Pediatrics Flashcards
APGAR scoring is a method of assessing newborn infants at ——— and ——— minutes of life with a scale of ————
1
5
0–10
(Further assessments are recorded at 5-minute intervals until a score of at least 7 is achieved)
Apgar scores do not predict the
overall infant outcome, nor are they diagnostic
Apgar scoring scale:
Apgar score is based on appearance, pulse, grimace, activity, and respiration
Pulse of 130, acrocyanotic, grimaces to stimulation, moving all extremities and crying. Apgar Score?
8
Note: 2pts for pulse, 1 for color, 1 for irritability (to get full points for withdraw, they have to withdraw from stimulus), 2 for tone, and 2 for respiration)
What does the APGAR tell you at each time point?
General info about how the newborn tolerated labor (1min) and the newborn’s response to resuscitation (5min)
What does the APGAR not tell you?
What to do next (does not guide therapy) OR
How the baby will turn out (does NOT predict neurologic outcome)
When assessing Moro on an LGA newborn, the right arm remains extended and medially rotated: Dx and Next step?
Dx: Erb-Duchenne C5-C6 (upper trunk).
(Klumpke is C8-T1 (lower trunk))
Next step: Refer if not better by 3- 6mo for neuroplasty
Erb-Duchenne Palsy: Cause? Appearance?
Cause: Most common brachial plexus injury, caused by lateral traction (on neck during delivery) of the C5 and C6 nerve roots (upper trunk)
Apperence: The arm is adducted and internally rotated, but the grasp reflex is intact (If C7 is involved, the wrist is held in a flexed position (waiter’s tip))
Brachial plexus injuries can occur during birth when traction is used with
shoulder dystocia
Klumpke Palsy: Cause? Appearance?
Cause: Traction or tear of lower trunk C8-T1 roots (upward force on arm during delivery; Least frequent brachial plexus injury)
Appearance: The wrist and hand are weak (claw-hand) and lack a grasp reflex. If sympathetic nerves are involved, unilateral miosis (Horner syndrome) may result.
When palpating the clavicles on a LGA newborn, you feel crepitus and discontinuity on the left: Dx?
Dx: Clavicular Fracture.
Tx: Will form a callus in 1wk. No tx needed. Can use figure of 8 splint.
(Different from adult med; newborns bones more apt for remodeling)
Complete clavicular fracture may diminish the ——— reflex.
ipsilateral Moro
All macrosomic infants should be examined for signs of —(2)—
birth trauma and hypoglycemia
A medical student rotating in the nursery notices severe scalp swelling in a newborn male. The edema from the lesion crosses suture lines. What is the Dx and NBSIM?
Caput Succedaneum. Is simply a swelling of the scalp secondary to “barotrauma” from going through the birth canal. Completely benign and resolves within days.
A medical student rotating in the nursery notices severe scalp swelling in a newborn female. The edema from the lesion does not cross suture lines. What is the Dx and NBSIM?
Cephalohematoma. Is a subperiosteal bleed. Resolves in weeks-months. Increased risk for anemia/jaundice as the blood resorbs.
A medical student rotating in the nursery notices streaks of blood emanating from the vagina of a 3 day old newborn female. What is the Dx and NBSIM?
Normal/reassure the parents. Arises secondary to withdrawal of maternal hormones (uterus shedding).
Caput succedaneum vs cephalohematoma: Presentation and location?
Caput succedaneum is external to the periosteum. Caput crosses the midline of the skull and suture lines, unlike a cephalohematoma, which is below the periosteum and does not cross suture line
Caput succedaneum: Cause? Presentation? Prognosis?
Cephalohematoma: Cause? Presentation? Prognosis?
See pic: Edema. Crosses suture lines.
Note: pitting edema
See pic: “Fluctuance. Doesn’t cross suture lines.”
Maternal diabetes can lead to what in newborn after placental supply of glucose is removed?
Elevation of maternal glucose
causes elevated fetal glucose, leading to fetal hyperinsulinism, which can result in hypoglycemia in the newborn after placental supply of glucose is removed.
Mothers with pre-existing diabetes (esp type 1): important management steps
Control glc in the 1st trimester & take 4mg folate/day
Mothers with pre-existing diabetes (esp type 1): important associated birth defects
Placental insufficiency/IUGR, Congenital heart dz, NTD, Caudal regression syndrome, Small left colon syndrome