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PNCB2 > Prenatal/Newborn Health Screening > Flashcards

Prenatal/Newborn Health Screening Flashcards

1
Q

What is considered appropriate for gestational age?

A

between the 10th and 90th percentile

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2
Q

What is considered large for gestational age?

A

weight >90th percentile

**associated with maternal diabetes

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3
Q

What does APGAR stand for and what is the max score received?

A 
A- appearance
P- pulse
G- grimace
A- activity
R- respirations

Max score of 10

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4
Q

Describe the Appearance scoring

A

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

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5
Q

Describe Pulse scoring

A

2 pts: normal (above 100 beats per min)
1 pt: below 100 bp
0 pt: absent

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6
Q

Describe Grimace scoring (responsiveness or reflex irritability)

A

2 pts: pulls away, sneezes, or coughs with stimulation
1 pt: facial movement only (grimace) with stimulation
0 pts: absent (no response to stimulation)

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7
Q

Describe Activity scoring (muscle tone)

A

2 pts: active, spontaneous movement
1 pt: arms/legs flexed with little movement
0 pts: no movement, floppy tone

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8
Q

Describe Respiration scoring

A

2 pts: normal rate and effort, good cry
1 pt: slow or irregular breathing, weak cry
0 pts: absent (no breathing)

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9
Q

What is the average newborn length?

A

20 to 21 inches (51 cm)

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10
Q

What is the average newborn weight?

A

7 lbs (5.1 kg)

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11
Q

What is the average newborn head circumference?

A

13 to 14 inches (33 to 35 cm)

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12
Q

Definition of pre-term/post-term

A

Born before 37 weeks or after 41 weeks–newborns born between 37 weeks and 41 weeks have the best outcomes

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13
Q

What causes symmetrical IUGR?

A

*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)

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14
Q

What causes asymmetrical IUGR?

A

*Acute, extra fetal compromise usually occurring >24 weeks
chronic hypertension, pre-eclampsia, renal disease, heart disease, hemoglobinopathies, abruptio placentae, multiple gestation, altitude

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15
Q

What causes LGA?

A

maternal diabetes
Beckwieth-Weidemann syndrome–congenital growth disorder
hydrops fetalis–fatal accumulation of fluid
large mother

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16
Q

What is rooting reflex, when does it appear, and disappear?

A

Baby will turn head toward anything that strokes newborn cheek or mouth
Appears at birth
Disappears at 3 to 4 months

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17
Q

What is the moro reflex, when does it appear, and disappear?

A

Startle reflex
Appears at birth
Disappears at 3 to 4 months

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18
Q

What is the moro reflex, when does it appear, and disappear?

A

Startle reflex
Appears at birth
Disappears at 3 to 4 months

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19
Q

What is considered appropriate for gestational age?

A

between the 10th and 90th percentile

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20
Q

What is considered large for gestational age?

A

weight >90th percentile

**associated with maternal diabetes

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21
Q

What does APGAR stand for and what is the max score received?

A 
A- appearance
P- pulse
G- grimace
A- activity
R- respirations

Max score of 10

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22
Q

Describe the Appearance scoring

A

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

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23
Q

If there are multiple cafe au lait spots or a child over the age of 5 has 6+ spots, what should you suspect?

A

neurofibromatosis

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24
Q

Describe Grimace scoring (responsiveness or reflex irritability)

A

2 pts: pulls away, sneezes, or coughs with stimulation
1 pt: facial movement only (grimace) with stimulation
0 pts: absent (no response to stimulation)

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25
Q

Describe Activity scoring (muscle tone)

A

2 pts: active, spontaneous movement
1 pt: arms/legs flexed with little movement
0 pts: no movement, floppy tone

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26
Q

Describe Respiration scoring

A

2 pts: normal rate and effort, good cry
1 pt: slow or irregular breathing, weak cry
0 pts: absent (no breathing)

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27
Q

What is the average newborn length?

A

20 to 21 inches (51 cm)

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28
Q

What is the average newborn weight?

A

7 lbs (5.1 kg)

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29
Q

What is the average newborn head circumference?

A

13 to 14 inches (33 to 35 cm)

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30
Q

Definition of pre-term/post-term

A

Born before 37 weeks or after 41 weeks–newborns born between 37 weeks and 41 weeks have the best outcomes

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31
Q

What is small for gestational age, symmetric, intrauterine growth retardation?

A

Head circumference, weight and length are all

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32
Q

What causes symmetrical IUGR?

A

*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)

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33
Q

When does the anterior fontanel close?

A

By 18 months

34
Q

What causes asymmetrical IUGR?

A

*Acute, extra fetal compromise usually occurring >24 weeks
chronic hypertension, pre-eclampsia, renal disease, heart disease, hemoglobinopathies, abruptio placentae, multiple gestation, altitude

35
Q

What causes LGA?

A

maternal diabetes
Beckwieth-Weidemann syndrome–congenital growth disorder
hydrops fetalis–fatal accumulation of fluid
large mother

36
Q

What is rooting reflex, when does it appear, and disappear?

A

Baby will turn head toward anything that strokes newborn cheek or mouth
Appears at birth
Disappears at 3 to 4 months

37
Q

What is sucking reflex, when does it appear, and disappear?

A

When roof of mouth is touched, baby will suck
Appears at birth
Disappears at 3 to 4 months

38
Q

What is the moro reflex, when does it appear, and disappear?

A

Startle reflex
Appears at birth
Disappears at 3 to 4 months

39
Q

What is the babinski reflex, when does it appear, and disappear?

A

Bottom of foot is stroked and big toe moves upward
Appears at birth
Disappears at 12 months or when walking

40
Q

What is the tonic neck reflex, when does it appear, and disappear?

A

Fencing reflex
Appears at birth
Disappears at 3 months

41
Q

What is the stepping reflex, when does it appear, and disappear?

A

Put baby foot on flat surface and then step
Appears at birth
Disappears at 1-2 months

42
Q

What is the palmar reflex, when does it appear, and disappear?

A

Put something in palm of hand and baby grips it
Appears at birth
Disappears at 3 to 6 months

43
Q

What is milia?

A

Pinpoint white papillose on face, cheeks, nose, chin and forehead
Spontaneously disappears at 3-4 weeks old
If persistent, may indicate a genetic syndrome

44
Q

What is miliaria?

A

obstructed sweat glands–prickly heat

45
Q

What is microstomia and when is it observed?

A

small mouth, trisomy 13 and 18

46
Q

What are cafe au lait spots?

A

Subtle shade discoloration located on flank

May not be present at birth but likely to increase in size with age

47
Q

If there are multiple cafe au lait spots or a child over the age of 5 has 6+ spots, what should you suspect?

A

neurofibromatosis

48
Q

What is junctional nevi?

A

flat moles

49
Q

If there are many junctional nevi, what should you suspect?

A

tuberous sclerosis
xeroderma pigmentosus
neurofibromatosis

50
Q

What are mongolian spots?

A

Benign, flat, congenital birthmark
bluish in color
lasts up to 3-5 years after birth–almost always disappears by puberty

51
Q

What is a port wine stain?

A

vascular birthmark consisting of superficial and deep dialed capillaries–reddish purplish discoloration of the skin, which is permanent

52
Q

If a port wine stain comes to the midline, what should you be concerned about?

A

sturge-webber–a serious near condition with seizures–ocular glaucoma characteristics

53
Q

What is a strawberry mark/hemangiomas?

A

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

54
Q

What is caput succedaneum?

A 
cone head
crosses midline (fluid under skin, simple swelling), resolves in 2-3 days
55
Q

What is cephalohematoma?

A

does not cross midline (blood under periosteum)

requires closer examination

56
Q

What are white forelocks, along with other abnormalities associated with?

A

deafness and retardation–waardenburg syndrome

57
Q

When does the anterior fontanel close?

A

By 18 months

58
Q

What fontanel is the largest? And what is the size?

A

Anterior fontanel is the largest at 2-5 cm

59
Q

When does the posterior fontanel close?

A

by 2-3 months (it may not be palpable by birth)

60
Q

What are common causes of wide fontanels?

A 
prematurity
IUGR
hydrocephalus
down syndrome
hypothyroidism
61
Q

What does a red reflex replaced by a black spot mean?

A

there is no clear pathway form the lens to the retina

62
Q

If the red reflex is replaced by a white color, what does this mean?

A

possible retinoblastoma or congenital cataracts

63
Q

If the sclera is deep blue color, what does this mean?

A

Possible osteogenesis imperfecta

**the normally white sclera may appear bluish in preemies

64
Q

What are brush field spots of the iris associated with?

A

down syndrome

**Also known as salt and pepper speckling

65
Q

What are colobomas?

A

looks like corn kernel in eye–embryonic fissure defect, can have different severities

66
Q

Where is the point of maximum impulse?

A

3rd to 4th intercostal space, left midclavicular line

67
Q

What could a radial-femoral pulse delay indicate?

A

possible coarctation of the aorta–requires pulse ox reading in all 4 extremities

68
Q

What is macroglossia?

A

large tongue due to hypothyroidism and mucopolysaccharidoses

69
Q

What is microstomia and when is it observed?

A

small mouth, trisomy 13 and 18

70
Q

What is macrostomia and when is it observed?

A

large mouth, mucopolysaccharidoses

Fish mouth is present with fetal alcohol syndrome

71
Q

What is micrognathia and what conditions is it found in?

A

undersized jaw

pierre-robin syndrome, teacher-collins syndrome, hallermann-streiff syndrome

72
Q

What is ortolani’s click?

A

a click is heard or felt as dislocation is reduced

ortolani–out

73
Q

What is barrow’s maneuver?

A

feeling of a slip as the femoral head slips away from the acetabulum causing dislocation

74
Q

What does sensitivity mean?

A

+=+

if patient has the condition, it will give a positive result

75
Q

What does specificity mean?

A
  • = -

if pt does not have condition, it will give a negative result

76
Q

What conditions to all 50 states require in their newborn screen?

A

PKU
galactosemia
hemoglobinopathies
congenital hypothyroidism

77
Q

PKU (phenylketonuria)

A 
1:10,000 to 25,000
developmental delay
severe mental retardation
siezures
aggression
autism 
hyperactivity
78
Q

Galactosemia

A

liver dysfunction, coagulopathies
occurence 1:60,000 to 80,0000
**25% of unrecognized infants develop sepsis

79
Q

Hemoglobinopathies

A

sickle cell disease, thalasemia
occurence 1:400 African-Americans
Anemia
sepsis

80
Q

Hypothyroidism

A 
occurence 1:3600 to 5000
Mental retardation 
neurologic abnormalities
metabolic abnormalities 
**presents with a late onset in 10% of patients
81
Q

What is considered low birth weight?

A

PNCB2 (18 decks)

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