Newborn exam

Question 1

what are the key components for newborn Hx

Answer 1

prenatal visits
previous pregnancies- any complications
health of other children
any complications during pregnancy
history of genetic conditions in family
lab findings: screening for Group B strep and blood type

Question 2

If the mom is hyperglycemic during pregnancy what is going on in fetus

Answer 2

seeing high sugar so produce hyperinsulinemia

post birth- hypoglycemic

Question 3

what do you note under the general observation for neonate exam

Answer 3

muscle tone and movement

color

Question 4

if the neonate is pale what can that suggest?

Answer 4

anemia

Question 5

what can strep B cause in neonate

Answer 5

sepsis

can kill infant in 4-5 days

Question 6

if the baby is jaundice 12 hrs after birth what are you going to look into

Answer 6

hemolytic disease

Question 7

what is harlequin skin

Answer 7

one side red, one side not

unknown cause–> no consequence

Question 8

what are normal newborn vitals

Answer 8

temp 36.5-37.5
Resp 30-60 breaths/min
HR 100-160 bpm
take length, weight, head circumference for growth charts

Question 9

what is caput succedaneum

Answer 9

tissue edema ABOVE periosteum which cross suture lines

Question 10

what is cephalohematoma

Answer 10

bleeding and fluid UNDER periosteum that occurs approx 2.5% births that does NOT cross suture lines

Question 11

what are vital signs that are pertinent for emergency

Answer 11

hypothermia

Question 12

what is choanal atresia

Answer 12

failure of communication between nose and pharynx

Question 13

what are symptoms of choanal atresia

Answer 13

infants have difficulty breathing and have cyclic cyanosis

Question 14

how do you confirm choanal atresia

Answer 14

pass small feeding tube into each nostril and should pass into nasopharynx easily.

Question 15

what fontanels do you palpate

Answer 15

anterior and posterior

Question 16

if the posterior fontanel is still open around 3mo
umbilical hernia
jaundice
what is your primary Dx

Answer 16

congenital hyperthyroidism

Question 17

when do you worry about caput succedaneum

Answer 17

if there is a lot of blood that can be leaking out

Question 18

what is Tx for cephalohematoma

Answer 18

usually heals itself. reabsorbs

Question 19

What do you look for in neonates for eye exam

Answer 19

red reflex! also symmetry, set/shape, discharge, erythema

absence–> immediate attention

Question 20

what can cause cataracts in newborn

Answer 20

retinoblastoma tumor

galactosemia- hepatomegaly also present

Question 21

what are epstein pearls

Answer 21

inclusion cysts in mouth

go away

Question 22

crepitus over clavicle is indicative of what

Answer 22

previous fracture

Question 23

how many spots must you listen to on cardiac exam of neonate

Answer 23

4 spots

Question 24

what pulse do you check in neonate? why?

Answer 24

femoral

if diminished–> could be coarcation of the aorta

Question 25

if the umbilical cord does not have 3 vessels- 2 aa 1 v

what is it assoc with

Answer 25

other anomalies

Question 26

what is a meconium stained umbilical cord suggestive of

Answer 26

stress in-utero
meconium in amniotic fluid
could have meconium in the lungs- immediate resuscitation

Question 27

are umbilical hernias emergency

Answer 27

no

Question 28

what do you look for on back of neonate

Answer 28

sacral dimples, hair, abnormal coloration, findings suggestive or neurotube defects

Question 29

what is a meningocele vs myelomeningocele

Answer 29

meningocele is just CSF outpouching

myelomeningocele is outpouch of both CSF and nerves

Question 30

a butterfly mark on sacrum may mean what

Answer 30

possibility of underlying defects (occult spinal dysraphism) and may need to be investigated if other findings are present

Question 31

what are the hip tests

Answer 31

barlow and ortolani tests

Question 32

describe GU exam for male neonate

Answer 32

check that testes are descended into scrotum

check for hypospadias

Question 33

what are the 3 types of hypospadias

Answer 33

subcoronal- opening is near head of penis
midshaft- opening is along shaft of penis
penoscrotal- opening is where penis and scrotum meet

Question 34

what is CO named in newborn

Answer 34

combined ventricular output

Question 35

how much of the CO in neonate goes to placental circulation?

fetal brain?

Answer 35

umbilical-placental receives 40%

fetal brain receives 20-30%

Question 36

what are the transition halmarks of newborn circulation

Answer 36

umbilical-placental circulation stops
Mean pulm artery pressure drops
pulm blood increases
pulm vasc R drops
R atrial P drops (decreased IVC flow)
L atrial P rises from inc in pulm blood flow(causes foramen ovale to close)

Question 37

how big is the ductus arteriosus in fetus

Answer 37

size of descending aorta

Question 38

what molecuel maintains the patent dutus

Answer 38

PGE2 prostacyclin I2

Question 39

when does the ductus arteriosus close

Answer 39

around 15 hrs of age

Question 40

what causes right to left shunting through the ductus

Answer 40

increased pulmonary vascular R

especially in hypoxia

Question 41

what are the resp transitions in neonate

Answer 41

after birth the lung compliance improves and airwayR decreases and functional residual capacity is established
surfactant!

Question 42

when does glycogenolysis begin in fetus

Answer 42

around end of third trimester

Question 43

if baby is seizing what should be included on differential

Answer 43

hypoglycemia