP responds to inflammation; collect 2 samples 24 hours apart; can give you an idea of bacterial vs viral
- Urine culture/urinalysis if still sick after 72 hours
- Lumbar puncture/spinal tap to check for meningitis