Peds: Prenatal/Newborn Assessment/Screening Flashcards
1
Q
Assessment of Prenatal History
A
- *course of prenatal care;
- *xenobiotic used during gestational period;
- *health problems during pregnancy;
- intrauterine fetal health problems;
- *mother’s perception of pregancy
2
Q
Assessment of Perinatal History
A
- *delivery process (vaginal vs c-section, planned vs emergent, induced, analgesia/anesthesia);
- *complications during delivery (meconium, placenta previa/abruption, forceps/vacuum);
- *birth size/wt (low < 2,500 g, very low < 1,500 g, extremely low < 1,000 g);
- *assessment of wt for gestational (average 10th - 90th percentile, large > 90th percentile, small < 10th percentile);
- *APGAR socres (5 areas= appearance, pulse, grimace, activity, & respiration = 0, 1, 2 pts possible with max score noted at 1 min & 5 min after birth = total max 10 pts)
3
Q
Assessment of Postnatal History
A
- *hospital course;
- *maternal problems (bleeding, infection, dehydration, breastfeeding, anesthesia response, fever, depression);
- *infant problems (ABO/RH incompatibilities, hyperbilirubinemia, Hip dysplasia, murmurs, Talipes equinovarus congenita (club feet), & genetic syndromes
4
Q
Newborn Physical Examination:
- average weight, length, head circumference
- gestational age
A
- *weight, length, head circumference:
- —average length 20-21 inches;
- —average wt 7 lbs (3.1 kg);
- —average head circumference 13-14 in (33-35 cm);
- – note ethnic differences in height;
- *assessment of gestational age:
- –37-41 weeks full term - best outcomes;
- –prior to 37 weeks premature;
- –after 41 weeks post term
5
Q
Newborn Physical Examination
IUGR = Intrauterine Growth Retardation:
- Small Gestational Age (SGA)
A
- SGA = small gestational age**
- **33% of SGA infants = SYMMETRIC
- – head circumference, weight, & length are < 10th percentile;
- *due to long term compromise to fetus as in genetic disorders, intrauterine infection, inborn metabolism errors, & environment- drugs, smoking, or radiation;
- **55% of SGA infants = ASYMMETRIC
- — head circumference & length are normal but weight is < 10th percentile;
- *due to extra fetal compromise occurring > 24 weeks; from chronic HTN, pre-eclampsia, renal disease, cyanotic heart disease, hemoglobinopathies, abruptio placentae, high altitudes (mountains), multiple gestation
6
Q
Newborn Physical Examination:
LGA or Large Gestational Age
A
- *weight > 90th percentile; may be due to-
- *Beckwith-Wiedemann syndrome: congenital growth disorder which causes hemihypertrophy, large organs, & other symptoms;
- *Hydrops Fetalis: fatal condition of which abnormal accumulation of fluid is noted in 2 or more fetal body areas;
- *maternal diabetes;
- *large mother
7
Q
Newborn Physical Examination:
Dubowitz/Ballard Exam for Gestational Age
- part 1: physical maturity assessment
A
- *physical maturity assessment–
- *2 hours of birth with pts (-2 to +5) given for six criteria:
- *skin texture (sticky, smooth, peeling);
- *lanugo (soft, downy hair- absent on immature infants, present on mature infants, and disappears with post maturity);
- *plantar creases (sole of feet ranging from absent to covering entire feet);
- *breasts (thickness & size of breast tissue);
- *eyes/ears, & genitals (male- presence/appearance of smooth to wrinkled scrotum; female- size/appearance of clitoris/labia)
8
Q
Newborn Physical Examination:
Dubowitz/Ballard Exam for Gestational Age
- part 2: neuromuscular maturity assessment
A
- *neuromuscular maturity assessment–
- *24 hrs of birth with pts given for six criteria:
- *posture- how arms/legs held (good tones/flex);
- *square window- how baby’s hand flexes toward wrist (90 degree angle flex- premies, flex to forearm- term);
- *arm recoil- how far arm’s spring back to flex position;
- *popliteal angle;- how far knees extend;
- *scarf’s sign- how far elbows cross chest (no cross midline- term; line of elbow cross midline- premie);
- *heel to ear- how close feet move to ears;
9
Q
Newborn Physical Examination:
Dubowitz/Ballard Exam for Gestational Age
- part 3: gestational age determination based upon sum of scores
A
- *low scores indicate immaturity;
* *high scores indicate mature or post mature infant
10
Q
The Dubowitz/Ballard Exam for Gestational Age has ____ parts.
A
**physical maturity, neuromuscular maturity, & gestational age determination
11
Q
Newborn Vital Signs
A
- *FEVER = temperature > 100.4 degrees F (38 deg. C);
- *PULSE 120-180 bpm;
- *RESP 30-80 bpm;
- *BLOOD PRESSURE < 112/74 mmHg
12
Q
Newborn Skin: Common Variations
A
- *typical skin changes - pallor, cyanosis, plethora (blotchy skin- polycythemia), jaundice, grey;
- *milia- pinpoint white papules to face, disappears 3-4 wks (widespread distribution = genetic syndrome);
- *miliaria- (R for red aka “prickly heat”)- obstructed sweat or eccrine gland ducts;
- *erythema toxicum- most common, appears 2-5 days after birth, blotchy red spots with overlying white/yellow papules/pustules; disappears 14th day;
- *Cafe au lait spots- subtle shade discoloration on either flank, may not present @ birth, size increase with age, more than 6 in child > 5 yrs suspect neurofibromatosis;
- *Mongolian spots- benign, flat, congenital birthmark with wavy borders/irregular shape, commonly blue, last 3-5 days after birth, disappear @ puberty;
- **Port wine stains- vascular birthmark of superficial deep dilated capillaries in skin, produce reddish/purplish discoloration, permament, associated to neuro (seizures) & ocular (glaucoma) disorders;
- *Strawberry mark- “hemangiomas”- 2% babies, raised soft red lumps, common in prematurity, hypo/per-pigmented, shrink/fade after 6 mos of age
13
Q
Newborn Neurological Exam:
Reflexes, LOC, Tones, & Posture
A
- *LOC- alert;
- *Posture- hips abducted/partially flexed, knees flexed, arms adducted, elbows flexed, fist clenched;
- *Tone- head inline at least 3 sec;
- *Reflexes- symmetrical;
- *Primitive Newborn Reflexes- pacing/stepping (disappears 1-2 mos), rooting, sucking, moro, plantar grasp, tonic neck (disappear 3-4 mos); palmar grasp (disappear 3-6 mos), Babinski “toes fan”- (disappears 12 mos or walking)
14
Q
Newborn Assessment of Head/Neck:
Head Variations
A
- *Caput Succedaneum- fluid under skin, simple swelling, crosses suture lines, result of birth trauma, disappears 2-3 days; no tx required;
- *Cephalohematoma- blood under periosteum (skull bone), does not cross midline, develops 24-48 hrs after birth, needs further evaluation;
- *Bossing- protruding of various skull bones- noted in Rickets, , beta-thalessema (late), acromegaly, congenital syphillis, prematurity;
- *Microcephaly- head circum smaller than 2 stand. dev, -small brain, fetal alcohol syndrome, chromo. abn, PKU
- *Macrocephaly- head circum larger than 2 stand. dev, hydrocephalus;
15
Q
Newborn Assessment of Head/Neck:
Eyes
A
- *sclera is normally white and may appear bluish in premies;
- *deep blue sclera- rule out osteogenesis imperfecta- prone to fxs;
- *red reflex- normally ranges from pink, orange, & red in color on exam;
- *red reflex- replaced by black spots (means no clear pathway from lens to retina);
- *red reflex- replaced by whitish color (means retinoblastoma or congenital cataracts);
- *Colobomas- (familial or spontaneous embryonic fissure defect- normally closes 5th wk gest)- mild forms affect iris, severe forms-choroid/optic nerve involved- suspect CNS defect ex. optic nerve hypoplasia;
- *Heterochromia- mix/diff colors of the iris;
- *Cloudy corner- sclerocornea, Peters anomaly, trauma, infection, dermoid tumor
- *Salt/Pepper speckling (Brushfield spots of the iris)- assoc to Down syndrome
