PE of Newborn Flashcards
normal frontal circumference at term
32-37 cm
normal length at term
48-52 cm
normal chest circumference at term
30-35 cm
landmarks for head circumference
glabella/supraorbital ridge anteriorly
most prominent part of the occiput posteriorly
t/f the new ballard score is performed as soon as possible after initial stabilization or 12 hours after birth
true, consists of neuromuscular maturity and physical maturity
components of new ballard score
neuromuscular: posture, square window (wrist), arm recoil, popliteal angle, scarf sign, heel to ear
physical: skin, lanugo, plantar surface, breast, eye/ear, genitals
infant classification and maturity by gestational age
pre-term <37 w
term 37- 41 6/7 w
post term >42 w
abnormal skin findings in newborn
pallor = low hgb cyanosis = hypoxemia plethora = polycythemia, over oxygenated, overheated
jaundice due to elevated bilirubin is most commonly observed beyond ___
the first 24 hours of life
clinical estimation of degree of jaundice
face only 5-8 mg/dl
face and upper trunk 8-12 mg/dl
lower trunk and extremity >12 mg/dl
t/f acrocyanosis is normal immediately after birth or few hours after birth
true, but can also be secondary to cold stress
t/f perioral cyanosis is always abnormal
false, common after birth
differential cyanosis points to
r-l shunt through pda
harlequin sign may be due to
immaturity of hypothalamic center that controls the dilatation of peripheral blood vessels
a reticular, lacy red pattern of the skin, marbled, purplish skin discoloration due to thermoregulation instability
cutis marmorata
a greasy white substance covering the skin, provides moisture barrier
vernix caseosa
when a baby’s skin resembles parchment
collodion infant
tiny sebaceous retention cysts that disappear a few weeks after birth
milia
numerous small areas of red skin with a yellow white papule in the center which contain eosinophils
erythema toxicum
skin lesion that does not blanch with pressure and does not disappear with time
port wine stain
mongolian spots disappear before age
4
small, flat, bright red umbilical lesions seen on occipital area, eyelids, and glabella
macular hemangioma
microcephaly vs macrocephaly
macro > 2 sd above mean
micro < 2-3 sd below mean
rate of hc increase
1 cm per month for first year (2 cm/mo for first 3 mo and then slower)
when do the fontanelles close
anterior (diamond) 9-18 mos
posterior 2-4 mos
head lesion that crosses the suture line and spontaneously resolves within days
caput succedaneum
what is a cephalhematoma
- secondary to rupture of bv that traverse the periosteum
- does not cross suture lines
- resolves in 2-3 w
what is molding
- temporary asymmetry of the skull due to birth (prolonged labor)
- normal in 1 wk
what is subgaleal hematoma
- caused by asphyxia, vacuum extraction, forceps delivery, or coagulopathy
- crosses suture lines and onto neck/ear
- progresses after birth
congenital cataracts occur due to
maternal infection with rubella
abnormal findings in the shapes of the eyes
lateral upward slope with inner epicanthal fold: trisomy 21
narrow palpebral fissure: fetal alcohol syndrome
what is mobius syndrome
symmetric facial palsy caused by absence or hypoplasia of 7th nerve nucleus
cause of facial nerve palsy
compression of facial nerve against sacral promontory or trauma with forceps
how to measure position of ears
draw imaginary line from inner and outer canthi of eyes across face
keratin containing cysts located on the hard and soft palate
epstein pearls
cystic swelling in the floor of the mouth which disappears spontaneously
ranula
small lesion on the oral mucosa secondary to trauma to the salivary glands
mucocele
diseases with macroglossia
beckwith’s sydnrome and congenital hypothyroidism
the scm is palpated to check for:
hematoma, thyroid enlargement, and thyroglossal duct cysts
t/f cc should be 5 cm less than hc
false, 2 cm
normal rr and hr
rr 30-60 rpm
hr 120-140 bpm
signs of respiratory distress
retractions, nasal flaring, grunting, tachypnea
absent or unequal breath sounds may indicate ___
pneumothorax or atelectasis
absent breath sounds with presence of bowel sounds indicates __
diaphragmatic hernia
t/f a murmur does not always signify the presence of heart disease and absence is not a reassurance of normalcy
true
the most common murmur in the immediate newborn are ___ that represent thee transition from __ to ___
flow murmurs that represent transition from fetal to neonatal circulation
scaphoid abdomen is associated with
congenital diaphragmatic hernia
t/f a smooth scrotum suggests prematurity
true
normal penile length at birth
2 cm, abnormally small = reduced androgen effect
t/f hydrocele is uncommon
false, it’s common and disappears by 1 year
t/f labia minora of term infants are enlarged and reddish in color
false, labia majora
meconium should pass within ___
48 hours of birth
abnormalities in the pulses
diminished in all extremities = poor co or peripheral vasoconstriction
absent or diminished femoral pulses = coarctation of aorta
abnormal pigmentation or hairy patches over lower back suggests
spina bifida
sacral or pilonidal dimple suggests
meningocoele
best time to do a neuro exam
prior to feeding
primitive reflexes
check slide
t/f fine tremors are abnormal, and clonic movements are normal
false, fine tremor is usually normal, clonic movements are not normal and may have seizures
erb duchenne paralysis involves
5th and 6th cn and is the most common brachial plexus injury (check slide)
klumpke paralysis involves
7th and 8th cn and 1st thoracic nerve (+ horner’s syndrome)
what is physiologic weight loss
loss of not more than 10% of body weight and recovered by 2nd week (30g/d)
factors suggesting non-physiologic jaundice
check slide
deep redness or purple lividity in a crying infant whose color may darken profoundly with closure of glottis preceding a vigorous cry
vasomotor instability
what causes pseudomenses
withdrawal of maternal hormones
what causes witch’s milk
elevated circulating endogenous steroid hormone and withdrawal of androgen after delivery
elevations in temp noted on the 2nd-3rd day of life
inanition fever
cause for inanition fever
low intake of fluids or exposed to high environmental temps,
t/f 80% of newborns exhibit physiologic desquamation
false, 60%
umbilical cord sloughs within ___, vessels functionally close but remain patent for ___
2 wks
10-20 d
t/f normal newborns have higher hg and hct with larger rbcs than older children and adults
true
