Normal Newborn Flashcards
What are the risk factors for complications in the newborn?
- AMA (>35 Y)
- age less than 16 Y
- tobacco use (vasoconstriction)
- alcohol or substance abuse
- family history
- genetics (sickle cell, Askasi Jew)
- obstetric history (prior pregnancies, miscarriage, abortions)
What are indications for prenatal testing?
- maternal age >35 years
- previous child with structural or chromosomal abnormalities
- parent with chromosomal or structural abnormalities
- ethnic factors (African-Americans, Jews)
- maternal disease state (diabetes, heart disease)
- environmental exposure (including medications)
- maternal infection (HIV, cytomegalovirus)
What are the recommendations for basic prenatal care at the first visit?
includes complete history and physical, blood type, hepatitis B surface antibody, rubella titer, HIV testing, Pap smear, sexually transmitted disease (gonorrhea, chlamydia) screening, hemoglobin, hematocrit and urinalysis. Risk factors are assessed here.
What are the recommendations for basic prenatal care at 15 - 20 weeks gestation?
includes a maternal serum marker screening (alpha feto protein - spina bifada, others, depending on the risk factors).
What are the recommendations for basic prenatal care at 26 - 30 weeks gestation?
may include a 1 hour glucose tolerance test, hemoglobin and hematocrit, and Rh immune globulin administration if indicated.
What are the recommendations for basic prenatal care at 36 weeks gestation?
includes a group B streptococcus screening test of the cervix
-treated in labor
When does the woman begin to feel the baby begin to move?
16 to 20 weeks
What is a biophysical profile?
The biophysical profile is a non-invasive test that can predict the presence or absence of asphyxia, and perhaps, the risk of fetal death.
What are the five parameters included in the biophysical profile score (BPS)?
These include data from two sources, ultrasound imaging and fetal heart rate.
the non-stress test
- ultrasound measurement of the amniotic fluid volume
- observation of fetal breathing movements
- gross body movements
- tone
Normal receives a score of 2 points, abnormal scores 0.
What is labor?
onset of REGULAR uterine contractions with progressive dilation of the cervix. Full dilation is considered to be 10 centimeters.
What is malpresentation?
refers to any position of the fetus in which the vertex is not the body part presenting to the maternal pelvis.
What is considered operative deliveries?
- forceps deliveries
- vacuum extraction
What does the rapid assessment of the infant include?
- APGAR score
- quick physical exam
- gestational age estimate
What is included in an APGAR score? Range? Timing?
Appearance Pulse Grimace Activity Respiratory (0 - 10) 1 minute 5 minutes
What are chest signs that a newborn may be in trouble?
Chest - asymmetry
What are abdomen signs that a newborn may be in trouble?
Abdomen - Abdominal distention
- kidney enlargement
- hepatomegaly or splenomegaly
- abdominal masses
- bladder enlargement
- abdominal wall discoloration
What are genital signs that a newborn may be in trouble?
Male - hypospadias or epispadias
- foreskin hooded over glans
Female - bulging mass between the labia majora and minora with palpable uterine distention
What are anus signs that a newborn may be in trouble?
delayed passage of meconium
What are extremity signs that a newborn may be in trouble?
- pulse lab between the brachial and femoral arteries
- unequal leg lengths
- positional deformity of the foot
- abnormal finger curvature or bending
What are skin signs that a newborn may be in trouble?
- peeling and cracking
- yellowish staining of skin and fingernails
- cracking deep enough to cause bleeding
- cutis aplasia on the scalp or body
What are head signs that a newborn may be in trouble?
- subgaleal hematoma
- enlarged or bulging fontanelles
- head circumference greater than crown-rump length > 1.5 cm
- head circumference smaller than crown-rump length by > 1.5 cm
What are spine signs that a newborn may be in trouble?
- lumbosacral sinuses or pits
look for infection
What is involved in the revised Ballard score?
slide
What is completed in the nursery?
a more detailed physical examination should be done, and a careful estimate of gestational age. This should be recorded in the child’s chart. Always make sure that you RECORD ALL findings!
Orders should be written, based on the specific child. Nursery orders should reflect the child’s weight and gestational age. If risk factors for illness are found, appropriate intervention should begin at this time.
