Newborns Flashcards
Close at 9-18 months
Anterior fontanels
Close at 3 months
Posterior fontanels
Require vitamin D supplement for days of life
Breast fed infants
Consists of 20kcal/30ml, Lactose
Breast milk
Long narrow face prominent forehead/chin, large ears, intellectual disability, autistic disorder
Fragile X disorder
Weight that falls below 3r to 5th percentile, causes diarrhea, dietary intake, malabsorption, (celiac disease, cystic fibrosis, food allergy) poor maternal bonding, frequent infections,
Failure to thrive
Genetic defect trisomy of chromosome 21, most common chromosomal disorder, average life span 60
Down syndrome
- Round face appears flat, - Upward slanting eyes, - Low set ears, - chronic open mouth caused by enlarged tongue, - short neck, - broad hands, - newborns have hypotonia and poor Moro reflex,
Down syndrome Characteristic
- congenital heart defects, - hearing loss, - visual problems, - cataracts, - sleep apnea, - early onset of Alzheimer’s, - educate parents about high - risk sports and avoid trampoline
Down syndrome High risk
Small head with narrow eyes flat nasal bridge, thin upper lip, ears are underdeveloped, mild to severe mental retardation, not obvious till adolescence, alcohol is prohibited during pregnancy affects CNS, somatic growth and facial structure
Fetal alcohol syndrome
A testicle that has not moved into the bag of skin below the penis before birth, maybe one or two, increases risk of testicular cancer, Tx - order US, corrected surgically
Cryptorchidism
Symptoms 2-5 days after birth, cause blindness, red conjunctiva, profuse purulent discharge and swollen eyelids, normally acquired during delivery, if positive acute conjunctivitis test for several STD’s,
Gonococcal ophthalmia neonatorum
Order gonococcal culture (Thayer-martin) herpes culture, chlamydial PCR,
Gonococcal ophthalmia neonatorum Dx
Ceftriaxone, topical erythromycin ointment, Test and treat mother and partner
Gonococcal ophthalmia neonatorum Tx
Symptoms 4 to 10 days eyelids are edematous, red and profuse watery discharge, and later becomes purulent
Chlamydial Ophthalmia neonatorum
Test exudate and conjunctival cells,
Chlamydial Ophthalmia neonatorum Dx
Azithromycin IM or oral erythromycin, prophylaxis is topical erythromycin ointment or tetracycline ointment, Test and treat mother and partner, reportable disease
Chlamydial Ophthalmia neonatorum Tx
Nasopharyngeal culture, frequent cough, bibasilar rales, tachypnea, hyperinflation, diffused infiltrates on chest xray
Chlamydial pneumonia
Erythromycin reportable disease
Chlamydial pneumonia Tx
Unexpected death in infants under 12 months, higher risk with premature, low birth weight, maternal smoking or drug use, poverty, decrease risk by position infant’s supine, avoid side lying or prone positions, avoid overheating infant with thick quilts
Sudden infant death syndrome
Beyond 7% is abnormal in infants
Weight loss
>10% weight loss, weak rapid pulse, tachypnea, deep breathing, parched mucous membranes, anterior fontanelle is sunken, tenting, cool skin , anuria, change in LOC,
Dehydration
HOW DO YOU ASSESS, OPTIONS: SKIN, WEIGHT, POSTERIOR FONTANEL, DON’T REMEMBER LAST OPTION
Dehydration Dx
Refer to ED for IV fluids, severe dehydration due to gastroenteritis leading cause of death in the world
Dehydration Tx
Blue to black covered patches, mistaken for bruising or child abuse, fades 2 to 3 years.
Mongolian spots
Multiple white papules located mainly on forehead cheeks and nose, due to retention of sebaceous material and keratin, resolves spontaneously
Milia, Miliaria, prickly heat
Small pustules surround by red base, erupts during 2 or 3rd day of life lasts 1to 2 weeks resolves
Erythema Toxicum Neonatorum
Excessive thick scaling on scalp, - Tx softening and removal of the thick scales after soaking in vegetable or mineral oil, shampoo scalp and gently scrub scales with soft comb, self-limited condition that resolve spontaneously in a few months
Seborrheic dermatitis (cradle cap)
Tufts of hair overlying spinal column usually at lumbosacral area, maybe sign of neural tube defect spina bifida,
Faun Tail nevus
Perform neurological exam focus on lumbosacral nerves order US of lesion to rule out occult spina bifida
Faun Tail nevus Dx
Flat light brown to dark brown spots > 5mm, if 6 or more > 5mm rule out neurofibromatosis, or von Recklinghausen’s disease (neuro disorder- seizures learning disability) refer to pediatric Neurologist
Café au Lait Spot
Neonates with pink red flat stain like skin lesions upper/lower eyelid or v1, v2 branches of trigeminal nerve, Tx - refer to pathologist to rule out congenital glaucoma, blanches to pressure, irregular size, lesions do not regress and grow with child
Port wine stain (nevus flammeus)
Raised vascular lesions ranging in size from .5 to 4.0 cm, bright red and feel soft to palpation, head and neck area, grow during first 12 months, resolve spontaneously, watchful waiting strategy, Tx - can treat with PDL therapy (laser)
Hemangioma (strawberry Hemangioma)
Misalignment of the eye,
Strabismus
Screening for strabismus
Hirschberg test
Inward turning of the eye
Estropia
outward turning of the eye
Exotropia
lazy eye
Amblyopia
response to loud noise
Gross hearing test
High risk factors for hearing loss - hyperbilirubinemia, - ear infections, - Apgar score low at birth, - rubella, - seizures
HEARS
At 1 to 2 years old
Lead screen
PKU, sickle cell, TSH
Required screens
Breast feed is preferred supplement with vitamin D, or formula fortified with iron
Nutrition
Avoid first year of life, causes GI bleed and IDA
Cow’s milk
4 to 6 months with rice fortified with iron
Solid foods
Diffuse edema of scalp crosses midline, caused by intrauterine and vaginal pressure from prolonged or difficult vaginal labor, scalp is molded, or cone shaped, resolves spontaneously, ecchymosis of scalp, scalp edema
Caput succedaneum
Traumatic subperiosteal hemorrhage, rule out skull fracture, swelling does not cross midline or suture line
Cephalohematoma
Avg 35cm, measure at each wellness till 3 years old, head circumference 2 cm bigger than chest, increase by 12 cm in first year
Head circumference
Urethral opening is underside of penis instead of normal placement
Hypospadias
Urethral meatus is upper side of penis
Epispadias
Weight loss 5 to 7 % after birth regain in 2 weeks
Neonates
Doubles by 6 months and triples in 12 months
Birth weight
White papules found on gum line resembles erupting tooth
Epstein pearls
First full set of teeth at 2.5 years old, permanent teeth at 6 years old
Teeth
Abnormality could indicate spina bifida
Anal wink
Upward extension of big toe with fanning of other toes
Plantar reflex (Babinski reflex)
Place finger in infant’s hand, pull away infant’s hand grip tightens
Palmar reflex (grasp reflex)
Disappears by 3 to 4 months, absence on 1 side rule out brachial plexus injury fracture, absence both sides rule out- spinal cord/brain lesion, older infant with continued more reflex rule out brain pathology
Moro reflex- (startle reflex)
Baby foot touches flat surface, will flex hip and knee on surface, abnormal with paresis or breech births disappears 6 weeks.
Step reflex
Eyelids close to light or response
Blink reflex
Turning head to one side with jaw over shoulders cause arm and leg to extend, the arm and leg on opposite side will flex, disappears by 6 months.
Tonic neck reflex (fencing reflex)
Stroking corner of mouth causes baby to turn toward stimulus and suck, disappears by 3 to 4 months
Rooting reflex
