Peds - Perinatal / Newborn Health Screening Flashcards
How many areas of assessment are included in the APGAR score? What are these areas?
1) 5 areas for assessment2) Appearance, Pulse, Grimace, Activity, and Respirations
What is the maximum APGAR score at 1 and 5 minutes?
10
How many points are possible for each of the APGAR assessment areas? How are they calculated?
1) 3 points maximum2) Calculated using the values 0, 1, 2 (0 counts as 1, 1 is 2, and 2 is 3).
`What is the Dubowitz-Ballard exam test for?
Tests for gestational age.
A baby born at 36 weeks would be considered _________. A baby born at 42 weeks is considered _____________.
1) premature (born before 37 weeks is premature)2) post-term (born after 41 weeks is post-term)
What is the average length, weight, and head circumference of a term a baby?
Term baby is born between 37 to 41 weeks.Length: 20 to 21 inches (51 cm)Weight: 7lbs (3.1 kg)Head circum: 13 - 14 inches ( 30 335 cm)
A baby with head circumference, weight, and length all less than the 10 percentile are considered _______________. What causes this?
1) small for gestational age (SGA): Symmetric intrauterine growth retardation (IUGR) 2) Long-term compromise to the fetus or presence of an intrinsic problem - Genetic - Intrauterine infection - Environment (drugs, nicotine, x-ray exposure, alcohol) - Inborn errors of metabolism
If head circumference and length are WNL, but weight is less that the 10th percentile, what is this considered? What causes this?
1) Asymmetric intrauterine growth retardation (IUGR) 2) Acute fetal compromise - Chronic HTN - Pre - eclampsia - Renal disease - Cyanotic heart disease - Altitude - Multiple gestation - Hemoglobinopathies - Abruption placentae
What are normal vital signs for an infant?
Temp:
Melanie calls you concerned that her newborn has pinpoint, white papules on the face, most prominent on cheeks, nose, chin, and forehead. What do you tell her?
These are milia, and will spontaneously disappear within 3 to 4 weeks after birth.
This often occurs in hot, humid locations, and is caused by obstructed sweat (eccrine gland) ducts. Also known as “prickly heat.”
Miliaria
Pam calls you reporting that her 4 day old infant has developed blotchy red spots on the skin with overlying white or yellow papules or pustules. What do you tell her?
This is erythema toxicum, the most common newborn rash. Usually appearing between 2 - 5 days after birth and resolves by the 14th.
Junctional nevi
(mole) - If present in large numbers suspect tuberous sclerosis, xeroderma, pigmentosus, or generalized neurofibromatosis.
Cafe au lait spots
Subtle shade discoloration located on either flank, may not be present at birth, but likely to increase in size with age.
In a child with cafe au lait spots when would you suspect neurofibromatosis?
If there are many large spots or if more than six spots in a child older than 5 years of age.
Mongolian Spots
Benign, flat, congenital birthmark with wavy borders and irregular shape. Common color is blue. May last 3 - 5 years after birth, usually disappears by puberty.
Port Wine Stain
Vascular birth mark consisting of superficial and deep dilated capillaries in the skin. Reddish to purplish discoloration of the skin. Permanent.
What is important to rule out in a patient presenting with a port wine stain?
Sturge-Webber - serious neuro condition with seizures.
John calls you reporting that his baby has raised, soft red lumps on the skin, what do you advise John?
These are hemangiomas (strawberry marks) that should start to shrink and fade after 6 months of age.
Name the primitive reflexes that are present in the newborn and typically disappear around 3 - 4 months after birth.
1) Rooting
2) Sucking
3) Moro
5) Tonic neck
What action is used to elicit the “sucking” reflex response?
A gloved finger is placed in the mouth to evaluate strength and coordination of the suck
What action is used to elicit the “rooting” reflex?
The cheek and the corner of the mouth are stroked.
What is the normal infant response to a “rooting” reflex stimulus?
The head should turn toward the stimulus, and the mouth should open
What action is used to elicit the “palmar grasp” response?
The palmar surface of the hand is stimulated with a finger
What is the normal infant response for the “palmar grasp” reflex?
The baby should grasp the finger. Attempts to withdraw the finger lead to a tightened grasp. When tested with both hands, the term neonate can be lifted off the bed for a few seconds
What action is used to elicit the “plantar grasp” reflex?
The sole of the foot and the toes are stimulated with a finger.
What response should a normal infant have to the “plantar grasp” reflex?
The toes curl around the finger.
What action is used to elicit the “moro reflex”?
Also known as “startle reflex” as it is a response to the sensation of loss of support. It can be elicited by a loud noise or bumping the bed. This reflex can be elicited with the neonate supine, grasping the hands and pulling up until the shoulders are slightly off the bed, then letting go of the hands, resulting in the shoulders falling onto the bed.
What action is used to elicit the “tonic neck reflex” (aka “fencing position”)?”
The infant is placed in a supine position and the head is turned to one side.
What response should a normal infant have to the “asymmetric tonic neck reflex/fencing position?”
Extension of the arm on the side toward which the head is turned and flexion of the arm on the opposite side occurs. The legs mimic the arms: extension of the leg toward which the head is turned and flexion of the leg on the opposite side.
This reflex is present in the newborn and disappears between 3 - 6 months _______________.
Palmar grasp.
This reflex disappears at 4 months _______________.
Plantar grasp.
This reflex is present in the newborn and disappears at 12 months or when walking _____________________.
Babinski
How is the “placing reflex” elicited? And what is the normal response?
The infant is held upright, and the top of the foot is gently scraped along a table or counter. The infant flexes the leg as if stepping up onto the counter and then extends the leg
This reflex is present in the newborn and disappears at 1 - 2 months.
Pacing / Stepping reflex
What action is used to elicit the “Babinski reflex?”
The sole of the foot is stimulated from heel to toe with the practitioner’s finger
What is the normal response to a “Babinski reflex” stimulus?
The toes extend and fan out, termed a positive response.
Tommy is 12 months old and has begin to walk, what primitive reflex should have disappeared at this time?
Babinski
Caput succedaneum
Crosses midline (fluid under the skin, simple swelling, resolves in 2-3 days)
Cephalohematoma
Does not cross midline (blood under periosteum, requires further examination).
Jamie is born small for gestational age, with unruly hair, microcephaly, and salt and pepper speckling of the iris. What are you suspecting?
Down Syndrome
*salt and pepper speckling = Brushfield Spots
In which of the genetic syndromes is microstomia observed?
*small mouth
Trisomy 13 and 18
When is macrostomia observed?
*large mouth
Fetal alcohol syndrome (fish mouth)
What causes macroglossia in a newborn?
Hypothyroidism, mucopolysaccharidoses
In which syndromes can micrognathia be observed?
*Recessed chin
Pierre-Robin syndrome
Treacher-Collins syndrome
Hallermann-Streiff syndrome
Ortolani’s click
A “click” is heard or felt during abduction of the legs or as dislocation is reduced.
Barlow’s Manuever
Feeling of a slip as the femoral head slips away from the acetabulum during adduction of the thigh, causing dislocation.
What are the mandatory screening tests in all 50 states?
1) PKU
2) Galactosemia
3) Hemoglobinopathies (sickle cell)
4) Congenital hypothyroidism
While examining a 2.5 week old infant, you notice irritability when you lift the infant and an asymmetrical Moro reflex. A spasm of the sternocleidomastoid on the left side is also present. What do these findings indicate?
Fractured clavicle
Newborn screening for hypothyroidism is done by measuring:
Thyroxine (T4) and TSH
Why are infants who have been identified as IUGR prone to developing hypoglycemia?
due to low levels of stored glycogen
You are performing a newborn physical exam and you notice white specks around the circumference of the iris, what do you also have to assess for?
heart murmur
A mother brings her 3-week old infant to see you because he has become less interested in breast-feeding over the last day. She feels he may have been slightly warm during his last feeding, but she didn’t take his temperature. He has not exhibited vomiting, diarrhea, rash, or any other signs of illness. His VS include, temp 97F, HR 190BPM, and RR of 40BPM. What should you do next?
After a thorough physical exam, send the baby to the ED for further testing and possible admission.
Which of the following reflexes would not be expected to disappear by 4 months of age:
a) Rooting
b) Babinski
c) Moro
d) Pacing/stepping
B) Babinski
