Pedia 3B - Applied Neonat Flashcards
Severity of Jaundice
A. Prenatal history
B. Natal history
C. Neonatal history
Neonatal
GP of mother
A. Prenatal history
B. Natal history
C. Neonatal history
Prenatal
Spontaneous breathing at birth
A. Prenatal history
B. Natal history
C. Neonatal history
Natal
Hx of Phototherapy
A. Prenatal history
B. Natal history
C. Neonatal history
Neonatal
APGAR
A. Prenatal history
B. Natal history
C. Neonatal history
Natal
History & PE
- Child swallows dirt, crayon, chalk etc
PICA
History & PE
Excessive thirst and water intake
Polydipsia
History & PE Generalized Jaundice (sparring sclera)
Carotenemia
History & PE
Child regurgitates food into mouth & chews it
Rumination
History & PE
Blue without dyspnea
met-hemoglobunemia
History & PE
Generalized Cyanosis + Warm Extremities
Central Cyanosis
History & PE
Generalized Cyanosis (sparring tongue)
Cold extremities
Peripheral Cyanosis
History & PE
Failure of muscle coordination
Ataxia
History & PE
Pacified Swallowing
?
Maybe it’s supposed to be “Painful”? = Odynophagia
History & PE
Difficult swallowing
Dysphagia
Odynophagia
Note that Odynophagia usually refers to painful swallowing while Dysphagia refers to difficulty swallowing
History & PE
Lycopenemia
Red skin
History & PE
Athetosis
Athetosis is a symptom characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet
Hx and PE
Unsteady gait
Ataxia
Hx and PE
Pulse
- INC w/inspiration
- DEC w/expiration
Sinus Arrhythmia
Hx and PE
Pulse volume DEC (or disappears) at the end of inspiration
Pulsus paradoxus
Hx and PE
Rapid, deep breathing in metabolic acidosis
Kussmaul’s breathing
Hx and PE
Alternating periods of deep and shallow breathing with recurring periods of apnea
Biot’s breathing
Hx and PE
Lying still in bed and do NOT want their abdomen touched
Peritoneal Irritation
Hx and PE
Irritability and dyspnea WORSE when laying flat
Congestive Heart Failure
Hx and PE
Shrill shrieking and high pitched cry
CNS disease
Hx and PE
Abdominal pain AGGRAVATED by palpation
Pain secondary to inflammation
Hx and PE
Abdominal pain RELIEVED by palpation
Pain secondary to SPASM
Hx and PE
4 month old with head circumference larger than the chest circumference
Normal
Insert more info
Hx and PE
12 month old w/Head > Chest
Marasmus
Hx and PE
Noisy, musical respiratory sound
Heard even w/o stethoscope
Wheeze
Hx and PE
Sensory Changes
CNS disease
Hx and PE
Dark urine
Myoglobinuria
Hx and PE
Exaggerated reflexes
Peripheral nerve disease
Eye
Latent Tendency of eyes to deviate
Heterophoria
Eye
Partial or complete loss of vision
Amaurosis
Eye
Ideal condition of exact ocular balance
Orthophoria
Eye
Constant misalignment of the eyes
Heterotropia
Eye
Abnormal shape of the pupil
Dyscoria
Head Shape
Head is elongated in AP diameter
Scapho-cephaly
Head Shape
Top of the head is POINTED
Turri-cephaly
Head Shape
One side of the head is more rounded
Plagio-cephaly
Head Shape
Tower head
Oxi-cephaly
Chest
Pre-sternal edema
Mumps
Chest
Shield-shaped chest
Turner’s
Chest
Absence of clavicle
Cleido-cranial dyostosis
Chest
Super-numary nipples
Renal abnormality
Chest
Pigeon Chest
Rickets
Behavioral Problems
Acting out
Adolescence
Behavioral Problems
Bed wetting
School age
Behavioral Problems
Breath holding
Pre-school
Behavioral Problems
Child neglect
Infancy
Prenatal, Natal, Neonatal
Gravida Parity
Prenatal
Prenatal, Natal, Neonatal
Mother’s age
Prenatal
Prenatal, Natal, Neonatal
Polyhydramnios
Prenatal
Prenatal, Natal, Neonatal
Maternal intake of metformin
Prenatal
Prenatal, Natal, Neonatal
Phototherapy
Natal
Prenatal, Natal, Neonatal
APGAR
Natal
Prenatal, Natal, Neonatal
Meconium staining
Natal
Prenatal, Natal, Neonatal
NSD
Natal
Prenatal, Natal, Neonatal
Duration of nursery stay
Neonatal
Prenatal, Natal, Neonatal
Severity of Jaundice
Neonatal
History and PE
Health history of the yaya
Family history
History and PE
Are these the natural parents?
Family Hx
History and PE
Is there bed wetting?
Personal and Social
History and PE
What is the usual eating pattern?
Personal Social/
Why not Nutritional??
History and PE
Was phototherapy done?
Neonatal
History and PE
History of repeated accidents?
Past medical history
History and PE
What was the pattern of weight gain?
Nutritional
History and PE
What was the age of weaning?
Nutritional
History and PE
APGAR score
Natal
History and PE
What was the total duration of labor?
Natal
History and PE
40th week of gestation
Neonatal
History and PE
Exchange transfusion was done
Past medical history
History and PE
APGAR score of 9
Natal
History and PE
Two cord coils
Natal
History and PE
Presence of cataract
Neonatal
History and PE
Blood in sputum
Hemoptysis
History and PE
Patient is blue without dyspnea
Met-hemoglobinemia
History and PE
Purposeless, repetitive movement
Tics
History and PE
Double vision
Diplopia
History and PE
Involuntary discharge of urine occuring during sleep at night
Enuresis
History and PE
Sensation as if surrounding objects are going round and round
Vertigo
History and PE
Purposeless, non-repetitive involuntary movement
Chorea
History and PE
Slow writhing movements of the distal portion of the extremities
Athetosis
History and PE
Purposeless, non-repetitive movements
Chorea
History and PE
Purposeless, repetative movements
Tics
History and PE
Rapid oscillatory movements
Present at Rest
Tremor
History and PE
Slow rhytmic movements of the extremities and face
Athethosis
History and PE
Intermittent contractions of a single muscle group (or group of muscles) resulting in a quick jerky motion of a limb
Myoclonus
History and PE: Posture
Extension of the neck
Decerebrate
History and PE: Posture
Flexion of the elbows and wrists
Decorticate
History and PE: Posture
Extension of the lower limbs
BOTH
Decerebrate
Decorticate
History and PE: Posture
Pronation of the forearm
Decerebrate posture
History and PE: Posture
Extension at the elbows
Decerebrate
History and PE: Skin
Blanch w/pressure
Macules
History and PE: Skin
Do NOT blanch w/pressure
Petechiae
History and PE: Skin
Confluent papules
Plaques
History and PE: Skin
Larger lesions are called bullae
Vesicles
History and PE: Skin
Central portion of the lesion paler than periphery
Wheals
History and PE: Normal or Abnormal
Hydrocele at 3months
Normal
History and PE: Normal or Abnormal
L scrotum is lower than right
Normal
History and PE: Normal or Abnormal
Active bowel sounds in late intestinal obstruction
Abnormal
History and PE: Normal or Abnormal
Kidney felt best in deep inspiration
Normal
History and PE: Normal or Abnormal
Milky white breast secretions in a 5 day old neonate
Normal
History and PE: History
Yaya diagnosted w/milk TB
Family History
History and PE: History
Sources of support
Personal and Social
History and PE: History
Baby sleeps after feeding
Nutritional history
History and PE: History
Exchange Transfusion
Neonatal history
History and PE: History
Oligohydromnios
Natal history
History and PE: History
Term of pregnancy
Pre-natal
History and PE: History
Phototherapy
Neo-natal
History and PE: History
Polyhydramnios
Natal
History and PE: History
Meconium Staining
Natal
History and PE: History
Adequacy of milk intake
NONE
History and PE: History
Teenage pregnancy
Pre-natal
History and PE: History
G1P1
Pre-natal
History and PE: History
Birth weight
Natal
History and PE: History
Forceps delivery
Natal
History and PE: History
Induced Labor
Natal
History and PE: Pathologic or Physiologic
Cephalhematoma
Physiologic
History and PE: Pathologic or Physiologic
Ebstein pearls
Physiologic
History and PE: Pathologic or Physiologic
Erythematoxicum
Physiologic
History and PE: Pathologic or Physiologic
(+) Anlke clonus at 1 week of life
Physiologic
History and PE: Pathologic or Physiologic
Unequal moro reflex
PATHOLOGIC
History and PE: Pathologic or Physiologic
Caput succedanum
Physiologic
History and PE: Pathologic or Physiologic
Scaphoid abdomen at birth
Pathologic
History and PE: Pathologic or Physiologic
Bounding dorsalis pedis pulses
Pathologic
History and PE: Pathologic or Physiologic
Mila over the tip of the nose at 3 days of life
Physiologic
History and PE: Pathologic or Physiologic
Peripheral cyanosis at 4 hours of life
Physiologic
History and PE: Pathologic or Physiologic
36.7 C at 24h life
Pathologic
History and PE: Pathologic or Physiologic
Head circumerfence of 34cm
Physiologic
History and PE: Pathologic or Physiologic
Globular abdomen at 46H life
Physiologic
History and PE: Pathologic or Physiologic
RR = 60/min at 1 hour life
Physiologic
History and PE: Pathologic or Physiologic
Negative fencing reflex at 1 week of life
Pathologic
History and PE: Pathologic or Physiologic
Consumes 15cc breastmilk at 12h life
Physiologic
History and PE: Pathologic or Physiologic
(+) Palmar grasp at 24H life
Physiologic
History and PE: Pathologic or Physiologic
Passage of urine at 30H life in a 34 week neonate
Physiologic
History and PE: Pathologic or Physiologic
(+) crepitations over the clavicular area
Pathologic
History and PE: Pathologic or Physiologic
(+) Head lag at 2 weeks of life
Physiologic
History and PE: Pathologic or Physiologic
Umbilical cord stump falls off at 21 days
Pathologic
History and PE: Pathologic or Physiologic
Urethral discharge on 3 day old male
Pathologic
History and PE: Pathologic or Physiologic
Highly pigmented genitalia on a newborn female
Pathologic?
History and PE: T/F
In taking hx, remember to have a period of communication with the child even though the parents are talking
T
History and PE: T/F
In asking questions, use both open-ended and leading questions
T
History and PE: T/F
During the process of questioning, if a parent does not look in your eyes directly, it always means evasion
F
History and PE: T/F
Abdominal pain made worse by squeezing the abdomen is likey to be spastic in nature
T
History and PE: T/F
FF a hx of doctor-shopping by the family, one must be aware of the pediatric version of “Sandifier Syndrome”
T
History and PE: T/F
Gravida = number of pregnancies reaching age of viability
F
History and PE: T/F
Snoring = form of grunt which occurs during sleep
T
Isn’t snoring a form of Stridor?
History and PE: T/F
Height should be measured in the supine position in infants and children below 2
T
History and PE: T/F
Head circumference is measured at the point of max: Glabella and 1 inch above occipital protuberance
F
History and PE: T/F
Normally at birth, head circumerence > chest circumferance and remains so until 6m of age
T
History and PE: T/F
Normally, the axillary temperature is lower than the oral
T
History and PE: T/F
Sinus arrythmia = rapid pulse during expiration and slower during inspiration
F
History and PE: T/F
A narrow blood pressure cuff will give spuriously high blood pressure
Broader cuff will give a lower reading
T
History and PE: T/F
Movement is lost in both pyramidal and extra-pyramidal dse
T
History and PE: T/F
(+) Moro reflex up to 6m is normal
F
History and PE: T/F
Absence of balancing reflex for sitting after 8 m is abnormal
T
History and PE: T/F
Knee jerk is an example of a deep reflex
T
History and PE: T/F
Social smile ~ 3 months
F
History and PE: T/F
Bloody vaginal discharge among newborns is pathologic
F
History and PE: T/F
Pleural pain gets worse on coughing.
T
History and PE: T/F
INC ICP gets worse w/coughing
T
History and PE: T/F
Sclera is spared in carotenemia and lycopenemia
T
History and PE: T/F
In PICA, aside from mental retardation, there is a Hx of swallowing any inedible thing
F
Condition: Polycythemia in IDM
CM:
Tx:
Condition:
CM: Phlethora
Tx: Partial Exchange transfusion
Condition: Hypocalcemia in IDM
CM:
Tx:
Condition:
CM: Lipsmacking
Tx: Ca bolus
Condition: RDS of prematurity
CM:
Tx:
Condition:
CM: EXP grunting
Tx: PEEP
Condition: ARF
CM:
Tx:
Condition:
CM: UO <1cc/kg/h
Tx: Fluids
Condition: Neonatal sepsis
CM:
Tx:
Condition:
CM: Poor suck
Tx: Ab coverage for G +/-
Condition: Hypoglycemia in IDM
Cause:
Condition:
Cause: Abrupt cessation of glucose production w/existing fetal hyper-insulinemia
Condition: Early hypocalcemia
Cause:
Condition:
Cause: Fxn’l hypo-parathyroidism
Condition:
Cause: Hyaline membrane disease in IDM
Condition:
Cause: Surfactant deficiency w/retained fetal lung fluid
Condition: Early hypocalcemia in IDM
Cause:
Condition:
Cause: Hypomagnasemia d/t maternal Mg renal losses
Condition: Neonatal seizures after double volume exchange transfusion
Cause:
Condition:
Cause: INC albumin binding of Ca
Condition: UTI
Symptomatology:
Condition:
Symptomatology: Failure to suck + Proteinemia
Condition: Group B Strep Pneumonia
Symptomatology:
Condition:
Symptomatology: Profound shock w/tachypnea and expiratory grunt w/air bronchgram
Condition: HMD type I
Symptomatology:
Condition:
Symptomatology: Progressive tachypnea, cyanosis, EXP grunting w/air bronchogram
Condition: Neonatal hypocalcemia
Symptomatology:
Condition:
Symptomatology: Jitteriness, excessive sweating, tachypnea at 3 days of life
Condition: Neonatal hypomagnesemia of IDM
Symptomatology:
Condition:
Symptomatology: Jitteriness, cyanosis excessive sweating at 4th day of life
SGA or LGA Associated
Hypoglycemia
Both
SGA or LGA Associated
Polycythemia
SGA
SGA or LGA Associated
Congenital infections
SGA
SGA or LGA Associated
Congenital malformations
SGA
SGA or LGA Associated
Long-term developmental problems
SGA
SGA or LGA Associated
Born to diabetic mother
LGA
SGA or LGA Associated
Hypo-calcemia
LGA
SGA or LGA Associated
Respiratory distress
LGA
SGA or LGA Associated
Caudal regression syndrome
LGA
SGA or LGA Associated
Congenital heart disease
LGA
Blue discoloration of the extremities
When exposed to cold
Acrocyanosis
_______ cyanosis, esp in peri-oral region, may indicate cardiopulmonary disease
Central
Poly-cythemic infants w/hematocrits above ____% may also look cyanotic at times if there is enough de-saturation of Hg (>__%)
Above 68%
>5%
Brown blood specimen
Met-hemoglobinemia
Factors associated w/Pallor (5)
D/t anemia Peri-natal asphyxia w/profound circulatory disturbance Hypo-glycemia Seizures Thermal cold stress
Jaundice d/t unconjugated bilirubin (skin color)
Yellow-orange
Jaundice d/t conjugated bilirubin
Yellow-green
Jaundice 5-8%
Face only
Jaundice 8-12%
Face + Upper trunk
Jaundice >12%
Lower extremities and trunk
Jaundice during ________ is NEVER considered physiologic
First 24h of life
Jaundice during initial 24h could indicate (2)
Hyper-bilirubinemia (d/t hemolytic dse such as Rh/ABO incompatibility)
Sepsis
Irregular, flat, erythematous
Blanch on pressure
Found on forehead, eyelids and nape of neck
Stork’s bites
Capillary hemangiomas
Fade during first months of life
Irregular, raised, erythematous
Barely noticeable in NB then rapidly enlarge over next 2 months
Disfiguration
Almost always involute spontaneously
Strawberry or cavernous lesions (larger hemangiomas)
Large hemangiomas that consume large numbers of platelets
Kasselbach-Merritt Syndrome
Small whitish papules
Nose, cheeks, forehead
Retained sebaceous material
Milia
Disappear during first weeks of life
Obstruction of eccrine sweat galnds
Pinpoint vesiculo-papular rash
Scalp, forehead, skinfold
Disappear w/in 1-2 weeks if not overheated
Miliaria
Superficial - crystallina
Deep-seated w/reddish appearance - rubra
MC rash of newborn period
Begins 2nd/3rd days
White papulo-vesicular lesions on erythematous base
NOT on palms/soles
Erythema toxicum
Benign :)
Papulo-vesicular
ANY body surface
Rupture–> pigmented macule w/scaly ring
Pustular melanosis
Black infant
MC type of nevus
Large, flat, greyish-blue
Lower trunk or buttocks
Mongolian spot
Light brown macules w/irregular borders
Any skin surface
Cafe-au-lait
No significance
Large and numerous cafe-au-lait spots may indicate
Neurofibromatosis
MC skull trauma
Caput succedaneum (edema of skull)
Collection of blood in periosteum
Single bone
10-20% associated w/fractures
Depression of the skull
Cephalo-hematoma
Liquifies at center
Calcifies at periphery
Size of fontanels
- Anterior
- Posterior
A - 2-3cm (48h of life)
P - 1cm
Normal head circumference
32-37 cm
Eye
Lateral upward slow
Inner epi-canthal fold
Trisomy 21
Could also be normal
Lateral downward slow
Renal dysplasia/hypoplasia (Potter syndrome)
Narrow palpebral fissures
Reduced inter-canthal distance
Fetal alcohol syndrome
Conjunctiva
- First 24-48h:
- After second day:
- After 4-5days:
- Several weeks:
Conjunctiva
- First 24-48h: Erythema + Discharge from Silver nitrate
- After second day: Gonococcal ophthalmia
- After 4-5days: Blenorrhea (Chlamydia or viral conjunctivas)
- Several weeks: Also Chlamydial + pneumonia and esosinophilia
Blue sclera
Osteogenesis imperfecta
Cutis laxa
Normal
D/t INC in venous pressure during delivery
Benign
Subconjunctival hemorrhages
Clouding of cornea (hazy grey)
(-) ROR
Cataracts
Glaycoma
White reflex on ophthalmoscopy
Retino-blastoma
Blushfield spots (small white spots at periphery of iris)
Trisomy 21
Normal
SGA
Salt and pepper appearance of retina
Congenital infection
- Cytomegalic inclusion disease
- Toxoplasmosis
Ear:
Anotica (Treacher-Collins syndrome)
Absence of ear
Pre-auricular pits are N/Ab
Normal
Ear examination of infant
Upward and anteriorly
Ear examination in an older child
UBO
Appearance of tympanic membrane in newborn
Less translucent
INC vascularity
Red bulging tympanic membrane
Otitis media
Cyanosis at rest
Disappears w/crying
Choanal atresia
Large tongue
Normal
Excessively large tongue (5)
Hemangioma Lymphangioma Hypothyroidism Mucopolysaccharidosis Beckwith Syndrome
Small epithelial inclusion cysts of the palate
Benign “Epstein’s Pearls”
Retention cysts along gyms
Ranula
Benign
Small Jaw
+ Glossoptosis + high arched palate
Normal
Pierre Robin Syndrome
MC mass in neck
Cystic hydromas
Neck mass Soft Lymphoid (+) Transillumination Ant triangle
Cystic hygromas
Neck Mass
Firm
SCM
(-) Transillumination
Branchial cleft cysts
MC Midline mass
Thyroglossal duct cyst
Goiters are rare unless endemic to area
Webbing of neck (3)
Turner
Noonan
Klippel-Feil
Most important sign of lung disease in neonate
Seen in resp distress, atelectasis, airway obstruction, aspiration
Reduced lung volume
Retractions
Newborn RR
Variable
Ranges 30-60 bpm
Mean: 40
Newborn breathing
Abdominal
Little use of accessory
Normalized at 8-12 hours
Contractions and cyanosis <8hours of life
Normal as fetal lung fluid is cleared
Cessation of breathing >15s
Cessation of breathing <15s + bradycardia
Apnea
Breasts in NB
Days 2-3
Dull percussion note in NB
Pleural effusion
Lobar atelectasis
Hyper-resonant percussion in NB
Pneumothorax
Lung cysts
Lobar emphysema
Breath sounds in NB ideally listened for at
Midaxillary line in midthorax
Breath sounds in NB and infant are more
Broncho-vesicular
Unilateral absence of breath sounds (40
Atelectasis
Pleural effusion
Pneumothorax
Cystic malformations
Bowel sounds in chest should alert to
Diaphragmatic hernia
Stridor on INSP
MC Laryngomalacia Also - Tracheomalacia - Laryngeal web - Vocal cord paralysis - Vascular ring
Excessive mucus in upper airway results in
Clears on coughing or crying
INSP Rhonchi
Crackles or rales associated with
Pneumonia
Delayed resorption of fetal lung fluid
Meconium aspiration
Pulmonary edema
Cardinal signs of heart disease in a neonate
Cyanosis
Respiratory distress
NB Blood pressure
Systolic
Diastolic
Mean
S 40-80
D 20-55
M 25-60
NB HR
90-160 (usually 120-140 term)
Single umbilical vessel associated with
Genito-urinary anomalies
Cardinal signs of intestinal obstruction
- Abdominal distension
- Failure to pass mecoium
- Bilious vomiting
Bruits heard in abdomen
Renal artery stenosis
High pitched bowel sounds
Mechanical obstruction
(-) Bowel sounds
Ileus
Septicemia
Liver in neonate found __ to __ cm below costal margin
1-2cm
Hard or nodular liver
Intrinsic liver pathology
Firm or rubbery liver
Extrinsic pathology (CHF)
Splenic enlargement beyond ___ cm below L costal margin is abnormal
1cm
Separation of musculature of the abdomen at midline
Diastasis recti
Associated w/circular umbilical hernia
Tufts of hair, pilonidal sinus, soft lumps may indicate
Spina bifida occulta
Male phallus at least __ cm in length
1cm
Urethral opening proximal to end of phallus
1’
2’
3’
Hypospadias
1’ - Urethral opening on glans but proximal to tip
2’ - Opening along shaft
3’ Opening anywhere from perineum to base
Caudal curve of penis
Chordee
Unilaterally cyanotic scrotum shortly after birth
Intra-uterine testicular torsion
Painless but can rarely be saved
Discharge from female NB
- White
- Blood tinged
Normal d/t hormones
Membrane at opening of vagina
Hydro-metro-colpos
Silk sign
INdirect hernia
Usual signs of indirect hernia in infants
- Male
- Female
Hydrocele
Prominence of labia majora
MCC Ambiguous genitalia
Congenital adrenal hyperplasia
Ovarian enlargement in NB
Cyst
Torsion
Uterine enlargement in NB
Hydro-metro-colpos
Fusion of digits
Syndactly
Unequal limb size is associated with
congenital malformations
Hemangiomas
Lymphangiomas
Intrauterine positional anomalies
Hip dislocation
Ortolani
Barlow
Asymmetry of gluteal folds
Optimal time to perform neurological examination
Prior to feeding
Frog-leg position
Hypotonic infants
Normal in pre-mature
Disconjugate gaze is normal up to
6 months
Esp immediately ff sleep
CN IX & X assessed by
Effective coordination of swallowing
Assessment of CN XII
Sucking and Milk expression
Reflexes
Appears:
Disappears:
Moro
Appears 28w
Complete 32w
Disappears 4m
Reflexes
Appears:
Disappears:
Palmar
Appears 28 (same as moro)
Developed by 32w
Disappears 2-3m
Reflexes
Appears:
Disappears:
Tonic Neck/Fencing
Appears: 35w
Peak: 1m postnatal
Disappears: 6m
Reflexes
Appears:
Disappears:
Stepping (involuntary walking)
Appears 35-36w
Disappears: 2m
Prematurity
Birthweight
Weeks Gestational Age
Mild
2000-2500 gm
35-37 weeks
Prematurity
Birthweight
Weeks Gestational Age
Moderate
1000-2000
29-35 weeks
Prematurity
Birthweight
Weeks Gestational Age
Severe
<1000
24-28 weeks
Skin - Shiny and translucent
Very premature
Sudden twitching of all extremities
Tremulousness of single extremities
NOT seizures
Immature, poorly myelinated CNS
Single most devastating problem for premature baby
Intra-ventricular hemorrhage
Apnea, cyanosis and autonomic instability
Seizures in NB
Sublte Cyclic flexing of digit or extremity Lip smacking Repetitive mouthing movements Yawning Apnea
NB Blood pressure
Systolic
Diastolic
Mean
S 40-80
D 20-55
M 25-60
NB HR
90-160 (usually 120-140 term)
Single umbilical vessel associated with
Genito-urinary anomalies
Cardinal signs of intestinal obstruction
- Abdominal distension
- Failure to pass mecoium
- Bilious vomiting
Bruits heard in abdomen
Renal artery stenosis
High pitched bowel sounds
Mechanical obstruction
(-) Bowel sounds
Ileus
Septicemia
Liver in neonate found __ to __ cm below costal margin
1-2cm
Hard or nodular liver
Intrinsic liver pathology
Firm or rubbery liver
Extrinsic pathology (CHF)
Splenic enlargement beyond ___ cm below L costal margin is abnormal
1cm
Separation of musculature of the abdomen at midline
Diastasis recti
Associated w/circular umbilical hernia
Tufts of hair, pilonidal sinus, soft lumps may indicate
Spina bifida occulta
Male phallus at least __ cm in length
1cm
Urethral opening proximal to end of phallus
1’
2’
3’
Hypospadias
1’ - Urethral opening on glans but proximal to tip
2’ - Opening along shaft
3’ Opening anywhere from perineum to base
Caudal curve of penis
Chordee
Unilaterally cyanotic scrotum shortly after birth
Intra-uterine testicular torsion
Painless but can rarely be saved
Discharge from female NB
- White
- Blood tinged
Normal d/t hormones
Membrane at opening of vagina
Hydro-metro-colpos
Silk sign
INdirect hernia
Usual signs of indirect hernia in infants
- Male
- Female
Hydrocele
Prominence of labia majora
MCC Ambiguous genitalia
Congenital adrenal hyperplasia
Ovarian enlargement in NB
Cyst
Torsion
Uterine enlargement in NB
Hydro-metro-colpos
Fusion of digits
Syndactly
Unequal limb size is associated with
congenital malformations
Hemangiomas
Lymphangiomas
Intrauterine positional anomalies
Hip dislocation
Ortolani
Barlow
Asymmetry of gluteal folds
Optimal time to perform neurological examination
Prior to feeding
Frog-leg position
Hypotonic infants
Normal in pre-mature
Disconjugate gaze is normal up to
6 months
Esp immediately ff sleep
CN IX & X assessed by
Effective coordination of swallowing
Assessment of CN XII
Sucking and Milk expression
Reflexes
Appears:
Disappears:
Moro
Appears 28w
Complete 32w
Disappears 4m
Reflexes
Appears:
Disappears:
Palmar
Appears 28 (same as moro)
Developed by 32w
Disappears 2-3m
Reflexes
Appears:
Disappears:
Tonic Neck/Fencing
Appears: 35w
Peak: 1m postnatal
Disappears: 6m
Reflexes
Appears:
Disappears:
Stepping (involuntary walking)
Appears 35-36w
Disappears: 2m
Prematurity
Birthweight
Weeks Gestational Age
Mild
2000-2500 gm
35-37 weeks
Prematurity
Birthweight
Weeks Gestational Age
Moderate
1000-2000
29-35 weeks
Prematurity
Birthweight
Weeks Gestational Age
Severe
<1000
24-28 weeks
Skin - Shiny and translucent
Very premature
Sudden twitching of all extremities
Tremulousness of single extremities
NOT seizures
Immature, poorly myelinated CNS
Single most devastating problem for premature baby
Intra-ventricular hemorrhage
Apnea, cyanosis and autonomic instability
Seizures in NB
Sublte Cyclic flexing of digit or extremity Lip smacking Repetitive mouthing movements Yawning Apnea