Peds - Perinatal / Newborn Health Screening

Question 1

How many areas of assessment are included in the APGAR score? What are these areas?

Answer 1

1) 5 areas for assessment2) Appearance, Pulse, Grimace, Activity, and Respirations

Question 2

What is the maximum APGAR score at 1 and 5 minutes?

Answer 2

10

Question 3

How many points are possible for each of the APGAR assessment areas? How are they calculated?

Answer 3

1) 3 points maximum2) Calculated using the values 0, 1, 2 (0 counts as 1, 1 is 2, and 2 is 3).

Question 4

`What is the Dubowitz-Ballard exam test for?

Answer 4

Tests for gestational age.

Question 5

A baby born at 36 weeks would be considered _________. A baby born at 42 weeks is considered _____________.

Answer 5

1) premature (born before 37 weeks is premature)2) post-term (born after 41 weeks is post-term)

Question 6

What is the average length, weight, and head circumference of a term a baby?

Answer 6

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)

Question 7

A baby with head circumference, weight, and length all less than the 10 percentile are considered _______________. What causes this?

Answer 7

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

Question 8

If head circumference and length are WNL, but weight is less that the 10th percentile, what is this considered? What causes this?

Answer 8

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

Question 9

What are normal vital signs for an infant?

Answer 9

Temp:

Question 10

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?

Answer 10

These are milia, and will spontaneously disappear within 3 to 4 weeks after birth.

Question 11

This often occurs in hot, humid locations, and is caused by obstructed sweat (eccrine gland) ducts. Also known as “prickly heat.”

Answer 11

Miliaria

Question 12

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?

Answer 12

This is erythema toxicum, the most common newborn rash. Usually appearing between 2 - 5 days after birth and resolves by the 14th.

Question 13

Junctional nevi

Answer 13

(mole) - If present in large numbers suspect tuberous sclerosis, xeroderma, pigmentosus, or generalized neurofibromatosis.

Question 14

Cafe au lait spots

Answer 14

Subtle shade discoloration located on either flank, may not be present at birth, but likely to increase in size with age.

Question 15

In a child with cafe au lait spots when would you suspect neurofibromatosis?

Answer 15

If there are many large spots or if more than six spots in a child older than 5 years of age.

Question 16

Mongolian Spots

Answer 16

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.

Question 17

Port Wine Stain

Answer 17

Vascular birth mark consisting of superficial and deep dilated capillaries in the skin. Reddish to purplish discoloration of the skin. Permanent.

Question 18

What is important to rule out in a patient presenting with a port wine stain?

Answer 18

Sturge-Webber - serious neuro condition with seizures.

Question 19

John calls you reporting that his baby has raised, soft red lumps on the skin, what do you advise John?

Answer 19

These are hemangiomas (strawberry marks) that should start to shrink and fade after 6 months of age.

Question 20

Name the primitive reflexes that are present in the newborn and typically disappear around 3 - 4 months after birth.

Answer 20

1) Rooting
2) Sucking
3) Moro
5) Tonic neck

Question 21

What action is used to elicit the “sucking” reflex response?

Answer 21

A gloved finger is placed in the mouth to evaluate strength and coordination of the suck

Question 22

What action is used to elicit the “rooting” reflex?

Answer 22

The cheek and the corner of the mouth are stroked.

Question 23

What is the normal infant response to a “rooting” reflex stimulus?

Answer 23

The head should turn toward the stimulus, and the mouth should open

Question 24

What action is used to elicit the “palmar grasp” response?

Answer 24

The palmar surface of the hand is stimulated with a finger

Question 25

What is the normal infant response for the “palmar grasp” reflex?

Answer 25

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

Question 26

What action is used to elicit the “plantar grasp” reflex?

Answer 26

The sole of the foot and the toes are stimulated with a finger.

Question 27

What response should a normal infant have to the “plantar grasp” reflex?

Answer 27

The toes curl around the finger.

Question 28

What action is used to elicit the “moro reflex”?

Answer 28

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.

Question 29

What action is used to elicit the “tonic neck reflex” (aka “fencing position”)?”

Answer 29

The infant is placed in a supine position and the head is turned to one side.

Question 30

What response should a normal infant have to the “asymmetric tonic neck reflex/fencing position?”

Answer 30

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.

Question 31

This reflex is present in the newborn and disappears between 3 - 6 months _______________.

Answer 31

Palmar grasp.

Question 32

This reflex disappears at 4 months _______________.

Answer 32

Plantar grasp.

Question 33

This reflex is present in the newborn and disappears at 12 months or when walking _____________________.

Answer 33

Babinski

Question 34

How is the “placing reflex” elicited? And what is the normal response?

Answer 34

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

Question 35

This reflex is present in the newborn and disappears at 1 - 2 months.

Answer 35

Pacing / Stepping reflex

Question 36

What action is used to elicit the “Babinski reflex?”

Answer 36

The sole of the foot is stimulated from heel to toe with the practitioner’s finger

Question 37

What is the normal response to a “Babinski reflex” stimulus?

Answer 37

The toes extend and fan out, termed a positive response.

Question 38

Tommy is 12 months old and has begin to walk, what primitive reflex should have disappeared at this time?

Answer 38

Babinski

Question 39

Caput succedaneum

Answer 39

Crosses midline (fluid under the skin, simple swelling, resolves in 2-3 days)

Question 40

Cephalohematoma

Answer 40

Does not cross midline (blood under periosteum, requires further examination).

Question 41

Jamie is born small for gestational age, with unruly hair, microcephaly, and salt and pepper speckling of the iris. What are you suspecting?

Answer 41

Down Syndrome

*salt and pepper speckling = Brushfield Spots

Question 42

In which of the genetic syndromes is microstomia observed?

Answer 42

*small mouth

Trisomy 13 and 18

Question 43

When is macrostomia observed?

Answer 43

*large mouth

Fetal alcohol syndrome (fish mouth)

Question 44

What causes macroglossia in a newborn?

Answer 44

Hypothyroidism, mucopolysaccharidoses

Question 45

In which syndromes can micrognathia be observed?

Answer 45

*Recessed chin
Pierre-Robin syndrome
Treacher-Collins syndrome
Hallermann-Streiff syndrome

Question 46

Ortolani’s click

Answer 46

A “click” is heard or felt during abduction of the legs or as dislocation is reduced.

Question 47

Barlow’s Manuever

Answer 47

Feeling of a slip as the femoral head slips away from the acetabulum during adduction of the thigh, causing dislocation.

Question 48

What are the mandatory screening tests in all 50 states?

Answer 48

1) PKU
2) Galactosemia
3) Hemoglobinopathies (sickle cell)
4) Congenital hypothyroidism

Question 49

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?

Answer 49

Fractured clavicle

Question 50

Newborn screening for hypothyroidism is done by measuring:

Answer 50

Thyroxine (T4) and TSH

Question 51

Why are infants who have been identified as IUGR prone to developing hypoglycemia?

Answer 51

due to low levels of stored glycogen

Question 52

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?

Answer 52

heart murmur

Question 53

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?

Answer 53

After a thorough physical exam, send the baby to the ED for further testing and possible admission.

Question 54

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

Answer 54

B) Babinski