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Medicine II: Pediatrics > Newborn Infant > Flashcards

Newborn Infant Flashcards

1
Q

Gestational Age

A

Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman’s last menstrual cycle to the current date.

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2
Q

Why is Gestational Age Important?

A

Gestational age can predict problems, morbidity, mortality, and can help you keep alert for certain problems

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3
Q

Gestational Age Assessment

A

Date estimation, Calculated from 1st day of last menstrual period.

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4
Q

Gestational Age Assessment Accuracy

A

Early OB ultrasound is best and is accurate within approximately 3 days. A later OB ultrasound can be accurate within approximately 2 weeks.

The Ballard Gestational Age Assessment is accurate within about +/- 2 weeks.

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5
Q

Ballard Exam

A

Estimates Physical Maturity as well as Neuromuscular Maturity by evaluating: Posture, Square window, Arm recoil, Popliteal angle, Scarf sign, Heel-to-ear.

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6
Q

Using a Ballard Exam

A

Add scores together and compare with estimated gestational age by OB (dates and/or ultrasound)

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7
Q

Significance of a Newborn Exam

A

A child’s first exam should be one of the most thorough the child ever receives. The newborn assessment is different from an adult exam!!!

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8
Q

Preforming a Newborn Exam

A

If you start at the head and plan to go to toes, a quiet child may no longer be quiet! Look, listen, feel; Listen to heart, lungs, and abdomen while the infant is quiet, then attempt to work “head to toe”. You may have to continuously adjust your exam and examine what becomes available.

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9
Q

Observation in the Cardiopulmonary Exam

A
  1. Look at the chest for color, symmetry, work of breathing, and respiratory rate.
  2. Observe for retractions, nasal flaring, malformations, abnormal pulsations, and parasternal heave.
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10
Q

Cardiopulmonary Exam: Heart Exam

A

Heart examination: Rate, rhythm, murmurs, gallops, clicks, loudest on right side or left side, location and strength of PMI (point of maximal impulse). Check femoral pulses and compare with brachial pulses

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11
Q

Cardiopulmonary Exam: Lung Exam

A

Listen to the lungs: Bilateral breath sounds, crackles, wheezes, or rhonchi

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12
Q

Abdominal Exam

A
  1. Inspect first
  2. Auscultate: Listen for bowel sounds: Present or absent
  3. Palpate: Feel the tummy!, One hand is generally fine. Palpate for liver, spleen, kidneys, and presence of masses. Make sure to palpate the umbilical cord and area.
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13
Q

Omphalocele

A

Abdominal contents pushed out in a sheath with the umbilicus.

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14
Q

Gastochisis

A

Abdominal contents are pushed out with out a sheet; Not indicative of gentic disorder.

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15
Q

Male Genitourinary Exam

A
  1. Penis: Phimosis is normal!!! Do not retract the foreskin! Look for epi- or hypospadias.
  2. Testes: Feel both testes, look for hydroceles, hernias, or other abnormalities.
  3. Anus: Check for patency and placement
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16
Q

Hypospadias

A

A condition in which the opening of the urethra is on the underside of the penis, instead of at the tip.

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17
Q

Normal neonatal phimosis

A

The inability to retract the distal foreskin over the glans penis.

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18
Q

Female Genitourinary Exam

A
  1. Labia: Large labia majora is common (maternal hormones). Examine for fusion and clitoral hypertrophy.
  2. Vagina: Vaginal discharge is common; white & mucoid to pseudo menses. May have hymenal tags
  3. Anus: check for patency and placement
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19
Q

Imperforate anus

A

A defect that is present from birth (congenital). The opening to the anus is missing or blocked. The anus is the opening to the rectum through which stools leave the body.

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20
Q

Ambiguous genitalia

A

If the process that causes this fetal tissue to become “male” or “female” is disrupted, ambiguous genitalia can develop. ‘Ambiguous genitalia’ or atypical genitalia is a birth defect of the sex organs that makes it unclear whether an affected newborn is a girl or boy. Causes include genetic abnormalities and hormonal problems.

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21
Q

Extremities Exam

A
  1. Digits: number and abnormalities (Examples: polydactyly, syndactyly, clinodactyly, single palmar creases (genetic problems-trisomy 21))
  2. Arms/Legs: Examine range of motion, tone, asymmetry
  3. Clavicles: Feel for fractures!!!
  4. Hips: Barlow and Ortaloni exam. Clicks are common and benign (estrogenic effect). Clunks are indicative of hip dislocation/relocation (developmental dysplasia of the hips).
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22
Q

Polydactyly

A

A condition in which a person has more than five fingers per hand or five toes per foot.

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23
Q

Congenital Talipes Equinovarus

A

Commonly known as club foot, is a foot deformity in which the foot is twisted inward with the toes pointing down.

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24
Q

Syndactyly

A

The most common congenital malformation of the limbs. Webbing of the fingers and toes is called syndactyly. It refers to the connection of two or more fingers or toes.

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25
Q

Spine Exam

A

Flip infant onto your forearm and look at entire spine. Feel the vertebral column for bony defects. Examine sacral area closely looking for clefts, hairy tufts, change in pigmentation
as well as for gross defects such as meningomyelocele, teratomas, sinus tracts.

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26
Q

Sacral Sinus and Dimple

A

A congenital dermal sinus is a scaly, multi-layered channel of tissue found along the body’s midline anywhere between the nasal bridge and the tailbone. The tract may end just below the skin surface or may extend to portions of the spinal cord, skull base or nasal cavity.

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27
Q

Hair tuft

A

A tuft of hair on the skin of the back is a common sign of Spina Bifida Occulta

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28
Q

Meningomyelocele

A

Meningomyelocele is a type of spina bifida, a kind of birth defect in which the spinal canal and the backbone don’t close before birth.

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29
Q

Meningocele

A

A protrusion of the meninges through an opening in the skull or spinal column, forming a bulge or sac filled with cerebrospinal fluid.

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30
Q

Skin Exam

A 
Look at the skin during the entire exam. Look for Jaundice, 
Mongolian spots (Important to document!!!), Rashes, HSV lesions, Milia, Transient pustular melanosis	, Cradle cap, Neonatal Acne, Stork bites and Erythema toxicum neonatorum.
31
Q

Mongolian Spot (Congenital dermal melanocytosis)

A

xx

32
Q

Erythema toxicum neonatorum

A

xx

33
Q

Transient pustular melanosis and Stork bite (Salmon patch hemangioma)

A

xx

34
Q

Sebaceous Gland Hyperplasia and Neonatal Acne

A

xx

35
Q

Cradle Cap (Seborrhea dermatitis)

A

xx

36
Q

HEENT Exam

A
  1. Head: Head circumference (average 34-35cm). Look and feel scalp. (Caput succedaneum, cephalohematoma, abrasions, sutures, fontanelles (anterior and posterior))
  2. Ears: Formed, pits, tags, rotation, position, size
  3. Nose: Nares patent bilaterally. ****Coanal atresia?- bilateral patent nares. Babies are nose breathers
  4. Mouth: Check for clefts (lip and palate), arched palate, neonatal teeth, Epstein pearls
  5. Eyes: Scleral hemorrhages, icterus, discharge, pupil size, extra-ocular movements, red reflex, clear cornea
  6. Neck: Range of motion, goiter, cysts, clefts
37
Q

Be able to identify: Anterior fontanelle, Major suture lines & Posterior fontanelle.

A

OK

38
Q

Cleft lip and palate

A

xx

39
Q

Retinoblastoma

A
  • absent red reflex
40
Q

“Epstein’s (keratin) pearls

A

xx

41
Q

Neurological Exam

A
  1. Look carefully and evaluate neurologic status during exam of other systems. Inspect symmetry of motion, tone, bulk, response to stimulation, pitch of cry, repetitive motions, palsies.
  2. Identify Primitive Reflexes: Moro, suck, rooting, palmar/ plantar grasp, stepping.
42
Q

Newborn Exam Pointers

A

Listen first, a crying baby doesn’t promote a good listening environment. Take your time, develop a system, and use it every single time.

Look at every square inch of the baby! Follow-up any abnormalities.

Don’t forget gestational age assessment

43
Q

Jaundice

A

Yellow discoloration of the skin due to an increase of bile pigments (Bilirubin) in the blood which deposits in the skin and other tissues. 65% of newborns develop jaundice (Bilirubin >5 mg/dL).

44
Q

Jaundice Pathophysiology

A

Red blood cells die and release heme which is metabolized to bilirubin. Increased Hct and turn over of RBCs in infants.

Bilirubin is bound to albumin in the blood, carried to the liver where it is conjugated for excretion. Decreased excretion in infants

45
Q

Neonatal Jaundice Treatment

A

Phototherapy: bilirubin in skin absorbs light and is converted to a stereoisomer urobilinogen that is water soluble and excreted in bile(stool) and urine without conjugation .

46
Q

Intravenous Immunoglobulin

A

IVIG: inhibits hemolysis by blocking antibody receptors on red blood cells.

47
Q

Trisomy 21 (AKA Down’s Syndrome)

A

Trisomy 21 occurs when there is an extra copy or translocation of chromosome 21.

48
Q

Common Physical Signs of Trisomy 21

A

Hypotonia, excess skin neck nape, flattened nose, large fontanelles, single palmar crease, small ears, small mouth with large tongue, upward slanting eyes, short hands with short fingers, white spots on the colored part of the eye (Brushfield spots)

49
Q

Common Associated Medical Conditions of Trisomy 21

A

Atrial or ventricular septal defect, dementia, cataracts, esophageal or duodenal atresia, hearing problems, hip problems, constipation, sleep apnea, leukemia, hypothyroidism and cognitive impairment (low IQ).

*** 50% have a congenital heart defect- order an echo

50
Q

Hyaline Membrane Disease (HMD) (Respiratory Distress Syndrome- RDS)

A

No air in lungs- hyaline membrane disease. Neonatal HMD/RDS occurs in infants whose lungs lack surfactant. Surfactant helps the lungs inflate with air and keeps the alveoli from collapsing.

51
Q

Hyaline Membrane Disease Presentation

A

Involves infants born prematurely in respiratory distress (hypoxemia, tachypnea, apnea, cyanosis)

52
Q

Hyaline Membrane Disease Evaluation:

A

ABG or VBG (decreased aO2, low pH);
CXR (characteristic “ground glass” appearance);
+/- CBC, CRP, culture (rule out infection, sepsis)

53
Q

Hyaline Membrane Disease Treatment:

A
  1. Delivering artificial surfactant directly to the infant’s lungs through endotracheal tube.
  2. Warm, moist oxygen
  3. Breathing support- ventilator, CPAP, ECMO
54
Q

Necrotizing Enterocolitis

A

Intestinal mucosal injury leads to breakdown in mucosal lining and bacteria translocate across the intestinal wall thus a sick baby! Infants usually already ill or premature.

Belly full of air, inbetween outside and gut and air in bowel wall and in liver. Due to a bacterial infection. Very serious.

55
Q

Necrotizing Enterocolitis Symptoms

A

Symptoms may come on slowly or suddenly and include abdominal distention, blood in stool, diarrhea, feeding intolerance, lethargy, temperature instability and vomiting.

56
Q

Necrotizing Enterocolitis Diagnosis

A

Diagnosis include labs (elevated WBC, low platelets, CRP), abdominal imaging and lactic acidosis.

57
Q

Necrotizing Enterocolitis Treatment

A

Treatment includes gut rest, gut decompression by NG tube, IV fluids and antibiotics.

58
Q

Necrotizing Enterocolitis is more common in ____________________.

A

premature babies

59
Q

Cryptorchidism

A

Failure of the testis to move, or “descend,” from an abdominal position, through the inguinal canal, into the ipsilateral scrotum. Most testicles are palpated at birth and cryptorchidism can be diagnosed during routine newborn examination.

60
Q

Observation of Cryptorchidism

A

Watchful waiting past 6 months is not an option because true undescended testicles rarely descend spontaneously after three months of age.

61
Q

Cryptorchidism is more common in ____________________.

A

Premature males.

Premature males: up to 33% affected. Term males: 3-5% affected.

62
Q

Cryptorchidism Treatment

A

xx

63
Q

Apgar Scoring

A

Quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. Recorded at 1 and 5 minutes of age. In severely depressed infants, scores can be recorded out to 20 minutes. No predictive value for long-­‐term outcome, serial scores provide useful description of severity of perinatal depression and response to resuscitative efforts.

64
Q

Components of an Apgar Score

A

Heart rate (0-­‐absent; 1-­‐slow 100)

Respiratory effort (0-­‐absent; 1-­‐slow, irregular; 2-­‐good, crying)

Muscle tone (0-­‐limp; 1-­‐some flexion; 2-­‐active motion)

Response to catheter in nostril (0-­‐no response; 1-­‐grimace; 2-­‐cough or sneeze)

Color (0-­‐blue/pale; 1-­‐body pink/extremities blue; 2-­‐ completely pink)

65
Q

Pre-term infants (<37 weeks) are at a higher risk for:

A
  • Respiratory distress syndrome
  • Necrotizing enterocolitis
  • Patent ductus arteriosis
  • Apnea
  • Hypoglycemia
  • Jaundice
66
Q

Post-term infants (>42 weeks) are at a higher risk for:

A
  • Asphyxia
  • Meconium aspiration
  • Trisomies and other syndromes
67
Q

Newborn Intraventricular Hemorrhage (IVH):

A

20-30% of infant <1500 grams.

Bulging fontanelle, apnea, metabolic acidosis, drop in hematocrit, hypotension, seizures.

68
Q

Newborn Intraventricular Hemorrhage (IVH) Diagnosis:

A

Diagnosis made by Head Ultrasound.

Outcome based on severity (Grade I-IV): I-II: low risk for severe deficits, III-IV: nearly all will have neurological deficits.

69
Q

Newborn Retinopathy:

A

66% of infant <1250 grams.

Occurs when normal retinal development is interrupted. Risk factors: prematurity,Oxygen, hypoxia.

70
Q

Diagnosis and Treatment of Newborn Retinopathy:

A

Screening eye exam 4-6 weeks old. Treatment based on severity (Stage I-IV). Close follow-up. Laser Therapy. MCC of blindness infants

71
Q

Caput succedaneum

A

Subcutaneous Edema. Poorly defined margins . Crosses the midline and over suture lines . Observation only.

72
Q

Cephalhematoma

A

Swelling over one or both parietal bones. Contained within suture lines. Can be associated with skull fractures and jaundice.

73
Q

Subgaleal bleeding

A

Subgaleal hemorrhage into the large potential space under the scalp is associated with difficult vaginal deliveries and repeated attempts at vacuum extraction. It can lead to hypovolemic shock and death from blood loss and coagulopathy triggered by consumption of clotting factors and release of thromboplastin from the injured brain. This is an emergency requiring rapid replacement of blood and clotting factors.

74
Q

Most common single cause of human birth defects.

A

Trisomy 21

Medicine II: Pediatrics (8 decks)

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