Newborn Exam Flashcards
four parts to the newborn hx
relevant maternal hx
pregnancy hx- past and if current
delivery hx
newborn hx (birth to time of exam)
what are the 4 components of the maternal hx
1) . family hx: newborn deaths (most isn’t pertinent)
2) . preexisting medical conditions (diabetes, HTN, Rheumatoid dz, hypo-hyperthyroidism) PLUS MEDS mom was on/is on
3) . Hx of previous pregnancies
4) . social hx
components of pregnancy hx (8)
1). LMP
2). Due date
3). hx of prenatal care
4). risk factors for pregnancy
5). maternal complications developed during
pregnancy
6). maternal lab data
7). maternal meds
8). fetal complications during pregnancy
what are three things that are maternal complications developed during pregnancy?
gestational diabetes, preterm labor, HTN/pre-eclampsia
what three lab tests do the baby and mom have to be cleared from before being discharged home?
syphilis, Hep B and HIV screen
components of labor hx (7)
1) . gestational age
2) . type of labor
3) . type of anesthesia
4) . rupture of the membranes and fluid characteristics
5) . maternal complications during labor
6) . fetal complications during labor
7) . meds given during labor
which type of anesthesia doesn’t affect the baby as much as general anesthesia?
spinal epidural (PLUS natural births)
if patient’s water broke more than 24 hours ago, what are you concerned about for the baby?
infection
components of delivery hx (4)
1) . type of delivery (I.e surgical assist?)
2) . complications during delivery
3) . Apgar scores
4) . resuscitation
3 examples of complications during delivery
1) . shoulder dystocia- can occur in overweight baby (overweight maybe bc mom had uncontrolled diabetes)
2) . Nuchal cord- caused by baby having a period of hypoxia while in the womb (think of true knot vs looser knot in umbilical cord that could cause this hypoxia)
3) . malpresentation- tells you how difficult the delivery was
what is the apgar score used for? what 2 time periods after birth is this score calculated?
its a marker of what condition the baby is in after delivery; after 1 and 5 minutes (can do 10 and 20 minutes as well)
what is a normal apgar score?
> 7 is considered normal for a term infant
5 things you are evaluating during a apgar score?
respiration, reflexes, heart rate, color, and tone
what is secondary apnea? what is tx for it?
baby was breathing once born but then suddenly stopped; tx is pressure ventilation with valve mask
when is the newborn exam first done?
within the first 12 hours of age
what are the 5 components of the initial assessment?
1) . vital signs
2) . anthropomorphic measurements
3) . color
4) . tone
5) . evidence of distress
overall: is this infant sick or well
what does anthropomorphic measurements tell you?
the size of the baby
HEENT exam (8 and some things to look for)
1) . head size- normal, big, small
2) . head shape- molding, caput, cephalohematoma
3) . sutures- split, open, fused
4) . ears- position/features, pts, tags, dimples (NO otoscopic exam)
5) . eyes- red reflex (retinoblastoma)
6) . nose- patency
7) . mouth-palate (see if smooth and intact), teeth, tongue tie
8) . neck- masses, pits, dimples
is tongue tie always corrected?
no, if baby is latching fine and mom isn’t complaining of pain, then tongue tie is fine (a lot of babies outgrow it)
what do you suspect if there is a wave of fluid under the baby’s scalp?
subgaleal hematoma (babies can bleed into space and die)
what is skull bossing?
a protrusion on the forehead with heavy brow ridge
what is important to remember about midline defects?
if you have two or more midline defects then look for a genetic cause
things to evaluate on chest exam (6)
1) . symmetry
2) . nipple spacing
3) . signs of distress
4) . breath sounds
5) . crepitus of clavicle
6) . breast tissue
what are four signs of distress?
1) . grunting- one of the most common things (baby trying to keep positive pressure inside lungs)
2) . nasal flaring
3) . retractions
4) . tachypnea
what are two things to evaluate for breath sounds?
symmetry and character
what is crepitus of clavicle a sign of?
indication of fracture, can be from delivery type
cardiac exam things (5)
1) . PMI
2) . HR and rhythm
3) . presence of a murmur
4) . capillary refill time
5) . pulses
which type of murmurs are pathological?
diastolic
are murmurs common in newborns?
yes, assume they have a murmur until you prove otherwise (concerning when its at least a grade 3 murmur)
what is important to note when checking pulses?
check all four locations for equal and strong pulses (femoral and brachial)
what’s one do not miss in the cardio exam?
coarctation of the aorta (check pulses for this)
abdomen exam things? (4)
1) . appearance
2) . examine umbilical stump
3) . palpate for masses, organomegaly
4) . bowel sounds
how many vessels are in the umbilical stump?
3: 2 arteries and 1 vein
what organ is commonly big in a baby?
liver
what is an omphalocele?
umbilical cord covers the abdominal organs
genitalia exam (4)
1) . can you tell if male or female
2) . female- look for clit size and external anatomy around vaginal vault
3) . male- presence and position of testes, penis size, scrotal masses, penile abnormalities
4) . anus- position and patency, presence of fistula
extremity exam
1) . all digits
2) . abnormalities of hand and foot shape
3) . palmar creases
4) . ROM of all joints
5) . stability of hips
6) . spine
what are two exams to test hip stability?
ortalani and barlow exam
what is palmar crease a sign of?
down’s
skin exam (4)
1) . color
2) . birthmarks
3) . bruising
4) . rashes
what are three things to check for color on skin exam?
1) . pale or plethoric
2) . presence of jaundice
3) . central or acrocyanosis
how does polycythemia present?
really red baby (blood is very thick and cant circulate well)
blueness is normal within __ hrs of birth
2 hrs
its important to differentiate a bruise from what skin marking?
slight gray macule
neuro exam (6)
1) . tone
2) . symmetry of movement
3) . muscle bulk
4) . arousal state
5) . jitteriness or irritability
6) . newborn reflexes (note if they are present)
what are four newborn reflexes?
1) . startle reflex
2) . palmar/plantar grasp
3) . suck
4) . root
what is the Dubowitz/ballard exam used for? what two categories does it use to calculate a score?
used to gauge gestational age; measures physical characteristics and neuromuscular maturity
Dubowitz/ballard exam can be off by how many weeks?
2
what is a common newborn medication? why?
vitamin K injection prophylaxis, prevention of hemorrhagic dz of the newborn
what age range is the newborn state screen run?
24 hrs-2 weeks of age
what is ophthalmia neonatorum? how is it treated?
perinatal-acquired gonococcal eye infection; treated with erythromycin ophthalmic ointment or silver nitrate
what vaccine is recommended prior to discharge in all newborns?
hep B
what is given to baby is the mom is Hep B positive?
Hep B vaccine AND immunoglobulin
________ is a common newborn problem
Jaundice
_______ jaundice is normal; __________ jaundice is abnormal
physiologic = normal pathologic = abnormal
at high levels, hyperbilirubinemia can result in what? how does this happen?
kernicterus: bilirubin is so high that it crosses the BBB and cause seizures
what is routinely screened for prior to discharge?
bilirubin screening
all newborns should be screened for what heart dz before discharge? how do they screen for this?
cyanotic; screen by pulse ox to measure pre vs post ductal O2 sats
kids who fail screening for cyanotic heart dz get what test next?
echo
what are 5 common newborn problems?
1) . hypothermia
2) . respiratory distress
3) . hypoglycemia
4) . near-term/late-preterm infants
5) . heart murmurs
what age and weight are considered premature and therefore usually leads to NICU admittance?
less than 35 weeks, under 1800 g
5 common complications of late preterm infant
hypoglycemia, hypothermia, poor feeding, respiratory distress, apnea
time frame recommendation for discharging newborns
24-48 hrs after birth with follow-up in 24 hrs
what are three contraindications to early discharge?
1) . concern for infection
2) . prematurity
3) . high risk for hyperbilirubinemia
