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Pediatrics > Newborn Exam > Flashcards

Newborn Exam Flashcards

1
Q

Components of a prenatal visit

A
  • Courtesy of pediatric office without charge
  • Chance to meet provider and see office/ask questions
  • Chance to discuss feeding options and what happens in hospital after birth ie circumcision, immunizations, hearing screen, etc
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2
Q

3 components to a complete newborn history

A
  1. Maternal and paternal medical history
  2. Maternal past obstetric history
  3. Current antepartum and intrapartum history
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3
Q

Maternal and paternal history review

A
  • Chronic medical issues in family
  • Dietary habits
  • Smoking or substance abuse
  • Occupational history
  • Social history - abuse or neglect
  • Family illnesses and congenital anomalies
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4
Q

Maternal OB history

A
  • Maternal age
  • How many times pregnant
  • How many times given birth
  • Pregnancy outcomes
  • Maternal blood type
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5
Q

Occuring right prior to delivery

A

Antepartum

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6
Q

Occuring during labor or delivery

A

Intrapartum

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7
Q

Time after delivery up to 6 weeks

A

Post partum

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8
Q

Review of antepartum and intrapartum hx

A
  • Mom’s history: US, amnio, screening labs
  • Tests that determine fetal well being: NST, dopplers of blood flow and BPP
  • Mom prenatal issues ie gestational DM, UTIs, HTN, preeclampsia, preterm labor
  • Significant issues like maternal fevers, difficult delivery, meconium stained fluid, vaginal vs C/s, forceps, resuscitation
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9
Q

Newborn hep B history

A
  • Maternal hep B status: newborn given hep B vaccine within 1st 12 hrs
  • Babies born to Hep B mom who do not get vaccine - 40% get hep b and 25% die from chronic liver disease
  • HBsAG and HBeAg vertical transmission 90%
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10
Q

What does the baby need to receive after birth if the mom has HBsAg

A
  • HBIG and Hep B vaccine ASAP after birth on opposite legs then Hep B again at 1 and 6 months
  • If HBsAg not tested and mom high risk, give hep B vaccine ASAP and do labs. If HBsAg +, give HBIG up to 48 hours after

no hep c vaccine yet and no prevention for newborns :(

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11
Q

What should you do if mom is HIV +

A
  • Babies receive antiretrovirals within 6-12 hours
  • Breastfeeding not recommended
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12
Q

What is APGAR?

A
  • Helps determine condition at birth
  • Recorded at 1 and 5 minutes after birth
  • Serial score shows progression/improvement
  • Scale 1-10 and want at least a 7
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13
Q

What does APGAR stand for?

A
  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respiration
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14
Q

What is a 0, 1, and 2 on Appearance APGAR score?

A
  • 0: cyanotic
  • 1: some cyanosis (extremities)
  • 2: all pink
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15
Q

What is 0,1,2 on pulse APGAR score?

A
  • 0: absent
  • 1: <100
  • 2: >100
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16
Q

What is 0,1,2 grimace on APGAR score?

A
  • 0: none
  • 1: “some” some flexion of extremities
  • 2: cries in response
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17
Q

What is 0,1,2 on activity APGAR score?

A

0: none
1: some flexion of extremities
2: active movement

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18
Q

What is 0,1,2 on respirations APGAR score

A

0 none
1 some - slow irregular
2 spontaneous cry

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19
Q

Dubowitz/Ballard Exam and scoring

A
  • Evaluates both physical characteristics and neurological characteristics of a newborn
  • 6 physical and 6 neurological signs of maturity scored
  • total score estimates gestational age
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20
Q

What are gestational age predictors?

A
  • LMP
  • Fetal US
  • Physical and neurologic development
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21
Q

What is a square window?

A

Wrist flexion, term baby wrist can bend all the way down

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22
Q

What is scarf sign?

A

How far arm will extend across body

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23
Q

Ballard postnatal assessment

A
  • Best performed at 30-42 hours of age
  • Takes about 3-4 minutes to complete even on sick infants
  • New ballard can test infants from 20-44 weeks
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24
Q

What can be accomplished with a prenatal visit?

A

Meet each other, see office

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25
Q

What vaccine is given to a newborn within 12 hours of birth?

A

Hep B

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26
Q

What is a perfect APGAR score?

A

10

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27
Q

What time after birth are APGARs done?

A

1 and 5 minutes

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28
Q

Is there a hepatitis C vaccine?

A

No

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29
Q

Unexplained death of a healthy baby younger than one, usually during sleep

A

SIDS

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30
Q

What causes SIDS?

A

True cause unknown
Thought to be related to area in brain that controls breathing and waking from sleep

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31
Q

Risk factors for SIDS

A
  • Certain types of brain defects (brain area that controls breathing underdeveloped)
  • Low birth weight
  • Respiratory infections - many who die recently had a cold
  • Sleeping on their stomach or side
  • Sleeping on a soft surface (fluffy blanket, soft mattress, waterbed)
  • Sharing a bed - with parents, siblings, or pets
  • Overheating - being too warm can increase risk
  • Males > females
  • Age 2-4 months
  • Race - more likely in black, native american, and alaskan native
  • Family history of SIDS
  • Second hand smoke
  • Premature birth and low birth weight
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32
Q

How do we reduce the risk of SIDS?

A
  • Place baby on back to sleep, never side or stomach
  • Keep crib bare with firm/flat mattress
  • No pillows, blankets, or stuffed animals
  • Don’t overheat baby and never cover baby’s head
  • Baby should sleep in parents room for first 6 months
  • Breast feed if possible
  • Do not rely on commercial devices that predict SIDS. They do not prevent
  • Offer pacifier
  • Get vaccines on time
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33
Q

What is normal cry of newborn? Abnormal?

A

Strong
* High pitched abnormal
* Low, hoarse cry sign of hypothyroidism
* Weak, poor cry can be sick infant

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34
Q

What is the average size of a full term baby in America?

A
  • 7 lbs
  • 19-20 inches long
  • Head circumference of 13-14 inches
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35
Q

Any jaundice within the first —- is abnormal

A

24

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36
Q

Bluish discoloration of infants hands and feet

A

Acrocyanosis

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37
Q

Is acrocyanosis normal or abnormal? What causes this?

A

Normal
Vasomotor changes that result in peripheral vasoconstriction and is benign

central blueness is not normal

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38
Q

skin has mottled look like cobblestone street

A

cutis marmorata

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39
Q

When is cutis marmorata more common? What causes this?

A

Skin is cold
Superficial blood vessels dilate and give red color then constrict and give blue color, rewarming helps color return

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40
Q

Cutis marmorata is a common skin finding in what condition

A

Down syndrome

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41
Q

Waxy or cheesy like appearance after birth due to substance made of water, lipids, and proteins

A

Vernix Caseosa

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42
Q

What is vernix caseosa and what is its function?

A

Biofilm that covers fetus during last trimester
* Protects newborn skin and provides barrier against infection
* Delayed bathing common- delaying over 12 hours may help thermoregulation, hypoglycemia, and rates of breast feeding

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43
Q

Light, fine hair that covers the newborn baby

A

Lanugo

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44
Q

What is the relationship between lanugo and age of baby? What is purpose of lanugo?

A
  • Younger baby, more hair
  • Thought to insulate baby and help vernix stick, disappears over time
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45
Q

Are males or females more likely to have SIDS?

A

Males

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46
Q

Does a family history matter with SIDS?

A

Yes

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47
Q

Does a pacifier increase or decrease the risk of SIDS?

A

Decrease

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48
Q

Is jaundice normal in the first 24 hours?

A

NO

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49
Q

Is it okay for a baby to have blue hands and feet? What is this called

A

Yes, acrocyanosis

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50
Q

What is faint thin baby hair called on a preemie?

A

Lanugo

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51
Q

Skin rashes in newborns

A
  • erythema toxicum
  • Newborn acne
  • Milia
  • Sebaceous gland hyperplasia
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52
Q

Red base, papular - vesicular rash that is common in newborns

A

Erythema toxicum

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53
Q

Re

What causes erythema toxicum? How long does it last?

A

Eosinophils in tiny vesicles
Appears 2-5 days after birth and resolves in weeks

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54
Q

What is the appearance and cause of acne neonatorium (newborn acne)?

A
  • Closed comedones - red and inflamed, looks like real acne on cheeks, forehead, and sometimes chest and back and resolves on own
  • Thought to be due to maternal hormones
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55
Q

Tiny, white epidermal cysts filled with keratin

A

Milia

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56
Q

What are locations of milia?

A

Usually on face, resolves in 2-4 weeks
If in roof of mouth, called Epstein’s pearl

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57
Q

What is a hemangioma?

A

Very common vascular birth mark located on face, scalp, or thorax, but can be anywhere consisting of small, densely packed blood vessels
Cause unknown

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58
Q

What is the progression of hemangiomas?

A
  • Start several months after birth
  • Grow rapidly, then remain fixed, then start to resolve
  • Most gone by age of 9
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59
Q

When would a hemangioma require immediate treatment?

A
  • Visual, hearing, rectal, vaginal, nasal obstruction
  • Airway obstruction
  • Huge hemangiomas may cause cardiac decompensation
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60
Q

“Stork bite” light red macules found over nape of neck, upper eyelids, and between eyebrows

A

Nevus simplex

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61
Q

Dark red macules anywhere on body consisting of thick, dilated blood vessels

A

Nevus flammeus/port wine stain

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62
Q

If port wine stain is seen on the face along the opthalmic branch of trigeminal nerve, about 25% will have —–

A

sturge weber syndrome

63
Q

What can port wine stains be associated with?

A
  • Vision problems
  • Angiomas that grow in brain and cause seizures and develomental disabilities
64
Q

Darkish blue birthmark over lower back and butt that is more common in darker skinned babies and lasts for years

A

Congenital dermal melanocytosis

Also known as “Mongolian spot”

65
Q

Light brown oddly shaped flat macules that can be anywhere

A

Cafe au lait spots

66
Q

How long do cafe au lait spots persist?

A

For life and may increase in number

67
Q

If there are more than 6 macules over half a cm of cafe au lait spots, what does that mean?

A

Major diagnostic criteria for neurofibromatosis 1

68
Q

What is normal for vaginal birth head appearance? Breech? C- section?

A

C-section: pretty head
Vaginal: elongated
Breech: narrow face and head

69
Q

What causes hydrocephalus?

A

Can be present at birth due to slowly increasing ICP causing ventricles to enlarge –> head grows in circumference
* Obstruction of flow (blocked 4th ventricle, dandy walker malformation or arnold chiari malformation)
* Overproduction of CSF (choroid plexus papilloma)

70
Q

What are findings in hydrocephalus?

A

Sunsetting eyes due to increased pressure
Increasing serial head measurements

71
Q

Treatment of hydrocephalus

A

VP shunt to shunt fluid from brain into abdominal cavity

72
Q

What fontanelles are present at birth? How do these change over time?

A
  • Anterior and posterior
  • Anterior closes from 9-24 months
  • Posterior closes around 2-3 months
73
Q

What does a bulging fontanelle indicate? A depressed fontanelle?

A
  • Bulging: increased intracranial pressure
  • Depressed: dehydration
74
Q

Defect caused by swelling of scalp due to pressure on the head during vaginal birth, decreased blood flow –> edema

A

Caput succedaneum

75
Q

Presentation of caput succadaneum

A
  • Can extend across suture lines
  • Localized soft tissue edema with poorly defined borders
  • Resolves after 2-3 days
76
Q

What is a cephalohematoma

A
  • Subperiosteal hemorrhage
  • Feels soft like cyst and usually occurs after difficult delivery or instrument associated delivery
  • Well defined outline and does not cross suture lines
  • Takes weeks to resolve
77
Q

Abnormal thinning of parietal bones in premature babies that gives sensation of ping pong ball on pressure

A

Craniotabes

78
Q

Where is craniotabes usually located?

A

Along parietal bones, sometimes occipital, running along lambdoid suture lines

79
Q

How long does craniotabes last? What happens if not?

A
  • Usually disappears in a few weeks
  • If not, think rickets, osteogenesis imperfecta or hydrocephalus
80
Q

What is subgaleal hematoma/hemorrhage?

A
  • Serious but rare complication of vacuum assisted delivery
  • Caused by rupture of emissary veins, which are connections between dural sinuses and scalp veins
  • Blood accumulates between epicranial aponeurosis of scalp and periosteum
  • Can accomodate up to one half of blood volume of neonate
  • Need to monitor BP, hematocrit, bilirubin, signs of hypovolemia
81
Q

Life threatening congenital anomaly with short jaw, cleft palate, and airway obstruction

A

Pierre Robin syndrome

82
Q

What causes pierre robin syndrome?

A
  • Failure of mandible to grow
  • Tongue blocks fusion of palate so cleft forms
  • Tongue obstructs airway
83
Q

Treatment of Pierre Robin syndrome

A
  • Fixing lower jaw and supporting child with feeding and breathing in meantime
84
Q

What is the presentation of facial nerve palsy at birth?

A
  • Damage during delivery, can be due to difficult/forcep assisted delivery
  • Involves lower part of facial nerve that controls mouth
  • Asymmetric crying face
  • Eyelid may not close on affected size
  • No movement on affected side
85
Q

Treatment for facial nerve palsy

A

Observation

86
Q

Collection of blood beneath conjunctiva due to trauma

A

Subconjunctival hemorrhage

87
Q

What is prognosis of subconjunctival hemorrhage?

A
  • Likely due to birth process and goes away on its own without treatment
88
Q

How is neonatal conjunctivitis treated?

A

Erythromycin ointment in eyes to prevent chlamydia

all newborns given after birth

leading cause of blindness in developing countries!

89
Q

What can congenital cataracts indicate?

A

Metabolic disease, congenital infection, or problem with thyroid

90
Q

What is presentation of glaucoma?

A

tearing
tight eyelids
terrified of light

91
Q

What happens if glaucoma is left untreated

A

damage to optic nerve can lead to blindness

92
Q

what can an absent, blunted, or white red reflex mean?

A
  • glaucoma
  • Congenital cataract
  • retinoblastoma
93
Q

Treatment for white reflex

A

immediate referral to opthalmology

94
Q

Rapidly developing eye tumor from immature cells in the retina

A

retinoblastoma

best cure rate of childhood cancers if caught early

95
Q

presentation and treatment of retinoblastoma

A
  • white pupillary response or leukocoria
  • Immediate referral (emergency!)
96
Q

Blocked tear duct at birth that is most common cause of tearing and sicharge from eye

A

Dacryostenosis

97
Q

Presentation of dacryostenosis

A
  • Tearing
  • Discharge
  • Heavy matting and debris on lashes
  • Redness of conjunctiva not normal
  • Spontaneous resolution in 90% of babies by 6 months
98
Q

Treatment of dacryostenosis if not resolved

A

referral for probing

99
Q

Infected tear duct

A

Acute dacryocytitis

100
Q

Presentation of acute dacryocystitis

A
  • Redness
  • Warmth
  • Swelling
  • Rare complication of stenosis
  • Staph aureus MC bacteria
  • Can lead to orbital cellulitis
101
Q

Treatment of acute dacryocystitis

A
  • Consult opthalmology
  • Probe to open area
  • Systemic antibiotics
102
Q

What extracranial bleed crosses suture lines?

A

Caput

103
Q

Which extracranial bleed does not cross suture lines?

A

Cephalohematoma

104
Q

What is the primary reason for newborn acne?

A

Maternal hormones

105
Q

What are the tiny, white keratin filled lesions called?

A

Milia

106
Q

When is a hemangioma a medical issue?

A

Obstructs orifice

107
Q

What facial birthmark can have other associated medical issues?

A

Port Wine Stain

108
Q

A cloudy eye at birth could mean what?

A

Congenital cataract

109
Q

What is a blocked tear duct called?

A

Dacryostenosis

110
Q

Caues of septal deviation?

A

Can be due to trauma at birth, will have respiratory distress if not addressed (newborns obligate nose breathers)

111
Q

Treatment for septal deviation?

A

Surgery as child gets older

112
Q

Congenital disorder where back of nose blocked due to abnormal bony tissue

A

Choanal atresia –> can cause feeding and breathing issues

113
Q

Treatment of choanal atresia

A

Surgery to open area

114
Q

Natal teeth

A
  • Teeth present at birth
  • Do not have strong roots and can be easy to aspirate
  • Usually removed and can be associated with several syndromes
115
Q

Oral thrush

A

White, thick coating inside the mouth and inside the cheeks. Cannot be scraped off, causes bleeding
* Painful for baby and cause trouble earing
* Yeast

116
Q

Treatment for oral thrush

A
  • Antifungal applied inside mouth (nystatin)
  • If mom breast feeding, clean breast and apply same medication
  • Boil all bottle nipples and pacifiers during treatment
117
Q

How is a normal location of ears determines?

A

Drawing line from inner canthus of the eye perpendicular to verticular axis of the head
If top part of ear beneath this line associated with syndromes

118
Q

Preauricular pits of ears

A
  • Small indentions in front of ear of newborn
  • Common, but can be associated with congenital anomalies
  • Should have formal hearing test
  • Risk of permanent hearing loss with ear pits or tags is fix times that of normal population
  • Rare that needs fixed
119
Q

If a patient has a ear pit/tag and any other craniofacial developmental issue, what should be performed?

A

Renal ultrasound

120
Q

What can a delay or absence of pulse in lower extremities indicate?

A

Coarctation of aorta

121
Q

What is a heart sign of congenital heart disease

A

Central cyanosis

122
Q

Birth defect in which abnormal opening in diaphragm that allows abdominal content to move into chest cavity

A

Diaphragmatic hernia

123
Q

How is diaphragmatic hernia managed

A

Diagnosed prenatally and surgery performed

124
Q

Presentation of diaphragmatic hernia

A
  • Tachypnea
  • Tachycardia
  • Cyanosis
  • One side of chest larger than the other
  • Concave abdomen
125
Q

What is omphalitis

A

Cord area infection

126
Q

Rectus abdominis does not close together completely over umbilical cord passage

A

Umbilical hernia

127
Q

Which population more commonly gets umbilical hernia

A

African americans

128
Q

Presentation of umbilical hernia

A
  • Soft bulge at belly button
  • More prominent when baby cries
  • Easy to reduce
  • Usually no medical issues
  • Rarely complication of incarceration
  • Usually resolves spontaneosly by 3-4 months
  • If not resolved by about 3, can send to surgery for eval
129
Q

What is umbilical granuloma

A
  • Soft, pink, friable lesion of granulation tissue at belly button
  • Forms in first few weeks of life from excess tisue that persists at base of cord
  • Persistent drainage of serous fluid, sometimes green discharge or moisture around cord
130
Q

Treatment of umbilical granuloma

A
  • Silver nitrate to cauterize
  • Can be treated several times with silver nitrate and may require surgery
131
Q

Leukorrhea

A

Vaginal DC in newborn females with milky white or blood streaked vaginal discharge as a result of maternal hormone withdrawal
Labia can be swollen or even bruised after birth

132
Q

Babies must —- after circumcision to be considered for DC home

A

void

133
Q

Fusion of digits

A

Syndactyly

134
Q

Extra digits

A

Polydactyly

135
Q

Congenital hip dysplasia

A

Head of femur does not fit in hip well due to socket of hip being too shallow

136
Q

Where/who is congenital hip dysplasia more common

A

left hip
girls
firstborn children
multiples
CHD
breech babies

137
Q

What is the risk of a missed congenital hip dysplasia?

A

life long limp and osteoarthritis of the hip

138
Q

Most common fracture in newborn

A

Clavicular fracture

139
Q

What are risk factors for clavicular fracture

A
  • Difficult vaginal delivery
  • Shoulder dysfocia
  • Post term
  • Induction
  • Higher birth weight
140
Q

Presentation of clavicular fracture

A
  • Crepitus
  • Swelling of area
  • Abnormal bone contour
  • Crying with movement
141
Q

At what age does big toe bending up and backward while other 4 toes fan out in Babinski become abnormal?

A

2

142
Q

What is a normal moro reflex?

A
  • Arms abduct at shoulder and extend at elbow
  • Adduction with flexion follows
143
Q

Tonic neck reflex

A
  • Turn infants head to one side and the same side leg and arm will extend and the opposite left will flex
  • Appears like fencing position
  • Gone by 8 months
144
Q

Traction response

A
  • Infant pulled from lying by it’s hands to a sitting position
  • First head lags
  • then comes to midline
  • Then flexes forward
145
Q

What can cause a brachial plexus injury

A
  • Difficult delivery
  • Hard pull on neck as shoulder pass through
  • Pulling on shoulders during head first delivery
  • Pressure on raised arms during feet first delivery
  • More common with large babies
  • breech delivery
  • Difficulty getting shoulder through
146
Q

Treatment of brachial plexus injury

A
  • Most babies recover by 3-6 months with observation
  • Massage and ROM exercises can help
  • Rarely -surgery needed if nerves ruptures or avulsed
147
Q

Sacral dimple

A
  • small hole or dimple near infants lower back in gluteal folds
  • if large or has tufts of hair or a lump, needs studied
  • Could be related to spina bifida occulta condition or tethered cord
  • US or MRI can help with diagnosis
148
Q

If nasal passages do not connect with the throat what is that called?

A

Choanal atresia

149
Q

What is white coating on tongue that won’t wipe off?

A

Thrush

150
Q

What is rooting reflex?

A

rubbing side of cheek and will look for nipple

151
Q

What does the big toe do in a + babinski in a newborn?

A

Up

152
Q

What is the most common fracture in a newborn?

A

Clavicle

153
Q

What increases the risk of congenital hip dysplasia?

A

Girls, firstborn children, multiples, family history of CHD
breech babies, multiples

Pediatrics (12 decks)

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