Newborn Evaluation Flashcards
presents day 2 or 3 of life and is mainly on the trunk → erythematous and raised yellow papule in the center → self limited
erythema toxicum
this is possible indicator that a baby was post term but also in normal term babies → typically resolves within a few weeks and not associated with later life conditions such as eczema
post-term desquamation
capillary malformation that causes the capillaries to appear closer to the skin and more red/pink color
Nevus simplex
abnormal migration of neural crest ccells moving towards the skin and likely in the sacral area → painless hyperpigmented spots
Mongolian Spots
discoloration of the skin due to vascular anomaly, will not cross midline → may need eye exam and brain imaging → do not fade in time and require interventional treatment
Port Wine Stain
benign noncancerous condition resulting in abnormal overgrowth of tiny blood vessels → appear within first 6 months of life → be concerned if too close to eye, in ear or nose, or multiple on the trunk of the body
capillary hemangioma
nevus present at birth and is melanocytic tumor → high malignancy potential and likely will need to be removed
melanocytic nevus
erythematous vesicular lesion in dermatomal pattern
Herpes Simplex
wide anterior fontanelle is associated with
congenital hyperthyroidism
external ear abnormalities can be associated with
kidney abnormalities
bleeding in the eye that is benign and seen after delivery → goes away by 2 months and should not affect vision
subconjunctival hemorrhage
You see a cyanotic and content baby. When you assess it begins to scream and turn normal pink color → you suspect?
choanal atresia
If a baby has cleft palate or lip you should assess them for
other midline abnormalities
How do you treat a baby born with teeth?
remove
benign tiny white cysts that appear in a babies mouth → looks like thrush
Epstein Pearls
baby can’t protrude tongue past lip and has trouble feeding → can’t move tongue side to side (Rooting Reflex)
Tongue Tied
internal rotation and wrist flexion → able to grab finger when you place it
Erbs palsy
Erbs Palsy is damage where?
upper nerve damage due to stretch and irritation
claw hand and unable to grab finger when placed
Klumpky’s Palsy
Klumpkys palsy results from
tearing of lower nerves
subcostal retractions + nasal flaring
respiratory distress
most important spot to check infants pulse
femoral
weakness of the rectal muscle → goes away as the abdominal muscles are strengthened
rectus diastasis
what do you want to do if infant has umbilical hernia?
push through and measure ring defect
unable to tell the geneder of baby due to virilized GU exam
congetintal adrenal hyperplasia
risk factors for developmental dysplasia of hip
female, breech, twin
adducting the hip while applying pressure to flexed knee and directing force posteriorly
Barlow test
testing for external rotation of the hip → flex hips and knee 90 degree and abduct the leg → assessing for hip dysplasia
Ortolani
flexing infants knees and bring flat feet and ankles towards the butt → checking knee height
Galeazzi
6 newborn reflexes
moro root palmar grasp pedal grasp suck gallant
subjective test that can assess mothers gestational age
Ballard Test
APGAR score assesses
activity (muscle tone) pulse grimace (reflex irritability) appearance (skin color) respirations
When do you perform the APGAR score?
1 minute → tolerate labor and being delivered? 5 minute → tolerate transition from mom to outside world?
when do you obtain blood spot specimen for newborn screening?
after 24 hours of protein containing foods
assess for life threatening defects that require catheter based intervention or heart surgery in neonatal period
critical congenital heart disease
probe microphone in ear canal to to measure cochlear response to stimulus
otoacoustinc emessions exam
electrodes are placed on the head to detect activity in auditory nerve and brainstem in response to stimulus
automatic auditory brainstem response (A-ABR)
which babies should get the car seat tolerance test?
babies with poor tone
Indications of failure of Car Seat Tolerance Test
apnea > 20 seconds bradycardia < 80 bpm desaturation < 88%
this cranial abnormality will cross suture lines and will self resolve
Caput
this cranial abnormality will not cross suture lines and the baby will most likely have jaundice
subdural hematoma
worst cranial abnormality → very swollen and full of blood
subgleal hematoma
crusty remnant of umbilical cord
umbilical granuloma
what should you do if the umbilical granuloma comes off before 2 weeks?
close it → apply silver nitrate to cauterize it
delayed reabsorption of lung fluid from pulmonary lymphatics → respiratory distress shortly after delivery (tachypnea, grunting, nasal flaring, retractions, cyanosis)
transient tachypnea of newborn (TTN)
risk factor for transient tachypnea of newborn
C section without active labor
Key CXR findings for transient tachypnea of newborn
hyperexpansion fluid in minor fissure
Treatment for transient tachypnea of newborn
symptomatic → supplemental oxygen NPO if RR > 60
cause of respiratory distress syndrome/hyaline membrane disease
surfactant deficiency → overly compliant chest wall → atelectasis
risk factors for respiratory distress syndrome/hyaline membrane disease
prematurity
key CXR findings for respiratory distress syndrome
“ground glass appearance” perihilar air bronchograms
Treatment for respiratory distress syndrome
prevention → give mom steroids before she delivers Surfactant administration
premature passage and aspiration of meconium in utero → presents like TTN, RDS and will have meconium stained amniotic fluid
meconium aspiration syndrome
biggest risk factor for meconium aspiration syndrome
post-term gestation
key CXR findings for meconium aspiration syndrome
diffuse patchy densities
Treatment for meconium aspiration syndrome
antibiotics → ampicillin or gentamicin
MC cause of neonatal pneumonia
Group B strep
CXR findings of neonatal pneumonia
diffuce alveolar/interstitial disease asymmetric and localized pleural effusion
neonatal pneumonia can be associated with
neonatal sepsis
treatment for neonatal pneumonia
antibiotics → ampicillin or gentamicin
any systemic bacterial infection documented by positive blood culture by 28 days of life → temperature instability, respiratory distress, feeding intolerance, abdominal distension, irritable, jaundice
neonatal sepsis
MC cause of neonatal sepsis
Group B strep
types of neonatal seizures
subtle, clonic, tonic, myoclonic
MC cause of neonatal seizures
perinatal asphyxia
best treatment for neonatal seizures
treat underlying cause anticonvulsant → phenobarbital, phenytoin, diazepam/lorazepam
infant withdrawal once born after being exposed to opioids in utero
neonatal abstinence syndrome (NAS)
most common systems affected in infant who was exposed to narcotics and barbituates (codeine, fentanyl, heroin, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, buprenorphine, levophanol, cocaine) in uter
CNS GI autonomic NS
infant with tremor, high pitch cry, irritability, excess suck, hyperalert, apnea, tachycardia was likely exposed to what in utero
stimulant (methamphetamine, cocaine)
How long should you monitor an infant with NAS for withdrawal symptoms?
5 days
20 point scale of symptoms baby may be having of NAS
Finnegan scoring system
pharmacological treatment options for NAS
morphine methadone clonidine
Prefered method for assessing NAS
Eat Sleep Console can eat > 30 mL? sleep undisturbed > 1 hr? easily consoled in < 10 min?
This is a known preventable cause of Cerebral Palsy → hypotonia, delayed motor development, dental dysplasia, sensorineural hearing loss, cognitive impairment
Kernicterus (unconjugated bilirubin crosses the BBB and deposits in basal ganglia)
when does physiologic benign hyperbilirubinemia appear?
DOL 1 - 7 (peak in 3 - 5)
when does breast feeding benign hyperbilirubinemia appear?
DOL 1 - 7
When does breast milk benign hyperbilirubinema appear?
DOL 6 to 1-3 months
increased bilirubin production + impaired ability to remove bilirubin → increased HCt and shorter RBC lifespan + immature UDP glucuronyl transferase
physiologic benign hyperbilirubinemia
exacerbated phyiologic hyperbilirubinemia + caloric deprivation → increased enterohepatic circulation + dehydration + delayed meconium passage
breast feeding hyperbilirubinemia
things that increase bilirubin production
hemolysis (isoantibodies, enzyme defects, structural defect) birth trauma polycythemia
Treatment for indirect hyperbilirubinemia
indirect sunlight phototherapy IVIG
Treatment for direct hyperbilirubinemia
GI/surgery/NICU consult AVOID PHOTOTHERAPY
management for GERD
more frequent, smaller volume feedings change formula or moms diet keep upright 30 min after feeding H2 antagonist (ranitidine), PPI (lansoprazole/omeprazole)
lacrimal duct gets blocked + white sclera
lacrimal duct stenosis
red conjunctivities that occurs due to erythromycin eye drops
chemical conjunctivitis
This conjunctivitis presents in the first week of life
gonorrheal conjunctivitis
this conjunctivitis presents in the second week of life
chlamydial conjuctivitis
How can you prevent neonatal conjunctivitis?
erythromycin ophthalmologic ointment
treatment for gonorrheal conjunctivitis
ceftriaxone
treatment for chlamydial conjunctivitis
erythromycin
Best lab to get for neonatal sepsis
blood culture
Treatment for neonatal sepsis
ampicillin and getnamicin
TORCH infections
Toxoplasmosis Other (syphilis, Hep B, VZV, Parvo B19) Rubella CMV HSV, HIV
microcephaly intracranial calcifications rash IUGR jaundice hepatosplenomegaly elevated LFT thrombocytopenia
shared characteristics of TORCH infection
Presentation of Toxoplasmosis
TOXOGONDI Tremors 0 - zero hearing X - optic chiasm 0 - zero IQ Greatly reduced head (microcephaly) water On the brain (hydrocephalus) Nothing (asymptomatic) Diffuse intracranial calcifications Icteric (hepatosplenomegaly)
How will newborn with syphilis present at birth?
asymptomatic
1 - 2 months old + maculopapular rash + snuffles + lymphadenopathy + hepatomegaly + thrombocytopenia + anemia + meningitis + chorioretinitis + osteochondritis
syphilis
Hutchinson teeth + mulberry molar + hard palate perforation + CN VIII deafness + bony lesions + saber shins + saddle nose deformity
syphilis
Treatment for syphilis
penicillin G
Baby exposed to Hep B (+) mom’s blood during delivery, treatment?
Hep B vaccine and HBIG within 12 hours afte birth
Treatment for VZV in neonate
acyclovir VZIG
MC presentaiton of Parvo B19
fetal hydrops
Treatment for Parvo B19
supportive care +/- IVIG - most die
Mc congenital infection in the US → can be transmitted transplacental, during delivery, postnatally
cytomegalovirus
“blueberry muffin rash” + Periventricular calcifications + hepatosplenomegaly + jaundice + thrombocytopenia + retinitis + hypotonia + lethargy + sensorineural deafness + development delay
CMV
Treatment for CMV
ganciclovir
“blueberry muffin rash” + sensorineural deafness + cataracts and congenital glaucoma + pulmonary stenosis and PDA
Rubella/German Measles
treatment for HSV in infant
acyclovir
transmission risk factors for HIV
breastfeeding
Management for HIV
antiretroviral prophylaxis (Zidovudine or triple drug therapy)
Gold standard for diagnosing Hiv
HIV DNA/RNA PCR
When can a baby who has had a circumcision go home?
after it has peed → usually monitor 2-3 hours
benign condition when infant is born with vesicle and superficial pustules that easily burst that progress to hyperpigmented freckles that resolve within 48 hours, macules can last several months
neonatal pustular melanosis
