Newborn exam Flashcards
what are the key components for newborn Hx
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
If the mom is hyperglycemic during pregnancy what is going on in fetus
seeing high sugar so produce hyperinsulinemia
post birth- hypoglycemic
what do you note under the general observation for neonate exam
muscle tone and movement
color
if the neonate is pale what can that suggest?
anemia
what can strep B cause in neonate
sepsis
can kill infant in 4-5 days
if the baby is jaundice 12 hrs after birth what are you going to look into
hemolytic disease
what is harlequin skin
one side red, one side not
unknown cause–> no consequence
what are normal newborn vitals
temp 36.5-37.5
Resp 30-60 breaths/min
HR 100-160 bpm
take length, weight, head circumference for growth charts
what is caput succedaneum
tissue edema ABOVE periosteum which cross suture lines
what is cephalohematoma
bleeding and fluid UNDER periosteum that occurs approx 2.5% births that does NOT cross suture lines
what are vital signs that are pertinent for emergency
hypothermia
what is choanal atresia
failure of communication between nose and pharynx
what are symptoms of choanal atresia
infants have difficulty breathing and have cyclic cyanosis
how do you confirm choanal atresia
pass small feeding tube into each nostril and should pass into nasopharynx easily.
what fontanels do you palpate
anterior and posterior
if the posterior fontanel is still open around 3mo
umbilical hernia
jaundice
what is your primary Dx
congenital hyperthyroidism
when do you worry about caput succedaneum
if there is a lot of blood that can be leaking out
what is Tx for cephalohematoma
usually heals itself. reabsorbs
What do you look for in neonates for eye exam
red reflex! also symmetry, set/shape, discharge, erythema
absence–> immediate attention
what can cause cataracts in newborn
retinoblastoma tumor
galactosemia- hepatomegaly also present
what are epstein pearls
inclusion cysts in mouth
go away
crepitus over clavicle is indicative of what
previous fracture
how many spots must you listen to on cardiac exam of neonate
4 spots
what pulse do you check in neonate? why?
femoral
if diminished–> could be coarcation of the aorta
if the umbilical cord does not have 3 vessels- 2 aa 1 v
what is it assoc with
other anomalies
what is a meconium stained umbilical cord suggestive of
stress in-utero
meconium in amniotic fluid
could have meconium in the lungs- immediate resuscitation
are umbilical hernias emergency
no
what do you look for on back of neonate
sacral dimples, hair, abnormal coloration, findings suggestive or neurotube defects
what is a meningocele vs myelomeningocele
meningocele is just CSF outpouching
myelomeningocele is outpouch of both CSF and nerves
a butterfly mark on sacrum may mean what
possibility of underlying defects (occult spinal dysraphism) and may need to be investigated if other findings are present
what are the hip tests
barlow and ortolani tests
describe GU exam for male neonate
check that testes are descended into scrotum
check for hypospadias
what are the 3 types of hypospadias
subcoronal- opening is near head of penis
midshaft- opening is along shaft of penis
penoscrotal- opening is where penis and scrotum meet
what is CO named in newborn
combined ventricular output
how much of the CO in neonate goes to placental circulation?
fetal brain?
umbilical-placental receives 40%
fetal brain receives 20-30%
what are the transition halmarks of newborn circulation
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)
how big is the ductus arteriosus in fetus
size of descending aorta
what molecuel maintains the patent dutus
PGE2 prostacyclin I2
when does the ductus arteriosus close
around 15 hrs of age
what causes right to left shunting through the ductus
increased pulmonary vascular R
especially in hypoxia
what are the resp transitions in neonate
after birth the lung compliance improves and airwayR decreases and functional residual capacity is established
surfactant!
when does glycogenolysis begin in fetus
around end of third trimester
if baby is seizing what should be included on differential
hypoglycemia
