Newborn Exam - Exam 1 Flashcards
What are the 3 components to a complete newborn history?
Maternal and paternal medical history
Maternal past obstetric history
Current antepartum and intrapartum history
What are the 4 different pregnancy outcomes?
TPAL = Term, preterm , abortus , living
How long is the post-partum delivery?
time after delivery up to 6 weeks
What vaccine is routinely given to all newborns shortly after birth?
Hep B
What do you do if mom is HBsAg+ and just gave birth?
HBIG (Hep B immune globin)
What is an APGAR score? What does it stand for?
This is a system that helps the provider determine the overall condition at birth
APPEARANCE
PULSE
GRIMACE (REFLEX IRRITABILITY)
ACTIVITY
RESPIRATION
At what time intervals after birth do you assess an APGAR score? What is the scale range?
1 min
5 min
10 min
scale goes from 0-10, 0 is the worst and 10 is the best
10 is a PERFECT APGAR score
**Draw the expanded APGAR scoring system
What is the Dubowitz/Ballard exam and scoring? When is it used?
This is an exam of the newborn that evaluates both physical characteristics AND neurological characteristics of a newborn .
used to estimate gestational age
Why is it important to know gestation? What is that called?
Important to know gestation due to knowing what behavior and medical issues can arise at different ages
Ballard age
What is the best indicator of gestational age? What is it dependent on? _____ can also add to predictive value
date of LMP
if periods were regular
Fetal US
______ and ______ development are cues to gestational age also
Physical
neurological
the ballard postnatal assessment is best when performed at _______ of age. What age range do the infants need to be?
30-42 weeks
New Ballard can test infants from 20-44 weeks
What is SIDS? What age range?
This is an unexplained death of a healthy baby that is younger than one
Usually happens during sleep
What is SIDS thought to be related to?
It is thought to be related to an area in the brain that controls breathing and waking from sleep .
What are the 9 risk factors for SIDS?
Certain types of brain defects – brain area that controls breathing is underdeveloped
Low birth weight - similar to above- less control over autonomic processes
Respiratory infections- Many infants who die recently had a cold .
Sleeping on their stomach or side
Sleeping on a soft surface ( fluffy blanket , soft mattress or waterbed )
Sharing a bed - with parents , siblings or pets
Overheating- Being too warm can increase the risk also.
Second hand smoke - babies who live with a smoker are at higher risk
Premature births - being born early and having a LBW increase the risk also
What gender is more likely to die from SIDS? What age range has the highest risk?
males more than females
largest risk between 2 and 4 months with family history
What 9 things can help reduce the risk of SIDS?
Placing the baby on the back to sleep / never the side or stomach
Keep the crib as bare as possible . Firm/ flat mattress
No pillows, blankets or stuffed animals.
Don’t overheat the baby . Never cover the baby’s head .
The baby should sleep in parents room for the first 6 months
Breast feed the baby if possible
Do not rely on commercial devices that predict SIDS . They do not prevent it .
Offer a pacifier .
Get vaccines on time .
What type of cry can indicate hypothyroidism?
Low , hoarse cry
What 3 measurements are plotted on a growth curve each newborn visit?
weight, height and head circumference
What is the average weight, height and head circumference for a full term baby in america?
7 lbs, 19-20 inches and head circumference of 13-14 inches
What color is considered normal for the skin of a newborn? When is jaundice abnormal?
pink and uniform (minus the hands and feet)
jaundice within the first 24 hours is abnormal
** ________ is the bluish discoloration of the infant’s HANDS and FEET. Bluish discoloration of the _____ and _____ is NOT normal
ACROCYANOSIS
face/head and chest
What is the underlying cause of acrocyanosis?
This effect is due to vasomotor changes that results in peripheral vasoconstriction and is benign
What is this? How common is it? How do you help the color return? **What else can it indicate?
Cutis marmorata
50% of infants when the skin is cold due to superficial blood vessels dilate and give red color. Then constrict and give blue color.
**Common skin finding in Down Syndrome
What is this? What is it composed of? What is the new standard with regards to this picture?
Vernix Caseosa
Actually made of 80 % water , 10% lipids and 10% proteins- a biofilm that covers the fetus during the last trimester to protect newborn skin and provides barrier against infection
- Delayed bathing is common - delaying over 12 hours may help thermoregulation , hypoglycemia and and the rates of breastfeeding
What is this? What does it indicate? What is the purpose?
Lanugo: Light, fine hair that covers the newborn baby
The earlier the baby is, the hairier it is
The hair is thought to insulate the baby and to help the vernix “stick” to the baby and will disappear over time
**What is this? **What is the associated timeframe? What does it involve? What is the tx?
**Erythema toxicum
**within the first week of life, 2-5 days after birth
Involves eosinophils in tiny vesicles
NO TX! will resolve within weeks
**What is this? **What is the associated timeframe? How common is it? What is the tx?
Acne neonatorum
around 2-4 weeks of age, one month old
20% of newborns
will resolve on its own
What is this? What are they composed of? When will they resolve?
Milia
Tiny, white epidermal cysts filled with keratin, usually on the face.
resolve in 2-4 weeks
**What is milia called on the roof of the mouth?
Epstein’s pearl
What does a hemangiomas consist of? Are they present at birth? When will they typically resolve?
They consist of small, densely packed blood vessels
NOT present at birth and will develop later
90% have resolved by the age of 9
What am I? When does it require treatment?
hemangiomas
Visual , hearing , rectal , vaginal , nasal, airway obstructions
Huge hemangiomas may cause cardiac decompensation
What am I? What is another name for it? When do they typically resolve?
Nevus simplex
” Stork Bite “
usually by childhood but a few persist
describe a nevus simplex in words
Light red macules that are found over the nape of the neck , upper eyelids and between eyebrows.
What am I? What is another name for it? What is it due to?
Nevus Flammeus
Port Wine Stain
Thick , dilated blood vessels
Describe nevus flammeus in words. They are also associated with _______ and _______ than can cause ________
Thick , dilated blood vessels
visions problems (glaucoma) and angiomas
that cause seizures and developmental disabilities
If nevus flammeus is seen on the face along the _______ branch of the ______ nerve, about 25% will have _________
ophthalmic
trigeminal nerve
Sturge Weber Syndrome
What is this? What is another name for it? What is the underlying cause?
Congenital dermal melanocytosis
“Mongolian Spot”
Darkish blue birthmark over the lower back and butt that is more common in darker skinned babies that lasts for many years
How can you tell the difference between a bruise and a Congenital dermal melanocytosis ?
a bruise will have different shades of purple/blue/brown throughout the bruise vs a Congenital dermal melanocytosis will be the same color all the way through
What am I? More than _____ over _____ this is a major diagnostic criteria for _______
Café au lait spots
6 macules over 1/2 cm
neurofibromatosis 1
What will the head of a newborn look like if given birth vaginally? What will a breech baby’s head look like?
head to be elongated usually
Breech babies have a narrow face and head at times
What is hydrocephalus due to? Is it present at birth? What is the tx?
increased ICP due to ventricles to enlarge possibly due to the obstruction of flow OR the overproduction of CSF
CAN be present at birth
Treatment is a VP (ventriculo- peritoneal ) shunt to shunt fluid from the brain into the abdominal cavity
What is an ophthomalogic finding common in hydrocephalus?
Sunsetting eyes – due to increased pressure
What position should the newborn be in when palpating the fontanelles? What does a bulging fontanelle indicate? depressed?
Palpate carefully with the infant sitting up
Tense and bulging anterior fontanelle may indicate increased intracranial pressure
Depressed fontanelle may show dehydration
What are the 2 fontanelles present at birth? When do they each close?
Anterior closes from 9-24 months
Posterior closes around 2-3 months
What am I? What is it caused by? Does it extend across suture lines? When does it resolve?
Caput Succedaneum
This defect is caused by swelling of the scalp due to pressure on the head during a vaginal birth. There is decreased blood flow to the area which results in edema
DOES extend across suture lines and is POORLY defined
resolves after 2-3 days
What am I? What is it caused by? Does it extend across suture lines? When does it resolve? What does it feel like?
Cephalohematoma (head bruise) subperiosteal hemorrhage
difficult or instrument associated delivery
well define but does NOT extend across suture lines
takes several WEEKS to resolve
feels soft like a cyst
What are the major differences between caput vs cephalohematoma?
caput: think CAP over the top of the head across suture lines, edema, superficial when compared to cephalohematoma
cephalhematoma: think blood and deeper than caput
see picture for layers diagram
What is craniotabes? What does it feel like? What bones is it most associated with? When is it normal for it to disappear?
This is an abnormal thinning of the parietal bones in PRETERM babies
Gives the sensation of a ping pong ball on pressure
It is usually along PARIETAL bones , sometimes occipital , running along lambdoid suture lines
will disappear in a few weeks if it does NOT, then something pathologic is going on
______ is a serious but rare complication of usually vacuum-assisted delivery. Caused by rupture of the _____ veins. Where does blood accumulate? Why is it dangerous for the newborn?
Subgaleal hematoma/hemorrhage
emissary
Blood accumulates between the epicranial aponeurosis of scalp and periosteum
This space can easily accommodate up to one half of the blood volume of a neonate
What is Pierre Robin Syndrome characterized by? Why does it happen? What is the tx?
Life threatening congenital anomaly that is characterized by a short jaw ( Micrognathia ) , cleft palate and airway obstruction
Happens due to failure of the mandible to grow. Tongue blocks fusion of the palate - so a cleft forms. Tongue then obstructs the airway
Treatment involves fixing the lower jaw and supporting the child with feeding help and breathing help in the meantime .
What is this? What are the main characteristics?
Pierre Robin Syndrome
short jaw, U shaped palatal cleft, airway obstruction
What am I? What nerve? When is it most notable? What is the tx?
Facial nerve palsy at birth
CN VII
when crying- will have asymmetric face and eyelid may not close on affected side
observation
What is given to newborn infants to prevent chlamydia right after birth?
erythromycin ointment in the eyes
What am I? What does it indicate?
congenital cataracts
May indicate some type of medical issue like a metabolic disease , a congenital infection or problems with the thyroid
How will glaucoma present in a newborn? Why is it important to catch early?
These kids have tearing, tight eyelids and terrified of light
causes major damage to the optic nerve and can lead to blindness
How often do you need a check a ped pt eyes? What are you looking for?
every visit for the first 3 years of life
red reflex
When checking a ped pt’s eye, you see a white response, what is the term? What does it indicate?
Leukoria
Retinoblastoma
What am I? What is the underlying cause? What should you do next?
Retinoblastoma
this is a rapidly developing eye tumor from immature cells in the retina
IMMEDIATE referral to ophthalmology
______ is the most common cause of tearing and discharge from the eye. What is it? How does it present? What is the tx?
Dacryostenosis
blocked tear duct at birth
heavy matting of the eye and debris on the lashes. redness of the conjunctive is NOT normal
most will spontaneously resolve, so wait until 9 months to refer out to punch hole
What am I? What is the underlying cause? What is the most likely bacteria? What dangerous condition can it lead to?
Acute dacryocystitis
infected tear duct
staph aureus
orbital cellulitis
What is the primary reason for newborn acne?
What are septal deviation caused by in a newborn? How do you check for it?
mother’s hormones
birth trauma
Make sure the nares are patent on exam
What is choanal atresia? What is the tx?
where the back of the nose is blocked due to abnormal bony tissue (happens during fetal development ). Can be unilateral or bilateral
sx to open the area
What are natal teeth? What is the tx?
teeth that are present at birth
need to be removed due to the risk of aspiration
______ is a white , thick coating inside the mouth and inside the cheeks that CANNOT be scraped off in newborns. What is the tx?
oral thrush
antifungal meds on a q tip: also need to clean maternal breasts and all bottle nipples as to not reinfect the newborn
How do you determine the normal position of ears?
A normal location of the ears is determined by drawing an imaginary line from the inner canthus of the eye perpendicular to the vertical axis of the head. If the top part ( helix) of the ear lies beneath this line, it is associated with other syndromes
What am I? What are they at an increased risk for? What is the tx?
Preauricular pits of ears
Risk of permanent hearing loss with ear pits or tags is five times that of the normal population. Can also indicate other congenital anomalies
VERY RARE that they need to be fixed. DO NOTHING
If a ped pt is found to have ear pit/tags AND any other craniofacial developmental issue, _____ should be performed. Why?
renal ultrasound
because ears and kidneys develop in the womb at a similar time
a simple ear pit alone does not increase the risk need to have an ear pit in combo with something else!
What is a normal newborn respiratory rate? What do you need to watch/listen for?
30-60 times a minute
Observe for any noisy breathing , increased effort , such as pulling the skin in between ribs . Watch for difficulty.
aka it should be easy for the kid to breathe
T/F: the great majority of newborn heart murmurs are benign
True!!
**ALWAYS need to check _______. A delay or absence in the lower extremities could indicate a _________
pulses in the upper and lower body
coarctation of the aorta (abnormal narrowing of the aorta)
What is important to check as part of the abdomen exam in a newborn? Most abdominal masses in newborns are associated with ______ anomalies
need to check if the anus is present or blocked
kidney
T/F: When the abdomen is relaxed in a newborn, normal newborn kidneys should not be able to be palpated
FALSE!!
newborn kidneys should be able to be palpated
What is a diaphragmatic hernia? What is the tx? What are 2 PE findings?
This is a birth defect where there is an abnormal opening in the diaphragm that allows the abdominal content to move into the chest cavity
sx to fix
One side of the chest is larger than the other .
Concave abdomen
will be tachypnea , tachycardia and cyanosis
______ is an infection of the umbilical cord. Do you need to clean it? How long does it usually stay attached on the baby?
omphalitis
The area is not cleaned specifically after birth
the cord falls off in about a week
What am I? What is the underlying cause? How common is it?
umbilical hernia
Sometimes the rectus abdominis muscles do not meet and grow together completely
This occurs in about 10- 20 % 0f newborns . More common in African Americans
umbilical hernias usually resolves spontaneously by ________ and usually do not cause any issues. If not resolves by _____ should order sx evaluation
3-4 months
by 3 years old
Describe umbilical granuloma in words. What is the underlying cause? What is the tx?
Soft, pink, friable lesion of granulation tissue at the belly button- very common
Forms in the first few weeks of life from excess tissue that persists at the base of the cord. There is some persistent drainage of serous fluid , sometime green discharge or moisture around the cord
silver nitrate to cauterize the area, may have to treat multiple times or require surgery
What is leukorrhea? What is it caused from? What is the tx?
Females have a milky white or blood streaked vaginal discharge
as a result of maternal hormone withdrawal
nothing!!! it will go away on it’s own
How would you describe a scrotum that is full term? At birth, are you able to retract the foreskin?
Scrotum has more folds the closer they are to term
The foreskin cannot be retracted at birth and need to confirm both testicles are in the scrotum
**What is the underlying cause of congenital hip dysplasia?
This is where the head of the femur does not fit into the hip well due to the socket of the hip being too shallow and not holding the head of the femur in place
**What are the 4 more likely patient populations to have congenital hip dysplasia?
It is more common in the left hip, in girls and in firstborn children, also in multiples
also more common in breech babies
**What are the Barlow and Ortolani tests?
Barlow: hold leg and push it backwards and a CHD will slide out posteriorly
Ortolani: Abduct flexed leg and the head of femur will pop out of hip socket
What is the tx for congenital hip dysplasia?
Pavlik harness
used to keep the femurs in place
______ is the MC fracture in a newborn. What are the 4 risk factors? What is the tx?
clavicular fracture
shoulder dystocia
post term
being induced
higher birth weight
do nothing, it will heal on its own
**What are the 5 primitive reflexes in a newborn?
Sucking
Rooting
Palmar Grasp
Babinski
Moro (startle) reflex
**Briefly describe the rooting reflex
Newborns will turn their head to the side of facial stimulation
**Briefly describe the palmar grasp. At what age does it develop?
Newborns hand will grasp the examiners finger
develops by 28 weeks
**Briefly describe the Babinski reflex. What age is it normal to?
The examiner takes an object such as a key or the back of a reflex hammer to stroke the bottom of a baby’s foot from heel up to big toe. The big toe should bend up and backward while the other 4 toes fan out
This response is only normal in kids under 2
**Briefly describe the Moro reflex
Hold the infant’s upper body off the table, and carefully allow the head to drop 1-2 cm .
The arms should abduct at the shoulder and extend at the elbow .
Adduction with flexion will follow
What is the tonic neck reflex? At what age will it disappear?
Turn the infant’s head to one side and the same side leg and arm will extend , and the opposite leg will flex .
Appears like a “fencing position “
Gone by 8 months
What is a traction response?
An infant is pulled from lying by its hands to a sitting position. FIrst the head will lag , then come to the midline, then flex forward . The baby will help a little
a ________ injury can happen if there is a hard pull on the neck as the shoulders pass through the birth canal. What is the tx?
brachial plexus
tx:
Most babies recover by 3-6 months with observation
Massage and ROM exercises can help
Rarely – surgery is needed if nerves are ruptured or avulsed
brachial plexus injuries are more common with _______, ______ and ______
large babies, diabetic moms and breech delivery
What is a sacral dimple? When does it need to be further evaluated? What do you need to do next?
This is a small hole or dimple near an infants lower back in the gluteal folds . (above the rectum near the tailbone )
if large, as tufts of hair or lump
US or MRI to help with diagnosis. Could be spina bifida occulta or a tethered cord
