Prenatal/Newborn Health Screening Flashcards
What is considered appropriate for gestational age?
between the 10th and 90th percentile
What is considered large for gestational age?
weight >90th percentile
**associated with maternal diabetes
What does APGAR stand for and what is the max score received?
A- appearance P- pulse G- grimace A- activity R- respirations
Max score of 10
Describe the Appearance scoring
2 pts: normal color all over with pink feet/hands
1 pt: normal color, but with blue hands/feet
0 pts: bluish-gray or pale all over
Describe Pulse scoring
2 pts: normal (above 100 beats per min)
1 pt: below 100 bp
0 pt: absent
Describe Grimace scoring (responsiveness or reflex irritability)
2 pts: pulls away, sneezes, or coughs with stimulation
1 pt: facial movement only (grimace) with stimulation
0 pts: absent (no response to stimulation)
Describe Activity scoring (muscle tone)
2 pts: active, spontaneous movement
1 pt: arms/legs flexed with little movement
0 pts: no movement, floppy tone
Describe Respiration scoring
2 pts: normal rate and effort, good cry
1 pt: slow or irregular breathing, weak cry
0 pts: absent (no breathing)
What is the average newborn length?
20 to 21 inches (51 cm)
What is the average newborn weight?
7 lbs (5.1 kg)
What is the average newborn head circumference?
13 to 14 inches (33 to 35 cm)
Definition of pre-term/post-term
Born before 37 weeks or after 41 weeks–newborns born between 37 weeks and 41 weeks have the best outcomes
What causes symmetrical IUGR?
*Suggests long-term compromise of fetus or presence of intrinsic problem
genetic issues, intrauterine infection, inborn errors of metabolism, and environmental (drugs, nicotine, X-ray exposure)
What causes asymmetrical IUGR?
*Acute, extra fetal compromise usually occurring >24 weeks
chronic hypertension, pre-eclampsia, renal disease, heart disease, hemoglobinopathies, abruptio placentae, multiple gestation, altitude
What causes LGA?
maternal diabetes
Beckwieth-Weidemann syndrome–congenital growth disorder
hydrops fetalis–fatal accumulation of fluid
large mother
What is rooting reflex, when does it appear, and disappear?
Baby will turn head toward anything that strokes newborn cheek or mouth
Appears at birth
Disappears at 3 to 4 months
What is the moro reflex, when does it appear, and disappear?
Startle reflex
Appears at birth
Disappears at 3 to 4 months
What is the moro reflex, when does it appear, and disappear?
Startle reflex
Appears at birth
Disappears at 3 to 4 months
What is considered appropriate for gestational age?
between the 10th and 90th percentile
What is considered large for gestational age?
weight >90th percentile
**associated with maternal diabetes
What does APGAR stand for and what is the max score received?
A- appearance P- pulse G- grimace A- activity R- respirations
Max score of 10
Describe the Appearance scoring
2 pts: normal color all over with pink feet/hands
1 pt: normal color, but with blue hands/feet
0 pts: bluish-gray or pale all over
If there are multiple cafe au lait spots or a child over the age of 5 has 6+ spots, what should you suspect?
neurofibromatosis
Describe Grimace scoring (responsiveness or reflex irritability)
2 pts: pulls away, sneezes, or coughs with stimulation
1 pt: facial movement only (grimace) with stimulation
0 pts: absent (no response to stimulation)
Describe Activity scoring (muscle tone)
2 pts: active, spontaneous movement
1 pt: arms/legs flexed with little movement
0 pts: no movement, floppy tone
Describe Respiration scoring
2 pts: normal rate and effort, good cry
1 pt: slow or irregular breathing, weak cry
0 pts: absent (no breathing)
What is the average newborn length?
20 to 21 inches (51 cm)
What is the average newborn weight?
7 lbs (5.1 kg)
What is the average newborn head circumference?
13 to 14 inches (33 to 35 cm)
Definition of pre-term/post-term
Born before 37 weeks or after 41 weeks–newborns born between 37 weeks and 41 weeks have the best outcomes
What is small for gestational age, symmetric, intrauterine growth retardation?
Head circumference, weight and length are all
What causes symmetrical IUGR?
*Suggests long-term compromise of fetus or presence of intrinsic problem
genetic issues, intrauterine infection, inborn errors of metabolism, and environmental (drugs, nicotine, X-ray exposure)
When does the anterior fontanel close?
By 18 months
What causes asymmetrical IUGR?
*Acute, extra fetal compromise usually occurring >24 weeks
chronic hypertension, pre-eclampsia, renal disease, heart disease, hemoglobinopathies, abruptio placentae, multiple gestation, altitude
What causes LGA?
maternal diabetes
Beckwieth-Weidemann syndrome–congenital growth disorder
hydrops fetalis–fatal accumulation of fluid
large mother
What is rooting reflex, when does it appear, and disappear?
Baby will turn head toward anything that strokes newborn cheek or mouth
Appears at birth
Disappears at 3 to 4 months
What is sucking reflex, when does it appear, and disappear?
When roof of mouth is touched, baby will suck
Appears at birth
Disappears at 3 to 4 months
What is the moro reflex, when does it appear, and disappear?
Startle reflex
Appears at birth
Disappears at 3 to 4 months
What is the babinski reflex, when does it appear, and disappear?
Bottom of foot is stroked and big toe moves upward
Appears at birth
Disappears at 12 months or when walking
What is the tonic neck reflex, when does it appear, and disappear?
Fencing reflex
Appears at birth
Disappears at 3 months
What is the stepping reflex, when does it appear, and disappear?
Put baby foot on flat surface and then step
Appears at birth
Disappears at 1-2 months
What is the palmar reflex, when does it appear, and disappear?
Put something in palm of hand and baby grips it
Appears at birth
Disappears at 3 to 6 months
What is milia?
Pinpoint white papillose on face, cheeks, nose, chin and forehead
Spontaneously disappears at 3-4 weeks old
If persistent, may indicate a genetic syndrome
What is miliaria?
obstructed sweat glands–prickly heat
What is microstomia and when is it observed?
small mouth, trisomy 13 and 18
What are cafe au lait spots?
Subtle shade discoloration located on flank
May not be present at birth but likely to increase in size with age
If there are multiple cafe au lait spots or a child over the age of 5 has 6+ spots, what should you suspect?
neurofibromatosis
What is junctional nevi?
flat moles
If there are many junctional nevi, what should you suspect?
tuberous sclerosis
xeroderma pigmentosus
neurofibromatosis
What are mongolian spots?
Benign, flat, congenital birthmark
bluish in color
lasts up to 3-5 years after birth–almost always disappears by puberty
What is a port wine stain?
vascular birthmark consisting of superficial and deep dialed capillaries–reddish purplish discoloration of the skin, which is permanent
If a port wine stain comes to the midline, what should you be concerned about?
sturge-webber–a serious near condition with seizures–ocular glaucoma characteristics
What is a strawberry mark/hemangiomas?
Affects 2% of more of babies (more common in premature babies)
Raised, soft red lumps on skin
After 6 months of age, typically shrink and fade
At each appt measure height/diameter to show mom they are shrinking
What is caput succedaneum?
cone head crosses midline (fluid under skin, simple swelling), resolves in 2-3 days
What is cephalohematoma?
does not cross midline (blood under periosteum)
requires closer examination
What are white forelocks, along with other abnormalities associated with?
deafness and retardation–waardenburg syndrome
When does the anterior fontanel close?
By 18 months
What fontanel is the largest? And what is the size?
Anterior fontanel is the largest at 2-5 cm
When does the posterior fontanel close?
by 2-3 months (it may not be palpable by birth)
What are common causes of wide fontanels?
prematurity IUGR hydrocephalus down syndrome hypothyroidism
What does a red reflex replaced by a black spot mean?
there is no clear pathway form the lens to the retina
If the red reflex is replaced by a white color, what does this mean?
possible retinoblastoma or congenital cataracts
If the sclera is deep blue color, what does this mean?
Possible osteogenesis imperfecta
**the normally white sclera may appear bluish in preemies
What are brush field spots of the iris associated with?
down syndrome
**Also known as salt and pepper speckling
What are colobomas?
looks like corn kernel in eye–embryonic fissure defect, can have different severities
Where is the point of maximum impulse?
3rd to 4th intercostal space, left midclavicular line
What could a radial-femoral pulse delay indicate?
possible coarctation of the aorta–requires pulse ox reading in all 4 extremities
What is macroglossia?
large tongue due to hypothyroidism and mucopolysaccharidoses
What is microstomia and when is it observed?
small mouth, trisomy 13 and 18
What is macrostomia and when is it observed?
large mouth, mucopolysaccharidoses
Fish mouth is present with fetal alcohol syndrome
What is micrognathia and what conditions is it found in?
undersized jaw
pierre-robin syndrome, teacher-collins syndrome, hallermann-streiff syndrome
What is ortolani’s click?
a click is heard or felt as dislocation is reduced
ortolani–out
What is barrow’s maneuver?
feeling of a slip as the femoral head slips away from the acetabulum causing dislocation
What does sensitivity mean?
+=+
if patient has the condition, it will give a positive result
What does specificity mean?
- = -
if pt does not have condition, it will give a negative result
What conditions to all 50 states require in their newborn screen?
PKU
galactosemia
hemoglobinopathies
congenital hypothyroidism
PKU (phenylketonuria)
1:10,000 to 25,000 developmental delay severe mental retardation siezures aggression autism hyperactivity
Galactosemia
liver dysfunction, coagulopathies
occurence 1:60,000 to 80,0000
**25% of unrecognized infants develop sepsis
Hemoglobinopathies
sickle cell disease, thalasemia
occurence 1:400 African-Americans
Anemia
sepsis
Hypothyroidism
occurence 1:3600 to 5000 Mental retardation neurologic abnormalities metabolic abnormalities **presents with a late onset in 10% of patients
What is considered low birth weight?
