PANCE book - Exam of newborn Flashcards
Ballard score
newborn assessment of activity, position, and tone to evaluate neuromuscular and physical maturity
rubric estimates gestational age
Causes of infant’s being small for gestational age
maternal drug use, chromosomal abnormality, viral infection, multiple birth, advanced maternal age, placental insufficiency, or lack of maternal weight gain
What is advanced maternal age?
> 35 yo
Most common cause of being large for gestational age
maternal diabetes
When should complete newborn exam be done?
within 24 hrs of birth
erythema toxicum
common rash in newborns 3-5 days old
small pustules with erythematous bases
spontaneous resolution in 1-2 wks
milia
common newborn rash
very small, white papules mostly on face
resolves w/o treatment in 1-2 months
miliaria
common newborn rash; “heat rash”
caused by blockage of eccrine sweat glands, resulting in flushed macular appearance
light clothing and decreased humidity speeds resolution
Mongolian spots
blue-black macule concentrated on back and buttocks of dark-skinned infants
most resolve in 4 yrs but may persist for life
craniosynostosis
premature fusion of one or more sutures
necessary to refer to neuro
Anterior fontanelle closes around _____ months and posterior fontanelle closes at _____ months.
10-26 mon
1-3 mon
If a third fontanelle is seen along sagittal suture this may be associated with ________.
Trisomy 21
caput succedaneum
fluid accumulation under scalp secondary to birth trauma
subgaleal hemorrhage
occurs beneath scalp; uncommon but results in enough blood loss to cause hemorrhagic shock!
How is hearing assessed in newborns?
auditory brain stem response or evoked otoacoustic emission testing
Absence of red reflex in infant may suggest what?
congenital cataracts, glaucoma, or retinoblastoma
Brushfield spots
gray/yellow spots at periphery of iris associated with Down syndrome
subconjunctival hemorrhages in newborns
benign finding associated with trauma of delivery; resolves with time
strabismus in newborns
“cross eyed”
almost always present in newborn period and is not pathologic unless persists past 4 months
choanal atresia
- unilateral or bilateral nasal obstruction
- bilateral results in respiratory distress as infants are obligate nasal breathers
- obstruction confirmed with CT
esophageal atresia presents as..
excessive drooling
Epstein pearls
small, pearly nodules along midline of hard palate; benign cysts
What indicates a submucosal cleft?
bifid uvula
Mouth findings of trisomy 21 infants
large tongue
webbed or redundant skin of neck may suggest _________.
Turner syndrome
Midline/thyroid neck mass finding
thyromegaly; congenital hypothyroidism and requires immediate attention to prevent growth failure/cretinism
neck mass finding within sternocleidomastoid suggests ________.
Torticollis, hematoma
signs of respiratory distress
grunting, intercostal retractions, tachypnea (+60), cyanosis
finding with pneumothorax or diaphragmatic hernia
decreased breath sounds unilaterally
pneumothorax would also have mediastinal shift
Most common causes of respiratory distress in newborn
aspiration, congenital pneumonia, transient tachypnea
Concerning findings in heart exam
rapid heart rate, cyanosis, CHF, diminished peripheral pulses
*murmurs may or may not be pathologic
Prune belly or absence of abdominal musculature may indicate what?
renal anomalies
What are prominent kidneys suggestive of?
hydronephrosis or cystic kidney disease
severely scaphoid belly + respiratory distress indicates?
diaphragmatic hernia
What may delayed stool production (+24 hrs) indicate?
Hirschsprung disease
signs of neurotubular defect or spina bifida on exam
gluteal cleft with pits, birthmarks, or tufts of hair
Normal HR at birth to 6 months
average 130-140, normal range up to 180-190
Avg HR 6-14 years old
90
respiratory rate at birth
30-60 bpm
respiratory rate 8-15 yrs old
15-25 (similar to adult)
When should testes descend?
usually at 3 months and 80% by 9 mon; if over 1 year refer to urologist
Concerns of prolonged empty scrotal sac?
testicular cancer and infertility; refer to endocrinologist
hydrocele
commonly observed (80% of newborns) collection of fluid in scrotum due to patency of vaginalis process
How is hydrocele mass differentiated from inguinal hernia?
transillumination
Which conditions are commonly associated with ambiguous genitalia?
chromosomal anomalies adrenal hyperplasia (affects testosterone)
How to treat vaginal adhesions in newborns?
estrogen or beclomethasone cream x 5-10 days
if doesn’t resolve, refer to urologist
Exams to test for developmental hip dislocation
Barlow maneuver: adduct fully flexed hip while pushing thigh posteriorly; dislocation + test
Ortolani maneuver: grasp medial aspect of flexed knee and fully abduct hip; feel for spasm or clunk
When should newborn’s hip clicking need ultrasound and referral to pediatric ortho?
- If Barlow and/or Ortolani maneuvers are positive
- If hip click persists past 1 month old
sucking and rooting reflex
earliest reflexes
when face stroked the baby will turn head towards that side and if offered nipple or finger will suckle
Moro reflex
allow infant’s head to drop 1-2 cm and observe for abduction of shoulders and elbows with spreading and extending of fingers; then adduction and flexion of same
disappears by 3-4 months old
grasp reflex
placement of finger in palmar or plantar surface elicits grasping response
disappears by 4 months old
Babinski reflex of infant
test is positive with upgoing plantar
may exist until 2 yo
traction response
pull infant by arms to sitting position
observe initial head lag, coming briefly to midline, then falling forward
Placing reflex
when infant dangled over flat surface with toe barely touching, triggers stepping response or extremity flexion
