Perinatal/ newborn health screening Flashcards
When detailed assessment of the pre/peri/ postantal course should be included in the history
newborn to age 3 years
Low birth weight
Low birth weight (LBW) < 2,500 g
Very low birth weight (VLBW) < 1,500 g
Extremely low birth weight (ELBW) < 1,000 g
Assessment of weight for gestational age
- Appropriate for gestational age (AGA): btw 10 - 90%
- Large for gestational age (LGA): weight > 90%, associated with maternal diabetes
- Small for gestational age (SGA): weight < 10%, symmetric (> chronic) vs assymetric (> acute assault)
APGAR score
Five areas of assessment for a total of 10 points: appearance, pulse, grimace, activity, respirations
- Max score at 1 & 5 minutes = 10, 3 points possible for each area: 0, 1, 2
- Appearance (skin color): normal color all over, normal color but hands and feet are bluish, bluish-gray or pale all over
- Pulse: Normal (>100), below 100, absent
- Grimace (responsiveness or “reflex irritability”: Pulls away, sneezes, or coughs with stimulation; facial movement only (grimace) with stimulation; absent
- Activity (muscle tone): Active, spontaneous movement; Arms & legs flexed with little movement; No movement, “floppy” tone
- Respirations: Normal rate & effort, good cry; Slow or irregular breathing, weak cry; Absent
Newborn assessment: weight, length, head circumference
Average:
weight: 7 lbs
length: 20-21 inches
HC: 13 - 14
Newborn assessment: gestational age
- Infants born at gestational periods 37 - 41 weeks have the best health outcomes
- Those born prior to 37 weeks of gestation are premature and those born after 41 weeks of gestation are post-term
Newborn assessment: intrauterine growth retardation (IUGR) - symmetric IUGR
SGA: symmetric IUGR (33% of SGA infants): HC, weight, and length are all < 10%. Usually suggests long term compromise to the fetus or the presence of an intrinsic problem:
- Genetic: congenital or chromosomal abnormalities
- Intrauterine infection: viral, bacterial, protozoal, spirochete
- Inborn errors of metabolism
- Environmental: drugs, nicotine, x-ray exposure
Newborn assessment: intrauterine growth retardation (IUGR) - assymetric IUGR
Assymetric IUGR (55% of SGA infants):
- HC & length within normal limits, weight < 10%
- May be due to acute extra fetal compromise (usually occurs > 24 weeks gestation): chronic hypertension, pre-eclampsia, renal disease, cyanotic heart disease, hemoglobinopathies, abruption placentae, multiple gestation, altitude
Newborn assessment: large for gestation age (weight >90%)
- Maternal diabetes
- Beckwith-Wiedemann syndrome: congenital growth disorder; hemihyperthrophy, large organs and other symptoms
- Hydrops fetalis: Fatal condition defined as an abnormal accumulation of fluid in two or more fetal compartments
- Large mothers
Newborn assessment: Dubowitz/ Ballard exam
- Physical maturity assessment, performed within 2 hours of birth
- Points -2 to +5 given for six criteria:
- Skin texture: sticky, smooth, peeling
- Lanugo: soft downy hair on baby’s body is absent in immature infants, present with maturity, and disappears with post maturity
- Plantar creases: On solfe of feet ranges from absent to covering the entire feet
- Breast: thickness and size of breast tissue
- Eyes/ ears: Eyes fused or open, amount of ear cartilage present, and the amount of elastic recoil of cartilage
- Genitals: Male: presence of testes and appearance of scrotum from smooth to wrinkled; Female: appearance and size of clitoris and labia
- Neuromascular maturity assessment: assessed within 24 hours
Newborn assessment: vital signs
- Temperature: > 100.4 F (38C) consider fever
- Pulse: 120 - 170 bpm
- Respiration: 30 to as high as 80
- BP: < 112/74
Newborn assessment: milia
Pinpoint white papules on face, prominent on cheeks, nose, chin, forehead
- spontaneously disappear within 3 to 4 weeks of life
- if persist or wide spread distribution, may indicate a genetic syndrome
Newborn assessment: miliaria
Obstructed sweat (eccrine gland) ducts, sometimes referred to as “prickly heat”
Newborn assessment: erythema toxicum
Most commone newborn rash; usually appears btw days 2 to 5 after birth; characterized by blotchy red spots on the skin with overlying white or yellow papulses or pustules; resolves by the 14th day
Newborn assessment: Cafe au lait spots
Typically a subtle shade discoloration located on either flank; may not be present at birth but likely to increase in size with age: suspect neurofibromatosis if there are many large spots or if more than 6 spots in a child older than 5 yo
Newborn assessment: junctional nevi
If present in large numbers, suspect tuberous sclerosis, xeroderma pigmentosus, or generalized neurofibromatosis
Newborn assessment: mongolian spots
Benign, flat, congenital birthmark with wavy borders and irregular shape; common color is blue; may last up to 3 to 5 years after birth, almost always disappear by puberty
Newborn assessment: Port wine stain
Vascular birthmark (malformation) consisting of superficial and deep dilated capillaries in the skin; produce a reddish to purplis discoloration of the skin; permanent. Associated with neuro (seizures) - ocular (glaucoma) characteristics
Newborn assessment: strawberry mark (hemangiomas):
Raised, soft red lumps on the skin, more common in premature babies; hypo/hyper-pigmented; after 6 months of age, the strawberry marks usually begin to shrink and fade
Newborn assessment: normal posture
Hips should be abducted and partially flexed with knees flexed, arms adducted, elbows flexed, and fists clenched
Newborn assessment: primitive reflexes - present at birth
Pacing/ stepping: disappears 1-2 months
Rooting: disappears 3-4 months
Sucking: disappears 3-4 months
Moro: disappears 3-4 months
Grasp (Palmar, plantar): disappears to to 6 months, plantar - 4 months
Tonic neck: disappears 3 months
Babinski: disappears 12 months or when walking
Newborn assessment: white forelocks
White forelocks with other anomalies are sometimes associated with deafness and retardation (Waardenburg syndrome)
Newborn assessment: common causes of wide fontanels
Prematurity IUGR Hydrocephalus Down syndrome Hypothyroidism
Newborn assessment: red reflex
- Red reflex replaced by a black spot means there is no clear pathway from the lens to the retina
- Red reflex replaced by a whitish color, may suggest retinoblastsoma or congenital cataracts
- the sclera is normally white and may appear bluish in premies; if the sclera is deep blue, osteogenesis imperfecta should be ruled out
Newborn assessment: choanal atresia
narrowing or blockage of the nasal airway by tissue, present at birth
Newborn assessment: microstomia
Small mouth, observed in trisomy 18 and 21
Newborn assessment: macrostomia
Large mouth, present in mucopolysaccharidoses; fish mouth is seen in fetal alcohol syndrome
Newborn assessment: macroglassia
Large tongue, seen in hypothyroidism and mucopolysaccharidoses
Newborn assessment: umbilical cord
Two arteries and one vein
Newborn assessment: testes
97% of full term males have descended tested at birth
Newborn assessment: developmental dysplasia of the hip
With hips flexed at 90 degrees and knees together, begin by abducting, then adduct while the examiner’s fingers are over the greater trochanters
- Ortolani’s click: a click is heard or felt as dislocation is reduced
- Barlow’s maneuver: feeling for a slip as the femoral head slips away from the acetabulum causing the dislocation
Newborn assessment: mandatory screening program
All states require PKU, galactosemia, sickle cell disease, congenital hypothyroidism
- a re-screen is mandatory for newborns tested at < 24 hours of age
- rescreen infants that appear symptomatic
Newborn assessment: PKU
Phenylketonuria
- Developmental delay
- severe retardation
- seizures
- aggression
- autism
- hyperactivity
Newborn assessment: galactosemia
Liver dysfunction, coagulopatheis
25% of unrecognized infants develop sepsis
Maple sugar urine odor
Newborn assessment: hemoglobinopathies
Sickle cell disease, thalassemia
- 1:400 African Americans
- anemia
- Sepsis
Newborn assessment: hypothyroidism
- Measurement of T4 and TSH in newborn
- Mental retardation, neurologic abnormalities, metabolic abnormalities
