Physical and gestational age assessment of the newborn Flashcards
White or Asian: pink, reddish, pale
Black: warmish brown tone
All babies: more ruddy if crying, acrocyanosis
Healthy, well-oxygenated, full term - Color Changes & Skin Characteristics
especially if cold
lacy pattern of dark & light areas
vasomotor fluctuations
Mottling
vasomotor disturbance; blood vessels on one side of body dilate (deep pink), other side constrict (pale)
Single or multiple episodes
Harlequin sign
first detectable on face & mucus membranes of mouth
Blanch tip of nose, gum line, forehead, sternum
Also examine sclera
Jaundice
Non-pathologic Unknown etiology Seen in first few days of life “flea-bite” dermatitis No Rx, peaks 24-48 hours of life, then disappears in hours or days
Erythema Neonatorum Toxicum (“normal newborn rash”)
Assess over abdomen
Should be elastic
Used to evaluate hydration, need to initiate feedings, presence of infectious process
Skin Turgor
Covers fetus in utero
Lubricates skin
White, cheeselike substance
Term or postterm: less present
Vernix Caseosa
Exposed sebaceous glands
Raised white spots on face, especially nose
Milia
Reddened areas over cheeks & jaws
Seen with difficult forceps delivery
Disappear in 1-2 days
Rare: facial paralysis
Forceps Marks
“Marked from birth”
Frequent cause of concern, anxiety, and blame
Cultural context
Birthmarks
Birthmark; Pale pink or red spots
Seen on eyelids, nose, lower occipital bone, nape of neck
Light-complected newborn; more noticeable if cries
Blanch, no clinical significance, disappear around age 2
Telangiectatic Nevi (“stork bites”, salmon patches)
Grey-blue pigmented areas
Lumbosacral or buttocks
Dark-skinned & Asian newborns
Disappear in late infancy or early childhood
Mongolian Spots
Flat, purple-red, sharply demarcated
Most often on face
Do not blanch, fade, or increase in size
Can be disfiguring
Nevus Flammeus (“port-wine stain”)
Dark red, rough-textured, sharply demarcated, raised
Usually head or face
Grow for several months, then shrink, but can take 7-10 years to disappear
Nevus Vasculosus (“strawberry marks”)
Flat, pigmented, sharply demarcated, “coffee with milk”
1 in 5 have them
1-3 spots okay, ># or > 5 mm linked to neurofibromatosis
Café au Lait Spots
Head 1/3 adult size
Circumference: 32-38 cm
Head circumference 2-3 cm > chest circumference
Measure from most prominent part of occiput to just above eyebrows
Head Circumference
Average: 30-36 cm
Lower edge of scapula, bring around anteriorly over nipple line
Chest Circumference
Large, ¼ total body size Palpate suture lines: open sutures or overriding? Identify fontanels Evaluate symmetry Evaluate molding
Newborn’s Head
Diamond-shaped, 2-3 cm wide x 3-4 cm long
Flat, but may swell with stooling, crying
Depressed = dehydration
Can feel pulsation of heart through it
Closes within 18 months
Fontanels: Anterior
Smaller, triangular in shape
May be almost closed at birth, but will be fully-closed by end of 2nd month
Fontanels: Posterior
Overriding of skull bones
Occurs as head accommodates to diameters of birth canal
Head seems elongated
Disappears spontaneously within few days
Asymmetry of Head: Molding
Diffuse, soft-tissue edema of scalp Caused by pressure on head in L & D Crosses suture lines Scalp ecchymosis ( blood into tissue) may be present Resolves in a few days
Asymmetry of Head: Caput Succadaneum (“caput”)
Collection of blood due to rupture of blood vessels between skull and periosteum No ecchymosis Doesn’t cross suture lines Slow process Resolves slowly; 2-6 weeks
Asymmetry of Head: Cephalohematoma
Closed much of time
Most often blue or slate-gray at birth
Darker eyes in darker-skinned
Permanent eye color can take up to 1 year
White spots (Brushfield’s) in periphery of iris
Lacrimal glands immature
Eyes
“cross-eyes”; Transient
Immature neuromuscular control
Disappears by 3-4 months
Strabismus