Newborn Exam Flashcards
1
Q
How long is the newborn stage?
A
first 28 days
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
3
Q
What is observed at birth?
A
Cyanosis
Respiratory distress
Genetic anomalies
Rashes
4
Q
What is auscultated at birth?
A
Lungs
Heart
5
Q
Why is color at birth important?
A
Indicator of CO
6
Q
What is indicative of birth trauma?
A
Fx clavicle
7
Q
What is assessed in the skeleton at birth?
A
Detect obvious congenital anomalies
8
Q
What is assessed in the umbilical cord at birth?
A
2 arteries and 1 vein
9
Q
What is assessed at the placenta at birth?
A
Placental infarcts or clots
10
Q
When is the APGAR score performed?
A
Assessed at 1 & 5 minutes
10 min if score remains low
11
Q
What is a low score and what does it suggest?
A
- Low scores alert clinician to the need for resuscitation efforts
A. ≥ 7 normal
B. 4 - 6 fairly low
C. ≤ 3 critically low
12
Q
What is A in APGAR and what are the scores?
A
- Activity/muscle tone
0: absent
1: Arms and legs flexed
2: active movement
13
Q
What is P in APGAR and what are the scores?
A
- Pulse
0: absent
1: 100
14
Q
What is G in APGAR and what are the scores?
A
- Grimace/irritability
0: absent response
1: grimace
2: sneezes, coughs
15
Q
What is A in APGAR and what are the scores?
A
- Appearance/skin color
0: pale blue grey
1: pink except extremities
2: pink all over
16
Q
What is R in APGAR and what are the scores?
A
- Respiration
0: absent
1: slow, irregular
2: good, crying
17
Q
What is included in the PE in the nursery?
A
1/ Weight
- Height
- Head Circumference
- Chest Circumference
- Vital signs
- Temperature
- Pulse, Heart Rate
- Respiration
- Blood Pressure
18
Q
What is a normal newborn HR?
A
100-180/min
19
Q
What is a normal newborn RR?
A
40-60/min
20
Q
What is normal newborn bp?
A
@ 12 hr 50-70/25-45
@ 96 hr 60-90/20-60
21
Q
What is examined in the skin of a newborn?
A
Color Texture & Turgor Edema Birth Marks Infectious lesions Capillary bleeding Trauma
22
Q
What are normal skin findings?
A
Erythema toxicum Milia Miliaria Mongolian spots Hemangioma Vervex caseosa Lanugo Mottling
23
Q
What are abnormal skin findings?
A
Pale conjunctiva
Jaundice
Cyanosis
24
Q
What is normal peeling of skin?
A
- Dry, flaky, peeling appearance of skin
- Very common
- Usually resolves spontaneously
25
What is erythema toxicum of skin?
1. Small pustules on erythematous bases
2. Very common
3. Appears 3-5 days after birth
4. Spontaneous resolution 1-2 weeks
26
What is milia of skin?
1. Tiny white papules
2. Keratin-filled epidermal cyst
3. Concentrated on nose, cheeks, forehead & chin
4. Resolves spontaneously 1-2 months
27
What is miliaria of skin?
1. “Heat rash”
2. Blockage of sweat glands
3. Flushed macular appearance of neck, face, scalp & diaper area
28
What are mongolian spots?
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
29
What are hemangiomas?
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
30
What is a stork bite?
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
31
What is port wine stain?
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
32
What is lanugo?
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
33
What is vernex caseosa?
1. Waxy or greasy covering
2. Protects skin from damage by amniotic fluid
3. More abundant in pre-term infants
34
What is mottling?
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
35
What is included in the Head part of the physical exam?
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
36
What are the characteristics of the anterior fontanelle?
1. 1-4 cm in size
| 2. Closes @ 6-12 months of age
37
What are the characteristics of the posterior fontanelle?
1. 1 cm in size
| 2. Closes @ 1-3 months of age
38
What is a cephalhematoma?
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
What is caput succedaneum?
1. Benign subcutaneous hematoma that crosses suture lines
| 2. Tourniquet effect of the cervix during delivery
40
What is head molding?
Ridges that develop when one bone slightly overlaps the other during delivery
Complete resolution over time
41
What is facial nerve palsy?
1. Often 2° to birth trauma
2. Infant monitored closely to determine if resolves
3. May require PT
42
What is included in the head and neck exam?
```
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
What is included in the eye exam over time?
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
What can an abnormal red reflex indicate?
1. Asymmetric red reflex warrants immediate referral to pediatric ophthalmologist
A. Congenital cataracts
B. Glaucoma
C. Retinoblastoma
45
What are brushfield spots and what can they indicate?
1. Brushfield spots asst w/ Down Syndrome
| A. Grey or pale yellow spots @ periphery of iris
46
What is strabismus?
1. Common in newborns
2. Resolves by 6 - 12 mo
3. Deviation of eye direction
47
What is subconjunctival hemorrhage (hyposphagma)?
1. Commonly asst w/ traumatic delivery
| 2. Resolve spontaneously
48
How can you determine if ears are low set? What is it asst. with?
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
What needs to be checked for the ears?
1. Visualize TM’s
2. Hearing test in nursery
A. Auditory brainstem response
B. Screening for congenital deafness
50
What is assessed in the nose exam?
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
What is a large tongue asst. with?
1. Trisomy 21
| 2. congenital hypothyroidism
52
What is assessed in the breasts?
galactorrhea: both boys and girls
53
What is a chest wall deformity most commonly asst with?
1. Fractures from birth trauma
| 2. Clavicle most commonly fractured
54
What respiratory signs are concerning?
1. Grunting
A. Asst w/ serious illness
B. Sign of resp distress
55
What cardiovascular problems are screened for?
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
True/false: prominent xiphoid processes are common in newborns?
1. Common finding in newborn
| 2. Becomes less prominent over time
57
What is pectus excavatum?
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
What are retractions?
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
What is the av HR of a newborn?
Avg 140 bpm
60
True/false: murmurs are common in newborns?
1. True. Murmurs are common
| A. Not always asst w/ pathology
61
What are common signs of congenital heart dz?
Cyanosis, CHF, ↓ peripheral pulses
62
What is included in the abdominal exam?
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
How long does it take an umbilical cord to heal?
1-2 wks
64
What do you have to do if you see a meconium stained umbilical cord?
1. Indicates meconium present in amniotic fluid for some time
2. R/O Meconium Aspiration
65
What are the sxs of meconium aspiration syndrome?
1. Rapid or labored breathing
2. Cyanosis
3. Slow heartbeat (
66
How is a child worked up for mecomium aspiration syndrome?
CXR, ABG
67
How is meconium aspiration syndrome treated?
1. +/- ventilator
2. Surfactant via ET tube, (+/- IV Antibx), if persistent pulmonary hypertension → inhaled nitric oxide is pulmonary vasodilator of choice
68
What is diastasis recti?
1. Separation between the 2 sides of rectus abdominis muscle
2. Spontaneously resolves
3. More common in premature & African-American newborns
69
What is included in the pe of the genitalia and rectum?
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
What is important to examine in the female genitalia?
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
What is hypospadia?
Opening of urethra on ventral (underside of) penile shaft
72
What babies are at a higher risk for congenital hip dysplasia?
1. 1 in 500 infants
| 2. Higher frequency in breech births
73
How is Congenital hip dislocation/dysplasia tested for?
1. Barlow maneuver
| 2. Ortolani maneuver
74
What is the barlow maneuver?
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
What is the ortolani maneuver?
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
What is inspected on the exremities?
1. Rudimentary digits
2. Club foot
3. Spinal deformities
A. Spinal bifida
77
Define club foot
Severe eversion of plantar surface
| Warrants immediate Ortho referral
78
Define spina bifida
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
What is included on the neuro exam?
1. Sucking & rooting
2. Moro or startle reflex
3. Palmar grasp
4. Placing reflex
5. DTR’s
80
What is the rooting reflex?
Stroking face of newborn elicits turning of head toward stimulus
81
What is the sucking reflex?
When offered a nipple, the infant will instinctively suckle
82
What is the moro reflex?
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
What is the palmar grasp reflex?
1. Placement of examiner’s finger in infant’s
| 2. Disappears by 4 months of age
84
What is the traction response?
1. Pull infant by arms to sitting position
| 2. Observe head lag initially, finally coming to midline before falling forward
85
What is the placing reflex?
When dangling infant, natural response will be toes/foot touch table w/stepping response
86
When is the babinski reflex still seen?
1. (+) Babinski may be noted as late as 2 yr of age
| 2. Upward fanning of toes
87
What endocrine disorders are screened for in a newborn?
1. Congenital adrenal hyperplasia
| 2. Congenital hypothyroidism
88
What hemoglobinopathies are screened for in a newborn?
1. Sickle cell disease.
| 2. Sickle cell trait (sickle cell carrier)
89
What infectious disorders are screened for in a newborn?
HIV (Human Immunodeficiency Virus)
90
What inborn errors of replacement are screened for?
1. Homocystinuria
2. Hypermethioninemia
3. Branched-chain ketonuria (Maple syrup urine disease -MSUD)
4. Phenylketonuria
5. Tyrosinemia
91
How is hypothyroidism screened and treated?
1. 1:4500 live births
2. Signs/Sx’s
Mental retardation, lethargy, thick tongue
3. 75% newborns asymptomatic
4. Rx: thyroid replacement
92
How is congenital adrenal hyperplasia screened and treated?
1/ Ambiguous genitalia
| 2/ Rx: corticosteroid replacement
93
How is PKU screened and treated?
1. Signs/Sx’s
A. Mental retardation, seizures. Autism
2. Rx: Low protein diet, avoid phenylalanine
94
How is galactosemia screened and treated?
1. Mental retardation, neonatal jaundice
| 2. Rx: lactose & galactose free diet
