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Pediatrics Exam 1 > Newborn infant and clinical exam > Flashcards

Newborn infant and clinical exam Flashcards

1
Q

Visit Priorities of a prenatal interview

A
  • Maternal/Paternal medical & genetic hx:
  • Social circumstances
  • Health of mother & father
  • including allergies or meds
  • Genetic problems in the family
  • Alcohol & smoking habits
  • Past maternal obstetric history
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2
Q

Newborn exam step 1

A

Review Delivery Record

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3
Q

Delivery record data

A
  1. Length
  2. Membrane rupture timing
  3. Delivery type & reasoning
  4. Medications used
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4
Q

If membrane rupture >24 hours =

A

↑ risk of infection
* Subtle S/S of infection in newborn
warrant greater attention
* Consider sepsis workup on the baby,
EVEN IF APPEARING WELL!

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5
Q

Significant peripartum events

A
  • Fetal distress
  • Meconium-stained amniotic fluid
  • Anesthesia & analgesia used
  • Infant status at birth
  • Maternal fever (T.O.R.C.H. infections)
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6
Q

Review Delivery Record: Condition of infant

A
  • APGAR Score = Resuscitation needed
  • Weight & length (absolute & %)
  • Vital Signs
  • Blood type, & Rh factor of infant
  • Gestational age
  • Fetal Distress
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7
Q

Future (mostly counseling) priorities during prenatal interview:

A
  • Feeding plan: Breast feeding vs. bottle feeding
  • Safety & general care concerns
  • Car seat usage
  • Exposure to cigarette smoke
  • Crib safety
  • Work plans/childcare plans
  • Social Support
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8
Q

If baby suspected to be born + for HIV

A
  • PCR testing for infant
  • Initiation of antiviral HIV treatment within 8-12
    hours following birth
  • Consult pediatric HIV specialist
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9
Q

Normal infant pulse =

A

100-160 bpm

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10
Q

Normal infant respiratory rate =

A

40-60 rpm

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11
Q

Newborn transition problems

A
  • Respiratory distress
  • Cyanosis
  • Hypoglycemia
  • Poor feeding
  • Temperature instability
  • Jittery or lethargic
  • Risk of withdrawal from maternal substance use
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12
Q

No meconium by 24 hours OR (+) abdominal distention = Workup for

A

Anal patency, Hirschsprung disease
* Other causes of intestinal obstruction:
* Cystic fibrosis, electrolyte abnormalities, hypothyroidism, & neuromuscular
disease

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13
Q

Color of baby meanings

A
  • Normal Hgb = 16-17g/dl: Ruddy appearance (healthy & red)
  • Plethoric (excessively red) in polycythemia, suspect maternal diabetes
  • Pallor (pale): with anemia or poor perfusion
  • Cyanosis (blue): typically manifests in the
    extremities when the newborn is cold, ALWAYS requires immediately evaluation
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14
Q

What do you call the baby on the right’s color?

A

Plethoric

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15
Q

What do you call the color of the baby on the left?

A

Anemic, abnormally pallid

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16
Q

Jaundice in the newborn

A
  • Yellow staining of the body tissues & fluids
  • Excessive levels of bilirubin in the bloodstream
  • Timing
  • > 24 hours
  • Physiologic jaundice of the newborn = Normal
  • < 24 hours
    Pathologic jaundice = Abnormal
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17
Q

Acute Bilirubin Encephalopathy

A

Neurological dysfunction in first postnatal weeks from bilirubin toxicity

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18
Q

Acute Bilirubin Encephalopathy clinical phases

A
  1. Early (1-2 days) - Poor feeding, high-pitched cry, stupor, hypotonia
  2. Middle (1st postnatal week)
    * Hypertonia of extensor muscles
    * Opisthotonos (severe arching of the neck & spine)
    * Retrocollis (tightening of the muscle of the neck & shoulder girdle)
  3. Late (after 1st postnatal week) - generalized hypotonia
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19
Q

Chronic bilirubin encephalopathy (Kernicterus)

A

Slower evolution of S/S over the first years of life
1. (1st year) - hypotonia, hyperreflexia, & delayed
motor development
2. (>1 year)
* Extrapyramidal dysfunction
* Dental enamel hypoplasia
* Visual
* Auditory
* Minor intellectual deficits possible

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20
Q

Kernicterus Risk Factors: Think J.A.U.N.D.I.C.E.

A

Jaundice within first 24 hours
A sibling who was jaundiced as a neonate
Unrecognized hemolysis such as ABO blood type
incompatibility or Rh incompatibility
Nonoptimal sucking/nursing
Deficiency in glucose-6-phosphate dehydrogenase
Infection
Cephalohematomas/bruising
East Asian or Mediterranean descent

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21
Q

Vernix Caseosa

A

(varnish cheesy)
* White, lipid-rich, moisturizer
* Fetal sebum, lanugo, & corneocytes
* Found in creases & flexor surfaces
* Lysosomes & lactoferrin are
antibacterial/fungal
* Helps retain heat
* Facilitates stratum corneum growth

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22
Q

Vernix retention after birth leads to

A

↑ skin hydration & ↓ skin surface
pH 24 hours after birth
* WHO recommends

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23
Q

Lanugo

A
  • Downy hair covering the body
  • More common with prematurity
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24
Q

Sebaceous gland hyperplasia

A
  • Small, yellow papules over nose & cheek
  • Disappear spontaneously
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25
Q

Acne Neonatorum

A
  • Acne appearance
  • Maternal hormonal influence
  • Spontaneous resolution in 2-3 months
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26
Q

What is this?

A

Cutis Marmorata
* Newborn’s skin is thin & blood vessels can be seen
* Bluish, mottled, lacey, reticular appearance
* Disappears with rewarming (if not consider sepsis, esp in an ill-appearing infant)

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27
Q

What is this?

A

Erythema Toxicum
* Benign, common rash (50%)
* Erythematous papules & pustules (eosinophils)
* Predominates on face & chest
* 1 - 2 days after birth
* Resolves within 5 - 7 days

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28
Q

What is this?

A

Transient Neonatal Pustular Melanosis
* Idiopathic pustular eruption of the newborn
* Resolves with hyperpigmented macules
* Less common than erythema toxicum
* More prevalent with darkly pigmented skin
* Present at birth, may appear up to 3 weeks after

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29
Q

What is this?

A

Dermal melanocytosis (Mongolian spots) - essentially a birth mark that goes away
* Bluish/black macular lesions
* Usually over lumbosacral area
* Native American, Asian infants (99-100%)
* Ectopic melanocytes, incomplete migration from
the neural crest to the epidermis
* Tend to disappear within one year
* Always document! (NOT a bruise!)

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30
Q

What are birthmarks called & when do they present?

A

Congenital Melanocytic Nevi
* Present at birth or appear in the first few months
* Tend to grow with children (esp puberty)
* ↑ risk of melanoma
* 2+ medium lesions → ↑ risk for neurocutaneous melanocytosis

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31
Q

What is this?

A

Cafe au lait spots
* Light-brown, oval macule
* dark brown on brown/black skin, possible
halos
* Found anywhere on the body
* 1.5 cm or larger

32
Q

One of the MAJOR diagnostic criterion for
Neurofibromatosis Type 1

A

Café Au Lait

33
Q

What is this?

A

Nevus Flammeus
(Nevus Simplex, Macular Hemangiomas, Vascular Nevi)
* “Stork bites” → back of neck
* “Crow’s nests” → above the eyes
* Benign, flat, red skin patches
* May disappear within 1st year
* Can persist & darken

34
Q

What is this?

A

Port-Wine Stain
* Nevus flammeus family
* Permanent skin discoloration
* May be associated with other
arteriovenous malformations

35
Q

What is this?

A

Strawberry or capillary hemangioma
* Elevated collections of capillaries
* Variable appearance
* Grow for 3-7 months, stabilize, then involute ~1
year old → resolved by 5 yo
* Usually, no scar or blemish
* Observation only, unless on the eyelid - Ophthalmology consult required

36
Q

What is this?

A

Cavernous Hemangioma
* Less common than strawberry hemangiomas
* Less predictable course
* Collection of larger blood vessels
* Larger than strawberry hemangiomas & bluer in color
* May be associated with thrombocytopenia
* Often, they mature & then disappear
* May treat with steroids or radiation

37
Q

What is this?

A

Milia
* Subepidermal keratin cysts
* Pilosebaceous units or
eccrine sweat ducts
* Disappear spontaneously

38
Q

Craniotabies

A

Thin, soft skull bones
* Caused by rickets or syphilis
* Common in babies born prematurely

39
Q

Caput Succedānēum

A

Cone-head
* Common
* Boggy swelling of subcutaneous
tissues of the presenting part
* Crosses suture lines*
* Head compression against cervix
impedes venous return
* Reabsorbs in 1–3 days

40
Q

What is Cephalohematoma?

A
  • Blood pooling subperiosteum
  • Confined to a single bone
  • CANNOT cross suture lines**
  • Apparent 2 hrs – 2 days after birth
  • Almost always parietal bone
  • From fracture*
  • Lasts >4 weeks
41
Q

What is this head shape called?

A

Caput succedānēum

42
Q

What is this head shape called?

A

Cephalohematoma

43
Q

Fontanelles

A
  • Anterior fontanelle (junction of two frontal & two parietal bones)
  • Larger
  • Closes ~18-24 months
  • Posterior fontanelle (junction of parietal & occipital bones)
  • Smaller
  • < 1 cm
  • Closes ~6 weeks
44
Q

Craniosynostosis

A
  • Abnormal, premature closure of skull sutures
  • Most common = Sagittal suture - Anterior/posterior lengthening of the head
  • Fusion of coronal sutures - Lateral widening of the head
  • Palpate sutures: Should move up & down independently
45
Q

Normal Head circumference of neonate, what would micro and macrocephaly be?

A

~34-35 cm
* Compare with normative data
* Microcephaly - ↓ head circumference
* <2 SDs of the mean for the gestational age

  • Macrocephaly - ↑ head circumference
  • > 2 SDs of the mean for the gestational age
  • May indicate Hydrocephalus
46
Q

Hydrocephalus

A

↑ volume of CSF
* Obstruction in the subarachnoid space
* Need pediatric neuro consult
* Treatment usually consists of
ventriculoperitoneal shunting

47
Q

Clinical features of Hydrocephalus

A
  • Macrocephaly
  • ↑ rate of head growth
  • Irritability
  • Vomiting
  • Voss of appetite
  • Impaired extraocular movements, Esp. upward gaze
  • Hypertonia
  • Hyperreflexia
48
Q

Facial appearance in neonates with downs syndrome

A
  • Eyes slanting up
  • sloping forehead
  • low-set ears with small canals
  • Glaucoma
  • Eye(s) appear larger than normal
49
Q

Facial appearance in neonates with fetal alcohol syndrome

A
  • Eyes appear too small
  • wide, flat nasal bridge
  • Lacking a groove between lip &
    nose (philtrum)
  • Small jaw (micrognathia)
50
Q

Facial appearance in neonates with Pierre Robin syndrome

A
  • Small chin (micrognathia): May predispose infant to respiratory obstruction
51
Q

Asymmetry of neonatal face while crying might be associated with

A

aortic valve abnormalities
* Also consider Facial nerve palsy

52
Q

Eyesight at birth

A

Visual acuity is poor (20/400)
* Lens is immobile
* Acuity improves the first 6 months
* Able to fixate & track by 2 months

53
Q

Nose exam on a neonate

A
  • Asymmetry of nares
  • Possible septal deviation
  • Birth trauma
54
Q

T/F Infants are obligate nose breathers

A

T

55
Q

Choanal atresia

A

narrow or blocked nasal airway (tissue)

56
Q

Torticollis

A

Head persistently turned to one side

57
Q

T/F It is NOT significant to hear fluid
during the Newborn exam

A

T

58
Q

2 MOST COMMON signs of heart disease in the newborn infant

A
  1. Cyanosis
  2. Diminished pulses
59
Q

Diminished pulses pathologies

A

i. Hypoplastic left heart + critical aortic stenosis
* Diminished pulses at all sites
ii. Aortic coarctation + interrupted aortic arch
* Diminished pulses in the lower extremities

60
Q

Polyhydramnios

A

excessive amniotic fluid

61
Q

Umbilical cord

A
  • 2 umbilical arteries & 1 umbilical vein
  • Only 1 umbilical artery may be
    associated with renal, CV, & MSK
    malformations
62
Q

Hypospadias

A

Urethral meatus displaced proximally on ventral penis
* Do NOT circumcise!

63
Q

Unpalpable testes may indicate
_____

A

Cryptorchidism

64
Q

Clinodactyly

A

In turning of a finger, usually 5th
* Trisomy 21 Feature
* Short broad hand, single palmar crease

65
Q

Intrauterine crowding causes an increased
risk for _____

A

Developmental Dysplasia of Hip

66
Q

Examine hips via these tests

A
  • Barlow test (dislocating the hip)
  • Ortolani (relocating the hip)
67
Q

Talipēs Ēquīnōvārus

A

Clubfoot
1. Metatarsus adductus
2. Varus heel deformity
3. Shortening of the Achilles tendon
* Treatment should begin while newborn
is in the nursery
* Serial casting

68
Q

Asymmetry with hemihypertrophy

A

May be associated with a Wilms tumor of the
kidney

69
Q

Brachial plexus palsies (Erb’s palsy)

A
  • One of the upper extremities flaccid
  • 2° difficult delivery with brachial plexus injury
  • Most common = C5, C6
  • Absent Moro reflex on the affected side
  • Consult pediatric neurology
  • Good prognosis
70
Q

Subdural Hematoma

A
  • Related to birth trauma
  • Tear(s) in the venous blood supply of the
    subdural space
  • Vomiting, irritability, lethargy, & seizures
    within 2-3 days of birth
  • May be asymptomatic
  • Neurological consult
71
Q

Most common neonatal intracranial hemorrhage

A

Primary Subarachnoid Hemorrhage

72
Q

Babinski reflex

A

is “POSITIVE”
* Toes splay
* Normal in infants < 6 months of age

73
Q

Moro (startle) reflex

A
  • 28 weeks gest. to ~3 months
  • Supporting head/neck, quickly lower baby down
  • Symmetric abduction & extension
74
Q

Rooting reflex

A
  • 28 weeks gestation
  • Stroking the cheek
  • Infant turns head towards stimulus & opens mouth
75
Q

Sucking reflex

A
  • 14 weeks gestation
  • Sucks in response to a nipple in the mouth
76
Q

Palmar Grasp reflex

A
  • 28 weeks gest. to ~ 4 months
  • Placing index finger in palm of hand will elicit grasp
77
Q

Tonic neck reflex

A
  • Disappears by age 8 months
  • Turn Infant’s head to one side
  • Ipsilateral arm & leg will extend
  • Contralateral arm & leg will flex
  • ”Fencing position”

Pediatrics Exam 1 (6 decks)

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