Peds - Neonate Flashcards
newborn vitals
HR: 100-160 bpm, RR: 40-60, BP varies, Temp - 98.6 rectally
full-term
37-42 weeks gestation
post-term
42 + weeks
preterm
> 37 weeks
LBW
<2500 grams
VLBW
<1500 g
ELBW
<1000 g
Appropriate for Gestational age
AGA - 10-90th percentile
SGA
small for gestational age, <10th percentile
LGA
large for gestational age, above 90th percentile
APGAR
a- activity/ muscle tone, p - pulse, g- grimace or reflex, a - appearance or skin color, r-respiration
neonatologists
specialized pediatricians that can follow sick babies until they are 2 or 3
S&S of significant illness in newborn
tachypnea, grunting, cyanosis, temperature instability/fever, poor perfusion, hypoglycemia
routine meds in first 48 hrs of life
vitamin K, opthalmic ointment
Physical Exam of newborn - basics
vitals, wt in kg (2.2 lbs/kg), length in cm (2.54 cm/ in), head cricumference in cm
PE of newborn - eyes
red reflex - retinoblastoma or congenital cataracts, full EOMs, subconjunctival hemorrhages
PE of newborn - ears
shape, size, placement, skin tags or preauricular pits, if abnormal - check renal system that develops at same time
PE of newborn - nose and mouth
patency of nares (choanal atresia), obligate nose breathers until 3 months of age
PE of newborn -mouth
hard and soft palates, epstein pearls, epithelial cysts, natal teeth
PE of newborn - neck
ROM, cysts and masses, thryomegaly
PE of newborn - chest
clavicle fracture, pectus excavatum, breast buds, supernumerary nipples
PE of newborn - cardiovascular
Central cyanosis, cardiac mumurs, femoral pulse, pulse ox before discharge for critical congenital heart disease
PE of newborn - abdomen
masses or organomegaly, abdominal wall defects, umbilical cord - 2 arteries and avein - smiley face
PE of newborn - genetalia
male - hypospadius, hydrocele, cyrptorchidism, inguinal hernias, female - swollen labia majora or physiological vaginal discharde, both - anus patency
PE of newborn - spine
sacral dimples, hair tufts - both suggest spina bifida occulta, Mongolian spots
PE of newborn - extremeties
fingers and toes, talipes equinovarus - club foot, developmental dysplasia of the hip
PE of newborn - neurological
overall tone, reflexes - rooting, sucking, asymmetric tonic neck, palmar grasp, plantar grasp, moro relex
Uncircumcised risk
UTIs, STDS and HIV, penile cancer
Hearing screening
in first 48 hours
otoacoustic emission
OAE, screening for hearing, sounds presented to ear canal and microphone measures response in ear canal
auditory brainstem response
screening for hearing loss, ABR, sounds presented and surface electrodes measure brainstem activity
Before discharge - parent care
umbilical cord, cricumcision, feeding, bathing, sleeping patterns and positions, car seats, safety
Call if baby has…
fever > 100.4F, respiratory distress, irritability, lethargy, decreased feeding, dehydration
Preterm birth risk factors - maternal
preeclampsia, drug abuse (cocaine), chronic medical condition, infection
preterm birth risk factors - fetal
multiple gestation, premature rupture of membranes, placenta previa, fetal distress
Viability limits
22-25 weeks, 400-750 grams, use new ballard
common problems in prematurity
temperature instability, apnea, bradycardia, feeding issues - fluids, electrolytes, nutrition - protein, fat, carbs, aa, vitamins, minerals
erythema toxicum
very common in newborns, erythematus macules and papules that evolved into pustules, look like flee bites, face, truck and extremities but no palms or soles, self-limited, no tx
cutis marmorata
reticulated mottling of skin, symmetric on trunk and extremities, vascular response to cold, resolves with warmed skin, no tx needed
harlequin phenomenon
newborn lies on side and erythema on one side with blanching on the contralateral side, develops suddenly and persists for a time, no tx needed
transient neonatal pustular melanosis
vesiculopustular rash, more common in black newborns, no erythema, lesions rupture and leave a scaly, pigmented macule (Ddx), entire body can be affected
acne neonatorum
closed comedones on forehead, nose and cheeks, can be open comedones, papules and pustules too, sebaceous gland stimulation from infant or maternal androgens, resolve spontaneously within4 months, can tx if longer than 4 months or extensive with benzoyl peroxide, severe/unrelenting - hyperandrogenism?
milia
1-2 mm pearly white or yellow papules due to retention of keratin within dermis, forehead, cheeks, nose and chin, spontaneously resolve, self-limited
miliaria
sweat retention due to partial closure of eccrine structures, 1-2 mm vesicles without erythema on head,neck, and truck, vesicle ruptures and desquamates, avoid overheating, remove excess clothing, air conditioning, self-limited and benign
seborrheic dermatitis
cradle cap - scalp, face,ears, neck, erythema and greasy scales, can spread to diaper, self-limited in most children, scales can be removes with a brush after shampooing followed by tar shampoos if needed
congenital melanocytic nevi
dirupted migration of melanocytes precursors in neural crest, brown to balck - flat or raised, potential for melanoma in a small % of kids, removal if large or changes in color, shape or thickness with regular followup
dermal melanosis
mongolian spots, flat bluish-gray brown lesions from trapped melanocytes, back or buttocks and lock like bruises, make sure to document, self-limited and fade by 2 years of age
hemangiomas
strawberry in infants, most involute and disappear by 10 years old (90%), may leave atrophy, telangiectasias, hypopigmentation or scars, can tx if getting near school age, tx if near orifice with prednisone, multiple - look for them in liver and GI tract too
nevus flammeus
port-wine stain, vascular birthmark, dark red to purple, do not fade ofer time, don’t require tx but can use laser to lighten , if near opthalmic distribution of trigeminal nerve watch for glaucoma - Sturge-Weber syndrome
nevus simplex
salmon patch, stork bites, angel kisses, flat salmon-colored lesions caused by telangiectasias in dermis, blanch readily, symmetric, benign and resolve
skin markers of spinal dysraphism
incomplete fusion of midline elements of the spine, midline lumbosacral skin lesions - lipomas, dimples, dermal sinuses, tails, hemangiomas, etc are cutaneous markers - image (MRI or ultrasound) to check especially with 2+ lesions at midline
cafe-au-lait spots
coffee with milk, normal is small
sucking blister
suck in utero, self-limited
lanugo
fine hair that will slough off, common with preterm babies
intraventricular hemorrhage
occurs in gelatinous subependymal germinal matrix of the premature infant, predisposed - premature, RDS, hypoxic-ischemic inury, incr. or decr. cerabral blood flow, hypovolemia
retinopathy of prematurity
retinal vessel development interrupted and restarted causing scar tissue beyond the plane of retina, risk - hyperoxia, extreme prematurity, can cause cataracts, glaucoma, and blindness
Respiratory Distress Syndrome (RDS)
hyaline membrane disease, caused by surfactant deficiency - not produced by fetal lungs until 26-28 weeks, develop tachypnea, grunting, retractions, nasal flaring, cyanosis, tx- intubate, oxygen, surfactant, complications - bronchopulmonary dysplasia (chronic lung disease) or oxygen toxicity
Group B Strep Infection
Major cause of sepsis in newborns, moms screened at 35-57 wks gestation and given intrapartum antibiotics if needed, signs in neonate - respiratory distress, apnea, bradycardia, hypoglycemia, fever/hypothermia, lethargy, meningitis, if any symptoms - evaluate and empiric therapy
Transient tachypnea of the newborn (TTN)
term and pre-term infants can get this, risk with C-section, fetal lung fluid retention, tachypnea, grunting, nasal flaring, retractions with clear lungs, CXR: hyperinflated, prominent vascular markings, spontaneously resolves in 48-72 hours and has no long-term complications
hyperbilirubinemia
jaundice in the first 24 hours of life is pathologic, physiologic - breakdown fetal RBCs and decreased bilirubin clearance, may be affected due to breast-feeding - lower fluid vol and frequency of stool or breastmilk - fatty acid impede bilirubin clearance, visible if >7 mg/dl, treat with phototherapy at >15, >20 risk for kernicterus, tx with ad-lib feedings and supplement with formula if needed, exchange transfusion at critical levels
Premie discharge criteria
no recent apnea or bradycardia, feed via breast or bottle, maintain temp, steady wt gain, medical conditions stable and clear follow-up plan
long-term complications of preterm birth
physical - ROP/visual, sensorineural hearing loss, smaller and shorter though may catch up by 2nd year, higher mortality rate at <2 years of age, risk for developmental delay, mental retardation, or cerebral palsy
