newborn physical assessment Flashcards
- small palpebral fissures
- upturned nose
- smooth philtrum
- thin upper lip
- flat nasal bridge
FAS
- upslanted palpebral fissure
- flat bridge
- protruding tongue
- hypotonia
- excess skin nape of neck
down syndrome
- Bleeding (hematoma) in subperiosteal space that does not cross suture line, tense swelling
- 1-2% of all deliveries, more common with vacuum/forceps
- Develops incrementally over 24hr, resolves within a few weeks
cephalohematoma
- Skin swelling (scalp edema) on presenting part of scalp that can cross midline/suture line.
- Above the periosteum
- Present at birth and stays same size; resolves within a few days
caput
- Rupture of emissary veins beneath the periosteum —crosses suture lines. Bleeding. Large potential space
- Diffuse fluctuant swelling of the head may shift with movement. Fluid wave; tracks down back of head/neck. Covers large area.
- 50% occur after vacuum assisted delivery
- Mortality: 12-14% due to shock, coagulopathy
subgaleal
3 birth related trauma
- cephalohematoma
- caput
- subgaleal
- Blockage of the posterior nasal aperture
- bilateral presents w/ acute resporatory distress and cyanosis relieved by crying, worsened by feeding, noisy breathing
- unilateral is majority and rarely causes sx
- pass catheter down nares
choanal atresia
- inability to close eye
- flattening of nasolabial fold
- mouth does not move down on AFFECTED side
- improves over first few weeks of life
facial nerve palsy
most frequent abdominal mass in newborns
enlarged kidneys
4 possible reasons for no stool in 48 hrs
- hirschsprung’s dz
- imperforate anus
- bowel obstruction
- cystic fibrosis
- encompasses a spectrum of conditions characterized by abnormal development of the acetabulum, proximal femur, and mechanical instability of the hip joint
- tx with pavlik harness for 3 months
DDH
anecephaly, myelomeningocele, meningocele
these are examples of what type of defects
open neural tube defects
- cyanosis of hands, feet, perioral area, resolves by 24-48 hrs
Acrocyanosis
red, irregular macule with a central yellow pustule/yellow-white papule
- 50% of term infants, onset between 24-48 hrs of life
- start on face then spread to trunk and extremities, lasts about one week
- anywhere on body except palms and soles
erythema toxicum
angel kiss and stork bite d/t capillary malformation
nevus simplex
- Pink/red sharply demarcated patch or macule
- capillary malformation
port wine stain
universal testing with vaginal-rectal culture for GBS is recommended at what weeks
36-37 wks
2 first trimester screens for birth defects (11-14wks)
- PAPPA and hcG
- nuchal translucency screening (US)
2nd trimester screening for birth defects (15-20 wks)
quad screen: AFP, estriol, hcG, inhibin A
- maternal fever, uterine tenderness
- sustained fetal and maternal tachycardia
- foul smelling amniotic fluid
these things should make you concerned about
maternal chorioamnionitis
- Estimates gestational age of the baby based on neuromuscular and PE
- Use with estimates of gestational age based on LMP and prenatal ultrasound
- Helpful when there is no prenatal care!
ballard score
Head Circumference < 3rd percentile – due to genetic disorders/chromosomal abnormalities, metabolic disorders, perinatal brain damage, infection, meds
microcephaly
used to prevent neonatal conjunctivitis in newborns
0.5% erythromycin ointment
- Prevents Vitamin-K deficiency bleeding (VKDB)
- decreases risk for clasic and late onset VKDB
Single IM dose of 1 mg vitamin K w/in 6 hrs of birth
Bleeding between 2 days- 1wk in GI tract, skin, nose, umbilical stump, circ site
classic onset VKDB
Bleeding in infants 2 wks- 6 months
Catastrophic brain and gut
late onset VKDB
hearing loss is typically diagnosed when? services should be provided when?
- Diagnose before 3 months
- Provide services before 6 months
- Pulse oxin right hand and either foot
- Any newborn with SpO2 < 95% or > 3% difference between pre and post ductal sat = positive screen
CCHD screen
which hepatitis vaccine is recommended for all new borns
B
what should you do if moms HebBsAG status is positive?
give vaxx and HBIG ASAP
if jaundiced, how soon should f/u be?
w/in 24hrs
if breastfeeding, how soon should f/u be?
w/in 48hrs
if formula-feeding, how soon should f/u be?
w/in 2-5 days
