Newborn Examination

Question 1

key components of the history

Answer 1

prenatal visits
previous pregnancy
health of other children
complications during pregnancy
genetic conditions?
laboratory findings–> screen for Group B strep and blood type
Group B strep–> cause neonatal sepsis, can kill infant in minutes

blood glucose levels ?

Question 2

observation/general appearance of the baby to take note of?

Answer 2

muscle tone and movement
–> Flaccid?

color–>
jaundice?
if there is jaundice in the first 24 hours this is BAD- hemolytic disease of the infant

or pallor suggesting anemia?

Question 3

what is acrocyanosis

Answer 3

feet look blue, lips blue

Question 4

what is the difference b/w central cyanosis versus acrocyanosis

Answer 4

central is diffuse blue color
need oxygen immediately

acrocyanosis
-peripheral blue color

Question 5

harlequin skin

Answer 5

reddish color

Question 6

vitals that are WNL
temp
resp
heart rate

Answer 6

Temperature 36.5-37.5° C

Respirations 30-60 breaths/minute

Heart rate 100-160 beats/minute

APGAR done at 1 min and 5 min

also need to measure length, weight, and head circumference for growth charts

Question 7

examination of the head….

Answer 7

fontanels both anterior and posterior

shape of the head:

• molding
• caput succedaneum
• cephalohematoma

Question 8

what is caput succedaneum

Answer 8

tissue edema above the periosteum which crosses suture lines

not an emergency

if the blood starts breaking down if there is a lot of it, this can contribute to jaundice

Question 9

what is cephalohematoma

Answer 9

bleeding and fluid under the periosteum that occurs approximately 2.5 % of births and does NOT cross sutures

Question 10

choanal atresia

Answer 10

Failure of communication between the nose and pharynx

Infants will have difficulty breathing and have cyclic cyanosis

Can check for patency in the nares by passing a small feeding tube into each nostril. The tube should pass easily to the nasopharynx

Question 11

examination of the eyes…

Answer 11

red reflex!!!
if there is absence of the red reflex this requires immediate attention

symmetry
set/shape
discharge
erythema

Question 12

examination of the hard and soft palate

Answer 12

abnoramlities will lead to feeding difficulties
can be associated with other abnormalities

Epstein pearls
cleft palate/lip

Question 13

examine neck and clavicles

Answer 13

palpate along the clavicles for crepitus, swelling or tenderness, especially if the delivery was difficult

Question 14

cardiac exam

Answer 14

Need to listen at a minimum in 4 spots (see image).

If dextrocardia is present need to listen on right side of the chest as well

May hear the murmur associated with patent ductus

Need to check femoral pulses

Question 15

looking at the umbilical cord…
what if there is only 2 vessels?
what if it is meconium stained?
umbilical hernia

Answer 15

meconium stained? this is baby poop

if babies are under stress in the utero, there may be meconium in the amniotic fluid

Question 16

examination of the back

Answer 16

sacral dimples
hair
abnormal coloration
neurotube defects–> spina bifida, meningocele, myelomeningocele

Question 17

what is the butterfly mark

Answer 17

Congenital midline vascular lesions raise the possibility of underlying
defects (occult spinal dysraphism) and may need to be investigated
further if other findings are present

Question 18

what are the exams for the hips

Answer 18

barlow test

ortolani test

Question 19

genitourinary tract for males…

what are the 3 main types of hypospadias

Answer 19

On males check that testes are descended into the scrotum
Check for Hypospadias

Three main types
Subcoronal: The opening of the urethra is located somewhere near the head of the penis.

Midshaft: The opening of the urethra is located along the shaft of the penis.

Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.

Question 20

what percentage of cardiac output goes to the umbilical placental circulation

Answer 20

40 %

Question 21

CVO

Answer 21

combined ventricular output

Question 22

how much of CVO is the fetal brain receiving ?

Answer 22

20-30% of the CVO

Question 23

what occurs during the transition to newborn circulation

umbilical placental circulation?
mean pulmonary artery pressure?
pulmonary blood ?
pulmonary vascular resistance?
right atrial pressure?
left atrial pressure?

Answer 23

Umbilical-placental circulation ceases
Mean pulmonary artery pressure drops dramatically at birth
Pulmonary blood increases dramatically at birth
Pulmonary vascular resistance drops dramatically
Right atrial pressure falls because of decreased inferior vena cava flow from the umbilical veins
Left atrial pressure rises because of increased pulmonary blood flow causing the foramen ovale to close

watch the videos!

Question 24

The Ductus Arteriosus

what maintains its patency?
when does it close?

Answer 24

The ductus in the fetus is about the size of the descending aorta

Patency is maintained by prostacyclin I2 (PGE2)
Falling levels of PGE2 results in functionally closing of the ductus by about 15 hours of age

Increased pulmonary vascular resistance can cause right to left shunting through the ductus especially with hypoxia

Question 25

After birth lung compliance improves and airway resistance decreases and functional residual capacity is established-WHY?

Answer 25

Failure to clear fluid from the alveolar spaces leads to respiratory distress

surfactant keeps the lungs open!

Question 26

what glucose transitions occur ?

when does glycogenolysis occur ?

Answer 26

During the third trimester fetal glucose levels are approximately 80% of maternal levels

The fetus does not synthesize glucose under normal resting conditions

After birth gluconeogenesis and glycogenolysis must maintain blood glucose levels

Glycogenolysis begins around the end of the 3rd trimester

seizures in the newborn b/c of glucose problems