Paediatrics/ Newborn and Infants Flashcards
What is a term infant?
A baby born between 37-weeks and 42-weeks gestation
What is a term Premature?
Less than 37 weeks
What is a term Postterm?
More than 42 weeks
When are Apgar scores measured?
At 1 and 5 minutes after birth
When should Apgar scores be repeated if the initial scores are less than 7?
At 10, 15, and 20 minutes after birth
What are the five Apgar categories?
- Heart rate
- Respiratory effort
- Muscle tone
- Reflex irritability
- Color
What is the maximum number of points on the Apgar score?
There are up to 2 points in each category for a maximum of 10 points.
How many vessels does a normal umbilical cord have?
Three (two arteries and one vein)
How long does it typically take an umbilical cord stump to fall off?
1-3 weeks
How should the umbilical cord be maintained?
- Air dry by keeping the diaper below the umbilicus
- alcohol is not recommended
- bathe the baby with a sponge bath but do not immerse the abdomen in water.
What is the typical weight of a healthy newborn?
2.5-4 kg
What is the typical Length?
46-54 cm
What is the typical Head circumference?
32-38 cm
What is the definition of low birth weight (LBW)?
Less than 2500 g at birth
What are the causes of LBW?
- Intrauterine growth restriction (IUGR)
- prematurity
- normal variant
What is the predominant cause of LBW in the United States?
Prematurity
What are the factors associated with IUGR (estimated fetal weight <10th percentile)?
- Genetic abnormalities
- multiple gestation
- fetal insulin deficiency
- placental insufficiency
- maternal disease (eg, HTN, sickle cell disease)
- drug use
What is large for gestational age (LGA)?
Larger than 90th percentile for gestational age
What is the weight of a term LGA baby?
More than 4000 g
What is the most common cause of LGA babies?
Maternal diabetes
Normal newborns may lose up to what percentage of their weight in the first week of life?
Up to 10%
A healthy baby should regain this weight by how many weeks of life?
2 weeks
In the first couple of months, about how much weight should a baby gain per day?
1 oz (or 28 g)
A normal baby’s respiratory rate and heart rate are slower than those of a normal adult. True or false?
False
A normal baby’s blood pressure is lower than that of a normal adult. True or false?
True
Doing a good initial heart examination rules out heart abnormalities. True or false? Why?
False
Some abnormalities may not be evident initially (eg, high pulmonary artery [PA] pressures on day one may diminish L → R shunting, so murmur of a ventral septal defect [VSD] is not appreciable)
When does the anterior fontanelle close?
During second year of life
When does the Posterior fontanelle close?
First few months of life
What is head “molding” in a newborn?
Irregularly shaped head with palpable ridges
What causes head “molding” in a newborn?
Pressure in the birth canal during labor and delivery
How long does head “molding” of newborn normally last?
It should disappear within a week
What is caput succedaneum?
Diffuse soft tissue edema of the scalp
What causes caput succedaneum?
Pressure on presenting part of scalp during delivery
Does caput succedaneum require treatment?
No. It resolves on its own in a few days.
What is cephalohematoma?
Hemorrhage below the lining of the bones of the skull
What usually causes cephalohematoma?
Small tearing of vessels during delivery
What are worrisome causes of cephalohematoma?
- Skull fracture
- coagulopathy
- intracerebral hemorrhage
What kind of treatment does an uncomplicated cephalohematoma require?
Usually none (resolves on its own), but the baby may need treatment for hyperbilirubinemia from blood resorption
Which crosses suture lines, cephalohematoma or caput succedaneum?
Caput succedaneum
What does an absent red reflex indicate?
Something is inhibiting light from getting to the retina (eg, cataract, tumor)
Intermittent strabismus is normal until what age?
3 months
What test on physical exam can assess ocular alignment?
The Hirschberg corneal light reflex test
How is the The Hirschberg corneal light reflex test performed?
The examiner notes the position of the corneal reflection from a light held 3 feet away from both eyes. Even with eye movement, the light should reflect in the same location of the cornea in each eye.
What will you see with left exotropia (left eye deviated laterally) in the Hirschberg corneal light reflex test?
The corneal reflection on the right will be over the pupil while the reflection on the left will be over the medial iris.
What is pseudostrabismus?
The perception of medial deviation (esotropia)
What contributes to pseudostrabismus?
Prominent medial canthal folds and a flat nasal bridge
What is the most common birth defect?
Hearing loss
What procedures are available to screen infants for hearing loss?
Measurement of otoacoustic emissions (OAEs) and/or auditory brain response (ABR)
All infants should be screened for hearing loss by what age?
1 month of age
Why is it so important to test for hearing loss in infants?
Hearing loss can significantly delay a child’s development, especially language acquisition.
Small, low-set, or floppy ears may be a sign of what other abnormalities?
- Chromosomal abnormality, renal abnormality
A common benign newborn rash consisting of small white papules on a blotchy erythematous base is called what?
erythema toxicum
What is the required treatment for erythema toxicum?
None (disappears on its own)
A female baby has swollen nipples and white vaginal discharge with a tinge of blood. Is this normal? What is the cause?
Yes.
Baby’s exposure to maternal hormones
What is the American Academy of Pediatrics’ stance on routine circumcision?
Not medically necessary
The Ortolani and Barlow maneuvers test for what abnormality?
Developmental hip dysplasia
What are some late diagnostic signs of developmental hip dysplasia?
Asymmetry of the following:
- thigh folds
- hip abduction and/or
- knee height
Lumbosacral dimples or hair tufts are concerning for what type of abnormality?
Underlying vertebral/spinal cord abnormality (eg, neural tube defect)
Does stroking the sole of the foot normally cause an infant’s toes to go up or down?
Up
Stroking a newborn’s cheek causes him to turn his head to the same side and make sucking motions with his mouth. What is this called?
Rooting reflex
When does the Moro reflex (startle reflex) normally disappear?
3-4 months
Every US state has a newborn screening program for metabolic and other inherited disorders. True or false?
True
Most state newborn screens include testing for what disorders?
Hypothyroidism, phenylketonuria, galactosemia, sickle cell disease
What is the most common chromosomal abnormality?
Down syndrome (Trisomy 21)
What are the most frequent causes of death in infants (<12 months old)?
- Sudden infant death syndrome (SIDS)
- perinatal conditions (eg, complications of prematurity)
- congenital abnormalities
- chromosomal abnormalities
About how many hours does a newborn sleep per 24 hours?
16-20
Tip: when you begin examining a newborn and s/he is not crying, take advantage of the opportunity to auscultate the heart and lungs and check for a red reflex.
