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Peds: Growth and Development > Newborn Exam > Flashcards

Newborn Exam Flashcards

1
Q

How long is the newborn stage?

A

first 28 days

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2
Q

What is included in the neonatal hx?

A 
1. Maternal & paternal Hx
A. Medical 
B. Genetic
2. Maternal OB Hx
3. Current OB Hx
A. Antepartum
B. Intrapartum
-Gestational age of infant
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3
Q

What is observed at birth?

A

Cyanosis
Respiratory distress
Genetic anomalies
Rashes

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4
Q

What is auscultated at birth?

A

Lungs

Heart

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5
Q

Why is color at birth important?

A

Indicator of CO

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6
Q

What is indicative of birth trauma?

A

Fx clavicle

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7
Q

What is assessed in the skeleton at birth?

A

Detect obvious congenital anomalies

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8
Q

What is assessed in the umbilical cord at birth?

A

2 arteries and 1 vein

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9
Q

What is assessed at the placenta at birth?

A

Placental infarcts or clots

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10
Q

When is the APGAR score performed?

A

Assessed at 1 & 5 minutes

10 min if score remains low

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11
Q

What is a low score and what does it suggest?

A
  1. Low scores alert clinician to the need for resuscitation efforts
    A. ≥ 7 normal
    B. 4 - 6 fairly low
    C. ≤ 3 critically low
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12
Q

What is A in APGAR and what are the scores?

A
  1. Activity/muscle tone
    0: absent
    1: Arms and legs flexed
    2: active movement
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13
Q

What is P in APGAR and what are the scores?

A
  1. Pulse
    0: absent
    1: 100
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14
Q

What is G in APGAR and what are the scores?

A
  1. Grimace/irritability
    0: absent response
    1: grimace
    2: sneezes, coughs
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15
Q

What is A in APGAR and what are the scores?

A
  1. Appearance/skin color
    0: pale blue grey
    1: pink except extremities
    2: pink all over
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16
Q

What is R in APGAR and what are the scores?

A
  1. Respiration
    0: absent
    1: slow, irregular
    2: good, crying
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17
Q

What is included in the PE in the nursery?

A

1/ Weight

  1. Height
  2. Head Circumference
  3. Chest Circumference
  4. Vital signs
  5. Temperature
  6. Pulse, Heart Rate
  7. Respiration
  8. Blood Pressure
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18
Q

What is a normal newborn HR?

A

100-180/min

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19
Q

What is a normal newborn RR?

A

40-60/min

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20
Q

What is normal newborn bp?

A

@ 12 hr 50-70/25-45

@ 96 hr 60-90/20-60

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21
Q

What is examined in the skin of a newborn?

A 
Color
Texture & Turgor	
Edema		
Birth Marks
Infectious lesions	
Capillary bleeding	
Trauma
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22
Q

What are normal skin findings?

A 
Erythema toxicum
Milia
Miliaria
Mongolian spots
Hemangioma
Vervex caseosa
Lanugo
Mottling
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23
Q

What are abnormal skin findings?

A

Pale conjunctiva
Jaundice
Cyanosis

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24
Q

What is normal peeling of skin?

A
  1. Dry, flaky, peeling appearance of skin
  2. Very common
  3. Usually resolves spontaneously
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25
Q

What is erythema toxicum of skin?

A
  1. Small pustules on erythematous bases
  2. Very common
  3. Appears 3-5 days after birth
  4. Spontaneous resolution 1-2 weeks
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26
Q

What is milia of skin?

A
  1. Tiny white papules
  2. Keratin-filled epidermal cyst
  3. Concentrated on nose, cheeks, forehead & chin
  4. Resolves spontaneously 1-2 months
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27
Q

What is miliaria of skin?

A
  1. “Heat rash”
  2. Blockage of sweat glands
  3. Flushed macular appearance of neck, face, scalp & diaper area
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28
Q

What are mongolian spots?

A
  1. Hereditary in dark skinned infants
  2. Entrapped melanocytes in dermis
  3. Involves small to large blue black macules on back & buttocks
  4. Present at birth or appears w/in 1st weeks of life
  5. Disappear spontaneously by 4 yr but can persist for life
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29
Q

What are hemangiomas?

A
  1. Appear during 1st few weeks of life
  2. Most common childhood tumor
  3. Proliferation stage up to 12 mo
  4. 50% disappear by age 5 yr
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30
Q

What is a stork bite?

A
  1. Salmon colored patches most commonly found on nape of neck
  2. Due to stretching or dilation of blood vessels
  3. Darker when infant cries
  4. Fades when pressure applied
  5. Frequently visible into adulthood
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31
Q

What is port wine stain?

A
  1. Usually flat & pink
  2. May deepen in color as child grows
  3. Often on face, but can appear anywhere
  4. Thickens & takes on a cobblestone-like appearance
  5. Laser therapy best Tx
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32
Q

What is lanugo?

A
  1. Thin hair overlying shoulder
    normally shed before birth @ 7-8 mo. of gestation
  2. Usually present in premature infants
  3. Sometimes present in full term
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33
Q

What is vernex caseosa?

A
  1. Waxy or greasy covering
  2. Protects skin from damage by amniotic fluid
  3. More abundant in pre-term infants
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34
Q

What is mottling?

A
  1. Lacy light purple appearing discoloration of skin
  2. Accentuated vasomotor response
  3. Common in newborns when exposed to cold temp or high altitude
  4. Asst. w/ trisomy 18 & trisomy 13
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35
Q

What is included in the Head part of the physical exam?

A
  1. symmetry of skull and face
  2. Molding (over-riding cranial bone)
  3. Fontanelles ( soft, not sunken or bulging )
  4. Head circumference 33-38 cm
  5. Facial symmetry
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36
Q

What are the characteristics of the anterior fontanelle?

A
  1. 1-4 cm in size

2. Closes @ 6-12 months of age

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37
Q

What are the characteristics of the posterior fontanelle?

A
  1. 1 cm in size

2. Closes @ 1-3 months of age

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38
Q

What is a cephalhematoma?

A
  1. Hematoma between skull & periosteum
  2. Boundaries limited by individual bones
  3. 2° to prolonged labor or instrument delivery
  4. Get xray of skull to determine not crack in skull
39
Q

What is caput succedaneum?

A
  1. Benign subcutaneous hematoma that crosses suture lines

2. Tourniquet effect of the cervix during delivery

40
Q

What is head molding?

A

Ridges that develop when one bone slightly overlaps the other during delivery

Complete resolution over time

41
Q

What is facial nerve palsy?

A
  1. Often 2° to birth trauma
  2. Infant monitored closely to determine if resolves
  3. May require PT
42
Q

What is included in the head and neck exam?

A 
1/ Head and Neck
A. Eyes 
B. Ears: Look for low set
C. Nose breathers til 4 months: make sure both nares are patent
D. Mouth: Cleft palate
2. Neck
A. Webbing 
B. Congenital abnormalities
C. Masses ( thyroid rare )
43
Q

What is included in the eye exam over time?

A
  1. Red reflex
  2. Visual following at 5-6 wks
  3. 180 degree tracking at 4 months
  4. Irritation & infection
  5. PERRLA
  6. Fundoscopic exam
44
Q

What can an abnormal red reflex indicate?

A
  1. Asymmetric red reflex warrants immediate referral to pediatric ophthalmologist
    A. Congenital cataracts
    B. Glaucoma
    C. Retinoblastoma
45
Q

What are brushfield spots and what can they indicate?

A
  1. Brushfield spots asst w/ Down Syndrome

A. Grey or pale yellow spots @ periphery of iris

46
Q

What is strabismus?

A
  1. Common in newborns
  2. Resolves by 6 - 12 mo
  3. Deviation of eye direction
47
Q

What is subconjunctival hemorrhage (hyposphagma)?

A
  1. Commonly asst w/ traumatic delivery

2. Resolve spontaneously

48
Q

How can you determine if ears are low set? What is it asst. with?

A
  1. Draw imaginery line from canthus of eye straight back to occiput
  2. Low set ears asst w/ trisomy 18, Downs syndrome, *Turner syndrome, *Noonan syndrome, *Goldenhar syndrome
49
Q

What needs to be checked for the ears?

A
  1. Visualize TM’s
  2. Hearing test in nursery
    A. Auditory brainstem response
    B. Screening for congenital deafness
50
Q

What is assessed in the nose exam?

A
  1. Nasal patency is best checked by placing a cold metal object below nose to check for fogging
  2. Choanal atresia presents with unilateral or bilateral obstruction
    A. Usually asst w/ other congenital anomalies
51
Q

What is a large tongue asst. with?

A
  1. Trisomy 21

2. congenital hypothyroidism

52
Q

What is assessed in the breasts?

A

galactorrhea: both boys and girls

53
Q

What is a chest wall deformity most commonly asst with?

A
  1. Fractures from birth trauma

2. Clavicle most commonly fractured

54
Q

What respiratory signs are concerning?

A
  1. Grunting
    A. Asst w/ serious illness
    B. Sign of resp distress
55
Q

What cardiovascular problems are screened for?

A
  1. VS
  2. Murmurs: if heard, get an echo
    A. anything that occurs only during diastole is pathologic, systole/systole-diastole are usually benign
    B. position dependent murmurs are usually benign/innocent
  3. Altered position of heart sounds
56
Q

True/false: prominent xiphoid processes are common in newborns?

A
  1. Common finding in newborn

2. Becomes less prominent over time

57
Q

What is pectus excavatum?

A
  1. With deep inspiration, sternum appears to be almost collapsed
  2. Can be found in normal infants
  3. Sometimes asst w/ connective tissue disorders
    A. Marfan Syndrome
58
Q

What are retractions?

A
  1. One of the most important physical findings in a newborn
  2. Sign of resp distress
  3. Asst w/sepsis, pulmonary pathology, cardiac disease, metabolic disorders, polycythemia
59
Q

What is the av HR of a newborn?

A

Avg 140 bpm

60
Q

True/false: murmurs are common in newborns?

A
  1. True. Murmurs are common

A. Not always asst w/ pathology

61
Q

What are common signs of congenital heart dz?

A

Cyanosis, CHF, ↓ peripheral pulses

62
Q

What is included in the abdominal exam?

A
  1. Check for diaphragmatic hernia
    A. Severe scaphoid belly + resp distress
  2. Masses &/or distention
  3. Liver & kidneys
    A. Prune belly or absence abd musculature asst w/ renal anomalies
    B. Prominent kidneys suggest hydronephrosis
63
Q

How long does it take an umbilical cord to heal?

64
Q

What do you have to do if you see a meconium stained umbilical cord?

A
  1. Indicates meconium present in amniotic fluid for some time
  2. R/O Meconium Aspiration
65
Q

What are the sxs of meconium aspiration syndrome?

A
  1. Rapid or labored breathing
  2. Cyanosis
  3. Slow heartbeat (
66
Q

How is a child worked up for mecomium aspiration syndrome?

67
Q

How is meconium aspiration syndrome treated?

A
  1. +/- ventilator
  2. Surfactant via ET tube, (+/- IV Antibx), if persistent pulmonary hypertension → inhaled nitric oxide is pulmonary vasodilator of choice
68
Q

What is diastasis recti?

A
  1. Separationbetween the 2 sides ofrectus abdominis muscle
  2. Spontaneously resolves
  3. More common inpremature& African-Americannewborns
69
Q

What is included in the pe of the genitalia and rectum?

A
  1. Inspect & palpate for anal patency
  2. Male genitalia
    A. Inguinal hernia
    B. Hypospadias
    C. undescended testicle
  3. Female Genitalia
    A. Imperforate hymen
    B. Vaginal bloody discharge
  4. Ambiguous genitalia esp in in vitro fertilization
70
Q

What is important to examine in the female genitalia?

A
  1. When examining the genitalia of a girl, it is important to visualize hymenal tissue
  2. Hymenal tissue is light pink tissue that can be seen between labia minora
  3. There should be a central opening, bulging suggests imperforate
71
Q

What is hypospadia?

A

Opening of urethra on ventral (underside of) penile shaft

72
Q

What babies are at a higher risk for congenital hip dysplasia?

A
  1. 1 in 500 infants

2. Higher frequency in breech births

73
Q

How is Congenital hip dislocation/dysplasia tested for?

A
  1. Barlow maneuver

2. Ortolani maneuver

74
Q

What is the barlow maneuver?

A
  1. Attempt to dislocate hip w/posterior pressure
  2. W/knees adducted & fully flexed, examiner’s thumb & index finger grasp knees while middle finger placed on outside of femur
  3. (+) test is palpable clic
75
Q

What is the ortolani maneuver?

A
  1. Grasp medial aspect of flexed knee w/ thumb & fully abduct hips
  2. (+) test spasm or “clunk” as hips are brought to full abduction
76
Q

What is inspected on the exremities?

A
  1. Rudimentary digits
  2. Club foot
  3. Spinal deformities
    A. Spinal bifida
77
Q

Define club foot

A

Severe eversion of plantar surface

Warrants immediate Ortho referral

78
Q

Define spina bifida

A
  1. Tufts of hair or hemangiomas that cross midline may represent spina bifida
  2. Portion of spinal cord & meninges exposed through gap in vertebral column
79
Q

What is included on the neuro exam?

A
  1. Sucking & rooting
  2. Moro or startle reflex
  3. Palmar grasp
  4. Placing reflex
  5. DTR’s
80
Q

What is the rooting reflex?

A

Stroking face of newborn elicits turning of head toward stimulus

81
Q

What is the sucking reflex?

A

When offered a nipple, the infant will instinctively suckle

82
Q

What is the moro reflex?

A
  1. Also called startle reflex
  2. Allow infant’s head to drop suddenly by 1-2 cm
  3. Observe for abduction at shoulders & elbows along w/ spreading & extending fingers
  4. Disappears by 3-4 months of age
83
Q

What is the palmar grasp reflex?

A
  1. Placement of examiner’s finger in infant’s

2. Disappears by 4 months of age

84
Q

What is the traction response?

A
  1. Pull infant by arms to sitting position

2. Observe head lag initially, finally coming to midline before falling forward

85
Q

What is the placing reflex?

A

When dangling infant, natural response will be toes/foot touch table w/stepping response

86
Q

When is the babinski reflex still seen?

A
  1. (+) Babinski may be noted as late as 2 yr of age

2. Upward fanning of toes

87
Q

What endocrine disorders are screened for in a newborn?

A
  1. Congenital adrenal hyperplasia

2. Congenital hypothyroidism

88
Q

What hemoglobinopathies are screened for in a newborn?

A
  1. Sickle cell disease.

2. Sickle cell trait (sickle cell carrier)

89
Q

What infectious disorders are screened for in a newborn?

A

HIV (Human Immunodeficiency Virus)

90
Q

What inborn errors of replacement are screened for?

A
  1. Homocystinuria
  2. Hypermethioninemia
  3. Branched-chain ketonuria (Maple syrup urine disease -MSUD)
  4. Phenylketonuria
  5. Tyrosinemia
91
Q

How is hypothyroidism screened and treated?

A
  1. 1:4500 live births
  2. Signs/Sx’s
    Mental retardation, lethargy, thick tongue
  3. 75% newborns asymptomatic
  4. Rx: thyroid replacement
92
Q

How is congenital adrenal hyperplasia screened and treated?

A

1/ Ambiguous genitalia

2/ Rx: corticosteroid replacement

93
Q

How is PKU screened and treated?

A
  1. Signs/Sx’s
    A. Mental retardation, seizures. Autism
  2. Rx: Low protein diet, avoid phenylalanine
94
Q

How is galactosemia screened and treated?

A
  1. Mental retardation, neonatal jaundice

2. Rx: lactose & galactose free diet

Peds: Growth and Development (13 decks)

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